Mix it up:

• Looking for a way to entertain your kids, or keep your own activity level up? Check out this thing I wish I had invented. Dice (or die) that you roll to determine what exercise you will perform. My kids were fighting over who got to roll it next, didn’t even realize we had turned off the TV and were exercising. 

Rock Paper Scissors, OK:

• Generally try to keep medical pearls out of this newsletter, but this one was too good. When someone has an injury to the arm or hand, this is a brief, unforgettable way to check for nerve function:
Rock: tests the Median nerve
Paper: tests the Radial nerve
Scissors: tests the Ulnar nerve
Ok sign: tests the Anterior Interosseous nerve
• See the linkfor full description and reference. Subscribe to the UMEM pearls if you want to learn Emergency Medicine in bitesize chunks. 

Embrace the Pain:

• Do you feel awkward exploring the machines at globogyms? Or perhaps you don’t belong to a gym? Maybe you haven’t been able to justify the expense of home equipment? Maybe you are intimidated (as I am) by the complex maneuvers involved in Olympic lifts? 
• None of these excuses will get you out of the “Murph.” This is an exercise session in memory of Navy Lieutenant Michael Murphy, 29, of Patchogue, N.Y., who was killed in Afghanistan June 28th, 2005.
• If you can run, squat, do push ups and pull-ups, you can do the whole workout with no equipment. If you can’t do pull-ups (yet), or don’t have a bar, climb under a table and do Australian pull-ups. Start with one fifth or even one tenth of the Murph, and gradually ramp it up (I wouldn’t do this more than once a week). 

1 mile Run
100 Pull-ups
200 Push-ups
300 Squats
1 mile Run

• This workout was one of Mike’s favorites and he’d named it “Body Armor”. From here on it will be referred to as “Murph” in honor of the focused warrior and great American who wanted nothing more in life than to serve this great country and the beautiful people who make it what it is. Partition the pull-ups, push-ups, and squats as needed. Start and finish with a mile run. If you’ve got a twenty pound vest or body armor, wear it.

Mindfulness:

• This buzzword is thrown around so much that we might be losing sight of what it means. Shirzen Young has a three part description of what mindfulness means: 
– Concentration Power– ability to focus on what you consider to be relevant at any given time
– Sensory Clarity– ability to keep track of what you’re actually experiencing in the moment
–Equanimity– ability to allow sensory experience to come and go without push and pull
• This is a precise, pragmatic definition of what is happening mentally when we practice mindfulness. 

Crunch:

• If you are following a low(ish) carb diet, you have certainly run into the issue of finding a crunchy food to dip in salsa, guacamole, hummus, etc. Quest tried out potato chips a few years ago but they don’t quite get the job done. Now Quest has tortilla style chips in a few different flavors, and they are very good. Low carb, high protein, processed yes but still healthier than a real chip. Thanks Alyssa Thomas for the chip recommendation.

Hula:

• Interesting article where subjects either used a weighted Hula Hoop (~3lb) or Walked. The Hula Hoop group averaged 13 minutes of activity per day, versus 10k steps for the walk group. The interesting finding here is that the Hula group reduced fat tissue in the abdominal area (android region, which is from the lilac crest [bone that protrudes at left and right lower abdomen] 20% of the way to the head). The Hula group also gained trunk muscle mass.
• This study seems to challenge the sad but accepted idea that humans cannot lose fat tissue in one precise area of the body, ie the thighs or abdomen, etc. But the Hula group did! The Hula group also lowered their LDL cholesterol, while the Walk group raised HDL and lowered blood pressure. 

Fat-Carb synergy:

• We have covered the curious relationship between 1) obesity and 2) foods high in fat andcarbs. This article used fMRI brain imaging to look at food reward. Foods that are high in fat and carb potentiate reward circuits in the brain our of proportion to how much someone subjectively likes the food. The high fat high carb (and usually low protein) were valued more by the subjects. 
• This is why the low carb advocates and the low fat advocates are usually both right. The only foods in nature with a lot of carbs and fat are milk and acorns, both of which fatten up animals. 

Fish or Fish Oil?

• We have covered this question before with recommendations from the Perfect Health Diet authors. 
• Gabe Mirkin, MD is a quadruple board certified doctor who writes on nutrition and exercise. Here he cites evidence for the benefit of fish in the diet, and the paradoxical apparent harm of fish oil capsules. 
• I still recommend buying Krill Oil if you want capsules, and actual Omega 3 fish oil in a bottle to get higher doses of Omega 3. And of course eat plenty of (low mercury) seafood. Thanks Matt Sinclair for recommending Dr Mirkin.

Stoics have feelings too:

• You have likely heard of the Stoics fondness for the Greek word Apatheia (Greek: ἀπάθεια; from a- “without” and pathos “suffering” or “passion”) From Wikipedia: “refers to a state of mind in which one is not disturbed by the passions. It is best translated by the word equanimity rather than indifference. The meaning of the word apatheia is quite different from that of the modern English apathy, which has a distinctly negative connotation. According to the Stoics, apatheia was the quality that characterized the sage.” Modern Stoic authors do employ the word indifference, which sounds slightly better than apathy. 
• But I very much prefer Ataraxia (ἀταραξία, literally, “unperturbedness”, generally translated as “imperturbability”, “equanimity”, or “tranquillity”). Wikipedia again: “first used in Ancient Greek philosophy by Pyrrho and subsequently Epicurus and the Stoics for a lucid state of robust equanimity characterized by ongoing freedom from distress and worry. In non-philosophical usage, the term was used to describe the ideal mental state for soldiers entering battle. 
• Lucid state of robust equanimity characterized by ongoing freedom from distress and worry – sounds like just about the best possible mental state. Stoics are not unfeeling robots, they are simply trying to always win the rationality vs emotions battle within themselves. Embracing positive emotions but dismantling the power of negative ones. 

Quotes:

Just as there is no profit in medicine if it does not expel the diseases of the body, there is no profit in philosophy if it does not expel the diseases of the mind.
Epicurus

Tradition is not something constant but the product of a process of selection guided not by reason but by success. 
FA Hayek