Random Thoughts from a Restless Mind

How did I spend all of the spare time my hip “gifted” me with over the last several weeks? Well, I did do a little bit of stuff on the intellectual side of my day job. I spent a bit of time working formally as a consultant, helping companies with new product development and working on writing projects in areas that interest me. Much more enjoyable were the couple of opportunities I had to interact informally with colleagues who’d reached out and requested a bit of wisdom from the mini-silverback in their midst. Both versions of this part of my professional life are very satisfying.

Neither, it turns out, is enough to fill all of the hours that would normally be taken up by going to work. After my daily PT was accomplished I was left with 5+ hours of “free” time, and I just couldn’t see spending it all on bingeing TV. Even something as noteworthy as “The Wire”, which I still regret missing and am still promising myself I will watch (Beth has no interest). What I did, instead, was indulge my interest in the field of lifespan and longevity research, an area I’ve wanted to explore for some time.

Now, my little combination of whimsy and drivel here is not the place to do an exhaustive review of the science involved in extended your lifespan by adding healthy years of living. For that I will save you the trouble of trying to find resources and once again recommend “Lifespan” by Dr. David Sinclair of Harvard. I will be sending copies of this around to friends and family who wish to know more than what I’m about to share, or the “why” behind my suggestions. If you just want to read his conclusions yourself there are about 100 pages that will do the trick. More interested in the potential social and societal ramifications of having a meaningful percentage of our populations living actively for 20 or 30 additional years? Sinclair shares his thoughts on these as well.

In a nutshell we can distill Sinclair’s (and other’s) conclusions down to two straightforward strategies that work at the cellular level. First, in order to enhance cellular vitality it is beneficial to maintain cell processes that function during times of deprivation in an “on” mode. Second, while doing so, one must enhance each cell’s ability to identify and repair defects and errors in both our genes and the “epigenetic” mechanisms that turn those genes on and off. Again, if knowing what this means in a more granular fashion is your cup of tea, “Lifespan” is excellent.

How, then, do we accomplish these goals at macro level? The stuff we choose to do in our day to day lives? Some of this you likely already know, especially if you have spent any time here in my Restless Mind. Deprivation is in many ways a synonym for stress. Tactic #1 is eat less. At a cellular level this, in and off itself, turns on the “save for a rainy day” mechanisms that extend the healthy life of the body’s cells. Honestly, your macro dietary move could be just that. Eat less. “Eat to promote results in the gym, not fat.” Yes, all of the research showing the effectiveness of particular forms of fasting are largely correct. You can turbocharge the effect of eating less with pretty much any version of fasting that you can, or are willing to adopt.

Let me step outside of “stress” for just a moment to discuss what to eat. Sugar is still the enemy. Processed food high in added sugar, especially manufactured sugar such as high fructose corn syrup, is a pro-inflammatory agent that works at cross-purposes to our goals here. Attempting to get as many of your daily carbohydrates from non-grains and non-sugars is STILL part of the prescription. Sinclair and a litany of others have repeatedly shown the deleterious effects of eating mammalian protein. Meat, especially red meat, is associated with higher rates of both heart disease and cancers of all sorts. Do you have to become a vegan to increase your healthspan? Heavens no. Just realize that with the exception of post-intense exercise recovery, our need for gobs of protein is lower than we think. Obtaining that protein from plant sources and fish is easier than you think.

Returning to the the concept of “stress”, you gotta get up and move. The couch is STILL your nemesis. Literally anything is better than nothing. Brisk walking works, and by brisk I don’t mean meandering behind your pug as he ponders the placement of his, well, you know. Wanna run? Sure. Why not? Just remember that you don’t need to run 10 miles/day to increase your healthspan. Turns out the health benefit is probably the same if you run 3 miles, and you might get almost the same with that brisk walk. The key is to elevate your heart rate and get a little bit out of breath. Nothing seems to be more effective than high intensity interval training or HIIT. No matter what you think about CrossFit, done properly it is simply the most efficient and effective way to inject physical stress into your recipe.

Lastly for the macro stuff is the truly macro: you have to build some strength. Old fashioned, full-bodied functional movements during which you move meaningful (meaning heavy to you) weight. Sure, you can use all manner of exercise machines that produce resistance that targets individual muscle groups, but healthspan necessarily means the absence of decrepitude. Doing movements such as the deadlift, squat, or press that cannot be broken down into component parts, and doing them while moving a load that is meaningful without being dangerous, is what will make it more likely that you will be able to rise unassisted in (much) later life.

But you knew all, or most, of that already, right? What’s new, at least for me, is what we can do on a daily basis with supplements and a common medication to enhance our body’s functions on a cellular and genetic level. There are a ton of things that have been proposed to slow aging at a cellular level. Many of them have been controversial, at least in part because the research has been less than overwhelmingly positive. Sinclair takes far more of these things than I am comfortable suggesting. I’m going to make it super simple, distilling everything I’ve read about “what to take” down to 4 substances, 3 of which are over the counter.

Let’s start with the simple science of the one medicine that has a direct effect that counteracts cellular aging. The ends of your chromosomes are protected by structures called centromeres. The longer the centromere, the physiologically younger the chromosome, and therefore, the cell. Metformin is a medication that is routinely prescribed as a first-line treatment for Type 2 diabetes. Metformin has been called the closest thing to the Fountain of Youth yet discovered. One of its notable “side effects” is that is elongates those centromeres, presumably increasing the lifespan of the cells themselves. An older medication, metformin is available as a generic for, like, $5 a month. Sinclair takes 1,000mg per day.*

You may have heard about Sinclair’s next suggestion, resveratol. Sinclair and his labs became famous for the findings on resveratol in 2006 that formed the backbone of the so-called “French Paradox”. The French supposedly were living longer despite eating a diet high in saturated fat because of the liberal partaking of red wine with those “unhealthy” meals. While reading “Lifespan” I found it interesting that the people living in the Sardinian “Blue Zone” routinely drink meaningful amounts of a local red wine, Canonnau, that contains high amounts of resveratol. Not all of the early enthusiasm about resveratol has survived deeper testing, but it appears to have little or no downside when taken without the alcohol chaser in the red wine. Sinclair takes 1000mg/day*.

The last supplement is a kinda two-fer. Nicotinamide mononucleoside (NMN) is a potent producer of NAD, the energy source for the activation of the “stress genes” as well as the proteins that function in cell repair. Again, the science is cool and it is well-described in “Lifespan” if you wish to explore it in greater depth. Theoretically the production of NAD results in a depletion of methyl groups that are necessary for other significant basic cellular activities. Sinclair suggests that, if this is so, this can be counteracted by adding trimethylglycine (TMG or betaine) to your supplement cocktail. Sinclair takes 1000mg of NMN and 500mg of TMG daily*.

So there you have it. A recipe that, coming from me, begins appropriately with something that sounds an awful lot like the original CrossFit prescription, “Fitness in 100 Words”, found in the CrossFit Journal Vol. 1 #2 2003. Eat less. Eat better. Move in such a way that you get a bit out of breath and do that regularly. Get and stay stronger by doing full-body functional exercises where you move weight. Do your homework and consider taking some or all of the supplements that David Sinclair and his family and co-researchers are taking to extend the lifespan of the cells in their bodies.

In so doing you will also be joining me, and my family, as I add Sinclair’s regimen to the pescatarian diet suggested by my daughter, and head back to the gym after my rehab from hip surgery. May we all increase our personal healthspan, adding many healthy and vibrant years to our lives.

*Reporting on these findings is not a medical recommendation. Note that you need a prescription from a doctor for metformin. Discuss metformin with your medical doctor.

1 Quiver. A group of cobras. Normally a totally icky thought, but Beth and I finally started watching Cobra Kai, so…

Why isn’t this what the Cobra Kai kids call their team?

2 Announcers. I no longer really watch sports of TV unless they are spectacles. Super Bowl, NCAA championship games, Majors in sports such as tennis and golf. However, as I find myself at home, often alone, with hours to burn, I have had sports of some sort on in the background these last couple of weekends. The games are still not very impressive. Honestly, it seems as if the quality of play in all of the major sports leagues has declined over the years. The individual sports, on the other hand, continue to amaze as one GOAT after another arises to thrill us with their exploits.

One thing, though, is amazingly consistent: the teams of announcers who are not the top teams are uniformly terrible. As I write today’s musings I have our local team, the Browns, filling auditory background. They appear to be on their way to blowing a 2 score lead in the last 2 minutes, and the announcers are simply awful. Their banalities are entirely devoid of insight, provided without an iota of style. In what turned out to be a rather exciting game it sounds like a snoozefest. They add nothing.

I suppose I can sorta, kinda understand why I’m left to suffer at the hands of these end-of-the-benchers. The Browns are not exactly NFL royalty, after all. But the same thing was on tap yesterday for the Notre Dame home game. NBC has spent a fortune buying the rights to these games and they can’t find better announcers? Seriously. Snooze fest.

It’s enough to make you pine for the CrossFit Games feed, ca. 2015 or so.

3 Healthspan. Given the luxury of time to myself I’ve been doing what I’ve done each time this has happened: do a deep dive into something that has appealed to me but escaped me due to time constraints. This is how I spent my time during my recovery from carpal tunnel surgery in 2003 (resulting in the launch of SkyVision), the early days of my new practice in the 2000’s where I just wasn’t all that busy (the start of my CrossFit immersion), and my first hip surgery in 2019 (a re-set of my nutrition and sleep study). During my post-hip rehab I’ve been looking into the ultimate form of increased longevity.

Healthspan, the measurement of healthy, vibrant years lived with a relative absence of both disease and decrepitude.

This is really the ultimate expression of the quest I’ve been on since discovering CrossFit in 2005. The ultimate goal I’ve sought as I’ve tried to develop a single measurement of health that encompassed both fitness and traditional health measurements. Whether or not we decide to measure our true biological age (actually possible, albeit pretty expensive at the moment), we probably should be adding to our quiver (regular use!) of strategies some of the things that the pioneers in longevity research have already uncovered.

For a CrossFit OG this is really the next logical phase. Work capacity across time and modal domains extended across a longer lifespan unencumbered by disease or infirmity = healthspan.

Do your self a favor and pick up a copy of “Lifespan” by the Harvard professor David Sinclair. If you are of a scientific bent you will thrill to the explanations of the first section. If you lean toward the more social engineering side you will likely find yourself nodding along with Sinclair’s thoughts on not only the expected effects of more people living not only longer but better, but on why this is likely good for everyone and everything. Most of you, I suspect, will jump to the “what to do” sections in which Sinclair lays out what we can, probably should, be doing to apply the science right now as I did (going back to read the science afterward).

Allow me to save you some time. I actually read several other books on both longevity and maintaining one’s mental faculties as we age, but all you really need to do IMO is read Sinclair. “Lifespan” not only covers all of the meaningful ground, it lays out a playbook for the next part of the journey. If I get a little inspiration and set aside a little bit of time I’ll expand on both the “soft” and “hard” interventions available right now to almost all of us to expand something much more meaningful than just a lifespan.

It’s time to work on expanding our healthspan.

4 Stethoscope. So, how did I end up faring on the other side of the stethoscope? As you may recall I had my right hip replaced about 10 days ago by a surgeon and in a facility where I was known to no one. Just one more middle-aged ex-jock with a busted up hip and a big prostate. Short story: surgery was uneventful and my recovery got off to a great start despite the fact that no one bothered to listen to the sad, sorry story about my prostates efforts to spoil the party last time. No matter. I was out after about 30 hours total.

What came next is the indictment of our increasingly consolidated healthcare system I thought I’d escaped. After 5 days of simply all-world recovery spent on the farthest righthand side of the Bell Curve I suffered a bit of a setback. On Post-Op day 8 my IT band and abductors went into full revolt mode and I was thrown back to day 3. I didn’t feel comfortable calling or texting either the nurse of PA who sat between me and the surgeon, opting instead for the PT who’d been with me the day before the wheels came off. Is that because I “normally” would have been able to just pick up the phone and buzz my surgeon buddy? Sure. Of course. But the vibe of a large hospital system where the system protocols reign made me wait days before I eventually texted the PA.

That’s probably the lesson for your buddy the Eyeball Boy. If there is a psychological barrier that is effective against someone as confident and plugged in as I am, what must it be like if you really ARE jsut one more middle-aged guy with a busted hip and a big prostate? It’s the big system, not the location of the big system, that creates the distance between doctor and team, and patient. I’m left with the realization that my experience would have been largely the same had I been here in the neighborhood and cared for by either of the big systems in town.

In the end I will surely be just fine. The PA responded to my Sunday text and seemed nonplussed by my symptoms, a response that will eventually make me feel better I’m sure. The big system is able to see me on Thursday, four days from now, if I get worse (no information about what to do if I get worse in the mean time), something they don’t foresee. The reality that a 3 or 4 day delay in my recovery will upset hundreds of apple carts does not register at any level in a large healthcare system. Honestly, I never would have known this had my recovery continued on its early course. My “review” of my journey on the other side of the stethoscope would have been mostly self-deprecation at the notion that I would notice any difference at all.

What I learned is that it’s not the distance between your house and your hospital that matters.

I’ll see you next week…

“If not for the pain, how would we know that we were alive?”

Who uttered this profound statement? Was it Rousseau or Rochefoucauld? I confess that I can neither remember the answer, nor conjure up enough Google-Fu to find it online. Rochefoucauld is famous for “We all have strength enough to bear the misfortunes of others,” which seems somewhat inconsistent. Perhaps it was Rousseau, then. No matter.

A few weeks ago I wrote about my very short encounter with a man who cried “Uncle”. Injured at 20, kept alive by an implantable defibrillator for some 22 years of unremitting pain, Billy Ray had no one to live for. All he knew was pain. He was imprisoned by his pain. Truly an island, he shook the shackles of his torment when he turned off his defibrillator.

For several months now I have had near constant pain that has been bad enough to impose itself on my minute-to-minute consciousness. Not like Billy Ray, mind you, and it’s only been 3 or so months. I am reminded of my friend Steve, one of the nicest, kindest, friendliest humans I’ve been privileged to know. He suffered the same pain from the same cause, but for myriad reasons he chose to carry the burdens of others and did not address his own for many, many months. He, and those closest to him, say that the pain changed him. His general bonhomie declined along with his patience and good cheer. Thankfully, surgery cured his pain. More thankful, still, is that the removal of his pain returned to us the friend we’d come to know and cherish.

I’ve given a lot of thought to this over the last several months. What makes my situation different is that I have a finish line. I can see ahead to the date when there is a 99% chance that the pain will be alleviated and I will be able to return to a life that is generally free from that type of burden. My time in this bubble has been relatively short, many months shorter than Steve and years shorter than Billy Ray. The finish line has been close enough that I hope I have been able to avoid any change in who I am, with the exception of the physical limitations that I have had that will also be alleviated.

Seeing the finish line ahead has meant hope, which has been a balm to sooth the pain.

My part of the medical world is mostly filled with caring for people whose lives will improve because they received that care. Indeed, that’s part of why I chose ophthalmology in the first place. There is a very small subset of my Dry Eye patients for whom relief is not possible, at least not from me and what I have to offer. This short stay in the dark world of chronic pain has given me a different perspective on that part of my practice. While it is not the same at all, doing what it takes to work through and around pain that does not go away will likely allow me to bring more light to that small part of my practice world.

For me, though, the answer lies just ahead at the finish line. The date is set, and all that remains is a phone call confirming the hour. I have people to live for, people whose misfortunes I will once again be strong enough to carry. Relief awaits at the finish line, along with all of the friends and family members who have been strong enough to bear my misfortune and carry me there.

I’ll see you next week…