[{"content":" Avoid Ultra-Processed Foods and Control Your Insulin Levels Use a continuous glucose monitor at home or blood testing from your healthcare provider to identify food and lifestyle choices that are spiking your blood sugar (and thus potentially your insulin levels) so that you can make adjustments to what you eat and the timing of your meals. Why should you care about insulin and blood glucose? There is growing evidence that high levels of insulin (hyperinsulinemia) may (along with other factors such as genetics) contribute to elevated risk for all four of our primary threats (cardiovascular disease, neurodegenerative disease, cancer and of course, metabolic disease) due to the inflammatory nature of insulin. There is evidence that what we eat (ultra-processed foods and a diet high in refined sugars) in combination with how frequently we eat leads to hyperinsulinemia and thus exposes us to a whole host of risks (see references below).\nWant to look at the science later but, right now, you are just interested in some actions to take?\nUse a continuous glucose monitor (CGM) like Abbott Lingo for two weeks. Each day over that period log how your diet, sleep, and exercise habits have positively or negatively affected your glucose levels. Read more to build your own understanding. If you have an average of over 7.8 mmol/L, or frequent spikes over 10 mmol/L, or fasting glucose levels over 5.6 over mmol/L then speak to your doctor before also making lifestyle changes. Even if your CGM shows stable blood sugar levels it is essential that you adopt and maintain a diet, sleep and exercise regime to protect yourself against high insulin levels in the future. In an ideal world you\u0026rsquo;d be able to easily monitor your insulin levels at home. However, at the current point in time that\u0026rsquo;s a test that you need a health care practitioner to arrange/do for you (which they might well do or have already done if they have concerns). Thus, to get some data yourself easily, you can at least use glucose monitoring as a \u0026lsquo;proxy\u0026rsquo; for insulin - on the basis that if your blood glucose is higher than the normal range throughout the day or is showing large spikes you can potentially infer what insulin levels in the blood might also be doing. This is not as valuable or accurate as directly measuring insulin though.\nAs your blood glucose goes up, then correspondingly behind it, so will your insulin levels go up as your body reacts to process the sugar consumed. Whilst insulin has a vital role to play in your metabolism, it is also an inflammatory hormone with receptors located on the majority of cells in the body. Thus, high long-term levels of insulin (hyperinsulinemia) pose a number of serious health risks:\nMetabolic and organ failure: Type 2 Diabetes [1], non-alcoholic fatty liver disease [2], and kidney disease [3].\nCardiovascular damage: Narrowing of the arteries and increased plaque deposits, stiffening of the arteries, and an increased risk of blood clotting leading to an increased risk of heart attacks and strokes. [4]\nNeurological damage: Alzheimer\u0026rsquo;s disease and vascular dementia. [5]\nCancer: An increased risk for some types of cancers. [6]\nThe growing rise in obesity, insulin resistance, and type 2 diabetes caused by the growth in consumption of ultra-processed foods high in refined carbohydrates is one of the major problems facing 21st century healthcare [7], [8], [9]\nWhat is a Continuous Blood Glucose Monitor (CGM)? A CGM is a small device that continuously samples your blood to monitor your glucose levels and sends that data to your phone. It enables you to see exactly what is happening to your blood sugar levels minute-by-minute over the day as you eat, train, rest, and sleep. These devices are generally quite discreet, pain-free to fit, and convenient to wear. There are medical/prescription-grade devices used by patients with a diagnosis of diabetes but there are also lifestyle devices that you can purchase over the counter. These are great for people without a diabetes diagnosis but who are interested in their blood sugar levels. The devices are relatively low-cost, disposable, and have a fixed life (although that fixed life does vary device to device). In essence, you are buying the data that the device provides you with rather than the device itself.\nBlood glucose science essentials What does the term \u0026lsquo;sugar\u0026rsquo; mean? Although the word sugar is used as a catch-all term, it can be divided into three specific types:\nGlucose: This is found in starchy foods such as bread, pasta, potatoes or in added sugar. This is the body\u0026rsquo;s primary fuel, and it is the only type of sugar that will trigger a significant insulin response. Excess glucose is stored as a fuel called glycogen in the liver and muscles, and when these reserves are full, the remaining glucose is converted into body fat.\nFructose: This is found naturally in fruits but is also a significant component of corn syrup and table sugar. Fructose does not trigger an immediate spike in insulin because (unlike glucose) the majority of the cells in the body cannot use it. The liver can process fructose but, when large amounts of it are consumed (for example, in sugary soft drinks), the liver becomes overwhelmed and turns the fructose directly into fat. Ultimately, this contributes to non-alcoholic fatty liver disease (NAFLD).\nSucrose: This is a double molecule composed of 50% glucose and 50% fructose it is what is commonly called \u0026ldquo;table sugar.\u0026rdquo; Sucrose is particularly problematic as it both causes an insulin spike and also heads to the liver and is thus more damaging to metabolic health than either on their own.\nWhere does sugar come from in your diet? Our sources of sugar are split into some primary types:\nSimple carbohydrates (sugars): these (e.g. table sugar) are made of only a few component units, which enables the body to break them down very rapidly. These lead to a spike in insulin, and if the sugar is not quickly consumed, they are easily converted to fat. Simple carbohydrates thus provide an immediate source of energy.\nComplex carbohydrates (starches): these (e.g. pasta, rice, potatoes and bread) are much longer chains of component units, and it takes the body significantly longer to break them down into individual glucose molecules. They provide a slower release form of energy.\nComplex carbohydrates (fibre): these (e.g. leafy greens and whole grains) are carbohydrates that your body cannot break down. They pass through you without raising blood sugar or insulin levels – but do slow down and buffer the absorption of sugars consumed at the same time. Fibre is, however, an important source of food for your gut microbiome.\nWhy is sugar important? Glucose is the primary source of fuel and is used in almost every cell in the body (e.g. our muscles and brain) to generate energy. There are two primary methods in which glucose is burnt, aerobic respiration (where you are not working hard enough to exhaust the available oxygen supply) and aerobic respiration (where your level of work is higher than the available oxygen supply). When you no longer have sufficient glucose available (for example, through restricting carbohydrate intake or through fasting), the body does have another available source of fuel. The liver can break down stored fat to produce small amounts of glucose (although nowhere near as much as that found in food) and ketones. You can think of ketones as the body’s ‘Plan B’ for when there isn\u0026rsquo;t enough sugar around. Specifically, ketones can cross from the blood to the brain and become the brain\u0026rsquo;s primary source of fuel when glucose levels are low.\nWhat is insulin? Insulin is the body\u0026rsquo;s primary storage hormone and has three specific roles:\nFirstly, glucose cannot enter cells directly. Instead, insulin acts as a signal to the cells to open \u0026lsquo;doorways\u0026rsquo; which allow the glucose to enter the cells to then be consumed to generate energy.\nSecondly, when enough glucose is present, insulin instructs the muscles and liver to store the excess in the form of glycogen (which can be thought of as a short-term energy reservoir).\nFinally, once the liver and muscle glycogen reservoirs are full, insulin instructs the body to store excess glucose as fat.\nCritically, whilst insulin levels are high, the body will remain in storage mode and not release stored fat to use as fuel. The more sugar you consume and the more frequently you consume it, the higher your ongoing insulin levels are.\nWhat happens when sugar intake is too high and/or too frequent? The most well-known consequence of high insulin levels (due to diet) is that of type 2 diabetes. In this condition, the cells become resistant to the level of insulin in the blood, causing the body (specifically the pancreas) to manufacture more and more insulin to conquer the cells\u0026rsquo; resistance. Eventually, this leads to burnout, with the pancreas unable to produce sufficient insulin and uncontrolled blood sugar levels. High blood sugar levels cause wide-ranging cellular damage across the body.\nHowever, as noted at the start of this article (and the references at the end), there are a range of other consequences of high insulin levels.\nA healthy, balanced diet which minimises simple carbohydrates and ultra-processed foods in conjunction with exercise, high quality sleep, and avoiding ‘snacking’ (to prevent continuously spiking insulin) is a way to avoid a lifestyle-induced drift into hyperinsulinemia, type 2 diabetes, and a range of other adverse health conditions.\nWhich monitor do I use? I use the Abbott Lingo for which I pay £59 (convert this\u0026hellip;).\nThe device is simple to apply, connects to my phone and lasts for 14 days. The app is straightforward to use and extremely useful for getting realtime feedback after meals and also for looking at what is happening whilst I am asleep. I also download all my data as a spreadsheet for my own analysis and for posterity.\nWhat did I learn from monitoring my blood glucose? It is worth noting that I am a vegetarian (for personal moral reasons rather than for health reasons). In fact, I follow a primarily plant-based diet apart from some occasional cheese or eggs (as part of family meals). I follow a time-restricted eating (TRE) lifestyle with a longer fast each week. I do not follow a ketogenic diet but avoid ultra-processed foods and simple carbohydrates. I was thus (arrogantly!) not expecting to get much out of using a continuous glucose monitor. However, the first time I used one, I gained some valuable insights:\nI was able to identify a few often eaten foods I was consuming that were contributing to significant and totally unnecessary insulin spikes. Just a few examples were the use of oat milk in my lunchtime smoothie, homemade pop-corn as a healthy snack, and lentil cakes. Just a few simple adjustments removed those spikes and keep my glucose levels firmly in the normal range through day and night without changing much in my diet at all.\nEven more valuably, I was able to see the impact of my late dinners (especially those after 8pm) on my nighttime metabolism and correlate nighttime sleep disruptions (as recorded on my Whoop) with elevated nighttime glucose levels (as recorded on my Lingo). As noted in the article on sleep, by shifting my eating hours to between 10 am and 4 pm, I was able to avoid the dreaded 3am wake-ups. Although I eat earlier I value family dinners, so I will still \u0026rsquo;eat\u0026rsquo; with my partner but just have a herbal tea. It\u0026rsquo;s a bit disruptive to family life, but the benefit in terms of sleep has been worth it!\nDuring my fast in week 2, my blood sugar was lower through the fast than in week 1, and my level of ketosis just before breaking the fast was higher in week 2 than week 1. This may suggest that better choices early in the week made it easier to get into ketosis later on in the week.\nI downloaded all my data from the Lingo app, and the following graphs I generated may be interesting. The first covers Week 1 where I just ate as normal to gather baseline data and spot sugar spikes. The second covers Week 2 where I aimed to learn from Week 1 and keep my sugar levels within the normal range of 3.9-7.8 mmol/L (millimoles per litre). My average glucose across the whole of week 1 was 5.5 and across the whole of week 2 was 4.6 which was quite a considerable improvement.\nFurther sources of information The Examine web site for independent, unsponsored meta-analyses of health research\nDr Robert Lustig on the Diary of a CEO podcast\nMetabolical by Dr. Robert Lustig\nOutlive: The Science and Art of Longevity by Pete Attia MD\nThe Obesity Code by Dr. Jason Fung\nThe Diabetes Code by Dr. Jason Fung\nReferences [1] Kahn, S. E., et al. (2021). \u0026ldquo;The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of Type 2 Diabetes.\u0026rdquo; The Lancet.\n[2] F. W., \u0026amp; Griffin, J. L. (2023). \u0026ldquo;The role of insulin resistance and hyperinsulinemia in the pathogenesis of NAFLD.\u0026rdquo; Nature Reviews Endocrinology.\n[3] Artunc, F., et al. (2024). \u0026ldquo;The kidney in metabolic syndrome: How insulin resistance drives chronic kidney disease.\u0026rdquo; Journal of the American Society of Nephrology.\n[4] Pandolfi, A., et al. (2021). \u0026ldquo;The Role of Insulin Resistance in Endothelial Dysfunction and Thrombosis.\u0026rdquo; International Journal of Molecular Sciences.\n[5] de la Monte, S. M. (2023). \u0026ldquo;The Evidence for Type 3 Diabetes and its Role in Alzheimer’s Disease Progression.\u0026rdquo; Journal of Alzheimer\u0026rsquo;s Disease.\n[6] Gallagher, E. J., \u0026amp; LeRoith, D. (2020). \u0026ldquo;Insulin and Cancer: Integrative Physiology.\u0026rdquo; Endocrine Reviews.\n[7] Swinburn, B. A., et al. (2019). \u0026ldquo;The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report.\u0026rdquo; The Lancet.\n[8] Lustig, R. H., et al. (2022). \u0026ldquo;The Role of Processed Foods in the Pathogenesis of Metabolic Syndrome.\u0026rdquo; Frontiers in Nutrition.\n[9] Hall, K. D., et al. (2019). \u0026ldquo;Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake.\u0026rdquo; Cell Metabolism.\n","permalink":"https://big10.health/posts/1-blood-sugar-monitoring/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.jpeg\" alt = \"A wearable CGM device sending data a phone\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch2 id=\"avoid-ultra-processed-foods-and-control-your-insulin-levels\"\u003eAvoid Ultra-Processed Foods and Control Your Insulin Levels\u003c/h2\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n        \u003cspan\u003e\u003ci class=\"fa-classic fa-heart\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-brain\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-atom\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-droplet\"\u003e\u003c/i\u003e\u003c/span\u003e\n        \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eUse a continuous glucose monitor at home or blood testing from your healthcare provider to identify food and lifestyle choices that are spiking your blood sugar (and thus potentially your insulin levels) so that you can make adjustments to what you eat and the timing of your meals.\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e\n\u003ch2 id=\"why-should-you-care-about-insulin-and-blood-glucose\"\u003eWhy should you care about insulin and blood glucose?\u003c/h2\u003e\n\u003cp\u003eThere is growing evidence that high levels of insulin (hyperinsulinemia) may (along with other factors such as genetics) contribute to elevated risk for all four of our primary threats (cardiovascular disease, neurodegenerative disease, cancer and of course, metabolic disease) due to the inflammatory nature of insulin. There is evidence that what we eat (ultra-processed foods and a diet high in refined sugars) in combination with how frequently we eat leads to hyperinsulinemia and thus exposes us to a whole host of risks (see references below).\u003c/p\u003e","title":"1. Avoid Ultra-Processed Foods and Control Your Insulin Levels"},{"content":" The Big 10 Toolbox Below you can find a high-level introduction to the Big 10 to give you a sense of where this journey is going. From each of those summaries you can then jump to a detailed article which will give you approachable, high-level information and some practical actions and suggestions. Each article also contains suggestions for books, video or podcasts you might find useful to start growing your own knowledge. Finally, each article concludes with literature references to help you with fact checking.\nI\u0026rsquo;ve not arranged the Big 10 in order of importance, but I would suggest that you look at the first three to begin with as they are key pillars of health. Also, there is increasing evidence that insulin is a contributing factor to all the four threats we looked at earlier, which would make number one important to consider early on in your journey through the Big 10.\nAll the Big 10 have the potential to improve your health right now and will help to combat at least one (if not several) of the four threats we identified earlier. The following icons are used to help you tell which they help to fight:\nCardiovascular disease Neurodegenerative disease Cancer Metabolic disease\nAlso, do remember to spend some time thinking about why you want to make changes to your lifestyle. Give yourself a strong motivation to hold to when the change feels tough!\n1. Avoid Ultra-Processed Foods and Control Your Insulin Levels Use a continuous glucose monitor at home or blood testing from your healthcare provider to identify food and lifestyle choices that are spiking your blood sugar (and thus potentially your insulin levels) so that you can make adjustments to what you eat and the timing of your meals. 2. Exercise Regularly and Include both Resistance and Cardiovascular Workouts Commit to a structured, consistent, regular programme of exercise that includes resistance training as well as cardiovascular and flexibility/stability work. Use a wearable and/or sports watch and apps to track your progress. 3. Get Enough Good Quality Sleep Aim to get 7–9 hrs a night and use a sleep tracker to understand the duration and quality of your sleep so that you can address any deficiencies. 4. Monitor Your Heart Health Check and track your blood pressure regularly. Use blood testing to monitor levels of key markers and uses scans to check for the presence of plaque buildup in your arteries. 5. Design Your Personal Supplement Stack Informed by Blood Testing Further improve your diet by including key supplements to reach the optimum levels and make up for the deficiencies found in the modern world. Periodically, use a blood testing service to check and monitor your levels. 6. Monitor Your Body Composition with DEXA Scanning Use DEXA scans to measure your visceral fat, lean muscle mass, and bone density so that you can reduce the risk of metabolic disease and increase your healthspan. 7. Support Your Brain Health Coming soon.... 8. Build and Maintain Relationships with Friends, Family and Loved Ones Coming soon.... 9. Eat Healthily, Consider Using Time Restricted Eating, and Prioritise Building a Strong Gut Microbiome Coming soon.... 10. Avoid Damaging Chemicals and Pesticides Coming soon.... ","permalink":"https://big10.health/posts/the-big-10/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"../../images/home-page-image.jpeg\" alt = \"A variety of human health topics\" class=\"banner-image\" \u003e\n\u003ca href=\"posts/coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"the-big-10-toolbox\"\u003eThe Big 10 Toolbox\u003c/h1\u003e\n\u003cp\u003eBelow you can find a high-level introduction to the Big 10 to give you a sense of where this journey is going. From each of those summaries you can then jump to a detailed article which will give you approachable, high-level information and some practical actions and suggestions. Each article also contains suggestions for books, video or podcasts you might find useful to start growing your own knowledge. Finally, each article concludes with literature references to help you with fact checking.\u003c/p\u003e","title":"The Big 10 Toolbox"},{"content":" Exercise Regularly and Include both Resistance and Cardiovascular Workouts Commit to a structured, consistent, regular programme of exercise that includes resistance training as well as cardiovascular and flexibility/stability work. Use a wearable and/or sports watch and apps to track your progress. Why should you care about exercise? Exercise is not just a good habit; it is, along with sleep and nutrition, a critical pillar of your well-being affecting almost all aspects of your mind and body. Exercise is also an essential consideration when thinking about your health span (not just living longer, but living well as you age).\nWant to look at the science later but, right now, you are just interested in some actions to take?\nIf you don't already have an established training programme (or if you do but feel like you are just going through the motions) find a local personal trainer. Ask them to design you a programme that has a solid base of resistance training but also includes cardiovascular workouts and flexibility. If you have any existing health conditions or are new to exercise talk to your doctor before starting such a programme. Get a high quality sports watch (if you don't already have one) like Garmin or an exercise/sleep/recovery tracking wearable like Whoop and start gathering data as you exercise. Get a sports performance app (if you don't already have one) like Strava and start tracking and analysing your performance and progress over time. After checking with your doctor and settling into your exercise programme book a VO2 Max test with someone like BodyView to understand how well your body takes up and uses oxygen. Use this value as a target to improve against using cardiovascular (and in particular HIIT) training. As covered in Big10 #6 - Monitor Your Body Composition with Specialist Scanning , book a DEXA scan with someone like BodyView to get an accurate figure for your Appendicular Lean Mass Index (ALMI). Use this value as a target to improve against using resistance training and high quality protein intake. I classify the benefits of exercise into two top-level categories:\n\u0026lsquo;Hard\u0026rsquo;: Your muscles, bones and metabolism\n\u0026lsquo;Soft\u0026rsquo;: Your brain, sleep, wellbeing and social connection\n\u0026lsquo;Hard\u0026rsquo; benefits Cardiorespiratory: Exercise strengthens your heart and lungs, ensuring your body is supplied with the oxygen needed to perform. Bone density and muscle mass: Heavy loading strengthens your bones and muscles, protecting against fractures and weakness as you age but also ensuring a healthy and active life. Glucose disposal: Muscle is the primary site for clearing sugar from your blood. Having greater muscle mass and exercising helps to control your blood sugar and protect against type 2 diabetes. Immune system: Muscle is a storage site for amino acids which your body can use to fuel your immune system when fighting illness. Hormonal: Exercise supports healthy levels of key hormones. \u0026lsquo;Soft\u0026rsquo; benefits Neurological: Exercise triggers the release of Brain-Derived Neurotrophic Factor (BDNF) which has powerful benefits for your brain. Sleep: Regular physical exertion improves sleep quality. Emotional Resilience: Exercise helps to regulate cortisol and reduce stress. Social connection: Whether it\u0026rsquo;s a running club, a yoga class, or a tennis match, exercise will bring you together with other people and make you feel great in the process. Self-confidence: The more you do hard things, the more you believe you can and the better you feel about yourself. Exercise is a vast topic. However, I believe, to simplify it a bit, there are two key measures that you can easily obtain for yourself. If you base your exercise routine around improving them (ideally with the help of a coach or personal trainer for at least some of your sessions), you can\u0026rsquo;t go far wrong. So, what are they?\nExercise metrics for longevity Whatever sports watch, wearables, and apps you use, they\u0026rsquo;ll be collecting a ton of data and generating all sorts of metrics and progression graphs and charts. Whilst being able to track your progress is inherently valuable and rewarding, there are two specific measures that stand out above the others when we are thinking about longevity and healthspan. If you know these scores for yourself and are working to progress them, then you are going in the right direction, whatever your specific exercise and sport preferences are:\nVO2 Max Technically speaking, VO2 Max is a measure of the maximum amount of oxygen your body can use during intense exercise. Effectively, it represents how well your lungs take in oxygen, how well your heart pumps that oxygenated blood, and how efficiently your muscles use that oxygen to create energy. VO2 Max is measured in milliliters of oxygen used per kilogram of body weight per minute (mL/kg/min) and is highly dependent on age, gender, and fitness.\nVO2 Max is more strongly associated with a longer life than almost any other health metric, including not smoking or having healthy blood pressure[2]. Your sports watch and/or wearable will be attempting to measure and track your VO2 Max, but the most reliable way to get an accurate reading is to be tested. This is a non-invasive but uncomfortable test which involves running on a treadmill (or using a stationary bike) whilst wearing a mask that both delivers oxygen and measures your waste gases. The treadmill will get steeper and faster until you are at your limit and/or when the technician can see your body has reached its maximum oxygen uptake capacity. Your sports watch/wearable will also give you an estimate of VO2 Max, but there is no substitute for getting an accurate reading and then providing that measure to your device as a benchmark since devices are good at spotting change/progress but less good at getting an absolute measure.\nDepending on your age, gender, and level of fitness, the value will be somewhere on the following tables. Your target should be to get it as high as you can and certainly to be (ultimately) well above the average for your age. The following charts are for the general population rather than for trained athletes:\nI get my VO2 Max testing done at the same facility ( BodyView) that does my DEXA scans. See (Big10 #6 - \u0026lsquo;Monitor Your Body Composition with Specialist Scanning\u0026rsquo;) and below, for more information on DEXA scans.\nTo improve your VO2 Max, you are looking at cardiovascular work (running, cycling, swimming, etc.) but you need to be getting into Zones 4 and 5 (see below). High Intensity Interval Training (HIIT) is perfect for this as its stop/start nature will give you more time at your limit than you could manage in a continuous block.\nLean muscle mass: There are actually several measures in this area which are interesting and all of them can be gathered from a DEXA scan See (Big10 #6 - \u0026lsquo;Monitor Your Body Composition with Specialist Scanning\u0026rsquo;):\nLean Mass: This is your total mass minus your fat mass and gives a number for the mass of your muscles, bones, organs, etc. Lean mass Percentage: This is the same as your Lean Mass but expressed as a percentage of your total body weight. Lean Mass Index: This is your lean mass but adjusted for your height (if you are taller, then your lean mass will be more spread out, if you are shorter, then it is more packed in). Appendicular Lean Mass: This is the lean mass on just your limbs (i.e. excluding your torso). This is calculated separately as it is a more specifically useful measure when it comes to longevity since it targets the areas most crucial for mobility and physical function. Appendicular Lean Mass Index (ALMI): This is the lean mass on just your limbs but adjusted for your height. The single most useful one of these measures for our purposes is your ALMI. Your target (much like VO2 Max) is to get yourself well above the average for your age and gender. Low values (especially later on in life) are associated with sarcopenia (muscle atrophy) so you, of course, want to aim for the opposite of that. The report that will be prepared for you by the consultant performing your DEXA scan will place you on that distribution for your gender and age bracket so you can see where you are at.\nA word of caution on bathroom scales. There are a number of smart scales on the market that will claim to be able to tell you your lean mass, but even the best (which can approach the cost of DEXA scan in price) don\u0026rsquo;t have the accuracy and reliability of a DEXA scan.\nTo improve your ALMI, the two primary factors to consider are:\nYour protein intake: Many people don\u0026rsquo;t get enough protein, and this becomes even more important as you load your muscles with resistance training. A good daily protein target (for the average population rather than elite athletes or body builders) is 1.6 g per kg of body weight [3]. So for a 70 Kg person, they\u0026rsquo;d be looking at around 112 g of protein per day. Aim to get as much of this from high-quality foods (which will vary, of course, depending on whether you eat meat or are vegetarian or vegan) but expect also to supplement with a protein shake of some description to hit your target. For athletes and body builders you would be looking at a target of up to 2.2 g per Kg body weight. There is more information on protein and supplements in Big 10 #5: \u0026lsquo;Design Your Personal Supplement Stack Informed by Blood Testing\u0026rsquo; Your resistance training programme: To increase your muscle mass, your resistance training is going to focus on lower repetitions at a higher load to cause significant hypertrophy (muscle micro-tears followed by repair and growth). This is where using a personal trainer can be very helpful to design you the right kind of programme. Like VO2 Max, ALMI is strongly associated with a longer life span [4] so it is essential to know your score and adjust your diet and training programme to improve it.\nIn summary, so long as you know (accurately) your VO2 Max and ALMI and have designed a programme that aims to improve both of them by using a mixture cardiovascular work, resistance training and a high protein diet you'll be going in the right direction for sure. But, it is really important that you talk to your health practitioner or doctor before starting a new exercise programme or making significant adjustments to your current one (particularly if you have any ongoing health conditions or concerns). The same is also true for increasing your protein levels significantly and especially if you have kidney or liver issues. My personal programme There is an almost infinite amount of health guidance and coaching available when it comes to exercise, to the extent that it can be a real challenge working out what the best thing to do is, and somehow fitting that into a busy work and family schedule. However, if useful, below you can see at a high level the programme that I follow. It works for me as it gives me good coverage across resistance training, flexibility, and cardio, whilst also including elements that contribute to positive well-being. I can also fit this into around 90 minutes, doing something each day of the week with my yoga sessions acting as a lighter recovery day, interspersed between heavier resistance and cardio workouts.\nResistance training: As discussed earlier, my view is that this is a non-negotiable part of any exercise programme aimed at longevity and health. I\u0026rsquo;m using a mixture of free and machine weights at my local gym. To be honest, I\u0026rsquo;d always prefer to be exercising outdoors, but I appreciate and am grateful for the long-term benefits that I believe resistance training will give me. I\u0026rsquo;m currently prioritising two leg sessions vs. one upper body session a week since my swimming also gives me a strong upper body workout. I\u0026rsquo;m also doing an extra legs session since my last DEXA scan showed an imbalance between legs and upper body in terms of lean mass. If you are new to resistance training, I\u0026rsquo;d strongly suggest starting with a coach or personal trainer to get a good programme worked out and to ensure you are using a good form. Be sure also to read my post on supplements for information on protein, creatine and other exercise-related supplements.\nCardiovascular (swimming): You have so many options here for what you could swap into your schedule. I\u0026rsquo;ve been a middle and long distance runner all my life and love running (but I\u0026rsquo;m not sure it loves me). In recent years, I\u0026rsquo;ve switched over to long-distance swimming as being potentially (for me) less injury-prone. I also love the mental well-being I get from swimming in cold and open water, and this has preserved the outdoors aspect that I loved in running. Another benefit from the open water swimming that I\u0026rsquo;m hoping to get is some vascular \u0026lsquo;work out\u0026rsquo; from the effects of handling the cold (especially as I still swim outdoors once a week, even in the winter months). Hopefully this complements the similar benefit obtained from my hot yoga classes. During my swim sessions I\u0026rsquo;m mixing in some higher intensity zone 4/5 work as well as the more endurance focussed zone 2-3 training since (as noted earlier) there are some very specific benefits from bursts of high intensity.\nCardiovascular (Norwegian 4x4): Norwegian 4x4s are a High Intensity Interval Training (HIIT) protocol aimed at boosting VO2 Max and achieving heart remodelling. The protocol is the result of a study conducted by researchers at the Norwegian University of Science and Technology (NTNU)[1]. The protocol is pretty straightforward, warm up and then do four mins of zone 4/5 exercise followed by three mins total rest and then repeat four times before warming down. This gives you 16 mins of intensity in a 25-minute block. I try to dial in two of these a week (generally tacking them onto my resistance sessions so I can use cardio machines at the gym). To keep it fun, I vary these between elliptical, rowing machine, static bike, and SkiErg machine. I included this in my programme because as mentioned earlier, VO2 max is a \u0026ldquo;gold standard\u0026rdquo; measure when it comes to longevity. It is a system-wide stress test that doesn\u0026rsquo;t just measure your lungs; it measures the harmony between your heart, blood vessels, and mitochondria (energy production). A direct, inverse relationship between cardiorespiratory fitness (VO2 Max) and all-cause mortality has been established in a large scale study [2].\nFlexibility (yoga): I love yoga (it has to be Ashtanga for me but there are many options) as it delivers a triple hit of flexibility, light resistance load, and balance whilst also throwing in a whole load of breath work, mindfulness and a lovely group/class community vibe. I use a hot class because I\u0026rsquo;m hoping (see my post on hot and cold) for some vascular benefits to complement the similar effect from my cold water swimming. I also find the heat helps me to feel more supple in the postures and makes it feel more of a workout also. There are some great apps for Yoga (e.g. Down Dog) but I would always suggest that a class with an expert practitioner leading it is going to lead to better and safer results. Poor form in Yoga is just as capable of causing damage as other forms of exercise.\nCardiovascular (hiking): This is a great way for me to give my step count a boost, along with getting all the mental wellbeing and sunlight benefits of being outdoors, and getting a good zone 1/2 workout AND spending time with my partner. I try and get a short (30 mins) walk around the middle of the day (when work permits) and a longer (10 K or so) hike at the weekends. This, however, is the \u0026lsquo;bonus\u0026rsquo; in my programme and the other elements have to take priority.\nSocial/wellbeing (climbing): For me this is primarily about mental well-being and spending time with friends than it is about pushing my strength and cardio fitness. There is so much positive stuff in climbing whether it\u0026rsquo;s the clarity of mind that comes from focussing on the route, managing fear, the commitment between climbing partners to keep each other safe, even just being outdoors.\nWearables: I use Whoop for tracking my strain, recovery and sleep and find it very beneficial in terms of feedback and thinking about how hard to push in any given session. I\u0026rsquo;m also a big fan of gamification in exercise and enjoy the sense of accomplishment of hitting my weekly commitments and long-term streaks. I\u0026rsquo;m still also using my older model Garmin Fenix Watch for a couple of specific reasons – it\u0026rsquo;s brilliant for tracking laps in the pool and, unlike Whoop, has GPS built in so for hiking (and running, of course) that probably gives better data than the phone geolocation capability that Whoop uses and means I can leave the phone behind (when safe to do so). Whereas I feel the sensor on the Whoop is much better than my (older) Garmin and is my go-to for vitals, recovery and sleep tracking. I also think the AI coach is better in Whoop than in Strava - but that could well just be personal preference. Although of course both devices overlap in their capabilities, for me (at least in 2026 anyway) it\u0026rsquo;s not an either or choice – both are valuable and have their place in my programme.\nApps: There are a huge number of sports performance and tracking apps out there, and different Apps will suit different sports better (for example, you might want a different app for resistance training as opposed to cardio). I use Strava which both my Whoop and Garmin sync to. I like the long-term trend views of fitness Strava gives but, perhaps more than anything, I like the social and slightly competitive aspect of it with friends and family. I don\u0026rsquo;t use social media at all since I (personal bias alert) view it as an algorithm-driven devil of dopamine hits, time-wasting, sleep disrupting, anxiety inducting noise - but I do love a bit of a scroll on Strava so I can see what people are up to and share my own training. I also use Apple Health as the underlying repostiory for all my data (being fed by my wearables, weight tracking, blood pressure, blood sugar monitor and so on)\nType Exercise How Often Duration Resistance Training Legs Twice a week 90-minute sessions including warm up and cool down Resistance Training Upper body Once a week 90-minute session including warm up and cool down Flexibility and wellbeing Hot yoga class Twice a week 60-minute sessions Cardiovascular and wellbeing Open water swim Once a week in the winter, twice a week in spring, summer and autumn 30-120 minutes depending on the season Cardiovascular Pool swim Once a week in the winter 60-minute session Cardiovascular High Intensity Interval Training (Norwegian 4x4s) Twice a week 25 minutes each time Cardiovascular and wellbeing Hiking Ad-hoc 120–240 minutes Social connection and wellbeing Climbing Ad-hoc 120 minutes Further sources of information The Examine website for independent, unsponsored meta-analyses of health research\nOutlive: The Science and Art of Longevity by Pete Attia MD\nForever Strong by Dr Gabrielle Lyon\nLifespan by Dr David Sinclair\nReferences [1] Helgerud, J., et al. (2007). “Aerobic High-Intensity Intervals Improve $VO_2\\text{ max}$ More Than Moderate Training.” Medicine \u0026amp; Science in Sports \u0026amp; Exercise.\n[2] Mandsager, K., et al. (2018). “Association of Cardiorespiratory Fitness with Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing.” JAMA Network Open.\n[3] Morton RW, et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. British Journal of Sports Medicine. 2018;52(6):376-384.\n[4] Srikanthan P, Karlamangla AS. Muscle mass index as a predictor of longevity in older adults. The American Journal of Medicine. 2014;127(6):547-553.\n","permalink":"https://big10.health/posts/2-exercise/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.jpeg\" alt = \"A picture of some weight\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"exercise-regularly-and-include-both-resistance-and-cardiovascular-workouts\"\u003eExercise Regularly and Include both Resistance and Cardiovascular Workouts\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n        \u003cspan\u003e\u003ci class=\"fa-classic fa-heart\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-brain\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-atom\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-droplet\"\u003e\u003c/i\u003e\u003c/span\u003e\n        \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eCommit to a structured, consistent, regular programme of exercise that includes resistance training as well as cardiovascular and flexibility/stability work. Use a wearable and/or sports watch and apps to track your progress.\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e\n\u003ch2 id=\"why-should-you-care-about-exercise\"\u003eWhy should you care about exercise?\u003c/h2\u003e\n\u003cp\u003eExercise is not just a good habit; it is, along with sleep and nutrition, a critical pillar of your well-being affecting almost all aspects of your mind and body. Exercise is also an essential consideration when thinking about your health span (not just living longer, but living well as you age).\u003c/p\u003e","title":"2. Exercise Regularly and Include both Resistance and Cardiovascular Workouts"},{"content":" Get Enough Good Quality Sleep Aim to get 7–9 hrs a night and use a sleep tracker to understand the duration and quality of your sleep so that you can address any deficiencies. Why should you care about sleep? Sufficient sleep of good quality [1] is a non-negotiable part of a long and healthy life and provides a vital daily reset for brain and body health. Sleep is essential because it:\nConsolidates memory Clears brain waste [2] Regulates emotions Strengthens the immune system Manages metabolism. For me the definitive piece of reading on sleep is the book Why We Sleep by Matthew Walker, and I can\u0026rsquo;t recommend it enough.\nWant to look at the science later but, right now, you are just interested in some actions to take?\nGet a high quality sleep tracking wearable like Whoop and start gathering information on how much sleep you are actually getting and the quality of your sleep. Read more to build your own understanding. If you are getting less than 7 hours of sleep or more than 9 hours of sleep a night, or if you are getting poor quality sleep or insufficient time in the key phases of sleep then you need to make some changes. These could include going to bed and getting up at the same time every day, avoiding bright light and attention grabbing devices near to bedtime, and not eating too late. There are a range of tips and tricks below you can look at. Sleep science essentials In this post I really focus on the variety of techniques I use to improve my sleep quality and duration rather than diving into the science behind sleep. However, there are some essential concepts that are worth understanding so that the tips make more sense. In addition, this post finishes up with some resources you can use to start to broaden your understanding of what happens when you sleep.\nThe circadian rhythm Your circadian rhythm is your internal, biological near-24-hour clock that cycles between sleepiness and alertness but is also involved in a wide range of other biological processes. This \u0026lsquo;master clock\u0026rsquo; is situated in a tiny region of the brain called the Suprachiasmatic Nucleus (SCN) which receives direct signals from your eyes. When it senses light (in particular key blue light frequencies from the sun), it tells the brain to stay alert and conversely, as light fades, it signals the production of melatonin to promote sleepiness.\nEven without the trigger of light, your circadian rhythm will still follow a 24-hour cycle but will slowly drift away. Anything that puts your internal clock out of sync with the external rise and fall of the sun (e.g., jet lag or shift working) disrupts the smooth operation of that circadian rhythm. Thus, maintaining consistent bedtime and wake times coupled with bright light upon waking and dim light at the end of the day will help to reinforce your circadian rhythm and promote good sleep.\nKey hormones involved in sleep Melatonin: As daylight fades, the retina of the eye sends signals to the brain to start the production of the hormone melatonin (primarily in the pineal gland). As melatonin levels rise, body temperature and blood pressure fall, preparing the body for sleep and acting like a biological ‘dimmer switch’ to manage the circadian rhythm. Conversely, light exposure (e.g. when the sun rises) inhibits melatonin production which helps to wake you up. Anything that interferes with melatonin can make it harder to feel sleepy. For example, melatonin inhibts insulsin (to keep blood sugar stable whilst you fast overnight) but eating late forces the body to produce insulin when it\u0026rsquo;s trying to shut that system down, which causes metabolic \u0026ldquo;noise\u0026rdquo; that disrupts sleep.\nAdenosine: If you think of melatonin as telling us \u0026ldquo;it\u0026rsquo;s dark\u0026rdquo; adenosine is telling us \u0026ldquo;it’s been a while since you slept\u0026rdquo;. Melatonin is about light and adenosine is about time [3]. The longer you stay awake, the more adenosine builds up in the brain, starting from the moment you wake. The rise in adenosine creates a ‘sleep pressure’ and when it reaches a certain level, it triggers the urge to sleep. Adenosine is a by-product of the body using ATP (adenosine triphosphate) for fuel, and thus can be thought of as a tracker for how long you have been awake. Whilst you sleep (specifically in the slow wave (deep sleep phase), adenosine is cleared from the brain and, by morning, levels are at their lowest ready for the cycle to start again. If you get enough sleep but very little deep sleep, you may well still feel \u0026lsquo;groggy\u0026rsquo; due to residual adenosine. Caffeine works by blocking the adenosine receptors in the brain (since it has a similar molecular structure to adenosine). It is thus truer to say that caffeine prevents you from feeling tired rather than giving you energy.\nCortisol: If you think of melatonin as a dimmer switch for your brain, then cortisol (often thought of as the ‘stress’ hormone) is the opposite and acts more like an alarm clock, kick-starting your system for the day. Cortisol levels should be at the lowest around midnight and begin to increase 2-3 hours before you wake up. Immediately upon waking (and especially when light hits your eyes) there is large spike in cortisol which makes you feel alert, increases blood sugar for energy and resets your circadian clock for another day. Cortisol levels should then decrease through the day, dropping significantly by sunset allowing melatonin to take over. However, if cortisol levels remain high (e.g due to chronic stress) the brain remains aroused and sleep is much more difficult. This can create a vicious cycle as a bad night’s sleep causes stress and higher cortisol levels the next day leading to more trouble sleeping the next night.\nOf course, a wide range of other hormones and chemicals are involved in sleep, and you might like to read up on some of the following:\nGABA (Gamma-Aminobutyric Acid): Reduces brain activity to keep you asleep. Orexin: Keeps you awake and alert. Histamine: In the brain this acts as a stimulant. Growth Hormone: Secreted during deep sleep and is essential for tissue growth and repair. Leptin \u0026amp; Ghrelin: Involved in managing hunger. The stages of sleep Your brain goes through a number of different stages of sleep during the night and these stages, the time spent in each, and the reptitive cycle between them is often referred to as your \u0026lsquo;sleep architecture\u0026rsquo;.\nThere are two distinct types of sleep which you cycle between\nNon-REM (Non-Rapid Eye Movement) REM (Rapid Eye Movement) A full cycle takes around 90 minutes, and you repeat this multiple times in the night. NREM sleep is itself broken down into 3 distinct stages which gives us an overall set as follows:\nStage 1 – Transition to Light Sleep: This is where you are \u0026lsquo;dozing off\u0026rsquo; and can easily be awoken. This stage lasts only a few minutes Stage 2 – Light Sleep: This is where you spend the largest amount of sleep time (about 50% of sleep) and its function is memory consolidation. Stage 3 - Deep Sleep also called Slow Wave Sleep (SWS): This is the most restorative sleep phase (about 25% of sleep). Its function is physical repair and growth. You get most of your deep sleep in the first half of the night. Stage 4 – REM Sleep: This is the phase of sleep where you dream and is characterised by rapid eye movements and paralysis (to stop us acting out our dreams). You spend about 25% of sleep in this phase and, as the night goes on, the phases of REM last longer, with the longest coming in the hours before awakening. It\u0026rsquo;s thus crucial to think not only of the number of hours sleep you get but also how much you spend in each stage - which is exactly where a good quality sleep tracker is invaluable.\nHow to get great sleep I\u0026rsquo;ll be straight up – until recent times my sleep has been appalling – both in terms of the attention I paid to it and the actual amount of quality of sleep I got. I\u0026rsquo;ve grappled with occasional bouts of insomnia most of my adult life and often worked late into the night, only getting minimal amounts of sleep before starting again the next day.\nI decided to try and tackle my sleep during a particularly unpleasant period of insomnia, and it took an absolute battery of techniques, all in combination, to bring it under control.\nHere\u0026rsquo;s the recipe of techniques that I use to get a good, restorative night\u0026rsquo;s sleep. It\u0026rsquo;s still far from perfect, but the general trend shows I am improving.\nUse a sleep tracker to give insight into how much sleep you are getting and the relative proportions of light, deep and REM sleep that make up your night\u0026rsquo;s sleep. I use Whoop but there are many other options out there. Your wearable might not be totally accurate in terms of discerning between sleep and lying very still and may also not discriminate well between the various phases of sleep. However, the good ones (Whoop, Oura, Apple Watch, Ultrahuman, Happy Ring, Eight Sleep, etc) will be ‘consistently inaccurate’ and thus are useful for showing long-term trends and monitoring improvements in sleep duration and quality even if they are not completely accurate on any given night. Go to bed at the same time every night and get up at the same time every day aiming for around 8hrs of sleep [1]. That consistency of schedule anchors your circadian rhythm and gives a consistent signal to your master clock, which then coordinates the biological processes in your body. If you can\u0026rsquo;t anchor both your sleep and wake time, then at the very least anchor your wake-time (with weekends and weekdays the same) and get bright light (see below) straight away. Don\u0026rsquo;t eat your last meal of the day (especially if it is high in carbohydrates) any later than 3hrs before you sleep [4]. The sugar spike after the meal (and the knock-on rise in insulin) can disrupt the release of melatonin. In addition, the consequent sugar crash in the middle of the night triggers a hormonal surge (cortisol and adrenaline) to release stored sugar which can leave you wide awake and alert in the middle of the night. See my post on Continuous Glucose Monitoring for how you can gain insight into how your diet and meal schedule affects your blood sugar during the night. Or, consume all your food for the day by later afternoon[4]. I found that all the other actions enabled me to fall asleep at night, but it was only this one that stopped me from waking for good at around 3am — by shifting my time restricted eating window to between 10:00 and 16:00. I still sit down with my family for dinner in the evening because that\u0026rsquo;s really important to me – but all my eating is done earlier in the day. Get bright natural light in the morning and during the day [5]. This is very challenging for me with my schedule and with living in an often rainy and dark country. So, I use Ayo light therapy glasses for 30 mins in the morning. These are better than many \u0026lsquo;SAD lamps\u0026rsquo; because although they have a lower intensity they focus in on the part of the spectrum that your circadian rhythm is most receptive to. In addition, because you wear them I can get your morning dose whilst going through my chores or even whilst doing some exercise. Much more practical for me than trying to sit 18 inches way from a lamp for 30 minutes! Avoid caffeine after midday and avoid caffeine completely if you are particularly sensitive to it [6]. Avoid alcohol or narcotics (e.g., cannabis). Although they may make you feel sleepy, they will disrupt the architecture of your sleep leading to poor quality sleep. You might get enough hours, but it won\u0026rsquo;t be the right kind of sleep [7] [8]. Avoid sleep tablets [9] for exactly the same reason. However, there is a new class of sleep medications (DORAs - Dual Orexin Receptor Antagonists) that may offer a more natural approach which you might like to discuss with your doctor if you suffer badly with insomnia. Avoid mobile phones, tablets and laptops in the 2 hours before settling down to sleep (partially because of the light from them but more because of the mental stimulation they cause) [10]. Keep the house lights as low as possible for the last couple of hours before bedtime [11]. This is something I\u0026rsquo;ve been unable to achieve given the practicalities of a busy family household. But, as with bright light in the morning, you are trying to anchor your circadian rhythm and maintain the natural day/night cycle that humans evolved with. If you do read in bed before going to sleep, then use a red light/dim light. For the same reason as with the house lights, I use a small pencil light which clips onto my book and find this one great. Keep the room cool and dark throughout the night [12] and if (like me) you live in a busy household, then a high-quality eye mask is invaluable. I’ve tried loads and finally found and love the Manta Pro. Use ear plugs [13] to block out noises that could wake you up, especially if you sleep in the same room as your partner. Again, I’ve tried many and Loop Dream are the standout winners for me Use noise-cancelling headphones [13] if noise is a real problem (it is for me as my partner snores heavily but I am determined that we sleep in the same bed together). I use Bose QuietComfort which I wear on top of the Loop ear plugs. As I’m a side-sleeper, a great hack I came across is to use a neck travel pillow on top of your pillow and nestle the bulky headphone on your \u0026lsquo;down-side\u0026rsquo; into the hole in the middle. Use white or brown noise [13], stories (e.g., the Calm App) or music specifically engineered to promote sleep (e.g Brain.fm). Personally, I love the MyNoise App and with the combination of brown noise, Bose headphones AND Loop ear plugs, I can fully control my environment and sleep in the same bed as my partner. Get up and go and read in another room (using a dim red light) if you cannot fall asleep within 30 minutes or wake up in the night for longer than 30 minutes. Don\u0026rsquo;t return to bed until you feel sleepy. By doing this you are trying to break the mental association of your bed as a place where you don\u0026rsquo;t sleep. Further sources of information The Examine web site for independent, unsponsored meta-analyses of health research\nThe Sleep Foundation\u0026rsquo;s web site\nWhy We Sleep by Dr Matthew Walker\nMatthew Walker on the Diary of a CEO podcast\nReferences [1] Watson NF, et al. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement. Journal of Clinical Sleep Medicine.\n[2] Xie L, et al. (2013). Sleep drives metabolite clearance from the adult brain. Science.\n[3] Borbély AA. (1982). A two process model of sleep regulation. Hum Neurobiol.\n[4] McHill, A. W., et al. (2017). \u0026ldquo;Later circadian timing of food intake is associated with increased body fat.\u0026rdquo; The American Journal of Clinical Nutrition.\n[5] Blume, C., et al. (2019). \u0026ldquo;Effects of Light on Human Circadian Rhythms, Sleep and Mood.\u0026rdquo; Somnologie.\n[6] Drake, C., et al. (2013). \u0026ldquo;Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed.\u0026rdquo; Journal of Clinical Sleep Medicine.\n[7] Ebrahim, I. O., et al. (2013). \u0026ldquo;Alcohol and Sleep I: Effects on Normal Sleep.\u0026rdquo; Alcoholism: Clinical and Experimental Research.\n[8] Gates, P. J., et al. (2014). \u0026ldquo;The effects of cannabinoid administration on sleep: a systematic review of human studies.\u0026rdquo; Sleep Medicine Reviews.\n[9] Riemann, D., et al. (2015). \u0026ldquo;Adverse effects of sleep-promoting medication on sleep architecture.\u0026rdquo; Sleep Medicine Reviews.\n[10] Gradisar, M., et al. (2013). \u0026ldquo;The Sleep and Technology Use of Americans: Findings from the National Sleep Foundation\u0026rsquo;s 2011 Sleep in America Poll.\u0026rdquo; Journal of Clinical Sleep Medicine.\n[11] Gooley, J. J., et al. (2011). \u0026ldquo;Exposure to Room Light before Bedtime Suppresses Melatonin Onset and Shortens Melatonin Duration in Humans.\u0026rdquo; The Journal of Clinical Endocrinology \u0026amp; Metabolism.\n[12] Okamoto-Mizuno, K., \u0026amp; Mizuno, K. (2012). \u0026ldquo;Effects of thermal environment on sleep and circadian rhythm.\u0026rdquo; Journal of Physiological Anthropology.\n[13] Zhou, J., et al. (2012). \u0026ldquo;Acoustic effects on sleep patterns based on EEG multi-step analysis.\u0026rdquo; Scientific Reports.\n","permalink":"https://big10.health/posts/3-sleep/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.png\" alt = \"A relaxing sleep scene\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"get-enough-good-quality-sleep\"\u003eGet Enough Good Quality Sleep\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n        \u003cspan\u003e\u003ci class=\"fa-classic fa-heart\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-brain\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-atom\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-droplet\"\u003e\u003c/i\u003e\u003c/span\u003e\n        \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eAim to get 7–9 hrs a night and use a sleep tracker to understand the duration and quality of your sleep so that you can address any deficiencies.\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e\n\u003ch2 id=\"why-should-you-care-about-sleep\"\u003eWhy should you care about sleep?\u003c/h2\u003e\n\u003cp\u003eSufficient sleep of good quality [1] is a non-negotiable part of a long and healthy life and provides a vital daily reset for brain and body health. Sleep is essential because it:\u003c/p\u003e","title":"3. Get Enough Good Quality Sleep"},{"content":" Monitor Your Heart Health Check and track your blood pressure regularly. Use blood testing to monitor levels of key markers and uses scans to check for the presence of plaque buildup in your arteries. Why should you care about heart health? Cardiovascular disease (CVD) is the leading cause of death globally [1] so anything you can learn about your genetic propensity to suffer from it, your current cardiovascular health, and the impact of your diet and lifestyle can help you to mitigate the risk. It\u0026rsquo;s important to note that the vascular damage that ultimately leads to incidents like a heart attack or a stroke starts long before the actual event and, despite there being a genetic aspect to this condition, there is much that can be done in terms of diet, lifestyle and exercise. In fact, should you find out that you do have a higher genetic risk, then knowing that makes it even more important to take early action and make long-term changes.\nWant to look at the science later but, right now, you are just interested in some actions to take?\nUse an at home blood draw service like Thriva and order an advanced lipids panel which must include apoA, apoB and Lp(a). If any of your results are out of the normal range then read more and speak to your doctor before also making lifestyle changes. Buy a high quality, reliable blood pressure monitor which sends its data to your phone like the OMRON EVOLV Wireless Monitor. Start checking your blood pressure every day until you have at least a weeks worth of data. If your average blood pressure is out of the normal range then read more and speak to your doctor before also making lifestyle changes. Dependent upon your age and the results of the above two actions consider booking a Coronary Calcium (CT) Scan with a provider like Scan.com. If the scan does not give you a score of zero for the amount of calcified plaque in the arteries supplying your heart then read more and speak to your doctor before also making lifestyle changes. Even if you get a green light across the board on the above actions, adopt and stick to a heart healthy lifestyle to protect yourself against future cardiovascular damage. Let\u0026rsquo;s start with a couple of key definitions and by clearing up one common confusion.\nFirst, what exactly do we mean by the term Cardiovascular Disease (CVD)? CVD is an umbrella term that encompasses a systematic decline affecting the heart and blood vessels (arteries, veins and capillaries). We can unpack it a bit further into the following specific conditions:\nCoronary Artery Disease (CAD): The hardening and narrowing (due to the build-up of plaque) of the arteries supplying the heart. This can lead to chest pain (angina) or myocardial infarction (MI) (a heart attack) whereby plaque ruptures and a fragment fully or partially blocks an artery supplying the heart. Cerebrovascular Disease (Stroke): This is similar to coronary artery disease, but instead affects the blood vessels supplying the brain. The incident could be caused by a blockage (an ischaemic stroke) or by a bleed (often due to high blood pressure leading to a burst vessel). Peripheral Arterial Disease (PAD): In this case the damage is to the arteries in the legs and arms leading to pain and even tissue death. Aortic Aneurysm and Dissection: Here the impact is felt in the aorta (the largest artery in the body) and manifests as weakness/bulging (aneurysm) or a rupture (dissection). There is a strong link between this condition and unmanaged high blood pressure. Before we get to the checks you can make and the tests you can have performed to keep a close watch on your heart health, let\u0026rsquo;s clear up some confusion and old-fashioned language around cholesterol and the risk of CVD. The following statement is something you might well be familiar with but is both inaccurate and untrue:\nIncorrect: \"Cholesterol is bad for your heart and arteries, and if you have high levels of it in your blood stream, it will 'block up' your arteries, just like deposits might block up a water pipe.\" Let\u0026rsquo;s pick this statement apart and correct it before we go any further! Firstly, cholesterol is not \u0026lsquo;bad for you\u0026rsquo;, it\u0026rsquo;s actually a fundamental building block of human life with a number of key roles such as:\nContributing to the formation and stability of cell walls Helping to create hormones such as testosterone, estrogen, and cortisol Helping in the synthesis of vitamin D and in the production of bile salts in the liver. Without a healthy level of cholesterol, quite simply, you would die and in fact, the majority of cholesterol is manufactured by your body, with only a minor portion coming from your diet. Thus, dietary approaches focused on reducing cholesterol are quite clearly nonsense. The issue does not lie with cholesterol itself. It lies with how cholesterol is transported around the body. Because cholesterol belongs to the lipids family (fats) it is not soluble and yet must be transported in the bloodstream. The way the human body achieves this is to wrap cholesterol up in spherical particles called lipoproteins, which are water-soluble. You can think of the lipoproteins as little boats which carry the cholesterol around the body. Lipoproteins are protein on the outside and lipid on the inside - hence their ability to both hold cholestrol and be transported in the blood. It is not the cholesterol that is bad - it\u0026rsquo;s the nature of some of the particles carrying it. There are two classes of lipoprotein you need to care about (and we\u0026rsquo;ll look more at this in the section on testing below).\nLow Density Lipoproteins (LDL): These carry more lipid in relation to protein and thus are less dense. Speaking simplistically, these are the \u0026lsquo;bad ones\u0026rsquo; High Density Lipoproteins (HDL): These carry more protein in relation to lipid and thus are denser. Again, simplistically, these are the \u0026lsquo;good ones\u0026rsquo; Let\u0026rsquo;s get a bit more specific so that you are ready for when we look at blood tests shortly. LDL (the bad, low-density ones) are wrapped in a molecule called apolipoprotein B (apoB) whereas HDL (the good, high-density ones) are wrapped in a molecule called apolipoprotein A (apoA). Every lipoprotein (not just LDL but also others) that contributes to arterial damage carries apoB.\nWhat you really need to concentrate on is not the amount of cholesterol but instead the levels of apoA (good) and apoB (bad) showing up in your bloodstream. So, if it\u0026rsquo;s not cholesterol \u0026lsquo;blocking up\u0026rsquo; your arteries, then what exactly is the damage that LDL (with its apoB marker) is causing? The key term here is atherosclerosis, which is the thickening and hardening of the inner wall of the arteries due to the build of plaque. In essence, the LDL (apoB) tends to stick to the inner wall of the artery (called the endothelium) and has an inflammatory and damaging effect leading to lesions on the artery wall. When there is significant LDL (apoB) present, it is the body\u0026rsquo;s efforts to tackle this damage that ultimately leads to fatty streaks (the precursor of plaque) forming on the artery walls. Specifically, as the body dispatches soldiers (called macrophages) to swallow up oxidised (effectively rancid) LDL stuck to the lining of the arteries those macrophages themselves can ingest too much of the cholesterol carried within the LDL and blow up to form a kind of foam. Given enough of this foam, a fatty streak forms, which is the core of the arterial plaque that forms as the body tries to build a barrier. This soft plaque is harder to detect (see scans later) but, over time, it will become hardened with calcium deposits. At this point the atherosclerosis is quite advanced and is more easily detectable. HDL (aopA) is considered to be good because it has the opposite effect and can pull the cholesterol back out of these macrophages and ship it back into the blood stream.\nThus, a much better version of that erroneous earlier statement would be:\nCorrect: \"If your body has high levels of the bad lipoproteins (LDL) used to carry cholesterol, this can have an inflammatory effect on the arteries’ lining. The bodies attempt to combat this damage can, over time, lead to the build-up of plaque. If your body also has high levels of the good lipoproteins (HDL) used to carry cholesterol, then this can help to undo the precursors of this plaque. If the balance between these two processes tilts the wrong way for too long, then plaque will form in the arteries. This plaque formation can happen slowly over time and may be forming for many years before any significant cardiovascular harm is felt. There is both a genetic and a lifestyle element to the balance between LDL and HDL. Thus, the use of blood testing is critical to understand both your genetic susceptibility and the effects of your diet and lifestyle.\" I\u0026rsquo;m unapologetic if this seems like a much more complex statement. If you want to take some ownership of your heart health, then the results of your blood tests are critical information that you need to know how to interpret properly.\nBefore we move on, let\u0026rsquo;s conclude with a look at some specific lipoproteins of particular concern and also discuss the role of triglycerides (as you are going to see those pop up on your blood tests also).\nVery Low Density Lipoprotein (VLDL): These lipoproteins are carrying mostly Triglycerides (fuel created by consuming more calories than are required) and a little bit of cholesterol. They are very light (due to the higher relative levels of fat) and large and are thus very low density when compared to LDL. They are concerning because once they have dropped off their triglyceride payload, the remnant is highly inflammatory and triggers an immune response in the arteries. Triglycerides: Are a type of lipid (fat) that are created when your body consumes more calories than are needed (effectively creating a reserve of spare energy). Triglycerides are increased by eating fatty ultra processed foods (e.g. trans-fats) and by consuming sugary drinks and foods. There are a number of reasons to care about triglycerides (e.g. they lower your good HDL and make your blood more \u0026lsquo;sticky\u0026rsquo; and likely to clot), but the primary concern is that their presence leads directly to the formation of the previously mentioned VLDL (very low-density lipoprotein). Small, Dense Lipoproteins: After the VLDL has dropped off its cargo of Triglycerides, it shrinks and becomes denser since it is now predominantly protein and cholesterol rather than fat (becoming the LDL we are familiar with already). However, when the levels of Triglycerides are high, after the LDL has dumped its cargo of Triglycerides, it will then be forced to drop its remaining cholesterol and take up even more Triglycerides. When these particles pass through the liver, an enzyme called hepatic lipase rips the Triglycerides out of them, causing them to collapse into small, dense particles with a higher percentage of the bad apoB protein compared to the fat inside. These small dense lipoproteins are dangerous as they are both inflammatory and their smaller size enables them to more easily penetrate the lining of the arteries. Lipoprotein(a) - abbreviated to Lp(a): Is formed when normal LDL fuses with a \u0026ldquo;kinked\u0026rdquo; protein string called Apolipoprotein(a) (don\u0026rsquo;t confuse this with the very similarly named apoA that we discussed earlier as a marker for good HDL!). The resulting structure is very effective at collecting up unpleasant oxidised lipids as it passes through the blood and then penetrating the lining of the arteries with this payload. The level of Lp(a) is controlled almost entirely by genetics and is not currently amenable to any medication or dietary influence. Around 20-30% of the population has levels high enough to create a risk, and a specific blood test can allow you to check yours (see below). It\u0026rsquo;s a \u0026lsquo;once a lifetime\u0026rsquo; test as there is nothing you can currently do about it, however, knowing you have this vulnerability enables you to double down on every other aspect of cardiac health to ensure all the risks you can control are as tightly managed as possible. In addition, gene silencing techniques are probably only a few years away, so, if you have this genetic pre-disposition, it\u0026rsquo;s important to do everything else you can to buy time until new therapies are available. Lp(a) is also hazardous as it is NOT routinely included in a lipid panel, and it is possible for other markers to look good whilst this, untested one, runs rampant. It is even more important to get tested for Lp(a) if you have any familial history of heart attack. Armed with all this information, you now have a decent chance of interpreting the information you can gather. So, let\u0026rsquo;s get back to what you can practically do to keep a close eye on your cardiovascular health:\nRegular blood testing to look at key markers (such as apoA and apoB). Once in your life testing to look for a genetic susceptibility to Lp(a). Daily checking and tracking of your own blood pressure at home. Scanning such as a Coronary Calcium (CT) scan or a CT Coronary Angiogram (CTCA) to actively visualise your arteries. Testing of blood (a lipids panel) You may well find (given your age, ethnicity, and family history) that your health care provider is running regular blood tests, but, if not, you can easily commission these yourself using an at-home blood draw service. I use Thriva but many other providers exist. What is essential is that your provider includes tests for apoA and apoB and also offers an optional extra test for Lp(a). You are (as we saw earlier) not interested in vague assertions and statements about cholesterol – you need the real data! Your testing provider (or, of course, your doctor) should also provide a report to help you interpret the results.\nHere\u0026rsquo;s what you can expect to see in your lipids panel results:\nApolipoprotein B (apoB): This is the marker for bad lipoproteins that damage your arteries, and you want this to be low and to trend lower over time if it is initially high. Apolipoprotein A (apoA): As we saw earlier, this is a key marker for good lipoprotein that protects your heart health. You want this (unlike most lipid test results!) to be as high as possible, and you want to actively work to get it up over time if it is initially low. ApoB:ApoA ratio: You want your good (apoA) to dominate your bad (apoB) so you want a lower number for this ratio and to see it trend down. High Density Lipoproteins (HDL): You may be more familiar with this measure from older tests. Nowadays (as discussed) apoA is a better predictor, but your panel will still include this value, and you would expect it to trend with your apoA reading Low Density Lipoproteins (LDL): Again, apoB is now a better predictor than the amount of cholesterol carried by LDL particles, but the value will still be in your panel and follow your apoB level Triglycerides: This is the measure of triglycerides in your blood which, as mentioned earlier, contribute to the presence of dangerous Very Low Density Lipoproteins (VLDL) and, subsequently, the also dangerous small dense lipoproteins. If your Triglycerides are elevated, you want, as a priority, to make diet and lifestyle changes to address this. Triglycerides/HDL Ratio: This is another useful measure because it gives you a clue as to the levels of the dangerous small, dense lipoproteins we discussed earlier. Even if you have LDL levels within a normal range, if this ratio is high, you may still be at risk from small dense lipoproteins. Cholesterol: This is the measure of cholesterol in your blood. As we have already discussed, we are much more interested in what is carrying cholesterol than in the cholesterol itself. This is just the sum of both the cholesterol carried by (good) apoA lipoproteins and (bad) apoB lipoproteins. It tells us nothing about the ratio of those. Non-HDL Cholesterol: This is your total cholesterol minus the cholesterol carried by the good HDL lipoproteins. This is interesting because the value is the sum of your (bad) LDL and also other lipids such as the dangerous very low-density lipoproteins (VLDL). If you thus subtract your LDL value from this value, you can get a feel for your levels of VLDL. I have been working to reduce the amount of (bad) LDL (aopB) whilst increasing the levels of good HDL (apoA) and also keeping an eye on my triglycerides. To make all the above discussions more real, you can see 18 months of my test results below:\nAlthough not (always) included in a lipid panel, another useful set of tests would be your Omega-3 level, Omega-6 level, and the ratio between them. Omega-3 and Omega-6 are unsaturated fats and both are essential for health. Specifically, Omega-3 has an anti-inflammatory effect, whereas Omega-6 has an inflammatory effect. If (as is the case for many people on a modern diet) the amount of Omega-6 dominates over Omega-3, you can increase your cardiovascular risk. You can read lots more about Omega-3 and Omega-6 in Big10 #5 (Design Your Personal Supplement Stack Informed by Blood Testing) Below you can see my recent Omega-3 and Omega-6 levels. As someone with a predominantly plant-based diet, this testing exposed to me that the supplement I was taking for Omega-3 just wasn\u0026rsquo;t cutting it and prompted me to switch to a more potent form. This has helped a bit, but there is still more to do. Most likely I will increase further the amount of my Omega-3 supplement. My diet is very healthy and avoids processed foods and seed oils, so I strongly suspect that the high Omega-6 levels are coming from things I don\u0026rsquo;t want to cut out (like nuts, seeds, tofu). Thus, an approach based on further increasing Omega-3 is my plan for now.\nGenetic susceptibility testing Earlier on we looked at Lipoprotein(a) – abbreviated to Lp(a) – and discussed that this was a particularly inflammatory lipoprotein whose risk is predominantly driven by genetics and is not amenable (currently) to management by either lifestyle or medications. Routine lipid panels (blood tests for heart health) don\u0026rsquo;t include it, but you should request or order this \u0026lsquo;once in a lifetime\u0026rsquo; test.\nIf you do find out that you have elevated levels of Lp(a), you should take even more seriously the heart health measures we will look at later on in this article. The fact that you cannot change your Lp(a) levels should not be a reason to give up, in fact quite the reverse, it should be a motivation to stack all the other odds in your favour!\nSadly, for me, I did test positive for this with levels at the top of the minor risk range. The ranges are defined as follows:\n32-90 nmol/L (minor risk) 90-200 nmol/L (moderate risk) 200-400 nmol/L (high risk) More than 400nmol/L (very high risk) With my result being: 86 nmol/l\nSo, what can you do if you too find out you have elevated Lp(a) levels?\nThe good news is that there is a new class of drugs, currently in clinical trials, which have shown the ability to reduce Lp(a) levels by 80% to 95%. These are NOT currently approved but show great promise and may be as little as 2-3 years out. So rather than despairing, I would urge you to think about taking every possible measure (see diet and lifestyle changes below) to buy yourself the time to allow such treatments to hit the market. If you would like to find out more about these drugs and track their progress, have a look at:\nTechnique: Small Interfering RNA (siRNA) Technique: Antisense Oligonucleotides (ASO) Drug: Olpasiran (uses siRNA) Drug: Pelacarsen (use ASO) For people with high risk Lp(a) levels, there are also two techniques which aim to reduce the level of Lp(a) (as opposed to the emerging treatments mentioned before, which aim to turn Lp(a) off at the source):\nPCSK9 Inhibitors: These are primarily for lowering LDL, but can also reduce Lp(a) levels. Apheresis: This is a physical process where your blood is filtered through a machine to remove Lp(a). It is highly effective but usually reserved for people with extreme genetic cases and existing heart disease because it is expensive and time-consuming. Noting all of the above, the other obvious management plan for Lp(a) is to stick fast to the diet and lifestyle advocated throughout the Big10. Specifically though:\nDrive apoB as low as possible: If your Lp(a) is high, your target for LDL/ApoB should be much lower than the \u0026ldquo;normal\u0026rdquo; range. Aim for optimal blood pressure to avoid the impact of mechanical stress on your arteries. For me, although my apoB was 0.72 g/L at the last time of testing, this is only just inside the optimal/ low-risk range, so I continue my work to drive this down through a diet high in fibre and low in saturated fats and sugars coupled with exercise. I would like to see if I can aggressively drive apoB down to at least 0.5 g/l or even further so I am also discussing with my doctor going onto statins as that will provide an additional lever. In addition, as seen earlier, I am also focused on correcting my Omega-6:Omega-3 ratio.\nIn the section \u0026lsquo;Diet and Lifestyle\u0026rsquo; below you can find lots more information on changes you can make to improve heart health Blood pressure monitoring Your blood pressure is one of the simplest (and most important) pieces of data you can gather on your own health, and yet it is remarkable how few people routinely (or ever!) check it. Elevated blood pressure is a significant red flag for cardiovascular ill-health and is closely related to your risk of cardiovascular disease, heart attack, and stroke. In the section we look at: The mechanics of blood pressure (i.e. what causes it to be elevated) and the impact of high (and low) blood pressure The \u0026rsquo;notation\u0026rsquo; used for blood pressure readings How you can check and monitor your blood pressure on an ongoing basis The mechanics of blood pressure As your heart beats to pump blood around your body, this will naturally generate pressure against the inside of your arteries. Further down you can see how this pressure is measured, but, for the moment, let\u0026rsquo;s just consider the mechanical factors in play that could cause that pressure to be higher than desired.\nAt a (very!) basic level your heart is simply a pump pushing fluid through a network of pipes (i.e a closed loop hydraulic system). Thus, thinking about the dynamics of fluids, the factors affecting pressure in such a system would be:\nThe flow rate: In essence, this is how much fluid (blood) the pump (your heart) is moving every second. Flow rate is driven by the amount of fluid the pump ejects into the pipes and how often the pump strokes (beats) The pressure in your arteries will thus increase if your heart forces more blood through them per second. The resistance: This is how difficult it is to push the fluid through the pipe network (blood through your arteries). Resistance is increased by how viscous (sticky) the fluid is, the length of the pipe network (arteries) and (most critically) the radius of the pipes (arteries). Radius has a huge impact on resistance (e.g. just at 10% decrease in radius leads to almost a doubling of resistance). The overall pressure in the system (your blood pressure) is calculated by multiplying the flow rate by the resistance. It is worth noting that a key difference from our pump/pipes example is that your arteries are flexible and thus much more capable of handling sudden spikes in pressure (think flexible rubber hoses vs rigid copper pipes).\nYour blood pressure is thus clearly going to vary in a completely healthy way (e.g. due to exercise) but also in unhealthy ways (e.g due to poor cardiovascular health). Transient changes in your blood pressure (e.g. due to exercise load, standing up, increased ambient temperature, sleeping, digesting etc) are perfectly normal and a sign of a healthy and responsive cardiovascular system. However, what you need to be concerned about is when your blood pressure is \u0026lsquo;stuck\u0026rsquo; at a high level – indicating an underlying issue such as increased resistance in your arteries due to blockages.\nDo also be aware that persistently low blood pressure (or sudden sharp drops in blood pressure) is also a cause for concern and should also be discussed with your doctor. This is also true for irregularities in the beating of your heart (arrhythmia) - which some blood pressure monitors can also identify.\nSo, if your blood pressure readings are consistently elevated (see further down for the normal blood pressure range), what might be some of the possible factors involved?\nArterial stiffening (e.g. a breakdown of elastin in the artery walls or a decreased ability of the arteries to expand and contract as required) Arterial narrowing (e.g. the buildup of plaque reducing the cross-section of the artery) Increased blood volume (e.g. high salt levels will require more water in the system thus increasing the volume of blood your heart needs to push around) Chronic stress (e.g. high cortisol levels causing an ongoing increase in heart rate due to a \u0026lsquo;fight or flight\u0026rsquo; reaction) The long and short of blood pressure is that if it's not sitting in the optimal or normal range when measured consistently and regularly then a consultation with your doctor is essential. This may well lead to some of the diet, lifestyle, and exercise changes discussed further down - but will also allow for a deep and detailed investigation and the consideration of appropriate medications Understanding a blood pressure reading When a monitor is used to measure your blood pressure (something you can easily do at home), it records the result as two numbers with a slash between them. For example 118/70. The first number is your blood pressure (in mm of mercury – mmHg) when your heart pumps blood out and is called the systolic blood pressure. The second number is your blood pressure between beats and is called the diastolic blood pressure. Specifically:\nSystolic pressure: This is the maximum pressure against your artery walls as the heart\u0026rsquo;s left ventricle contracts to push blood around your body. Diastolic pressure: This is the pressure exerted as (between beats) your arteries recoil (since they are elastic) and keep the blood moving forward even whilst the heart is resting. The \u0026lsquo;official\u0026rsquo; values for what constitutes normal vs elevated blood pressure have changed over the years, but the current ESH (European Society of Hypertension) guidelines are as follows:\nTaking and tracking your blood pressure You can purchase a blood pressure monitor yourself and then check your own blood pressure regularly. I use (and find very convenient) the OMRON EVOLV Wireless Monitor which sends the readings straight to their app on your phone, which then synchronises them with Apple Health. There are, however, some specific things to keep in mind when purchasing a blood pressure monitor to ensure that you get one which is providing accurate values (and continues to do so over time):\nUpper arm only – don\u0026rsquo;t waste your time or money or wrist or finger monitors. Ensure it has been clinically validated as you want absolute confidence in the values it gives you. In the UK look for British and Irish Hypertension Society (BIHS) seal of approval. In the US: Look for the AMA (American Medical Association) \u0026ldquo;Validated Device Listing\u0026rdquo; (VDL) or the AAMI (Association for the Advancement of Medical Instrumentation) standard. Ensure it clearly states how long the device is guaranteed to remain accurate for before it must be returned for servicing (or replaced) Check the minimum and maximum cuff size against your arm mid-upper arm diameter as this is a very common cause of inaccurate readings. Look for reputable suppliers and don\u0026rsquo;t base your decision on price You\u0026rsquo;ll be doing this daily, so a little extra investment for one that is convenient to use and well integrated is worth it Don\u0026rsquo;t forget to take your blood pressure at the same time(s) each day and do it whilst at rest and comfortable so that you are getting comparable, consistent readings.\nTo make this a bit more real, below you can see my blood pressure readings over a month period:\nDiet and lifestyle changes you can make. Given how critical cardiovascular health is (recall it is the number one cause of death globally), then it is vital to adopt and maintain a lifestyle that maintains great heart health or seeks to address poor heart health. A number of the Big10 are aimed at maintaining and improving heart health and a wealth of information can be found in each of them. But, in summary:\nBig10 #1: Avoid Ultra-Processed Foods and Control Your Insulin Levels\nBig10 #2: Exercise Regularly and Include both Resistance and Cardiovascular Workouts\nBig10 #3: Get Enough Good Quality Sleep\nBig10 #5: Design Your Personal Supplement Stack Informed by Blood Testing\nBig10 #9: Eat Healthily and Prioritise Building a Strong Gut Microbiome\nHeart health scans Along with monitoring your blood pressure, another valuable source of data can be obtaining a scan of your heart to look specifically for the buildup of plaque. In this section we look at two specific scans:\nA Coronary Calcium (CT) Scan A CT Coronary Angiogram (CTCA) What is a Coronary Calcium (CT) Scan? A coronary calcium CT (computed tomography) scan is a non-invasive scan that uses X-rays from many angles to build up a detailed 3D picture of (specifically in this case) the heart’s coronary arteries with the aim of detecting calcium buildup. It relies on calcium being a dense material that absorbs X-rays (similar to how bones are visualised). In essence, the term computed tomography means to take many flat images (slices) and then stack them to build a 3D image - much like the flat slices of a loaf of bread stack to create a 3D loaf of bread. The arteries that are of interest in the interpretation of this scan are the arteries that supply blood to the heart and enable it to do its work of pumping blood around the body.\nWhy should you care about coronary calcium scans? The scan measures calcium deposits in the coronary arteries. Calcium deposits are an indicator of the amount of plaque built up in those arteries. Plaque is a mixture of fat and cholesterol that calcium sticks to, thus making it visible to the scan. This narrowing can sometimes lead to symptoms such as chest pain (angina), fatigue and shortness of breath. In the event of the plaque rupturing and a piece breaking off, this can lead to a blockage of the arteries and a sudden partial or total loss of blood supply to an area of the heart. This is commonly called a ‘heart attack’ or a Myocardial Infarction (MI). The proper term for the buildup of plaque and the hardening of the arteries is atherosclerosis. It may be inferred that if plaque can be detected within the arteries of the heart, then it may also be present in the carotid arteries (that supply the brain). The consequence of such plaque could be a stroke (caused either by the narrowing of arteries leading to the brain or a piece of the plaque breaking off/rupturing causing a clot which travels to the brain or blocks the artery).\nTo be a little more specific, there are three types of plaque:\nNon-calcified (soft) plaque Partially calcified (hardened) plaque Heavily calcified Soft plaque is essentially a greater risk since it can easily be ruptured, leading to a clotting reaction due to the plaque contents spilling into the blood. This sudden clot (rather than the slowly building-up plaque) is what can lead to a heart attack. Harder plaque (which has been calcified by the body specifically to avoid this rupture risk) is more stable, and although it can narrow the artery (leading to chest pain), it would be less likely to cause a sudden heart attack.\nWe are using the level of calcium as a proxy for the plaque that might be present (it is not the calcium per-se that poses a risk, it is simply an indicator of plaque which poses the actual risk). The scan interpretation gives a score (where the lower the number, the lower the inferred buildup of plaque and thus a lower inferred risk of a heart attack in the coming years). An ideal score would be zero, indicating no observable calcium deposits/ plaque, but bear in mind that this is age-dependent and that a higher score may be expected for someone more elderly, whereas in a younger person it would be a cause for concern. Your score should be considered against your age, gender and family history.\nKnowing your score enables your doctor or consultant to suggest lifestyle changes, medication, or more aggressive treatment depending on the severity of the condition that the score indicates.\nRemember, this is only a scan of the arteries supplying the heart and does not directly measure the carotid arteries (those supplying the brain) thus it could be possible to have a zero score and yet still have plaque in the carotid arteries. A coronary calcium scan provides a specific view of the heart but only a general sense of plaque levels more widely.\nThere are some limitations of a coronoary calcium scan\nIt cannot provide any information on soft/ non-calcified plaques, meaning that a score of zero cannot be used to rule out coronary artery disease. For non-zero scores it cannot provide a measure of the level of obstruction or narrowing (stenosis) of the arteries. Due to differences in evaluation techniques, the comparison of different measurements over time may not be reliable. It is possible that a rising score across serial tests may actually indicate an improvement in the underlying risk as softer plaque is encouraged to calcify (harden) due to a treatment programme (e.g. an intensive course of statins). [2] Unlike a coronary calcium scan, which can only detect hardened plaque, a CT Coronary Angiogram (CTCA) scan can detect both hard and soft plaque and may also be able to provide a view of the impact on blood flow. However, this scan is a little more involved than a Coronary Calcium scan since it does require the intravenous introduction of a contrast dye into your body to make the arteries visible. For this reason, a coronary angiogram is normally used when there\u0026rsquo;s a clear reason to investigate. Whereas the slighty less invasive coronary calcium scan may be more appropriate for otherwise healthy people who want a \u0026lsquo;check-up\u0026rsquo; of their heart. You can think of the CT calcium as a general screening test, whereas a coronary angiogram is a more detailed investigation. It\u0026rsquo;s important to discuss with your doctor (given your own health history) which scan would be most appropriate for you.\nHow much does a Coronary Calcium scan cost? Unless referred by your doctor due to a specific concern, you will likely need to pay for this privately. For the scan along with interpretation and a consultation, you would expect to pay around £500 (convert this\u0026hellip;).\nI booked mine through Scan.com, had the scan conducted at Virtual Cath Lab (VCL) Surrey and was very satisfied with the service, the consulation, and the report (along with access to my scan images) that was provided. But, of course, you should have a look around as a number of providers are available.\nWhat did I learn from my Coronary Calcium Scan? The headline of my report was:\n\u0026ldquo;The calcium score is zero. No aortic valve calcification. Limited images of the lungs, mediastinum, upper abdomen and bones are unremarkable.\u0026rdquo;\nThis was a reassuring result and provided positive feedback for the heart-healthy lifestyle I lead and choices I make. However, given my genetic pre-disposition for Lp(a) and the fact that I had levels of apoB and Triglycerides both above normal before taking action (along with a suboptimal Omega-6: Omega-3 ratio), I will likely also organise a CTCA scan to look for evidence of soft plaque.\nFurther sources of information The Examine web site for independent, unsponsored meta-analyses of health research\nDr Pradip Jamnadas on the Diary of a CEO podcast\nReferences [1] World Health Organization (2021). “Cardiovascular diseases (CVDs) Fact Sheet.” WHO Newsroom.\n[2] Puri, R., et al. (2015). \u0026ldquo;Impact of statins on serial coronary calcification during atheroma progression and regression.\u0026rdquo; Journal of the American College of Cardiology.\n","permalink":"https://big10.health/posts/4-heart-health-monitoring/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.jpg\" alt = \"A CT machine\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"monitor-your-heart-health\"\u003eMonitor Your Heart Health\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n        \u003cspan\u003e\u003ci class=\"fa-classic fa-heart\"\u003e\u003c/i\u003e\u003c/span\u003e\n        \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eCheck and track your blood pressure regularly. Use blood testing to monitor levels of key markers and uses scans to check for the presence of plaque buildup in your arteries.\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e\n\u003ch2 id=\"why-should-you-care-about-heart-health\"\u003eWhy should you care about heart health?\u003c/h2\u003e\n\u003cp\u003eCardiovascular disease (CVD) is the leading cause of death globally [1] so anything you can learn about your genetic propensity to suffer from it, your current cardiovascular health, and the impact of your diet and lifestyle can help you to mitigate the risk. It\u0026rsquo;s important to note that the vascular damage that ultimately leads to incidents like a heart attack or a stroke starts long before the actual event and, despite there being a genetic aspect to this condition, there is much that can be done in terms of diet, lifestyle and exercise. In fact, should you find out that you do have a higher genetic risk, then knowing that makes it even more important to take early action and make long-term changes.\u003c/p\u003e","title":"4. Monitor Your Heart Health"},{"content":" Design Your Personal Supplement Stack Informed by Blood Testing Further improve your diet by including key supplements to reach the optimum levels and make up for the deficiencies found in the modern world. Periodically, use a blood testing service to check and monitor your levels. Although there is no substitute for a healthy diet that avoids ultra-processed foods supplements have a role to play in making up for deficiencies caused by modern lifestyles and farming practices. Supplements can also support your training performance, sleep, recovery, gut health, heart health, and longevity. However, there is little point in taking supplements blindly. You need to have your blood tested and design a supplement stack tailored to your own specific needs. Want to look at the science later but, right now, you are just interested in some actions to take?\nUse an at home blood draw service like Thriva and order a broad panel of tests covering vitamins, key hormones, liver and kidney function. You may well want to combine this with a heart health panel as well. Read more to build your own understanding and if any of your results are out of the normal range speak to your doctor before also making dietary and lifestyle changes. What are supplements? The term supplement is rather generic, and it is better to break this down into some more specific categories:\nMicronutrients These are vitamins and minerals that the body cannot make on its own or perhaps or cannot make them in quantities sufficient for survival and optimal function. A well-known example in this category would be vitamin C for immune system support (amongst other reasons).\nMacronutrients These are products derived from the three main food groups which are protein, fats and carbohydrates. A well-known example in this category would be protein powder to keep protein intake sufficient for your lifestyle and training needs.\nBiologics These are living organisms (or the by products of living organisms). A well-known example in this category would be pro-biotics for gut health.\nBotanicals These are herbs and plant extracts which are not always essential for health but may provide other benefits. A well-known example in this category would be ashwaganda to help manage stress.\nMetabolites These are substances (or the intermediates or precursors used to build them) that your body produces naturally but which are supplemented to boost levels beyond what is normal. A well-known example in this category would be the hormone melatonin, which could be used judiciously to help with sleep issues caused by jet lag.\nCatalysts These are substances (often enzymes) that speed up reactions in your body. A well-known example in this category would be protease to help digestion by breaking down protein.\nWhy should you care about supplements? The fundamental reasons why supplementation may be valuable to you are:\nThe mismatch between the environment that humans evolved in and the environment that we live in today: You can think of supplements as a corrective action you take to compensate for the very different nutrient densities, light levels and microbial exposure that humans find in the modern world. It is not so much that you might supplement because humans themselves are broken but more because the modern environment is nutrient-poor. To name but a few: modern farming practices (which have reduced the mineral content of soil and also bred crops for yield at the expense of mineral content), the foods we consume, the sleep/wake cycles we keep, living primarily indoors and higher stress levels all contribute to this problem. Performance enhancement: As you push beyond your normal limits (e.g. in training and sporting performance), it may be beneficial to take work-enhancing (ergogenic) supplements to support this load. Specific genetic indivduality: You may have conditions that make it harder for you to convert or use nutrients and, under medical guidance, supplementation may help with your specific issues. Coping with periods of stress: There are times when you might be under periods of higher load than normal such as pregnancy, surgery recovery or mental stress and supplementation may be valuable. Because the supplement is better than the food itself: You may want the benefits of a specific nutrient but without the downsides (or large required volume) of the food source it is naturally found in. Synergy: Some supplements require others to work fully. For example, taking vitamin D without also taking vitamin K2 and magnesium is counter-productive. It is also crucial to remember that supplements are not regulated in the way that drugs are. Whilst a drug must be proved safe and effective before it can be marketed and sold, the same is not true of supplements (or the conditions they are manufactured in). It is thus essential to:\nSeek guidance from your doctor or health practitioner before taking supplements (and even more so if you have existing health conditions or are taking medications). Stick to classes of supplement that are well-studied and have a clear benefit. Choose products from well-known suppliers with high-quality production controls (see \u0026lsquo;what you should look out for\u0026rsquo; further down). Understand the actual levels within your own body via testing conducted by your health practioner, doctor or a well-known and reptuable company. Why should you use a blood testing service to monitor your supplementation? Supplementation should not be about \u0026lsquo;shooting blind\u0026rsquo;. You want to know both that the supplements you are paying for are actually ones that you need and that you are not missing out on ones where you are deficient. Blood testing (generally using an at-home self-draw supplier or via your health care practitioner) is a great way to check the levels of common macronutrients (e.g. Omega-3/6), Vitamins (e.g. vitamin D) and minerals (e.g. iron). You can integrate this with blood testing also for heart health, kidney and liver function (amongst others) since many suppliers will offer a range of tests, and you can build a personalised package that meets your needs. See my article on blood testing for more on this topic and for the supplier I chose.\nIt\u0026rsquo;s also worth bearing in mind that some supplements at too high a dosage (particularly if they are contained within a number of products leading to a higher dosage in total) can have health consequences. For example, vitamin D, whilst essential for calcium absorption, is fat soluble, which means that (unlike Vitamin C) it can build up in your body in turn leading to higher that desired calcium levels (with consequences for your blood vessels and kidneys). On the other hand, some supplements beyond a certain level cannot be stored in the body and will be excreted. Vitamin C is a prime example of this. Thus, regularly re-checking your levels is a good way of making sure your supplementation programme is leading to optimal levels in your blood steam.\nBear in mind that a particular blood test is only a snapshot in time, and it\u0026rsquo;s important for you to monitor your trends (especially as you change/modify your supplementation stack). Therefore, booking in periodic retesting for your blood is a good idea so that you can establish that trend view. Most good blood service testing services will offer an app or portal interface where you can visualise and report on that data and monitor your trends over time.\nWhat should you look out for when choosing supplements? The supplements marketplace is an absolute minefield with a huge number of products from a vast number of suppliers, some of whom will be marketing products with little or no proven benefit or products of low quality with poor production controls. This problem has only been exacerbated by the internet and social media. Once you have decided on a particular type of supplement you want to take and are looking for an appropriate product, here are some points to consider:\nHas a Certificate of Analysis: Does the product have a Certificate of Analysis (CoA) or can the supplier provide one? This should be from a third party lab and verifies that what is on the label is actually what is in the product. It should also be for the specific batch that your product is from. Has Third-party endorsement: Look for endorsement by (and the logo of) national bodies and assoication of good standing (e.g. in the UK this could be organisations like Informed Sport or the Soil Association). Actually contains a therapeutic dosage: Check the dosage used in clinical studies (or that has been recommended for you) and make sure the product meets that. Less reputable suppliers will include trace amounts of little benefit simply so they can list them on the packaging. Has good bioavailability: There is little point taking a product if your body cannot absorb it. Cheaper nutrients are often formulated in ways that are harder to absorb. For example, look for: Liposomal versions (which are encased in such a way as to shield them from stomach acid) Chelated minerals (which are bound to amino acids or organic acids for easier absorption) Lighter molecular weights (Dalton size) with smaller Dalton size for proteins and collagen lead to easier absorption Is a clean product: Look out for excessive fillers and long lists of \u0026lsquo;Other Ingredients\u0026rsquo; For botanicals, is standardised to a specific percentage of active compound: You want to be paying for the actual active ingredient and not just lots of clippings. Take the time to research the product, look at the company manufacturing it and read reviews. Stick to high-quality products from well-known suppliers and don\u0026rsquo;t use price as a factor when making a final choice. It is generally true that the cleaner, better formulated and more bioavalable products will come with a higher price tag.\nWhat supplements do I take? The following list is my personal supplementation programme based upon the results of my blood tests and my own lifestyle, diet, sleep and training needs. It is not a one-size fits-all list for anybody to use and may well not be complete or even sufficient. I am constantly exploring, reading, investigating and adjusting my supplements. With that said, much of what you will find below and the reason for taking them will provide you with useful insight into what your own programme might look like. It is essential that you discuss with your doctor or health practitioner before making changes to your diet or taking new supplements. Type Product Supplier Biologic MegaSporeBiotic Plus Microbiome Labs Biologic Probiotics Every Day Optibac Biologic Kefir Biotiful Micronutrient D3 + K2 Nutrition Geeks Micronutrient Magnesium Glycinate 3-in-1 Complex Nutrition Geeks Micronutrient Iron Bisglycinate Thorne Micronutrient Niacin (Nicotinamide Riboside) Tru Micronutrient Liposomal Vitamin C Zooki Micronutrient Vegan Omega-3 Algae Oil (DHA + EPA) MAV Nutrition Micronutrient Daily Multivitamin (Men) Centrum Micronutrient/Botanical Vegan Pro Collagen Builder Feel Botanical Turmeric with Black Pepper \u0026 Ginger Nutrition Geeks Botanical Ashwagandha KSM with L-Tryptophan \u0026 Vitamin B6 Nutrition Geeks Enzyme Nattokinase Vinco Macronutrient Creatine Monohydrate Creapure Macronutrient Elite Repair Protein Powder Raw Sport Macronutrient/Biologic Zoe Daily 30+ Zoe Macronutrient Organic Omega Seed Mix Whole Food Earth Macronutrient Organic Ground Flaxseed Trend Macronutrient Inulin High Grade Prebiotic Fibre NKD Living Macronutrient Wheat Bran Wholefood Earth Macronutrient Chia seeds Supermarket MegaSporeBiotic Plus [1] MegaSporeBiotic uses a spore-based delivery system to dramatically increase the chances of these bacteria surviving the upper gastrointestinal tract and reaching the colon where they can help to promote a healthy gut microbiome. Rather than being a transient probiotic, these organisms aim to colonise the gut where they help to kill off bad bacteria and promote good ones. Specifically, this product delivers: Bacillus Clausii (produces natural antibiotics to kill off bad bacteria), Bacillus Subtilis (helps to restore the gut lining and also helps with exercise recovery), Bacillus Coagulans (can survive if you are also taking antibiotics) and Bacillus Licheniformis (produces useful enzymes and B vitamins).\nProbiotics Every Day [2] Optibac Every Day Probiotics complements the MegaSporeBiotic product with 5 different strains. These strains are more fragile than the organisms found in the MegaSpore product but work well together if you think of the previous Bacillus quartet more like \u0026lsquo;security guards\u0026rsquo; and the Lacto/Bifido more like \u0026lsquo;settlers\u0026rsquo;. They are also some of the best-researched strains around and are well understood. Specifically, this product delivers Lactobacillus Rhamnosus (helps with \u0026rsquo;leaky gut\u0026rsquo;, pathogen control and antibiotic-associated diarrhoea), Bifidobacterium Bifidum (breaks down complex carbohydrates and helps with inflammation), Lactobacillus Helveticus (helps reduce cortisol and breaks down dairy proteins), Bifidobacterium Longum (neutralises toxins and helps with autoimmune issues), Lactobacillus Crispatus (produces lactic acid to help kill bad bacteria).\nKefir [3] Kefir is a fermented product that is a great alternative to the standard probiotics.\nKefir overlaps to some extent with strains present in the Optibac product but claims to offer a much wider range (with some brands claiming 40+ different strains). In addition, this is a fermented product and packs a huge punch when it comes to delivering a high density of organisms. Specifically, Kefir also brings yeasts such as Saccharomyces Cerevisiae and Kluyveromyces Marxianus (both of which help to fight bad bacteria like Candida and help the gut to recover from antibiotic use) and produces the \u0026lsquo;prebotic\u0026rsquo; kefiran (which helps probiotics stick to the gut wall and helps with inflammation). A final benefit of Kefir is that (since it is fermented) it is effectively a lactose product that has been \u0026rsquo;externally digested\u0026rsquo; thus helping with dairy sensitivity, the breaking down of milk proteins and increasing vitamin concentration (specifically B vitamins and K2). On balance, although there is some overlap, Kefir has a valuable additional role to play.\nVitamin D3 + K2 [4] Vitamin D is needed for the absorption of calcium. There are two types of vitamin D (D3 and D2) I prefer D3 as it is the exact form that humans produce when exposed to sunlight as opposed to D2 and because resarch has shown that D3 outperforms D2 at raising vitamin D levels in the blood and is more effective at calcium regulation than D2. It take a version combined with vitamin K2 because that \u0026lsquo;directs\u0026rsquo; the calcium to the correct place (eg to your bones rather than to soft tissues like your arteries)\nMagnesium Glycinate 3-in-1 Complex [5] Magnesium has four key roles: it has a key role in energy production, it blocks excitatory signals in the brain and promotes calm down to help with sleep, it relaxes muscles in counterpoint to calcium (which contracts them), and finally, it is essential for vitamin D\u0026rsquo;s conversion to its active form. Low magnesium levels contribute to low energy levels, poor sleep, muscular fatigue and render your vitamin D supplementation pointless. This product provides much greater bioavailability (uptake) than standard magnesium oxide. It provides a mixture of magnesium glycinate (supports muscle relaxation and sleep), magnesium malate (boosts energy and reduces fatigue) and magnesium citrate (promotes digestion and mineral absorption). I am though interested in how likely (or rather not) these forms are to actually be able to cross the blood brain barrier and thus assist with sleep. It is more likely that it is the glycine that the magnesium glycinate is bound to that is having a positive sleep effect as that can cross the barrier and has an inhibitory effect on neurotransmission. Thus, of further interest would be Magnesium L-Threonate which uses the glucose transporters to trick the barrier into letting it through and has been shown to raise magnesium levels within the cerebrospinal fluid.\nIron Bisglycinate [6] I take this product specifically because my last blood tests showed a below-normal reading both for transferrin saturation (17% against a normal range of 25% to 45%) and for ferritin (20 micrograms per litre against a normal range of 30 to 300). Transferrin is a protein that carries iron in your blood, and the saturation level indicates how much of the transferrin is occupied with iron. Ferritin is a protein that stores iron in your cells as a non-toxic ready-to-use reservoir. I suspect that my primarily plant-based diet in combination with poor bio-availability of iron in my general multipurpose tablet (ferrous fumarate) at only 27% RDA is the reason for this deficiency. Iron has three primary roles: It enables the protein haemoglobin to carry oxygen in your blood, it helps to convert nutrients to energy in your cells, and it helps store oxygen reserves in your muscle cells. There are a range of consequences of low iron levels, and the effects can be felt at lower levels before the issue becomes more serious. The associated issues include fatigue, shortness of breath, poor concentration, brittle hair/nails, restless limbs and cravings. Even more interesting – I\u0026rsquo;d been struggling with really irritating \u0026lsquo;restless arms and legs\u0026rsquo; late evenings and at night, and there is a connection between this and low iron levels. Within days of starting this supplement, it cleared up completely. I like this product over the standard ferrous fumarate because (as mentioned earlier in this article) it is glycinated, which helps with absorption, is much kinder to the stomach (does not feed bad bacteria) and is less vulnerable to caffeine affecting its uptake. On the point of caffeine, it is worth noting that iron uptake is helped by vitamin C but inhibited by tannins (tea/coffee). It may also be possible that calcium affects iron uptake. You thus might want to consider the timing of your iron supplement (as I don\u0026rsquo;t drink tea or coffee, this is less of an issue for me).\nNiacin (Nicotinamide Riboside) [7] NAD+ (Nicotinamide Adenine Dinucleotide) is a coenzyme (a small non-protein catalyst) with critical roles in energy production and DNA repair. It is of much interest in longevity and biohacking discussions but is a large and unstable molecule, meaning that direct supplementation in a tablet is unlikely to be effective. Instead, taking Niacin (Nicotinamide Riboside) provides an essential building block for the production chain leading to NAD+. Niacin is the common name for vitamin B3, but there is significant variation within the B3 \u0026lsquo;family\u0026rsquo; within Nicotinamide Riboside being more effective at raising NAD+ levels without the side effects (e.g. flushing) of standard Niacin (Nicotinic acid). I have this supplement in the \u0026lsquo;might help but can\u0026rsquo;t do any harm\u0026rsquo; category given the link with NAD+ and how well studied Niacin is in human trials.\nLiposomal Vitamin C [8] Vitamin C is an essential micronutrient that humans cannot make and must instead ingest. Vitamin C is well known from its historic association with curing scurvy – a condition sailors developed after long periods at sea without fruit or vegetables). Vitamin C has a number of key roles in protecting your DNA and cells from damage, the formation of connective tissues (via the building of collagen), and the immune system. The standard dose is around 80 mg (milligrams) to give 100% RDA. Interestingly, whilst this is well above the \u0026lsquo;bare minimum\u0026rsquo; 10 mg per day needed for basic function - that is a general population figure and does not account for the fact that our ancestors probably consumed vastly more than this with a higher intake of fresh forage and nor does it account for higher levels of post-exercise recovery or the greater oxidative stress found in modern life. Thus, 200 mg is more often used as a dose that gives saturation in the blood and (given that vitamin C is water-soluble and will be excreted in excess) 1000 mg is commonly used as an intensive therapeutic dose. Zooki is one of the market leaders in Vitamin C, and their liposomal formulation protects the vitamin C in the gut and results in better bioavailability (uptake) and higher concentrations for a longer time.\nVegan Omega-3 Algae Oil (DHA + EPA) [9] To understand Omega-3, you also need to understand Omega-6 and the ratio between them. Both are essential fatty acids (EFA) that humans cannot make and thus must get in our diet. Omega-3 has a key role in inflammation, which at moderate levels is essential for fighting infection and recovering from injury. Omega-3 has a key role in supporting your cell membranes to allow nutrients in and waste products out. Unfortunately, both Omega-3 and Omega-6 compete for exactly the same enzymes that they need to be converted into their active form. In the modern world many of us consume more Omega-6 than we used to do (due to ultra-processed seed oils). This can easily result in a body over-primed for inflammatory responses (which can be a risk for heart health) and deficient in Omega-3. The solution to this is three-fold. Firstly, blood testing to understand the levels and ratio between Omega-3 and Omega-6 in your blood. Secondly (if required), lifestyle changes to reduce the amount of Omega-3 consumed. And finally (if required) dietary changes and supplementation to increase the amount of Omega-3. Taking this last point, Omega-3 has been particularly challenging for vegetarians and vegans to obtain since the go-to source is white fish oil. Fish do not produce Omega-3, but they do store in their tissues the enzymes (EPA and DHA) required for Omega-3 production found in the algae that they eat. Historically, vegans and vegetarians would be told to consume flax seeds, chia seeds, and walnuts. However, these sources result in very low conversion to the required enzymes. The good news is that there are commonly available algae oil products which cut out this chain and deliver the exact same product as that found via fish oil. I take this supplicant because my last round of heart health blood testing showed a poor balance between Omega-3 and Omega-6 (17.1:1 vs a desired range of 2.5:1 to 11:1) and low levels of Omega-3 (3.47% vs a desired range of 4% to 12%).\nDaily Multivitamin (Men) I currently take this product as a general safety net containing a wide range of quite standard formulations of common micronutrients to catch any unnoticed deficiencies in my diet. My intention is to review this against everything else I\u0026rsquo;m taking and see whether it can be removed. It\u0026rsquo;s worth also noting that in this role, this product failed to prevent the iron deficiency noted above – further evidence supporting its lack of value against a more considered approach using more highly bioavailable forms of higher quality.\nVegan Pro Collagen Builder [10] Collagen is the single most abundant protein in the human body. Firstly, it has a key role in providing tensile strength (for example, allowing your skin to snap back or allowing tendons to endure high loads under work). Secondly, collagen is the primary component of cartilage for smooth, pain-free movement between bones. Finally, it forms the structure of your arteries and your gut lining. There is a tendency (exacerbated by social media) to think of collagen as a beauty product related to younger-looking skin. In reality, it\u0026rsquo;s a critical protein with a wide range of roles and is crucial if you have a high training load. Our modern lifestyle makes it worth considering collagen supplementation for a number of reasons. Firstly, higher blood sugar levels have a damaging impact on collagen fibres (called glycation). Secondly, vitamin D is a key regulator of tissue regeneration - but there\u0026rsquo;s little point supplementing your vitamin D if there\u0026rsquo;s no material available for the actual repair work. Finally, our ancestors ate the vast majority of the animals they caught (including cartillage and skin) via (for example) broths whereas we tend to focus only on the muscle meat leading to an amino acid imbalance. Collagen (in its direct form) as a supplement is generally sourced from either bovine or marine sources, making it unsuitable for vegetarians and vegans. However, humans make collagen in abundance when provided with the right building blocks. Thus (being primarily plant-based) I use a collagen builder product which contains those essential building blocks needed for the body to produce collagen. Key things to look out for in a collagen builder are: glycine, proline, and hydroxyproline listed specifically on the label and that it also lists silica (e.g., standardised bamboo extract). Look also for the chelated forms of copper and zinc (unless you\u0026rsquo;re already getting these through your other micronutrient supplements taken at the same time). Check that the product contains vitamin C at a minimum of 200 mg unless that can already be found in your supplementation programme. If you are taking a protein powder supplement, it is worth checking the contents of that, as many of these products will contain some (but probably not everything) found in a collagen builder.\nTurmeric with Black Pepper \u0026amp; Ginger [11] Turmeric itself is a spice. However, the active ingredient within it that you are looking for is called curcumin, which is a biological signalling molecule. Curcumin has three beneficial roles. Firstly, it can act to reduce inflammation, secondly, it acts both as an antioxidant defence itself and also via its ability to \u0026lsquo;wake up\u0026rsquo; the body\u0026rsquo;s own antioxidant systems. Finally, it has been shown to increase the levels of brain-derived neurotrophic factor (BDNF), thus contributing to long-term cognitive support. A supplement is the best route to go here, since to get to a therapeutic dose of curcumin (500 mg to 1000 mg), you would need to consume 30g of turmeric every day. Many turmeric supplements also contain black pepper. The active ingredient in black pepper that works well with turmeric is piperine, which increases the bioavailability of the curcumin by inhibiting the liver from clearing it and also by tricking the gut lining into letting it through. Ginger is probably added to this supplement because it is also thought to have an anti-inflammatory effect and also contributes to gut motility, moving the supplement more quickly from the stomach to the small intestine, where it can be absorbed, thus increasing bioavailability.\nAshwagandha KSM with L-Tryptophan \u0026amp; Vitamin B6 [12] Ashwagandha is a botanical supplement for which a wide range of beneficial claims are made (wider than have actually been evidenced). However, there are some key areas where clinical trials (particularly those using standardised extracts such as KSM-66) have shown significant results. Firstly, Ashwagandha is an adaptogen (a substance with the ability to reduce stress) that has been shown to reduce the levels of cortisol in chronically stressed adults. There is also some evidence that it improves sleep efficiency and also helps you to fall asleep faster (particularly in anxious individuals diagnosed with insomnia). Studies in healthy men have shown increases in muscle mass and strength and support in training recovery. I take this supplement specifically to help with my ongoing sleep challenges and of course opted for a high-quality standardised KSM-66 variant. This particular supplement also includes vitamin B6, which has a key role in the production of brain hormones – for example, serotonin (mood), dopamine (motivation), and GABA (relaxation). The supplement also contains L-Tryptophan, which is a primary precursor to serotonin (your \u0026ldquo;calm and content\u0026rdquo; neurotransmitter). The B6 in here is a duplicate with what is found in my general multi-vitamin, further evidence that the multi-vitamin can probably be removed from my programme after a thorough audit – but in any case the two combined are well within the safe ceiling for B6. It\u0026rsquo;s important to note that the leaves of the plant (Withania somnifera) are not advised for consumption, so make sure that your supplement is derived from the root (as is true for KSM-66)\nNattokinase [13] Nattokinase is an enzyme extracted from fermented soybeans (natto). It has three benefits which have been clinically proven, but also some hoped-for benefits. Firstly, it has a role both in breaking down micro clots and in preventing plaque formation, effectively acting as a natural blood thinner. It does this by breaking down fibrin (the sticky protein mesh that forms blood clots). Secondly, it has shown a mild effect in reducing blood pressure. Recent studies have also shown that it can help to reduce bad cholesterol and triglycerides while increasing good cholesterol. However, those trials were conducted at higher doses than the normal standard dose (about 2.5x higher). I take a standard dose of this because my blood pressure, although good, is at the higher end of the normal range. I also take it because my last heart health blood tests still show I have some work to do in reducing bad cholesterol and triglycerides. There are also some clinically unproven hopes that it may have a role in reversing arterial plaque or potentially in breaking down the plaques in the brain associated with Alzheimer\u0026rsquo;s disease, but larger-scale trials and trials on humans are still needed. It should not be noted that nattokinase should not be taken alongside pharmaceutical blood thinners without strict medical supervision, consult your health practitioner or doctor first if you are taking antiplatelets or anticoagulants.\nCreatine Monohydrate [14] Creatine is one of the most heavily researched supplements with a key role to play both in training and in cognition. Creatine increases your stores of phosphocreatine, which supports energy generation during high-intensity activity. This is beneficial both in physical training and, since the brain is also extremely energy-hungry, it has benefits for short-term memory and reasoning. These brain benefits are particularly valuable when you are under stress or suffering from sleep deprivation. There is also evidence that it helps with reducing inflammation and aids recovery after intense exercise. With creatine, it doesn\u0026rsquo;t matter when you take it (for example, before or after a workout) what is important is that you are consistent in taking it daily since creatine works by achieving saturation in the body. Creatine monohydrate is well-tested and well-understood. A widespread myth with creatine is that it can damage your kidneys. There is, in fact, zero evidence for this. It\u0026rsquo;s likely that this idea comes from the fact that taking creatine will lead to an increase in your creatinine levels, which in some blood tests is used to assess kidney function. It is important when taking creatine to let your doctor or health practitioner know before they do a kidney test so they do not misinterpret your results. I take this supplement both to support my resistance training and as part of my work on improving sleep – particularly when coping the next day after a bad night. I also take creatine because my diet is primarily plant-based, so I\u0026rsquo;m not getting the creatine found in red meat and fish and to a lesser extent chicken. Creatine is thus perhaps even more valuable for vegetarians and vegans than for meat eaters. I opt for the more expensive \u0026lsquo;gold standard\u0026rsquo; Creapure product as I am taking this at 10 mg a day for both muscular benefit and neurological benefit and thus want the highest possible quality product.\nElite Repair Protein Powder Powders and drinks are simply a convenient and concentrated way of getting sufficient protein. Although you\u0026rsquo;ll be getting more or less protein naturally in your diet, many people are deficient in protein, and certainly if you have a heavy training load, you\u0026rsquo;ll almost certainly need some extra. Protein is key for rebuilding the micro-damage that muscle fibres undergo when exercised, leading to repair and development. It also has the benefit of helping with satiety (feeling full), so if you are trying to reduce carbohydrates (or at least cut out the refined ones), then switching a carbohydrate-heavy snack for a protein supplement will prevent an insulin spike and help you to feel full. Protein is also a raw material for your antibodies, enzymes and hormones. Whey (a by-product of cheesemaking) is a very popular choice but, being primarily plant-based, I opt for a vegan alternative. When choosing vegan protein supplements, make sure they use a blend (rather than just one ingredient like pea) to ensure you still get the full range of amino acids. Definitely look for a product with an endorsement by an independent party such as Informed Sport (as is the case with Raw Sport\u0026rsquo;s Elite Repair), and personally, I stay away from pre-made drinks and shakes as being over-priced and often with too many \u0026lsquo;other ingredients\u0026rsquo;. I normally have two scoops (that\u0026rsquo;s about 30% of my daily protein need) as a base for my lunchtime smoothie with a whole bunch of other great stuff (many in this list!) and a second one (often blended with some dark berries) after my training later on in the day.\nZoe Daily 30+ [15] This specific mixture is a potent pre-biotic. You can think of prebiotics as the fertiliser that your prebiotic organisms need to thrive. There\u0026rsquo;s not a great deal of point taking lots of probiotics if you don\u0026rsquo;t give them the right things to eat. In addition, using a diverse prebiotic mixture will help your gut to be colonised by beneficial microorganisms other than the ones you\u0026rsquo;re specifically supplementing with. There\u0026rsquo;s an element of trust is this product for me. Zoe is a fascinating organisation bridging research, public health, and commerce who run rigorous trials and studies with access to large sections of the population via their membership. In addition, their alignment with being anti-calorie counting (as a broken and outdated model), pro-diversity of foods, and with an emphasis on food timing aligns exactly with my own philosophy. They developed this blend with the specific intent of providing a prebiotic that would encourage a wide range of microorganisms and actually took the effort to trial it - which is more than can be said for many of the supplements on the market. I take it specifically because it helps me to have confidence that I\u0026rsquo;m getting a wide diversity in my daily intake, despite what\u0026rsquo;s going on in life that day.\nOrganic Omega Seed Mix This contains a mixture of pumpkin seeds, sunflower seeds, golden linseed and sesame seeds. This mixture is high in good fats, protein and fibre and low in carbohydrate as well as being a natural food source of magnesium and zinc (pumpkins seeds), Viatmin E and selenium (sunflowers), plant-based Omega-3 (linseed) and contributes to reducing bad colestreol (sesame and sunflower). Due to their high fat and fibre content (also see flax and chia below) they help to buffer glucose in the rest of the meal. To help with activation and absorption, I blend this into my lunchtime smoothie and let them soak for a little while.\nOrganic Ground Flaxseed Flaxseed is the exact same product as linseed mentioned in the mixture above (but is the term more commonly used in North America than in Europe). The only slight difference is that this is the brown variety rather than the golden variety, but both are identical and are a source high in fibre and Omega-3 precursors. It\u0026rsquo;s essential that flaxseed (linseed) is milled before consumption as their hulls are too tough, and the whole seed will pass through the human tract undigested. You can mill them yourself, but I find it easier just to buy a pre-milled variety and add a tablespoon of this to my lunchtime smoothie. It\u0026rsquo;s worth nothing that along with all the other reasons to have a high-fibre diet, it\u0026rsquo;s extra important to me as I have diverticulitis and a high-fibre diet is the standard management technique for this condition (if you are wondering why there are quite so many fibre heavy macronutrients in my supplmenets list)\nInulin High Grade Prebiotic Fibre [16] To understand the value of inulin, it\u0026rsquo;s worth understanding clearly the difference between soluble and insoluble fibre. Neither is digestible by humans, but both have an important role and provide a lot more than just \u0026lsquo;roughage\u0026rsquo; in your diet. Soluble fibre dissolves in water to form a gel-like substance which slows down digestion and thus carbohydrate absorption. This reduces blood sugar spikes and gives you a \u0026ldquo;slower burn” from your food. Soluble fibre is also an extra source of nutrition for your gut microbiome (it\u0026rsquo;s a prebiotic). On the other hand, insoluble fibre adds \u0026ldquo;bulk\u0026rdquo; to your stool and stimulates your intestines, speeding up the passage of food and waste. This helps to keep you regular and avoid constipation. Inulin is a superstar of the soluble fibre world! It’s an excellent pre-biotic feeding the good bacteria in your gut (see the pro-biotics earlier), it has a strong effect on slowing down and smoothing out carbohydrate absorption and promotes feelings of satiety (fullness). Inulin also increases the acidity of the colon slightly, helping with the absorption of calcium and magnesium. I just add a couple of tablespoons to my lunchtime smoothie.\nWheat Bran [17] Wheat bran is an excellent source of insoluble fibre which helps to increase faecal bulk and transit time, avoiding constipation. Simply by creating a physical barrier in the gut, it can also help to slow down food absorption and moderate the glucose response. In addition diets high in cereal fibre have also been linked to a lower risk of developing type 2 diabetes. Specifically, I also take it because I have diverticulitis, and the standard management for this condition is to reduce the risk of constipation and increase transit time. As for the inulin, a couple of table spoons of this go into my lunchtime smoothie. A quick word of caution, it\u0026rsquo;s important to slowly increase the amount of fibre in your diet over time. Increasing fibre too quickly can lead to discomfort, bloating, and diarrhoea.\nChia seeds [18] Chia seeds are a mixture of soluble and insoluble fibre. Specifically, soaking them in advance develops a mucilaginous (gluey) gel which, as mentioned earlier, helps to slow down food absorption and buffer glucose response spike whilst also forming a protective film over the mucous membranes of your digestive tract. Chia seeds also provide insoluble fibre to help with bulk and combat constipation. Another advantage of chia seeds is that they are a rich source of Alpha-Linolenic Acid (ALA) which is a precursor to the enzymes EPA and DHA (used to produce Omega-3). The conversion rate is low, but in combination with flaxseed (see earlier) and my Omega-3 algae supplement, I’m getting a diverse source of Omega-3 building blocks. Finally, they are a source of antioxidant compounds (e.g. quercetin, kaempferol, and chlorogenic acid) which help to neutralise free radicals and contribute to cellular protection\nSupplementation \u0026lsquo;holidays\u0026rsquo; It\u0026rsquo;s worth considering whether some supplements need a break either to prevent the body from stopping producing its own supply (due to an ongoing expectation of an external source) or to avoid the risk of higher accumulation for fat-soluble substances. This should also be informed by ongoing blood testing. I need to do some more reading and thinking, but these are the supplements I\u0026rsquo;m looking at from a \u0026lsquo;holiday\u0026rsquo; perspective:\nAshwagandha: As an adaptogen that I\u0026rsquo;m using to manage stress response and cortisol levels (and help with sleep), I suspect continuous use could blunt its effects and perhaps something like 5 days on and 2 days off would be a good balance. Iron: Ideally, I would get this from my diet but (from last blood tests) was not. At my next blood test point I can have a look and see if this is one that I could try coming off or reducing the frequency and then re-test again Vitamin D: I\u0026rsquo;m writing this in the depths of the winter in a Northern Hemisphere country where vitamin D is a challenge. In the summer months this is less likely to be the case, so I could look at reducing the frequency of vitamin D supplementation in the summer months. The additional value here is that (even with the additional K2) excessive vitamin D could lead to high levels of calcium in the blood. I\u0026rsquo;m thinking of dropping down to every other day from the spring onward and testing mid-summer to see how my vitamin D levels look. Nattokinase: This enzyme acts on blood viscosity, helping with blood pressure and clotting. It is, however, probably also a good plan to let the body also manage its own clotting cycle, and my blood pressure is generally optimal/normal. Perhaps 3 weeks on and 1 week off for this one. The Probiotics (MegaSpore and Optibac): If I get my gut microbiome to a great place, it might be that just the combination of Kefir plus Zoe 30+ and a high-fibre diet could maintain that condition. Said that as someone with diverticulitis, gut microbiome is super important. An option would be to use a commercial gut microbiome testing service, remove the additional probiotics and re-test a few months later. Further/ongoing areas of investigation for me I\u0026rsquo;m always reading, researching, and thinking about my supplementation stack. The following list is my \u0026rsquo;todo list\u0026rsquo; that I\u0026rsquo;m looking at for future research and potentially inclusion in my routine.\nI\u0026rsquo;d like to make a more thorough audit of exactly the best time of day for each of these supplements to be taken and then distribute my supplementation stack accordingly to get the maximum benefit from each one. GABA (gamma-aminobutyric acid): GABA is an inhibitory neurotransmitter which, at optimum levels, can act to calm the mind, turn down stress signals and promote sleep. However, there doesn\u0026rsquo;t seem to be much evidence that supplements can cross the blood brain barrier. It sounds like it could be helpful with settling my mind before sleep but needs more investigation Further sources of information The Examine web site for independent, unsponsored meta-analyses of health research\nMetabolical by Dr. Robert Lustig\nFood for Life by Tim Spector\nGood Energy by Dr. Casey Means\nReferences [1] Cuentas, A. M., et al. (2017). \u0026ldquo;The Effect of Bacillus subtilis DE111 on the Daily Bowel Habits of Free-Living Populations.\u0026rdquo; Journal of Probiotics \u0026amp; Health.\n[2] Hill, C., et al. (2014). \u0026ldquo;Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic.\u0026rdquo; Nature Reviews Gastroenterology \u0026amp; Hepatology.\n[3] Bourrie, B. C., et al. (2016). \u0026ldquo;The Microbiota and Health Promoting Characteristics of Kefir.\u0026rdquo; Frontiers in Microbiology.\n[4] Saggese, G., et al. (2015). \u0026ldquo;Vitamin D in childhood and adolescence: an expert testimony on vitamins D2 and D3.\u0026rdquo; European Journal of Pediatrics.\n[5] Gröber, U., et al. (2015). \u0026ldquo;Magnesium in Prevention and Therapy.\u0026rdquo; Nutrients.\n[6] Abbaspour, N., et al. (2014). \u0026ldquo;Review on iron and its importance for human health.\u0026rdquo; Journal of Research in Medical Sciences.\n[7] Tramontano, A., et al. (2022). \u0026ldquo;Nicotinamide Riboside in Health and Disease.\u0026rdquo; International Journal of Molecular Sciences.\n[8] Carr, A. C., \u0026amp; Maggini, S. (2017). \u0026ldquo;Vitamin C and Immune Function.\u0026rdquo; Nutrients.\n[9] Lane, K., et al. (2014). “Bioavailability and potential uses of vegetarian sources of omega-3 fatty acids: a review of the literature.” Critical Reviews in Food Science and Nutrition.\n[10] De Phillipo, N. N., et al. (2018). “Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review.” Orthopaedic Journal of Sports Medicine\n[11] Hewlings, S. J., \u0026amp; Kalman, D. S. (2017). \u0026ldquo;Curcumin: A Review of Its Effects on Human Health.\u0026rdquo; Foods.\n[12] Chandrasekhar, K., et al. (2012). \u0026ldquo;A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults.\u0026rdquo; Indian Journal of Psychological Medicine. (Note: This is the landmark study for KSM-66).\n[13] Chen, H., et al. (2018). \u0026ldquo;Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases.\u0026rdquo; Biomarker Insights.\n[14] Kreider, R. B., et al. (2017). \u0026ldquo;International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine.\u0026rdquo; Journal of the International Society of Sports Nutrition.\n[15] Bermingham, K. M., et al. (2023). “Plant diversity and the gut microbiome: results from the PREDICT studies.” The American Journal of Clinical Nutrition.\n[16] Slavin, J. (2013). \u0026ldquo;Fiber and Prebiotics: Mechanisms and Health Benefits.\u0026rdquo; Nutrients.\n[17] Stevenson, L., et al. (2012). \u0026ldquo;Wheat bran: its composition and benefits to health, a European Perspective.\u0026rdquo; International Journal of Food Sciences and Nutrition.\n[18] Ullah, R., et al. (2016). “Nutritional and therapeutic perspectives of Chia (Salvia hispanica L.): a review.” Journal of Food Science and Technology.\n","permalink":"https://big10.health/posts/5-blood-testing-and-supplements/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cstyle\u003e\n  /* Wrap the table to allow horizontal scrolling on mobile */\n  .table-container {\n    width: 100%;\n    overflow-x: auto;\n    margin: 20px 0;\n    border-radius: 8px;\n    box-shadow: 0 2px 5px rgba(0,0,0,0.1);\n  }\n\n  table {\n    width: 100%;\n    border-collapse: collapse;\n    min-width: 500px; /* Ensures the table doesn't get too squashed */\n    font-family: sans-serif;\n    background-color: #fff;\n  }\n\n  th {\n    background-color: #f4f7f6;\n    color: #333;\n    font-weight: bold;\n    text-align: left;\n    padding: 12px;\n    border-bottom: 2px solid #ddd;\n  }\n\n  td {\n    padding: 12px;\n    border-bottom: 1px solid #eee;\n    color: #555;\n  }\n\n  /* Optional: Zebra striping for readability */\n  tr:nth-child(even) {\n    background-color: #d9edf7;\n  }\n\n  /* Mobile hint: Subtle indicator that the table is scrollable */\n  @media screen and (max-width: 600px) {\n    .table-container::after {\n      content: 'Scroll horizontally ↔';\n      display: block;\n      text-align: center;\n      font-size: 12px;\n      color: #999;\n      padding: 5px;\n    }\n  }\n\n\n\n\u003c/style\u003e\n\u003cimg class=\"banner-image\" src = \"cover.jpg\" alt = \"A range of supplements\"\u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"design-your-personal-supplement-stack-informed-by-blood-testing\"\u003eDesign Your Personal Supplement Stack Informed by Blood Testing\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n      \u003cspan\u003e\u003ci class=\"fa-classic fa-heart\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-brain\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-droplet\"\u003e\u003c/i\u003e\u003c/span\u003e  \n      \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eFurther improve your diet by including key supplements to reach the optimum levels and make up for the deficiencies found in the modern world. Periodically, use a blood testing service to check and monitor your levels.\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e\n\u003cbr\u003e\nAlthough there is no substitute for a healthy diet that avoids ultra-processed foods supplements have a role to play in making up for deficiencies caused by modern lifestyles and farming practices. Supplements can also support your training performance, sleep, recovery, gut health, heart health, and longevity. However, there is little point in taking supplements blindly. You need to have your blood tested and design a supplement stack tailored to your own specific needs.\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cdiv class=\"big10-key-actions\"\u003e\n    \u003cdiv\u003e\n        \u003cp style=\"font-weight: bold\"\u003eWant to look at the science later but, right now, you are just interested in some actions to take?\u003c/p\u003e","title":"5. Design Your Personal Supplement Stack Informed by Blood Testing"},{"content":" Monitor Your Body Composition with Specialist Scanning Use DEXA scans to measure your visceral fat, lean muscle mass, and bone density so that you can reduce the risk of metabolic disease and increase your healthspan. Body composition scanning provides key information on the levels of visceral fat you are carrying (which is a significant contributor to metabolic disease). These scans also provide an accurate measurement of your lean muscle mass, which is a key marker for longevity. Want to look at the science later but, right now, you are just interested in some actions to take?\nBook a DEXA scan with a supplier like Scan.com. In your report look out for evidence of abnormal levels of visceral fat or under-average lean muscle mass (in fact you really want lean muscle mass to be above average as this is a key marker for longevity). Read more to build your own understanding and discuss any abnormal results your scan consulant highlights with your doctor. If you are not happy with your visceral fat or body fat percentages then make dietary and exercise changes to correct these issues. If your lean muscle mass is not above average for your gender and age look carefully at the volume and quality of resistance training in your exercise programme. If you are not currently using an exercise programme talk to your doctor before making any changes and use a personal trainer to get your started in the right direction. What is a DEXA Scan? There are two main uses of this scan:\nTo measure your body fat and overall body composition. It is significantly more accurate, detailed, and useful than the body mass (BMI) score (which cannot tell the difference between muscle and fat) [1]. If you are beginning (or following) a weight loss or fitness programme, it provides a great baseline view and allows you to track and monitor your progress in terms of reducing body fat and increasing your lean muscle mass. The second use is to measure your bone mineral density (BMD)and see how dense (or strong) your bones are. This is used to help assess your chances of osteoporosis (a condition where bones become weak or brittle, increasing the risk of fractures) and osteopenia (where your bone mineral density is assessed as lower than normal but not yet at the level for a diagnosis of osteoporosis). Why should you care about DEXA scans? Visceral fat: This fat (the ‘hidden’ fat laid down around your internal organs) is of particular concern due to its role in inflammation, insulin resistance, cardiovascular health, and other conditions [2]. Such conditions have a huge long-term impact on the chances of the long and healthy life you seek. A DEXA scan will give you a specific measure for visceral fat and allow you to put in place strategies to tackle it, such as time-restricted eating and fasting, in combination with dietary changes.\nLean muscle mass: A DEXA scan can provide early warning where your lean muscle mass is below the normal, which is an indicator for sarcopenia (the age-related progressive loss of muscle mass, strength, and function). To live a long, healthy, and active life, you need to maintain as much muscle function as possible and keep the rate of that inevitable loss as low as possible [3]. Getting an understanding of your muscle mass (overall and broken down by limbs and torso) lets you put in place strategies (such as resistance training and dietary protein) to fight the age-related loss of muscle.\nBone density: Similarly to the point on muscle mass above, the ability to get early insight into your bone density and to track reductions in it enables you to put in place strategies to slow this. Such strategies could include resistance training and dietary changes to include sources or supplements rich in calcium and vitamin D.\nHow much does a DEXA scan cost? In the UK you may qualify for a bone density scan free of charge, but body composition scans are generally not available for free. For a combined package of bone density plus body composition along with a consulation and report you would expect to pay privately around £250 (convert this\u0026hellip;).\nI booked mine through BodyView and was very satisfied with the service, the consulation, and the report provided. But, of course, you should have a look around as a number of providers are available.\nWhat did I learn from my DEXA scan? I\u0026rsquo;m very happy to share my report so you can have a detailed look at what you might expect to receive following on from your own consultation.\nI gained an invaluable insight from my recent DEXA scan. In short, although my measures for body fat percentage, visceral fat, and bone density were good, my lean mass was below average. The specific distribution of my lean mass showed a normal distribution for my arms, below average for my trunk and way below average for my legs.\nThis feels consistent with insufficient and irregular strength training coupled with my preference for using swimming to get my cardio workout (and using specific additional land-based swim training for my shoulders). This has probably helped to keep the arms and shoulders close to normal but allowed my legs to languish. A couple of extenuating factors here could be:\nMy use of time restricted eating on the day of the scan leading to a lower amount of water stored in muscles (when you fast, your body needs to buffer less salt and dumps water) – but at best this would account for maybe 0.5-1Kg of lean mass My preference for low-weight, high-rep strength sessions in the gym focussed on endurance as opposed to high-weight, low-rep workouts (focussed on muscle growth). This result is a risk for longer term problems related to insufficient muscle mass and function and has led to me re-evaluate my weekly training regime to:\nIncrease the overall amount of resistance training within my schedule Temporarily bias the number of leg workouts over upper body workouts Shift the number of reps downwards and the load higher I’ll then rescan in 6 months and see what improvements I can make. Finally, in summary, here is my Longevity Health Index Result:\nFurther sources of information The Examine web site for independent, unsponsored meta-analyses of health research\nOutlive: The Science and Art of Longevity by Pete Attia MD\nForever Strong by Dr Gabrielle Lyon\nReferences [1] NICE (National Institute for Health and Care Excellence), Clinical Guideline [CG189]: Obesity: identification, assessment and management\n[2] Ross, R., et al. (2020). \u0026ldquo;Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity.\u0026rdquo; Nature Reviews Endocrinology.\n[3] Cruz-Jentoft, A. J., et al. (2019). \u0026ldquo;Sarcopenia: revised European consensus on definition and diagnosis.\u0026rdquo; Age and Ageing.\n","permalink":"https://big10.health/posts/6-body-composition-monitoring/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.jpg\" alt = \"A futuristic image of a scan\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"monitor-your-body-composition-with-specialist-scanning\"\u003eMonitor Your Body Composition with Specialist Scanning\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n      \u003cspan\u003e\u003ci class=\"fa-classic fa-droplet\"\u003e\u003c/i\u003e\u003c/span\u003e  \n      \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eUse DEXA scans to measure your visceral fat, lean muscle mass, and bone density so that you can reduce the risk of metabolic disease and increase your healthspan.\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e\n\u003cbr\u003e\n\u003cp\u003eBody composition scanning provides key information on the levels of visceral fat you are carrying (which is a significant contributor to metabolic disease). These scans also provide an accurate measurement of your lean muscle mass, which is a key marker for longevity.\n\u003cbr\u003e\u003c/p\u003e","title":"6. Monitor Your Body Composition with Specialist Scanning"},{"content":" Support Your Brain Health Coming soon.... ","permalink":"https://big10.health/posts/7-neurological-health/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.jpg\" alt = \"A brain scan\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"support-your-brain-health\"\u003eSupport Your Brain Health\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n        \u003cspan\u003e\u003ci class=\"fa-classic fa-brain\"\u003e\u003c/i\u003e\u003c/span\u003e  \n        \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eComing soon....\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e","title":"7. Support Your Brain Health"},{"content":" Build and Cherish Relationships with Friends, Family and Loved Ones Coming soon.... ","permalink":"https://big10.health/posts/8-social-connection/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.jpg\" alt = \"A picture of friends\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"build-and-cherish-relationships-with-friends-family-and-loved-ones\"\u003eBuild and Cherish Relationships with Friends, Family and Loved Ones\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n        \u003cspan\u003e\u003ci class=\"fa-classic fa-brain\"\u003e\u003c/i\u003e\u003c/span\u003e \n        \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eComing soon....\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e","title":"8. Build and Cherish Relationships with Friends, Family and Loved Ones"},{"content":" Eat Healthily, Consider Using Time Restricted Eating, and Prioritise Building a Strong Gut Microbiome Don't worry about particular diets or restrictions (unless they are for personal moral reasons). Instead, focus on eating real food and avoiding processed foods and refined sugars. If suitable for you, time-restricted eating can be an effective way to manage your insulin levels and control your weight. Feed the trillions of good bacteria living inside you so that they can nourish and protect you. Want to look at the science later but, right now, you are just interested in some actions to take?\nXXXXXX Why should you focus more on eating real food than on any particular diet? TBC\nWhy could you consider time restricted eating and even fasting? The essence of time-restricted eating is to eat roughly the same amount of calories as you do normally but to reduce the window of time in the day when they are consumed (and to avoid snacking between meals).\nWhile time-restricted eating and longer fasts can be a useful tool for metabolic control, they are not suitable for everyone. Please consult your doctor before changing your eating patterns. Specific concerns (but note this is not an exhaustive list) would be: You are a medicated diabetic You are pregnant or breastfeeding You have a history of eating disorders You are underweight You are a child There are many patterns to follow, so you can experiment with what works for you. For example, you could skip breakfast, eat lunch around midday and dinner around 6pm. You are thus only eating for around 6hrs of the day and fasting for 18hrs of the day (which is referred to as an 18:6 split).\nRather than launching straight in with something like an 18:6 split, you might want to build up slowly by starting with perhaps a 12 hr feeding window and reducing that over time. Although there are all sorts of patterns and ratios you could use, try to avoid eating close to your bedtime, leaving at least 3 hrs if not more between your last meal and sleep. You can read more about eating and sleep in Big 10 #3.\nWhat are the benefits of time-restricted eating? Metabolic health: Throughout your fasting period you are avoiding elevating your blood glucose (and thus insulin), which can help to combat high-insulin levels, inflammation, and protect against type 2 diabetes. You can read more about blood glucose monitoring and insulin in Big 10 #1 Visceral fat reduction: Visceral fat is the \u0026lsquo;hidden\u0026rsquo; fat that builds up around your organs and is particularly dangerous when it comes to inflammation and metabolic health. In your fasting period your body will draw down on this visceral fat and, over time, help to reduce it to a healthier level. You can read more about visceral fat in Big 10 #6 Weight loss: Although you are not attempting to restrict your calories, a natural function of restricting the feeding window is that it can be hard to consume the same amount you always did. In addition, eating real foods which are high in fibre, good fats and protein (and low in refined sugar) will help you feel fuller and experience more even blood sugar levels. Both of these will also help with weight loss over time, and you may well find that time-restricted eating is less uncomfortable (and more sustainable in the long term) than calorie restriction. Achieving ketosis: Straight after your last meal your body is in a fed state, insulin levels are elevated, and your cells are burning glucose. As you move deeper into your fasting window, blood glucose levels begin to drop and your pancreas will signal to your liver (via the hormone glucagon) to break down stored glycogen to release more glucose. Towards the end of the fasting period (around 16 hours, but this can vary hugely person to person and depending on what your last meal was), all the \u0026rsquo;easy\u0026rsquo; sugar is gone, and the body flips to breaking down stored fats (lipolysis). The brain cannot use these free fatty acids (the product of lipolysis) as fuel as they cannot cross the blood-brain barrier – so the liver converts them into ketone bodies. Unlike fat, these ketone bodies (e.g Beta-hydroxybutyrate - often abbreviated to BHB) can cross the blood-brain barrier and are a very efficient source of energy. Some people report feeling more alert and focussed when in ketosis, and this (along with metabolic stability, reduced inflammation and possibly even longevity and cell renewal) is one of the benefits that advocates of a ketogenic diet espouse. Some people find a ketogenic diet hard to stick to in the long term, and time-restricted eating can be a way to \u0026lsquo;dip your toes\u0026rsquo; into ketosis daily. If you are interested in finding out if you are actually achieving ketosis towards the end of your fasting window, you might like to use a blood ketone monitor such as Keto Mojo or even a continuous ketone monitor like SiBio. Ignore the urine test strips as they are generally not accurate and are more of a gimmick. To be honest, on a 16-hour or 18-hour fasting window you may not get into ketosis (or if you do, not to a significant level or not for very long) and, if this interests you, then you might want to intermittently add in a longer fasting window. Fasting for longer periods of time If time-restricted eating works well for you and you feel well on it, then you could also try adding in occasional longer fasts (e.g. a 48 hr fast once a fortnight). A longer fast will intensify the benefits listed above, and you are much more likely to achieve a high level of ketosis.\nAs for the time-restricted eating, work up to this slowly both in terms of the duration of your fasts and how often you do them. It is also important to stay well-hydrated when fasting as the drop in insulin levels will trigger your kidneys to stop holding onto salt, which will take with it a significant amount of water. Excessive plain water drinking on a longer fast has the potential to lead to low sodium levels, so you might to add a pinch of salt or an electrolyte tablet that contains salt to some of your drinks over the fast.\nRemember, humans have been practising fasting for religious reasons for thousands of years, and we evolved in an environment where access to food was often intermittent and unpredictable. Although our modern conditioning to eat regularly and snack often makes fasting feel \u0026rsquo;extreme\u0026rsquo;, provided fasting is suitable for you (see above) it is a perfectly normal activity for your body. Most people\u0026rsquo;s bodies have significant fuel reserves in the form of fat, and the shift to ketosis will power your brain and body from those reserves very well. It is also worth noting that your feelings of hunger will not remain constant over the fast (tending to come in waves or at intervals) and will decrease or stop as your body enters ketosis.\nWhat are the additional benefits of longer fasts? Autophagy\nWhy should you care about your gut microbiome? Further sources of information A great source of information on time-restricted eating and fasting is Dr Jason Fung, and a couple of his books are listed in \u0026lsquo;Further Source of Information\u0026rsquo; at the end.\nhttps://www.youtube.com/watch?v=CpEbEqp-5FE\nReferences ","permalink":"https://big10.health/posts/9-nutrition-tre-and-gut-microbiome/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.jpg\" alt = \"Healthy food\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"eat-healthily-consider-using-time-restricted-eating-and-prioritise-building-a-strong-gut-microbiome\"\u003eEat Healthily, Consider Using Time Restricted Eating, and Prioritise Building a Strong Gut Microbiome\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n        \u003cspan\u003e\u003ci class=\"fa-classic fa-heart\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-brain\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-atom\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-droplet\"\u003e\u003c/i\u003e\u003c/span\u003e\n        \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eDon't worry about particular diets or restrictions (unless they are for personal moral reasons). Instead, focus on eating real food and avoiding processed foods and refined sugars. If suitable for you, time-restricted eating can be an effective way to manage your insulin levels and control your weight. Feed the trillions of good bacteria living inside you so that they can nourish and protect you.\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e\n\u003cbr\u003e\n\u003cdiv class=\"big10-key-actions\"\u003e\n    \u003cdiv\u003e\n        \u003cp style=\"font-weight: bold\"\u003eWant to look at the science later but, right now, you are just interested in some actions to take?\u003c/p\u003e","title":"9. Eat Healthily, Consider Using Time Restricted Eating, and Prioritise Building a Strong Gut Microbiome"},{"content":" Avoid Damaging Chemicals and Pesticides Coming soon.... ","permalink":"https://big10.health/posts/10-chemicals-and-pesticides/","summary":"\u003cscript src=\"../../js/font-awesome.js\"\u003e\u003c/script\u003e\n\u003clink rel=\"stylesheet\" href=\"../../css/big10-health.css\" type=\"text/css\"\u003e\n\u003cimg src = \"cover.jpg\" alt = \"A picture of chemicals\" class=\"banner-image\" \u003e\n\u003ca href=\"../coaching\"\u003e\u003cimg src=\"../../images/profile-picture.jpeg\" class=\"profile-circle\"\u003e\u003c/a\u003e\n\u003ch1 id=\"avoid-damaging-chemicals-and-pesticides\"\u003eAvoid Damaging Chemicals and Pesticides\u003c/h1\u003e\n\u003cdiv class=\"big10-summary\"\u003e\n    \u003cdiv\u003e\n        \u003cspan\u003e\u003ci class=\"fa-classic fa-heart\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-brain\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-atom\"\u003e\u003c/i\u003e\u003ci class=\"fa-classic fa-droplet\"\u003e\u003c/i\u003e\u003c/span\u003e\n        \u003cbr\u003e\n        \u003cspan class=\"big-10-box-text\"\u003eComing soon....\u003c/span\u003e\n    \u003c/div\u003e\n\u003c/div\u003e","title":"10. Avoid Damaging Chemicals and Pesticides"}]