The Chair-Cursed Body
How Do Chairs Kill?
Humans were not designed to sit. Being crammed into a chair all day long is as unnatural as eating all day long. It seemed logical that sitting would be associated with illness, but I needed to prove it. To topple The Chairman, Professor Smallbrain and Dr. Micromind, I needed help—I need the Cricketers’ Brain Trust.
The Cricketers’ Brain Trust is one of the world’s leading scientific groups in diabetes research. Its members, Yogish Kudva, Andy Basu, Chinmay Manohar and their boss, Rita Basu, work at Mayo Clinic.
Yogish, or Dr. Brain, is a living encyclopedia on diabetes and pretty much everything else. He remembers facts, names and scientific papers, often from decades before. If Wikipedia ever goes bust, Yogish can replace it. Andy, intense, mustached and penetrating, is the Hercule Poirot of treating adult-type diabetes. Chinmay is a young technological genius. In a few hours, he can throw together a few microchips and create a working technology. In meetings he might say barely eight words, but each one is patentable. Finally, there is Rita, who controls “the boys” with the power of a Roman charioteer and the intellect of Ruth Bader Ginsburg.
The members of the Cricketers’ Brain Trust know diabetes. Hypothesizing that the chair might be partially to blame for an epidemic of diabetes1 running riot across the developed world, they wanted to perform experiments to prove their idea. So they called a meeting.
Yogish began. He explained that after a meal, a person’s blood sugar climbs to mountainous levels. It peaks after about 60 minutes and then declines for the next few hours. The body handles this spike in blood sugar in part by having the body make more insulin, which pushes the sugar into the “stand and walk” muscles of the thighs, buttocks and trunk. Yogish reeled off the names of genes that function in the individual muscle cells to handle the extra insulin and blood sugar. Most had names that are easily forgotten—GLUT4, FABP1 and so on. He saw me glazing over and said, “Jim, look, it’s simple! When you eat a meal, your blood sugar shoots up, your pancreas pushes out insulin and the insulin drives the meal’s sugar into the muscle.”
Andy could see I was still lost. He stroked his mustache and summarized: “Basically, when you eat, the pancreas squirts out insulin, so that the muscles and other vital organs get the glucose they need. Any sugar left over gets converted into fat.”
Chinmay smiled, adding, “That’s what we think is wrong with sitting; if you sit, you do not use your meal sugar and so you get diabetes.”
Yogish joined in, explaining that the body is designed to activate dozens of systems (he started to list them) so that when you eat the food, fuel is made available to the individual muscle cells and organs that need it. This fuel-delivery system, he explained, is designed to allow the body to be continuously active after eating.
I thought back to when I worked in Jamaica and the Ivory Coast, where workers ate breakfast at dawn and labored all morning in the fields. They then took a break for lunch and afterward returned to manual work. It made sense—the food you eat needs to be delivered to the muscle to be used for active work. If you spend the afternoon sitting in front of your computer, the fuel is unused and so ends up as fat.
Andy said what I was thinking: “The trouble is, Jim, nowadays everyone eats but no one physically works their body afterward.”
Yogish bumped the table excitedly. His voice was getting louder. “Jim, all of the cells and molecular mechanisms are built on the premise that the body moves all the time because we work physically. That’s the whole problem; today we eat three meals, sit all day and are not physical at all. The cellular engines were never built to sit. When we sit all the day, the surplus fuel is washing around the bloodstream like a massive oil slick in the ocean.”
Chinmay added, “That’s why we think a third of the population has elevated blood sugar, called prediabetes, and one in ten adults actually has diabetes.” I waited for him to say something else, but he was silent.
Andy spoke. “If you sit all day long and all of the muscle engines are idle, and the surplus blood sugar fills the bloodstream, what do you think happens next?” He paused. “Diabetes.”
Yogish added passionately, “The American Diabetes Association defines prediabetes as a blood sugar above 100 and below 126 milligrams per deciliter. Seventy-nine million Americans have prediabetes. Two-thirds of people with prediabetes go on to develop full-blown diabetes within ten years.” He paused. “Diabetes is an elevated blood sugar equal [to] or above 126 and 26 million people have diabetes, mostly adult-type diabetes. Every year there are 2 million new cases of diabetes diagnosed. For every two people diagnosed with diabetes, there is someone else who has it but does not know. The annual cost of diabetes is $6,700 per person.”2
The more I thought about the cause of diabetes, the more I understood why the Cricketers’ Brain Trust wanted to study sitting. Because most of us are sedentary all day, our blood sugar rises hugely after each meal. Our sedentary muscle cells never use the sugar we consume; instead, it swirls around the bloodstream. The body tries to fight this by making more insulin to suppress the elevated blood sugar. But then, after constant overexposure to high levels of insulin, the body becomes insensitive to it. The mixture of high blood sugar and high blood insulin is diabetes. The huge spikes in blood glucose after each meal would not occur if people moved after they ate, just as we’re designed to do.
Rita stepped in. “We need to do some studies, to get data,” she said. We all looked to her. Andy brushed his mustache. “It would be fascinating,” he suggested, “to meticulously measure the mountainous climbs of blood sugar after each meal and then see what happens if somebody walks after their meal like they used to do.” Yogish interjected, “We could perform complex mathematics to examine whether walking after a meal can lower the elevations of blood glucose and potentially prevent diabetes. The trouble is,” he concluded, “we need a technology that can measure blood sugar and nonexercise-NEAT activity every second before and after a meal.” All eyes fell on Chinmay. He smiled. “We can do that.”
A year later, the studies were published.3 Blood sugar and NEAT movements were measured continuously every second before and after volunteers consumed meals. The data were irrefutable and startling. If people sit after a meal, their blood sugar peaks like a mountain for about two hours. If, however, people take a 15-minute walk at 1 mph after a meal, the mountains become safe, gentle, rolling hills. With a 1-mph walk after a meal, blood sugar peaks are halved. Looking at the data was life changing. People can lower their high blood sugar after a meal simply by taking a short walk after they eat. The day I saw the data was the day I changed. Whether it’s breakfast, lunch or dinner—after every meal, I take a short NEAT walk, usually for 15 minutes. The Cricketers’ Brain Trust had discovered why the chair causes diabetes.
Food is fuel. We consume food to propel the body. If you sit instead, mountain-high blood sugar values result. With chair addiction on the rise, no wonder diabetes rates are predicted to double.
The Australians Come to Town
Just as the Cricketers’ Brain Trust was publishing its data in 2012, I went to a meeting hosted by a furniture company called Ergotron. Ergotron was getting into the NEAT business, building standing desks. It had convened an international panel to learn more about the sitting disease. I paced at the back of the room and listened to the lectures; my presentation was not until the end of the day.
Throughout the day, I noticed a young sandy-haired man watching me. At the afternoon coffee break, he tapped me on the shoulder. “I’m giving the presentation after yours,” he said. Professor David Duncan was from the Baker IDI Heart and Diabetes Institute in Australia. His team had addressed the issue of diabetes and sedentariness in a different way. It had taken a group of people who are normally active and imposed a chair sentence on them. The people were made to sit for days on end. The team discovered that the more these people sat, the worse their blood sugars became. However, intermittently moving could dramatically improve blood sugar values. His conclusion was the same as that of the Cricketers’ Brain Trust: Sitting causes diabetes. David said, “Create opportunities within your waking hours to limit sitting time.” He went on to explain that for every hour you sit watching television or listening to a lecture, your life expectancy decreases by 22 minutes.4 By the time his lecture finished, the entire audience was slowly pacing up and down the room.5
The plot was about to get thicker. Enter Professor Mark Hamilton, a physiologist from Louisiana who looks more like a choirboy. Although he is a superb scientist, what intrigues me about Mark is his fervor. He had conducted some unusual experiments. In one he’d taken rats and raised their hind legs in a harness. These animals existed quite happily without having to carry most of their own weight. It was an animal model of sedentary living. He discovered that these rats were prone to very high levels of triglycerides, one of the components of the cholesterol system. These high triglycerides were associated with the rats’ sluggishness, hardening of the arteries and diabetes.6 Mark also measured thousands of genes from their muscles—sedentariness was associated with multiple gene changes in the muscle cells (the same ones that Yogish pointed out contributed to diabetes). The evidence was accumulating: Fundamental changes in biology occur if you sit for too long.
Mark later conducted studies in humans rather similar to the Australian group. He would bring people into his research center and make them sit all day long. Repeatedly sampling their blood, he examined what happened to the cholesterol system if you force a person to become chairbound. The data were astounding. Even in people with well-controlled cholesterol, he saw values of triglycerides rise so high as to be associated with cardiovascular disease.7 At the same time, data were coming in from epidemiologists from around the world. For example, Japanese scientists found that the less you walk, the worse your cholesterol panel.8 Swedish scientists showed that the more you sit, the progressively greater your risk of a heart attack.9 Dutch scientists found that sedentariness was associated with stiffening arteries.10 German scientists demonstrated that excessive sitting softens the skeleton.11 The evidence base was deepening. One study from Sydney looked at 22,497 Australian adults. People who sat 11 hours or more per day had a 40 percent greater risk of premature death than people who sat for four hours or less. Sitting accounted for 7 percent of all premature deaths.12 It was clear that the chair sentence extends beyond obesity; if you sit too long, diabetes, osteoporosis, heart disease and early death follow.
Added to diabetes, obesity and heart disease came new culprits of the chair sentence. Cancers of the breast, colon, lung and endometrium,13 depression, hypertension, back pain and poor sleep quality were associated with prolonged sitting. And it’s not subtle—for example, regardless of a woman’s body weight, strolling for an hour a day reduces breast cancer risk by 14 percent, compared with being sedentary.14
A few years ago, I heard Mark Hamilton lecture in Miami; he showed the classic image of the Marlboro Cowboy astride his horse. Sitting is more dangerous than smoking, he explained. Professor Steven Blair was also at this meeting. One of the masters of the exercise revolution, he explained that 18 percent of the population smokes and smokers get lung cancer, cardiovascular disease and asthma; nonsmokers, 82 percent of the population, don’t get smoking illnesses. Professor Blair went on to explain that more than three-quarters of Americans sit all day long. Therefore, the total population risks associated with sitting, when you add them all up, are far greater than the risks associated with smoking. I had been quoted in the press as saying, “Sitting is the new smoking.” I was wrong; if you look at America as a whole, sitting is worse than smoking!
You might have thought that going to the gym protects you from lethal sitting. If you are one of the 15 percent of Americans who belongs to a gym, I have something eye-opening to tell you. Going to the gym, even several times a week, does not reverse the harmful effects of prolonged sitting. Dr. Emma Wilmot at the University of Leicester explained. “People convince themselves they are living a healthy lifestyle, doing their 30 minutes of exercise a day. But they need to think about the other 23.5 hours.”15 People who go to the gym do not reverse the health impact of prolonged sitting.16 Even if you go to the gym, excessive sitting kills.
Lastly, it does not matter what age you are; chair-sentenced elderly are less able to manage the tasks of daily living compared to more active peers.17
Although it is a good sound bite—“Sitting is the new
smoking”—the concept is important. Knowledge about sitting disease has grown exponentially with about 10,000 scientific publications in the last 15 years. Leading experts agree that sitting actually causes more ill health than smoking. The chair sentence affects people of all ages, both sexes and from multiple countries. The ill effects of sitting, the chair disease, are a shopping list of misery.
Think of the size of the anti-smoking lobby, the campaigns against smoking, the funds invested in stop-smoking programs and the catalogs of anti-smoking legislation. Where is the anti-chair lobby and stand-not-sit legislation? Up until now, there has not been a movement to reverse the chair sentence, although government bodies are beginning to hear the call; Australia, Europe, the United States and Canada all in the last few years formally recognized the harm of prolonged sitting.18
Get up! You can prevent prediabetes from becoming diabetes and prehypertension from becoming hypertension. Sitters die sooner—for every hour you sit, two hours of life walk away!
Quiz
Here is the ABC of illnesses associated with excessive sitting. Without looking ahead at the question that follows, please read through this list with care. When you are done, read the question.
Harmful Effects of Sitting
A—Arthritis
B—Blood pressure, back pain
C—Cancer, cholesterol problems
D—Diabetes, dementia
E—Emphysema, exacerbation of asthma
F—Fat gain
G—Gestational diabetes
H—Heart attack
I—Immobility, isolation, infertility, impaired glucose metabolism
J—Joint aches
K—Kyphosis of back, kidney problems
L—Loneliness, leg swelling
N—Nutricide (death caused by poor nutrition), nerve entrapment (e.g., carpal tunnel)
O—Obesity, obstructive sleep apnea, osteoporosis
P—Poor productivity, Potts disease
Q—Quality of life
R—Relationship problems
S—Stigmatization, sedentary minds,
swollen ankles, sexual dysfunction
T—Trapped feeling, tendonitis
U—Underachiever, unhappiness
V—Varicose veins
W—Wasted opportunities
X—X-rated angst and impaired performance
Y—Yearning for something better
Z—Zest
Here’s the question: You have just read through a list of the ills associated with sitting. Are you still sitting down?