Cheers!

This is High on Health. Your essential companion for navigating the ever-changing skies of healthcare, innovation, and wellbeing.

I've been on the road (or, more accurately, in the air ✈️) again this week - from Berlin to New York to Cleveland and back! 🌍 Needless to say, the first snow this year completely surprised everyone at the Berlin airport, and the "de-icing procedure" ¹ caused a significant delay right from the start. Ah, the joys of travel, right? ❄️ 😅

On the bright side, the kids were thrilled about the early snow this year! It's all a matter of perspective, after all. And the best part of the snowy and cold weather is that the Christmas markets (link for Berlin) are now open! This means the perfect atmosphere for mulled wine and roasted chestnuts. 🎄🍷🌰

Of course, I couldn't resist exploring the root causes and weather phenomena and learning about arctic oscillation and polar vortex 🌀. I'm a geek for this kind of nerdy stuff. 😎

Building on last week's theme of gratitude for personal connections that enrich our lives, I had a chance to encounter a colleague in the hotel elevator and then share a wonderful dinner. I also had a catch-up breakfast with a close, long-time friend in New York and joined an amazing team dinner that included our BCG X crew, the client, and the co-creation hospital team. It's these moments that truly enrich life, sandwiched between the hustle and bustle of work. 🛗 🤝 🍽️

And, oh, we've been talking a lot about jet lag and the toll of long-haul flights on our wellbeing. 🛫😴 It's something many of us can relate to, right? I've got my set of jetlag hacks, but I'm diving back into the science to bring you more. 🔍 Eager to hear your tips too, so drop a comment, and let's swap travel wellness secrets! ✨

Here's to healthier travels and connections!

Take care!

PS: In case you were wondering, the washing machine is still broken, and we eagerly await the service team's repair. On Saturday, I went to a laundromat... 👕🧺🕰️

¹ De-icing solution is often a combination of water and propylene glycol, heated to approximately 65°C/150 °F, and sprayed under pressure onto the wings of an aircraft. It provides protection for about 22 minutes, so an additional application might be required if there are any delays in takeoff.

This airline says it’s figured out how to reduce jet lag

Jet Lag: Your Guide to Sound Sleep After Travel

Interventions to Minimize Jet Lag After Westward and Eastward Flight

Jet Lag: Your In-Flight Challenge

Are you planning to travel eastwards or westwards? Will you sleep on the plane or stay awake? Would you like to have a drink or snack, or prefer not to? Whether it's a vacation or a business trip, jetlag can be a major challenge. It leaves you feeling exhausted and disoriented, with symptoms that resemble a hangover (without the fun part). Almost everyone has experienced it at some point. This week, we will take a closer look at this phenomenon and explore ways to combat it. So, join us as we delve deeper into the topic. 🛫

As we prepare to delve into the world of jet lag, remember: fasten your seatbelts, stow your baggage, and put your seats and table trays upright. Keep this device on, though – you've got a newsletter to finish! ✈️

Jet Lag: What’s the Big Deal?

Travel has become much easier thanks to advancements in transportation, but it comes at a cost. Long-distance journeys, such as flying from Frankfurt to San Francisco, can disrupt our internal clocks due to crossing time zones. This leads to jet lag, which can cause symptoms like sleep issues, fatigue, and decreased focus. Jet lag can affect travelers and flight crews who regularly cross multiple time zones. Although north-south flights generally do not cause jet lag, transmeridian travel can impact well-being. 🛫🕒💤 

Jet lag is a complex condition that varies widely among individuals and even across different flights. Common symptoms experienced after crossing over three or more time zones include digestive issues, appetite changes 🍽️, mood swings such as anxiety and irritability 😟, as well as dips in physical and mental performance 🧠. Sleep disturbances are a classic sign of jet lag, with difficulty falling asleep or waking up early, depending on the flight direction.

It can be difficult to distinguish jet lag symptoms from general travel fatigue¹ . Helpful tools like the Liverpool Jet Lag Index can be used to identify the differences, particularly when the time zone shift is only 1-2 hours.

The Science Behind Jet Lag

Jet lag's got three main culprits: our natural 24-hour day/night cycle 🌞🌜, super-fast planes ✈️, and our own internal body clocks 🕰️.

1. The natural time system is based on the 24-hour rotation of the earth, which creates day and night. The world is divided into 24 time zones, each spanning 15 degrees longitude. However, time zones often follow country borders rather than strict lines of longitude. Moving eastward speeds up time while moving westward turns back the clock.

2. Aircraft speed also contributes to jet lag. Modern planes can cross time zones quickly, but our internal clocks can't keep up. To make the case, flying from Hamburg to Anchorage takes 10 hours, but time-wise, it can feel like you never left. This mismatch leaves our inner timekeeper baffled.

3. Finally, our internal clock, which regulates sleep, hunger, and hormones, is also responsible for jet lag. When we travel across different time zones, our body's 24-hour rhythm gets disrupted. It's not just about feeling sleepy at noon or hungry at breakfast; it's a range of off-sync feelings. Adjusting to a new time zone takes time, and it can stretch over days or even weeks as our body slowly aligns with the local time.

Jet Lag: A Personal Story

The time it takes to recover from jet lag varies greatly among individuals and is influenced by the direction of travel and the number of time zones crossed. The recovery time can differ from person to person.

Some people, known as "fast adapters," can adjust their body clocks in just a few days. Others, referred to as "slow adapters," may require two weeks or more. ⚡️⏳

Evening types and younger individuals with less stable circadian rhythms tend to adapt more quickly. On the other hand, morning people, older adults, and individuals with more stable rhythms may take longer to adjust after traveling across different time zones.

Our bodies have a network of biological clocks that regulate important functions such as hormone release and body temperature. The master of these clocks is the suprachiasmatic nucleus (SCN) in the brain, which synchronizes our sleep-wake cycles and other circadian rhythms. The SCN releases the sleep hormone melatonin in response to changes in light detected by the optic nerves – less light means more melatonin and a sleepier you.

Jet lag can disrupt this system, especially when crossing multiple time zones, particularly eastward. Your body's clock may struggle to adjust quickly, leading to sleepless nights and disrupted biological functions. This includes increased stress hormones causing irritability, higher blood pressure, irregular appetite, and disruption of melatonin release, which can affect your overall health.

Overcoming jet lag is difficult, as our circadian clock is slightly longer than 24 hours. We tend to adjust better to flying from east to west (phase delay) than from west to east (phase advance). Sleep quality is also affected by body temperature fluctuations during sleep. Jet lag symptoms are at their worst when you wake up at your body's minimum temperature.

Jet lag is a complex phenomenon involving various biological and environmental factors, with individual experiences differing based on internal rhythms and travel specifics.

Overcoming Jet Lag: Strategies and Tips

Jet lag can be a difficult problem to solve quickly, but researchers Charmane I. Eastman and Helen J. Burgess have offered practical strategies to help combat it. They recommend gradually adjusting your body's rhythms before traveling.

One effective tip they suggest is using a light box to simulate sunlight, which can help phase-advance your rhythms for west-to-east trips. This involves going to bed and waking up earlier. Conversely, for east-to-west journeys, you should stay up later and use the light box at your regular bedtime. Since living through winters in Berlin, I have owned this one.

Another tip they suggest is taking melatonin supplements. For west-to-east travel, take 0.5 mg of melatonin about four and a half hours before your new bedtime, gradually increasing the daily dose. The process is reversed for east-to-west travel, with melatonin intake aligned with the later bedtime.

Both light exposure and melatonin should be used as part of a personalized plan, which apps like Timeshifter can aid.

Andre’s personal toolkit

After years of frequent travel, I have developed tools to manage jetlag. Here are practical tips to use before, during, and after your flight.

Before the flight

• Plan your trip: It may sound trivial, but planning your trip in advance can make a huge difference. Make sure to

  • arrange your transportation to and from the airport,

  • check-in online before arriving,

  • avoid checking in luggage if you can,

  • pack all your travel documents and necessities, such as chargers, converter plugs, and power banks,

  • select a preferred seat in advance so you can travel comfortably (isle for easily getting out of your seat and away from the lavatories for less disturbances).

• Good night's sleep the day before traveling: Ensure you are well-rested before your trip. Traveling can be stressful, and being in a well-balanced and rested state can help you deal with any unexpected situations that may arise.

• Proper travel attire: Traveling in uncomfortable clothes can be a hassle. When I first started traveling for work, I used to look down on people who wore their pajamas on the plane. However, I have realized the importance of comfortable clothing while traveling. I prefer to wear stretchy or baggy travel pants, merino wool long sleeves, a down vest, and compression recovery socks. They make a huge difference in preventing swollen feet and provide a general positive impact. I wear older versions of Skins, but there are many options. Trust me, you'll thank me later.

During the flight

• Hydration: Whenever someone offers me water, I always accept it. Additionally, before take-off, I ask the flight attendant for an extra bottle in advance so as not to “inconvenience” them later. As mentioned earlier, the dry atmosphere inside an aircraft can cause dehydration, so staying hydrated is important. However, drinking a lot of water also means you have to get up and go to the restroom, which allows you to move around.

• Stay active: I make it a point to move regularly throughout the flight. Whether taking a short stroll, chatting with co-travelers, or doing some stretching, I ensure that I don't just sit in my chair for extended periods.

• Avoiding alcohol, out-of-sync caffeine, and heavy meals: Over time, I have become more lenient with my strictness regarding my food and drink intake while flying. However, I still remain mindful of my consumption. For instance, I only have one glass of wine at an appropriate time of day, and I only drink coffee if it doesn't interfere with my schedule. I have experimented with my food intake in the past, and there have been times when I wouldn't eat any catered food, even on a 9-hour flight. Nowadays, I am more relaxed in my approach, but I still make sure only to eat until I am 80% full and avoid heavy foods that can cause bloating.

• Noise-cancelling headphones or customized earplugs: Huge game-changer! I love listening to podcasts and audiobooks and watching my favorite downloaded movies or shows. The advancements in audio technology over the years have been remarkable, and the well-known brands and models all perform exceptionally well. If you're looking for some "silence" in your life, I highly recommend investing in customized earplugs. Simply visit an audiologist or hearing aid dispenser, have impressions of your ears taken, and request earplugs with pressure compensation. Trust me, it's worth it!

After the flight

• Freshen up: Ideally, after a long-haul flight, I prefer to transfer to the hotel and change into my business attire. However, if this is not possible, I often head to the arrival lounge at the airport to freshen up and at least put on a shirt to appear presentable. Those who know me well will understand that I am not always the most formal dresser, but I try to make an effort when necessary.

• Light workout: After a long flight, I will try to exercise. I prefer an outdoor workout such as an easy run, but if it's impossible, I will do some mobility work, stretching, yoga, or a moderate bodyweight workout. The crucial thing here is to avoid overdoing it.

• Blend in: I try to adjust to new time zones quickly when I travel. If I fly west, I stay up until my normal bedtime, even if it means staying awake for more hours than usual and then go to sleep. On the other hand, when I travel east, I go to bed earlier. In most cases, I set an alarm to make sure I get enough sleep. I also avoid drinking an extra glass of wine the first evening after arrival, as I know it can disrupt my sleep patterns.

There is a long list of things I have tried and tested over the years. I've read the research, talked to performance coaches who work with professional sports teams and designed their travel details. Some of those things have worked for me, while others haven't done much for me.

Someone once told me to disinfect my seatbelt and tray before touching them. This was before the pandemic. Yeah, I won’t do that since I believe exposure to some germs can strengthen my immune system in the long run.

I hope this information was helpful to you and, as always, I would love to hear your thoughts and comments!

¹ Feeling drained after a long flight is often travel fatigue, not jet lag. It’s caused by the physical toll of travel, like dehydration in dry airplane cabins and discomfort from prolonged sitting. Unlike jet lag, which disrupts your circadian rhythm, travel fatigue usually fades after some good rest without the lingering effects on your internal clock.

Charlie Munger, an investing legend, believed in the power of never-ending learning. His steadfast commitment to continuously expanding his knowledge and understanding has shaped his remarkable career and serves as a shining example for those seeking growth in business and personal life. Munger's dedication to learning illuminates the path to success, reminding us of the endless possibilities that arise when we open ourselves to new ideas and knowledge.

You know, I'm a big advocate of physical activity and I'm pleased that its benefits can be supported by science.

A recent study published in the European Journal of Preventive Cardiology suggests that maintaining high fitness levels can significantly reduce the risk of mortality due to cardiovascular disease in men with high blood pressure. The study, led by Professor Jari Laukkanen of the University of Eastern Finland, is the first to examine the combined effects of fitness and blood pressure on the risk of cardiovascular mortality.

Some key points from the study include the following:

• The study examined 2,280 men aged between 42 and 61 from eastern Finland, with baseline measurements taken between 1984 and 1989.

• Blood pressure and cardiorespiratory fitness were measured, with blood pressure categorized as normal or high and fitness as low, medium, or high.

• During the 29-year follow-up, 644 cardiovascular deaths were recorded.

• The study revealed that high blood pressure increased the risk of cardiovascular death by 39%, while low fitness levels raised this risk by 74%.

• Men with high blood pressure and low fitness faced over double the risk of cardiovascular death compared to those with normal blood pressure and high fitness.

• High fitness levels somewhat reduced, but did not eliminate, the increased cardiovascular mortality risk in men with high blood pressure.

• The study underscores the importance of controlling blood pressure, improving fitness through regular physical activity, and maintaining a healthy body weight.

• The study supports ESC guidelines recommending 150 to 300 minutes per week of moderate-intensity or 75 to 150 minutes per week of vigorous-intensity aerobic physical activity for adults to reduce the risks of death and illness from cardiovascular causes.

ShaktiMat - the acupressure mat

Having a history of back pain from years of competitive sports, I've tried numerous devices, treatments, and remedies to alleviate my discomfort. Through this extensive search, I've discovered the ShaktiMat acupressure mat, which stands out as one of the best, if not the best, solution I've found.

The ShaktiMat acupressure mat is designed to support the body naturally in relaxation and stress relief, proving to be a cost-effective and therapeutic solution. The mat is particularly effective for various conditions, including tension-related back pain, stress-induced insomnia, chronic stress, fatigue, and general body tension. I even use it during meditation sessions like Yoga Nidra.

The mat has more than 6,210 plastic tips that simulate acupuncture by improving blood circulation and triggering endorphin release. Honestly, it can be uncomfortable at first, but it becomes much more comfortable and pleasant after the initial minute.

In summary, the ShaktiMat acupressure mat offers a natural way to support the body's self-healing process, making it an indispensable tool for anyone seeking relief from chronic back pain and tension, as well as an aid in meditation and relaxation practices.

There are many different manufacturers out there, but ShaktiMat claims to be the original. By purchasing from them, you are supporting a strong social cause. Check them out!

I would like to provide an update on my ongoing runner transformation. As always, I am prototyping and experimenting with different formats. Please let me know what type of content you would prefer to see.

My primary aim is to hold myself accountable and perhaps motivate others. Any support is greatly appreciated!

DISCLAIMER: None of this (such as text, graphics, images, and other materials) is medical or health advice. This newsletter is strictly for informational, educational, and entertaining purposes only. While I’m a medical doctor and a dentist by training, I’m not your doctor. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on high on health! Please be careful and do your own research.