MENS SANA IN CORPORE SANO.
“A healthy mind in a healthy body.” Almost two-thousand years ago a Roman poet named Juvenal penned a list of what is desirable in life; and the first sentiment on that list gave rise to the Latin maxim above. Mankind viewed caretaking of physical health as central to the mental and spiritual well-being of an individual. More modern thinkers began to run astray after Descartes described the mind as a separate essence from the body in the seventeenth century. Descartes was merely describing different aspects of a person. But subsequent theorists and psychologists like Freud proposed an increasingly disparate distinction, which we can openly see in many people’s worldview today. One could say humanity lost its way from the eighteenth to twentieth centuries, beginning to think of the spirit and the mind and the physical being each in unconnected silos. Practical successful therapy has not affirmed any such separation. Endocrinology and neuroscience has not affirmed any such separation. Rather, the arc of humanity came back to its senses in the present day. The deeper that researchers dig, the more our modern understanding affirms Juvenal and all those who came before him. We may utilize separate terms; but the highest state of our mental and spiritual health will be best reached by curating our physical well-being. “In everything that men do the body is useful; and in all uses of the body it is of great importance to be in as high a state of physical efficiency as possible. Why, even in the process of thinking, in which the use of the body seems to be reduced to a minimum, it is matter of common knowledge that grave mistakes may often be traced to bad health. And because the body is in a bad condition, loss of memory, depression, discontent, insanity often assail the mind so violently as to drive whatever knowledge it contains clean out of it. But a sound and healthy body is a strong protection to a man, and at least there is no danger then of such a calamity happening to him through physical weakness: on the contrary, it is likely that his sound condition will serve to produce effects the opposite of those that arise from bad condition. And surely a man of sense would submit to anything to obtain the effects that are the opposite of those mentioned.” - Socrates In the fifth century BC, the Greek military strategist and historian Xenophon recorded this account of Socrates in the third chapter of Memorabilia. In the fitness industry, many people have quoted a preceding section of the same chapter as a way to showcase the renowned philosopher’s endorsement of exercise. Indeed it is. But the chapter as a whole is far more than that. Look closely at the closing statement: a sensible person would submit to anything to avoid mental and physical deterioration. Anything. Anything. This year, presenters at the 2023 summit for the American College of Cardiology and the World Congress of Cardiology are arguing that 8% of deaths are attributable to lack of sleep. Low sleep quality raises risk of cardiac event by nearly 70%. The findings are not even yet published, but based on 172,321 people who participated in the National Health Interview Survey between 2013 and 2018, conducted by the CDC and National Center for Health Statistics. Though as of yet unpublished, these claims mimic prior published research indicating that insomnia and sleep disturbance rank among the top risks for heart attack [1.] For at least twenty-five hundred years we have known humans need sleep and humans need movement. These are two of the least provocative and least contentious sentences in health and wellness. They are so undoubted that they extend far beyond expert consensus to total unanimity. They are boring, really. But the questions of “how much?”, “how to implement?”, and “why?” open a broader discussion. That is where the interest lies. And that is where we must focus. The autonomic nervous system governs our expression of sympathetic and parasympathetic response. Otherwise known as fight-or-flight versus rest-and-digest, this relationship is tied quite tightly to risk of all-cause-mortality. Simply, during stress, heart rate rises and heart rate variability lowers. During rest, heart rate lowers and heart rate variability rises. Even modest decreases in sleep end up placing the body in greater sympathetic response THE ENTIRE DAY [2]. As such, we see contemporary studies this year finding that a single night of sleep deprivation ages the brain faster [3]. Essentially, when we persistently get low quality and short sleep, we consistently run the autonomic nervous system in sympathetic governance. There is absolutely nothing wrong with stress inherently, briefly. As Socrates said, we should attend to our fitness. Sympathetic response (as the reader will soon discover in the discussion on exercise) is part of a healthy life when accompanied by physical expression. When we need to fight or flee, absolutely we ought to do so. We ought to be able to do so. For a short duration. In fact, the short intense intentional stress of exercise appears to help bring about a subsequent parasympathetic counter-response in a symbiotic relationship covered below. In part, short intentional sympathetic response allows adenosine to tell the brain it is tired and ready for the wind down [9]. However, without sufficient sleep, by definition, we are in prolonged sympathetic agitation and unable to get all the benefits of repair and flourish from parasympathetic activation. “A peaceful heart leads to a healthy body.” - Proverbs 14:30 Years ago, studies on shortened telomeres in traumatized children gave us a clue. Unsurprisingly, then, researchers at Bar-Ilan University published findings in Nature in 2019 showing that sleep reduced DNA damage [4]. Now, the depth of this may not strike readers immediately. However, what we are talking about is slowing or reversing aging itself. What we are talking about is reducing cancer incidence. When we talk DNA damage or DNA resilience, we are talking the basis of progress and regress, growth and death, abundance or dearth. Whether we are discussing general stress, the accumulated cell damage we term “aging”, the accumulated errant cell proliferation we call “cancer,” or really any other negative experience in cell function, the crux of the matter rests firmly on chromosomal dynamics and DNA degradation. How we defend cells and rebuild health rests, quite literally, on rest. This is a significant problem, because the modern person sleeps less than in any prior period of human history. Historians and sleep researchers agree that it was entirely normal for adults, even peasants, to sleep nine to twelve hours per day regularly. Generally, they broke daily sleep into two periods, not one, which helps. Now, we can blame our single bout of sleep. We can blame the change on the incandescent lightbulb, as its widespread use aligns well with the historical timeline shift in human sleep loss. We can blame it on the Industrial Revolution and expectations of certain labor hours. And we can certainly have the discussion over blue light and work-life balance at some point. But where we lay the cultural, technological, or historical blame leaves us little workable solution anyway. None of us are totally revising the forward march of technology and modernity. Rather, we have an even bigger attached problem to address. We do not even get as much sleep as we think we do. A demographic-population-matched study of over two-thousand participants showed that, while people think they get a little over seven hours of sleep on average, they get closer to six [5]. Even our incorrect overestimate is too little. But our actual behavior is possibly half or less than half of what we genuinely need and historically used to get. It should come as no surprise. And it takes little leap of imagination or logic to see the connections to prevalence of disease, depression, and simply the overwhelming popularity of broken spirits in the world. Without adequate sleep, life is lived less vibrantly. And we can readily see the consequences of eight to ten generations in a row of increasingly sleep-deprived populations. Weight-loss studies gave us another clue to the stark divide between under-rested and adequately-rested people some time ago, as even when we account for energy/calorie matching, people who sleep more lose more of the weight from fat tissue than people who sleep less (and, therefore, lose a greater percent of weight from healthy tissue) [6, 7]. And this is not merely an observational conclusion. It turns out that the mechanism is known and understood. We are continuously making new cells. We first make progenitor cells, which will become the replacement to the old cells of whatever types we replace. When we are under-slept, under-rested, and over-stressed, the percent of the progenitor cells which become adipocytes (new fat cells) goes up a lot [8]. It is a sobering finding, showing us that sleep loss incurs measurable injury to hormonal functioning and the actual cellular life cycle within us. Juvenal and Socrates and Solomon and researchers are in agreement: to heal our spirit, we must heal our bodies. For this, sleep is clearly critical and low-hanging fruit. We could view it as the “yin,” so to speak; and, if so, then movement or exercise is the “yang” to our total wellness. Frankly, neither one exists well without the other. In terms of implementation, people struggle dearly when they endeavor to approach improvement in one and not the other. That is, there is ample evidence that exercise improves sleep [9]. Yet people with better sleep are more likely to exercise [10]. We can unpack those chicken-and-egg sequences, debate which should precede which until the cows come home, and really get nowhere fast. Fundamentally, we are not likely to make any headway until we embrace them as two halves of a whole, concurrently accessible, necessarily concurrent. Tribal societies, ancient cultures, and classical education models did not separate athletic expression from mental and spiritual pursuits. Like our reduced sleep, it is a very modern invention to think of the human condition as capable of its potential with reduced movement. Without exercise, we live smaller. 2008 might have been a crushing year for financial markets globally; but it was a banner year for exercise physiology for all mankind for all of time. The first myokine was identified, solidifying the theory that skeletal muscle is a hormonal/endocrine organ. Researchers at McMaster University provided powerful evidence that very short but intense bouts of exercise provide more/equal benefits to that of very lengthy exercise. And Dr. John J. Ratey, MD published the book, Spark: The Revolutionary New Science Of Exercise And The Brain. In Spark, Ratey exposed readers to some of the most recent neuroscience findings regarding exercise while repeatedly referencing the Naperville school district as an applied proof-of-concept case study. Essentially, cortisol crosses the blood-brain barrier, opening up pathways for neural damage, immune inadequacy or dysregulation, cognitive deterioration, emotional downturn, and all of the neurodegenerative diseases. One protection is BDNF (brain-derived neurotrophic factor). Exercise is uniquely positioned to express BDNF. Literally, exercise makes us better in just about every way. It is pretty cut-and-dried, not a lot of controversy. Ratey added that Naperville has been far ahead of the curve with integrating athletics of an incredibly broad selection into their academic emphasis; and Naperville alone is the only place in America in about four decades which has been able to rank in international math and science testing versus Asian countries. Spark was great. Ratey was not wrong. But science has unpacked a lot more since 2008. Namely, intense effort is superior at BDNF expression [11]. Although Ratey was mostly convinced in the benefit of aerobic exercise, intense effort is king. We have since found that lifting to limit a weight that is 70% or even 90% of an individual’s 1-rep maximum causes significant rises in BDNF long after the exercise session is over [12]. This, of course, does not mean that people should exert at an unsafe effort or in an unsafe manner. Rather, relative to their personal ability, they should work up to intensities which are high for them. And, as we already covered above, adequate sleep must exist in order to be able to operate at intense physical levels. Each reinforces the other, in kind, over time, and a greater synergy between sympathetic and parasympathetic expression may reign. The brain-protective benefit is clear. The sleep benefit is clear. The progress benefit is clear. In conjunction, the yin and yang of sleep and exercise support and gird up one another, allowing the individual to explore his or her full potential. With intentional movement and improved sleep hygiene, cardiologists say we reduce our risk of heart attack. Geneticists say we reduce DNA damage. Neurologists say we improve our ratio of sympathetic to parasympathetic response. Socrates might say we have our strongest protection for our minds. And Juvenal said, MENS SANA IN CORPORE SANO. 1.) Sofi F, Cesari F, Casini A, Macchi C, Abbate R, Gensini GF. Insomnia and risk of cardiovascular disease: a meta-analysis. Eur J Prev Cardiol. 2014 Jan;21(1):57-64. doi: 10.1177/2047487312460020. Epub 2012 Aug 31. PMID: 22942213. 2.) Castro-Diehl C, Diez Roux AV, Redline S, Seeman T, McKinley P, Sloan R, Shea S. Sleep Duration and Quality in Relation to Autonomic Nervous System Measures: The Multi-Ethnic Study of Atherosclerosis (MESA). Sleep. 2016 Nov 1;39(11):1927-1940. doi: 10.5665/sleep.6218. PMID: 27568797; PMCID: PMC5070747. 3.) Chu C, Holst SC, Elmenhorst EM, Foerges AL, Li C, Lange D, Hennecke E, Baur DM, Beer S, Hoffstaedter F, Knudsen GM, Aeschbach D, Bauer A, Landolt HP, Elmenhorst D. Total sleep deprivation increases brain age prediction reversibly in multi-site samples of young healthy adults. J Neurosci. 2023 Feb 20:JN-RM-0790-22. doi: 10.1523/JNEUROSCI.0790-22.2023. Epub ahead of print. PMID: 36804738. 4.) Zada, D., Bronshtein, I., Lerer-Goldshtein, T. et al. Sleep increases chromosome dynamics to enable reduction of accumulating DNA damage in single neurons. Nat Commun 10, 895 (2019). https://doi.org/10.1038/s41467-019-08806-w 5.) Silva GE, Goodwin JL, Sherrill DL, Arnold JL, Bootzin RR, Smith T, Walsleben JA, Baldwin CM, Quan SF. Relationship between reported and measured sleep times: the sleep heart health study (SHHS). J Clin Sleep Med. 2007 Oct 15;3(6):622-30. PMID: 17993045; PMCID: PMC2045712. 6.) Xuewen Wang, Joshua R Sparks, Kimberly P Bowyer, Shawn D Youngstedt, Influence of sleep restriction on weight loss outcomes associated with caloric restriction, Sleep, Volume 41, Issue 5, May 2018, zsy027, https://doi.org/10.1093/sleep/zsy027 7.) Nedeltcheva AV, Kilkus JM, Imperial J, Schoeller DA, Penev PD. Insufficient sleep undermines dietary efforts to reduce adiposity. Ann Intern Med. 2010 Oct 5;153(7):435-41. doi: 10.7326/0003-4819-153-7-201010050-00006. PMID: 20921542; PMCID: PMC2951287. 8.) Bahrami-Nejad Z, Zhao ML, Tholen S, Hunerdosse D, Tkach KE, van Schie S, Chung M, Teruel MN. A Transcriptional Circuit Filters Oscillating Circadian Hormonal Inputs to Regulate Fat Cell Differentiation. Cell Metab. 2018 Apr 3;27(4):854-868.e8. doi: 10.1016/j.cmet.2018.03.012. PMID: 29617644; PMCID: PMC5889123. 9.) Banno M, Harada Y, Taniguchi M, Tobita R, Tsujimoto H, Tsujimoto Y, Kataoka Y, Noda A. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. 2018 Jul 11;6:e5172. doi: 10.7717/peerj.5172. PMID: 30018855; PMCID: PMC6045928. 10.) Baron KG, Reid KJ, Zee PC. Exercise to improve sleep in insomnia: exploration of the bidirectional effects. J Clin Sleep Med. 2013 Aug 15;9(8):819-24. doi: 10.5664/jcsm.2930. PMID: 23946713; PMCID: PMC3716674. 11.) Gibbons TD, Cotter JD, Ainslie PN, Abraham WC, Mockett BG, Campbell HA, Jones EMW, Jenkins EJ, Thomas KN. Fasting for 20 h does not affect exercise-induced increases in circulating BDNF in humans. J Physiol. 2023 Jan 11. doi: 10.1113/JP283582. Epub ahead of print. PMID: 36631068. 12.) Church DD, Hoffman JR, Mangine GT, Jajtner AR, Townsend JR, Beyer KS, Wang R, La Monica MB, Fukuda DH, Stout JR. Comparison of high-intensity vs. high-volume resistance training on the BDNF response to exercise. J Appl Physiol (1985). 2016 Jul 1;121(1):123-8. doi: 10.1152/japplphysiol.00233.2016. Epub 2016 May 26. PMID: 27231312.
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