Category Archives: Disease - Page 4

Autoimmune Panel: Wahls, Ballantyne, Jaminet, & Gray

Posted by on September 3, 2013 28 comments

This is probably the most important and interesting podcast I’ve had the privilege of being part of: an expert panel on Recovering from Autoimmune and Neurodegenerative Diseases.

The panel was arranged by Whitney Ross Gray of Nutrisclerosis, who has recovered from Multiple Sclerosis with an ancestral diet rich in animal foods.

The expert panelists were:

  • Terry Wahls, M.D., who has famously recovered from Multiple Sclerosis on an ancestral diet rich in plant foods, and is now leading a clinical trial studying ancestral diets as treatments for M.S.
  • Sarah Ballantyne, Ph.D., who blogs at The Paleo Mom. Sarah suffered from an autoimmune disease, lichen planus, as well as other ailments, and healed them (and lost 120 pounds) with an ancestral diet.
  • Paul Jaminet, Ph.D. I had a chronic disease with neurological symptoms that overlapped with M.S., but it turned out to be an infectious disease and cleared with antibiotics. However, this could not be diagnosed until after I’d made considerable progress addressing it through an ancestral diet, which became the Perfect Health Diet.

Questions were solicited beforehand from patients suffering from autoimmune and neurodegenerative diseases, and in an hour and forty minutes we covered many fascinating topics.

I think the combination of personal experience recovering from chronic diseases, and scientific and medical expertise, made for an exceptionally useful conversation. If you are interested in these diseases – or just in how to be healthy, since the methods that address these conditions are generally beneficial for anyone’s health – take a listen.

My thanks to Whitney for organizing the discussion, Carl for hosting it, and Terry and Sarah for making a great panel.

Circus, Swim, and Nails: Three Cancer Stories

Posted by on August 29, 2013 21 comments

Last weekend we want to see Cavalia Odysséo, a circus of horses, acrobats, and aerialists. It is a magnificent show.

Our trip to the circus began, in a way, many months ago. In March 2012, I got an email that began, “My mother has terminal cancer.”

PHD and Laurette Charron’s Cancer

The email was from Michel Charron, an aerialist with Cavalia Odysséo. Here is what he wrote:

I rushed home from Miami … to New Brunswick, Canada, to see what I could do for Mom.  The doctors say there is nothing they can do for her now….  The doctors have already decided that she is dead, and that there is nothing to be done but to keep her as comfortable as possible to the end.

She has cancer of the liver and of the colon.  They have found lesions on her lungs, which they believe are also cancerous….

When I arrived ten days ago, my mother was totally unrecognizable.  She was taking six pain pills a day, had no tone in her facial expressions, could not pronounce the letter ‘s’ properly, had severely restricted mobility, as well as difficulty concentrating and following regular conversation….

We are all alone here and would greatly appreciate some friendly advice.

I gave my cancer suggestions. The gist of my dietary advice for cancer can be found in these two posts: An Anti-Cancer Diet, September 28, 2011, and Toward an Anti-Cancer Diet, September 15, 2011. Extracellular matrix is very important, so soups and stews with connective tissue are important. Good, balanced nutrition is crucial; many nutrient deficiencies, excesses, and imbalances promote cancer. Lifestyle is very important too: circadian rhythm entrainment may be the single most important factor determining cancer prognosis.

I didn’t hear from Michel for seventeen months. Last Friday, Michel sent another email:

I contacted you last year regarding my mother, Laurette, who was diagnosed with generalized cancer and given very little time to live.  You proved a light in very, very dark times.  My mother not only lived nine months longer than predicted, but the quality of her life improved dramatically.  Thank you for that.

Cancer is a terrible disease, and had Laurette’s cancer been caught earlier there would have been hope of recovery, but Michel was grateful for the extra time he had with his mom. She got off most of her prescription medications, dropping from 22 drugs to 5, and became physically and mentally able to enjoy what remained of her life. Michel and Laurette were able to spend time together, share their love for each other, and say farewell.

It happens that Cavalia Odysséo is playing in Boston right now, and Michel invited us to the show. If you ever have a chance, it is well worth a trip. The horses – there are 63 horses in the show – are a pleasure to watch; the scenery is magnificent; and the performers superb. This trailer will give you an idea of the show:

Here is the circus tent:

cavalia 01

Michel invited us back stage after the show. Here we are with some of the performers – Michel is holding our book:

cavalia 03

With Michel and his wife and co-performer Tomoko:

cavalia 03b

Some of the horses, exhausted by the show, turn their backs to visitors:

cavalia 02

And here I am getting a lesson in aerialism from Michel:

cavalia 04

Thank you, Michel! It was a magical night.

The Big Swim

If you’ve read the jacket of our book, you’ll know that Court Wing, head trainer at CrossFit NYC, says in his blurb, “One of my best friends was on the diet while undergoing chemo and his bloodwork numbers were so good that they would have been considered average … for a person without cancer.”

I haven’t yet told the story of Court’s friend, D. Kirk MacLeod. Kirk discovered he had cancer when his colon ruptured in August 2010. He’s had multiple surgeries and chemotherapies since.

Kirk has now done something remarkable. On August 4, he swam the Northumberland Strait between New Brunswick and Prince Edward Island – an 11 mile swim. He wrote beforehand:

I really do feel like I am accomplishing the impossible… I have gone from less than 160 pounds, weak and worn from chemotherapy before Christmas (less than I weighed in high school!) and two major surgeries in February and March…to 185 pounds, fit, strong and ready to swim over 14 kilometres on Sunday, August 4th!!! I started slowly training at the beginning of June!

In July I started training “hard” under the guidance of Court Wing (my Crossfit coach from Crossfit NYC) and Max Wunderle (my swim coach of TriMax Fitness). I also had invaluable eating advice from Paul Jaminet (The Perfect Health Diet). Their help and direction has been phenomenal – I couldn’t have done it without them!

After the swim, Kirk wrote:

It was brilliant… It was hard as hell…and it was an accomplishment I never imagined….

I finished in 6 hours and 25 minutes. We figure I swam about 17 km … maybe more.

I was only cleared to train at the end of May and started training in June…I began at zero. I couldn’t even do basic exercises with weights. I wasn’t a swimmer. I had never trained in swimming.

It’s an incredible story and an incredible accomplishment. Here’s Kirk:

cavalia 05

Kirk did his “Big Swim” to benefit the Brigadoon Children’s Camp Society, a charity for chronically ill kids. If you’d like to reward his hard work, donate here through Canada Helps.

Cancer and Nailbiting

Reports from other cancer patients suggest that cancer therapies are much less toxic when patients are eating PHD. Here, for example, is Bill Rafter:

About 6 months ago I learned that I had metastatic prostate cancer. The treatment recommended was hormone therapy and targeted radiation…. The effects are a total suppression of sexual drive, hot flashes similar to those experienced by menopausal women, and the feeling that one is an old, old man…. I found the last one particularly brutal, and questioned whether I wanted treatment at all.

A friend gave me a good book on cancer, recommending an all-out approach rather than the sequential attempts favored by most oncologists. Nutrition was a major part of the approach. I then trolled my friends for books on nutrition and one commented that PHD was the best he had ever read. I am overwhelmed by what it has done for me.

After reading PHD, I immediately adopted the recommendations in full, with the exception of fasting. I then went thru 44 radiation treatments, and never felt fatigue, a common symptom. No more old man feelings, and no thoughts of quitting treatment. Hot flashes are completely gone, which really puzzles the oncologists. Everyone wants to know what stopped the hot flashes.

Of course breezing through therapy is not the same as recovering, but it is a good start. If therapies have fewer side effects, higher doses can be utilized, and treatments might be more effective.

Bill continued:

But that’s not all. Ever since grade school I have been a nailbiter. I knew the habit was caused by a chemical imbalance, rather than behavioral, but could never figure out what. But since adopting PHD, my fingernails have grown to the extent that filing them is annoying. That makes me wonder that if PHD brought my system into balance, how many other imbalanced people could also benefit.

I think a lot of people can benefit from PHD. Similar to Bill’s case, it’s rare for only one health condition to improve when diet and lifestyle are improved. Usually all or nearly all health problems improve. This suggests that poor diet and lifestyle are contributors to many diseases.

Invitation to Perfect Health Retreats

A few recent events have increased my interest in how PHD, or ancestral diet and lifestyle generally, affect cancer:

  • Shou-Ching and I have recently been asked to assist in developing the dietary and lifestyle advice for a cancer clinical trial.
  • Our Perfect Health Retreats provide a fairly controlled environment where we might be able to see and measure the effect of PHD on cancer patients. Michel told us that when he put his mother on PHD, he saw notable improvements after two weeks. So a thirty day program may be long enough to generate observable results.
  • The launch of the Journal of Evolution and Health gives a scholarly forum for communicating observations and exploring hypotheses.

As readers know, my mother died of cancer, so this is of special interest to me. I suspect that diet and lifestyle have a much bigger impact on cancer than most realize. There is shockingly little research underway into this aspect of cancer management.

To gain more insight into how diet and lifestyle may affect cancer outcomes, I’d like to invite cancer patients to come to our Perfect Health Retreats. Perfect Health Retreats are not a medical program, there is no medical treatment or advice available – just great food, an environment designed for optimal healthfulness, and an educational program teaching how to live for optimal health. So the program will not be suitable for severely ill patients.

If you’re interested in participating, please contact Paul Jaminet at paul@perfecthealthretreat.com and 617-576-1753 or Whitney Ross Gray at whitney@perfecthealthretreat.com and 910-763-8530.

Omega-3 Fats and Cancer

Posted by on July 14, 2013 77 comments

On Wednesday a new paper reported that higher levels of long-chain omega-3 fats (EPA, DPA, and DHA) in blood are associated with a 43% increased risk of prostate cancer and a 71% increased risk of aggressive prostate cancer. [1] This built on earlier work by the same group. [2] In a press release, the authors stated:

“We’ve shown once again that use of nutritional supplements may be harmful,” said Alan Kristal, Dr.P.H., the paper’s senior author …

“[W]e have confirmed that marine omega-3 fatty acids play a role in prostate cancer occurrence,” said corresponding author Theodore Brasky, Ph.D.

They sound confident! Is there anything to it, and should it affect our dietary advice?

Mechanisms Linking Omega-3 Fats to Cancer

In our book and on this blog, we’ve already discussed two mechanisms linking excessive omega-3 intake to cancer risk.

First, there is the issue of lipid peroxidation. Of all fatty acids, long-chain omega-3 fats are the most readily peroxidized:

PUFA relative peroxidizability

Peroxidation of PUFA generates highly toxic compounds, such as aldehydes, which mutate DNA and turn proteins into advanced lipoxidation end products (ALEs). [3, 4] These lipid peroxidation products have been implicated as causal factors in cancer. [5]

Second, oxidation products of DHA promote angiogenesis – the creation of new blood vessels to feed tumors. These products make cancers grow rapidly. I’ve blogged about this (DHA and Angiogenesis: The Bottom Line, May 4, 2011; Omega-3s, Angiogenesis and Cancer: Part II, April 29, 2011; Omega-3 Fats, Angiogenesis, and Cancer: Part I, April 26, 2011).

So there are known mechanisms by which the long omega-3s in fish oil may promote cancer.

The Brasky et al Papers

The new study by Brasky et al measured omega-3 fat levels in plasma phospholipids. Thus, it doesn’t measure any omega-3s in cells, only omega-3s in serum particles like LDL, HDL, and VLDL; and even in those particles it excludes omega-3 fats found in triglycerides.

This is a very different biomarker than the Omega-3 Index of William Harris, which looks at the omega-3 phospholipids in red blood cell membranes. [6] This biomarker might behave quite differently than the Omega-3 Index.

The study measured plasma phospholipid omega-3s in a group of people, then followed them for 6 years or so to see who developed cancer. Here are the group averages [1]:

Brasky 2013 Table 2

Statistically the most reliable data is in the no cancer vs total cancer comparison. There we find that subjects who went on to develop prostate cancer averaged 3% more DHA and 4% more EPA+DPA+DHA in plasma phospholipids than those who didn’t develop cancer.

Does This Variation Reflect Dietary Intake?

Chris Kresser kindly sent a link to an analysis of the study published at LecturePad by William Harris: “Omega-3 Fatty Acids and Risk for Prostate Cancer.” Harris tells us how to translate the plasma numbers to the corresponding Omega-3 Index numbers:

Based on experiments in our lab, the lowest quartile would correspond to an HS-Omega-3 Index of <3.16% and the highest to an Index of >4.77%).

Even the top quartile of the Brasky et al subjects had quite low omega-3 levels:

In Framingham, the mean Omega-3 Index of participants who were not taking fish oil supplements was 5.2% and for those taking supplements, it was 7.5% [7]. Both of these numbers are considerably higher than the values reported by Braskey et al., even in their highest quartile.

The trial asked its participants not to take supplements, and it looks like they drew a study population whose fish intake was much lower than that of Framingham, Massachusetts, residents.

If dietary omega-3 intake was low in all subjects and varied only slightly among participants, how do we know that this biomarker is related in any way to dietary intake? There could be other factors – genetics, oxidative environment, omega-6 fat intake, antioxidant intake, changes in the proportions of VLDL, LDL, and HDL, to name a few – that affect this biomarker.

Does High Dietary Intake Lead to More Cancer?

If high dietary intake of omega-3s caused more cancer, we would expect cultures that consume lots of fish oil to have higher prostate cancer rates. But epidemiological studies have found that high omega-3 intakes seem to be associated with low cancer rates. For instance, the Japanese eat eight times more omega-3 fatty acids than Americans and their blood levels are twice as high, yet the prostate cancer rates are only one-sixth the American rate.

Of course, there are many confounders in epidemiological studies. Harris helpfully provides a summary of clinical trials in which fish oil was provided as part of the study and cancer outcomes measured:

Harris reply to Brasky 2013

Although none of these studies produced a statistically significant link between omega-3 intake and cancer, incidence of cancer diagnosis or death was increased in every one of the clinical trials except the GISSI-Heart Failure study and perhaps the Origin study. A meta-analysis might find a small cancer promoting effect of omega-3s.

UPDATE: Vladimir Heiskanen points me to an interesting paper in which the effect of dietary fatty acids on cancer metastasis was examined. Colon carcinoma cells were injected into the portal vein (which leads from intestine to liver) of rats and 3 weeks later rats were sacrificed and their livers were examined for metastases. The rats were on three diets — low-fat, high omega-6 (safflower oil), high omega-3 (fish oil). The results:

At 3 weeks after tumor transplantation, the fish oil diet and the safflower oil diet had induced, respectively, 10- and 4-fold more metastases (number) and over 1000- and 500-fold more metastases (size) than were found in the livers of rats on the low-fat diet. [7]

I wish they’d used a saturated fat or monounsaturated fat diet, rather than a low-fat diet, as the control, as this would have clarified that polyunsaturates specifically promote metastasis; in the study the rats’ food was mixed with fish oil or safflower oil, greatly increasing the fat fraction and decreasing the carbohydrate, protein, and micronutrient fractions, so the control diet deviates in many respects from the high-PUFA diets. However, the results are consistent with the idea that fish oil is more cancer-promoting than the less peroxidizable safflower oil, perhaps because of the unique pro-angiogenic effects of DHA products.

Conclusion

There might be biological contexts in which omega-3 fats promote cancer.

This doesn’t mean we should refrain from eating omega-3 fats. Cardiovascular disease causes more deaths than cancer, and omega-3 fats are protective against CVD.

However, I think these studies support the PHD advice:

  • Eat enough oily marine fish to achieve omega-6 and omega-3 balance;
  • Minimize omega-6 intake so that omega-6 and omega-3 balance is achieved at the lowest possible intake of polyunsaturated fats.

All nutrients can be eaten in excess, and omega-3 fats surely fall into this category. The right amount of oily fish is probably about one to two meals per week.

References

[1] Brasky TM et al. Plasma Phospholipid Fatty Acids and Prostate Cancer Risk in the SELECT Trial. J Natl Cancer Inst. 2013 Jul 10. [Epub ahead of print] http://pmid.us/23843441.

[2] Brasky TM et al. Serum phospholipid fatty acids and prostate cancer risk: results from the prostate cancer prevention trial. Am J Epidemiol. 2011 Jun 15;173(12):1429-39. http://pmid.us/21518693.

[3] Hulbert AJ et al. Life and death: metabolic rate, membrane composition, and life span of animals. Physiological Reviews 2007 Oct;87(4):1175–213, http://pmid.us/17928583.

[4] Hulbert AJ. Metabolism and longevity: is there a role for membrane fatty acids? Integretive and Comparative Biology 2010 Nov;50(5):808–17, http://pmid.us/21558243.

[5] Nair U, Bartsch H, Nair J. Lipid peroxidation-induced DNA damage in cancer-prone inflammatory diseases: a review of published adduct types and levels in humans. Free Radic Biol Med. 2007 Oct 15;43(8):1109-20. http://pmid.us/17854706.

[6] Harris WS, Von Schacky C. The Omega-3 Index: a new risk factor for death from coronary heart disease? Prev Med. 2004 Jul;39(1):212-20. http://pmid.us/15208005.

[7] Griffini P et al. Dietary omega-3 polyunsaturated fatty acids promote colon carcinoma metastasis in rat liver. Cancer Res. 1998 Aug 1;58(15):3312-9. http://pmid.us/9699661.

Beyond Standing Desks: Portable Outdoor Workstations

Posted by on July 3, 2013 71 comments

A note from Paul: I’m happy to introduce Kamal Patel’s first post on PHD! Kamal is the funniest and maybe smartest guy in the ancestral health movement. A Ph.D. candidate in nutrition and a leader in the Ancestral Health Society, you may know him from PaleoHacks or Paindatabase.com. For more, check out Kamal’s bio on our About Us page. Welcome Kamal!

Goal: Do some computer work outside a couple times a week. Get maximal benefits from the sun in a minimum amount of time, while fitting all the necessary gear inside a backpack.

Resources: Tiny budget, free Amazon Prime shipping, access to a sunny park.

Why do computer work outside?

Hi, Kamal here (see below Shou-Ching for a short bio). I love sunlight. You probably love sunlight too. Turns out the sun is important for things outside of just vitamin D production. Ever wonder why indoor cats gravitate towards sunlight, even though they get their vitamin D from food? Probably not, since it just makes intuitive sense that animals want to be outdoors. The desire to be free of inside confines applies not just to indoor cats but also to indoor humans. Yet indoor humans sometimes need to see peer-reviewed articles before changing their habits. Don’t fret, we’ll start with a couple of those before delving into five specific steps for creating an outdoor workstation.

Escape plot foiled by hammock

My kitty’s escape to sunlight, foiled by a vicious hammock

Sun exposure increases production of endorphins and nitric oxide, which can translate into benefits for both pyschological well being as well as disease prevention. Light boxes benefit not only seasonal affective disorder but also non-seasonally linked depression. Brief but regular exposure to ultraviolet light from tanning beds can help the mysterious and painful chronic condition called fibromyalgia, and sunlight may benefit pain after surgery. The draw of UV radiation is so powerful that frequent tanners can literally get addicted to catching rays. Unfortunately, the “pro-sunshine” lobby isn’t pouring billions into research on sun exposure, so the specific mechanisms of sunlight benefit will likely remain more mysterious than the mechanisms of blockbuster medications like Viagra and Prilosec.

Step 1: Dress for success

Look at your skin. Does it look more like Paul’s, or does it look more like Kamal’s?

paul_kamal

Debating who has worse posture

If it looks like Kamal’s, you might be getting vitamin D not-at-alls (PS: that’s a rhyming mnemonic). Let me explain. I first got my vitamin D tested in 2008, and it came in at a whopping 19 ng/ml…even with taking a multivitamin most days and getting sunlight at lunchtime! As you probably know, pigmented and/or tanned skin serves as sunscreen, making it tough for darker people to synthesize vitamin D without very long sun exposure times. Indians may also produce less active vitamin D (calcitriol) from a given amount of sun exposure due to genetic predisposition.

But my problems apply to you lighter-skinned folk as well — my outdoor lunch excursions were done while wearing business casual clothing with short sleeves. This means covered torso and legs, leaving only about 25% of my skin exposed for vitamin D production. If you factor in things that can lower vitamin D production further, such as cloud cover, not laying down horizontally, higher BMI, and increased age, then it might be worth it to create a “sunlight maximization” strategy. 

How serious are you about getting that extra sunlight? If you’re moderately serious, consider small changes like taking off your shoes and rolling up your pantlegs a bit while sitting in the park. If you’re extremely serious and okay with looking strange, consider occasional use of…mesh basketball jerseys! Yup, those cheapo mesh tops are made of thin material covered with tiny holes. One day I’ll buy a UV meter and check the actual numbers, but my suspicion is that wearing such a jersey would greatly increase skin exposure to the sun, perhaps doubling it or more. I bought my jersey for about $10 on Amazon, and sometimes change into it before leaving for the park. If you don’t already have blue-light blocking glasses to ratchet down light exposure before bedtime, you can buy a pair of those plus a jersey on Amazon in order to level up to free shipping.

 

Step 2: Acquire tiny chair and tiny laptop

Now that you’ve freed up enough skin to get some substantial sunlight, the next step is to assemble your outdoor office. This part is fun. Eventually you’ll want a small chair, especially if you’re planning on spending many hours working outside. To get a chair that you can stuff in your backpack, just head to REI or any place that sells camping gear. I chose a collapsible model at REI called “Flex Lite” that weighs only 1.75 pounds and folds down to 14×4 inches. 

portable-chair

Tiny chair and tiny laptop fit into backpack with plenty of room to spare.

Laptops are expensive, so you can totally just use whichever model you have. BUT…if you have a few bucks to spare or your current model is in need of replacement, I’d recommend getting an ultra-light laptop, at under 3 pounds. That way, you can fit the tiny laptop and tiny chair along with a hearty lunch in your backpack. Just remember that a laptop with a matte screen works much better than a glossy screen for outdoor use.

Step 3: Optimize ergonomics

The name of the game when working at a computer is to avoid repetitive stress injuries. Simply by being outside, it will give you more incentive to get up and walk around once in a while. But there are other ways to introduce some structured change-of-posture. You can set a timer for every 20 or 30 minutes or get an app on your phone that reminds you to get up. You could also take a break from sitting in the chair to sit on the grass. Note that sitting with feet in contact with the earth (aka “earthing” or “grounding”) is speculated to have some health benefits, which is another bonus for getting in some outdoor office time.

For those with wrist problems, consider switching up your input method every now and then. Switching from right to left hand on occasion is the easiest way to do this. Other ways are switching from trackpad to mouse or trackball and using keyboard shortcuts more. Later this summer, a motion-detecting input device called “Leap Motion” is coming out that will allow you move the cursor with your MIND! Just kidding, not with your mind. But it does allow you to move the cursor with your hands in the air, Minority Report style, reducing much pressure from overstressed wrist tendons and ligaments. Fancy gadgets aside, if you’re going to spend more time outside, it’s a perfect opportunity to think more about varying your working position and revisiting ergonomics.

Step 4: Get pumped

This is going to sound cheesy, but so be it. Working outside can make you feel more alive. The transition from typical cubicle to standing desk is exciting. Work typically takes up the majority of one’s adult life, and standing cracks the mold of being a robotic office cubicle worker. Incorporating some outside work time removes so much of the drudgery aspect from work that it can confuse the most pessimistic of brains.

Normalizing circadian rhythm is an essential part of the health equation, and a complementary factor is being outdoors in the sun. “Sick building syndrome” doesn’t get a ton of research attention, but it’s a very real thing. One reason outdoorsy vacations provide a sense of well-being could be a lack of droning artificial light, stale air with concentrated indoor pollutants, and disgruntled coworkers. Even an office full of windows isn’t perfect. Office windows filter out UVB rays (meaning no vitamin D production or improved mood through endorphin release) but allow some UVA through (meaning staying indoors behind a window doesn’t keep you risk-free from skin damage and cataracts).

Step 5: Get outside already!

office-supplies

Directions: Stuff into backpack, leave for park while whistling CCR’s “Lookin’ Out My Back Door”.

Above are my typical outdoor office supplies, all of which easily fit into a normal-sized backpack with room to spare. From the top left, there’s a travel-sized sunblock, laptop, collapsible chair, flipflops, coconut chips plus sardines in olive oil, and mobile wifi device. If you don’t want to get a mobile wifi device, you can usually get free or cheap mobile wifi from your smartphone.

In terms of practical recommendations, I advise people with school or office work to gradually spend more time working outside. If you find yourself able to be productive working outside, only then consider buying a chair or other outdoor accouterments. Wearing a mesh jersey might seem drastic, but it has a couple benefits. For darker-skinned individuals, it can substantially decrease the prolonged time needed to produce vitamin D. Very light-skinned individuals who are at higher risk of skin cancer could wear sunblock on parts of the body that are more prone to skin damage (like the face) and couple that with producing vitamin D from a jersey-clad torso.

To reiterate because of its importance, a critical concept for office work is VARIATION. The capital letters are to show that I’m not joking around. Combining typical indoor seated work with at least occasional standing work and occasional outdoor seated work is a solid ergonomic base. Increasing the standing to a few hours a week may result in weight loss of several pounds a year. When indoors, a “microbreak” of under a minute could be spent grabbing some water, taking a lap around the office, or climbing a set of stairs. These microbreaks have been shown to reduce muscular discomfort without compromising productivity. When outdoors, microbreaks are pretty much just awesome. Breathe in some fresh air, stare at the clouds, say hello to the doggies at the park. All the studies in the world can’t relay just how nice it is to work outside a couple times a week.