Monthly Archives: December 2007

Keeping Your Brain Sharp – Diabetes is a Close Cousin to Alzheimer’s!

Keeping Your Brain Sharp – Diabetes is a Close Cousin to Alzheimer’s!

Competency #

Reference: Online Journal FASEB, published August 24, William Klein, reported in Scientific American,  http://www.northwestern.edu/neurobiology/faculty/klein.html

Date:  12/07

Diabetes is like Alzheimer’s!  Wow!  I’ve not heard that before.  We have known for a while that the rate of diabetes is climbing at a terrible pace in line with our getting heavier.  And we also have known that dementia is increasing with dire predictions about the number of future citizens that will get it.  And if there is anything than motivates me to change behavior, it’s the terror of getting Alzheimer’s.  We all joke about how a nice quick heart attack sure beats 10 years in a nursing home recognizing no one around us.   I don’t want long life without quality of life.

The link?  It goes like this.  Researchers at Northwestern have found a very interesting phenomenon.  Our blood contains tiny little proteins called ADDLs (amyloid beta-derived diffusable ligands).  These are small proteins that act like hormones because they circulate around the body instead of staying put.  They are also found in the brains of Alzheimer’s patients in abundance.  No one has really known what they are doing there.  The Northwestern team found that they attach tightly to the ends of nerve cell synapses, where one nerve cell connects to another and communicate with each other.  This tight attachment prevents the nerve cells from restoring their insulin receptors by keeping them from being transported from the nerve cell body where they are made.  That blockade results in insulin resistance, which messes up glucose metabolism and keeps the memory cells from communicating with each other.  That means no new memories.  That’s Alzheimer’s characteristic problem.  Alzheimer’s may not be a problem with cell death as much as a problem of “synapse failure” and brain cell insulin resistance caused by the blockade by ADDLs, which then results in cell death.

The hypothesis put forward by the Northwestern team is that Alzheimer’s may be simply another form of diabetes.  It looks like diabetes because in the brain cells, there is the inability to take up glucose, which results in intracellular starvation. While glucose might be out there in the blood, it’s not in the cell.  That might explain why some folks have tons of plaques, but are able to think and remember just fine, but folks with persistent diabetes commonly start getting cognitive decline.

Wait a minute!  Diabetes leads to cognitive decline!  Whoa Nellie.  Well, actually, we’ve known that for several years now.  Many studies have linked our growing obesity to our increasing rate of Alzheimer’s.  It may be that both diabetes and Alzheimer’s are disorders of insulin resistance.  Alzheimer’s just targets the brain.  Regular old obesity related diabetes gets every part of your body.  That’s the emerging hypothesis.  It’s not the plaques that are causing problems, it’s the small proteins called ADDLs that block normal energy metabolism through insulin resistance.  And we can cause similar damage to our brains by becoming diabetic.  That means just by getting overweight, we contribute to injury to our brains.

WWW:  What will work for me?  I now know how the Grinch stole Christmas.  He took away my sugar.  He told me that if I ate chocolate, fruit cake, candy canes, plum pudding, eggnog, and all my left over Halloween candy, that I would get “cognitive decline”.  I am slightly insulin resistant.  It’s in my genes.  Ok, so one little itty-bitty resolution.  Just don’t buy any Trader Joe’s Truffles this year.  Last year, I bought 10 boxes, of which I only gave 8 away.  Somehow, two ended up in my own stocking.  This year, nothing but apples and coal.  If I can resist gaining one pound over the holidays, next year I will have a month less of struggle to get back to normal.  The good news, I may be able to remember the struggle!    Maybe a hike or two in all the snow isn’t such a bad idea.  Probably barefoot is better.  Then I can boast to my grandchildren….

Nutragenics

Nutragenics

Competency # 15 Vits

Reference: Scientific American, Dec 2007  Nutragenetics

It just isn’t there yet!  Can’t you imagine it?  Be a CSI and swab your cheek.  Pop it in an envelope and mail it off to a company that mails you back an answer in a couple of weeks.  Their answer will “tell you what you should eat based on your risk profile.”  Evaluate your DNA and your genes and figure out what mutations you carry so that you can tell what foods are good for you, and what might be really bad.

No doubt this is the future of medicine.  Just like Star Trek was the future of space travel.  “Beam me up, Scotty.”  But the science isn’t there yet.  There will be a time when we can predict your risk profile.  That science has started with some cancer risks.   We can evaluate some chromosome stuff with pregnancies.  The promise is fascinating and will soon be here, just not yet.

Here is how the science might work.  Scientific American’s December issue details how one gene on chromosome 1, our longest chromosome, might be a good example.  On the end of chromosome 1 is a gene for an enzyme called methylene hydrofolate reductase (MTHFR).  MTHFR breaks down a chemical called homocysteine.  In some studies, homecysteine is believed to be tied to higher risk for heart attack and stroke.  Some people get a mutation of MTHFR that is slightly less active than normal.  Their homocysteine levels are higher.   If you have that mutation, can you lower your risk for a heart attack?  Here is the clincher.  The companies involved ostensibly measure that risk and then directed to eat extra B vitamins and lower your homocysteine.  Guess how much those vitamins cost you!  Yes, hundreds of dollars a year.

You got it.  The internet has become populated with companies that promise the mystery of your DNA interpreted into valid behavior change.  These companies make amazing claims.  Too amazing.  In response, last year, the GAO (Government Accountability Office) ran a little sting.  They sent off many DNA samples from one 9 month-old baby and one unrelated adult, and made up the story about who the people were.  The answers they got back from four different internet nutragenetics companies were all obviously bogus.  For example, when two samples from the baby were sent in as two different people, the investigators got back contradictory recommendations, except for the recommendation to take lots of expensive vitamins.  What I think is a hoot is that when the investigators sent in dog or cat DNA, they did get failed results.  So, there may be some human testing going on.

What was more disingenuous was that the nutragenetics companies obviously overreached and pretended to assess bone health, insulin resistance, antioxidant activity, susceptibility to infection and heart health.  We can’t predict that reliably, even with the whole clinical picture.  Sorry, it’s just not possible yet.

There is some good science out there about genes.  Hopefully, the sour experience of these bogus companies won’t sour us on the bright future coming.

WWW:  What will work for me.  If you get an ad to swab your cheek and mail it in for a couple of hundred bucks, run.  Call your doctor and make an appointment.  Get it out of your system.  Ask your own doctor about what vitamins you need.  As for me, I’m having and apple and watching CSI tonight.   The fantasy, so far, is better than the reality.  And on CSI, the good guys always win.

The Trouble with Sweet Part 6: Fructose: America’s Most Dangerous Food

The Trouble with Sweet Part 6:  Fructose:  America’s Most Dangerous Food

Competency # 11 Sugar

Reference: Review Article, American Journal Clinical Nutrition, Nov 2007

Sugar is killing us!  Ok, ok.  It’s just a hypothesis.  But it’s the lead article in the prestigious American Journal of Clinical Nutrition.  This isn’t just a random fly-by-night new idea.  It’s in the leading journal in nutrition in the world.  That gives it heft and weight.  Yes, it’s about how we gain weight and how we end up with heart disease.  I believe this has major implications for you and me.   Here is the logic.  See if you can follow this.  The connections are all evidence based.

In 1890, only 4% of American’s were obese.  Heart attacks were rare.  High blood pressure was rare.  As our consumption of table sugar accelerated in the twentieth century, vascular disease began to appear.  Hypertension started showing up.  Cardiology was born.  Lots of cardiologists’ kids went to college on new cardiac procedures.  I learned Advanced Cardiac Life Support.  We decided heart attacks were caused by fat. We’ve barked up the wrong tree.  Sugar is the only food that’s been correlated with scientific certainty with our epidemic of obesity, and our epidemic of vascular disease.  Now, every developing country in the world is going through the same cycle along with the level of their sugar consumption.

Remember: table sugar is two “sugars” attached.  Glucose and fructose.  It’s NOT the glucose.  It’s the fructose in table sugar that’s implicated.  When we invented HFCS (high fructose corn syrup), we added another 25 pounds a year, per capita, of sugar consumption, and we got fatter along with that consumption.   We are now consuming 150 lbs a years of sugar:  75 lbs per years of fructose for each and every one of us.  Fructose is what’s in fruit, but only in tiny amounts (5-6%).  Fructose is not digested like glucose.  Your liver takes it up and burns it immediately.  There is no feedback loop to digest it slowly.  Sort of like throwing gasoline on a campfire, fructose revs up your liver cells and forces them to go into hyper drive.  It burns up all the ATP into ADP.  That’s your basic energy-supplying molecule.  When all the ATP is gone, your liver cell is in a metabolic panic and has to make triacylglycerol (the beginning of blood fats) and URIC acid.   Uric acid is the break down product of ADP metabolism.

Uric acid?  We always thought it was an innocuous chemical that caused gout in some folks.  Turns out it is a precise predictor of vascular disease.  Obese teenagers with new onset hypertension all have elevated uric acid.  Lower the uric acid and the hypertension gets better.  Have a big meal of fructose and your uric acid goes up.  If you have a big meal of fructose, your liver gets fatty.  Same thing in animals.

So what is it that uric acid does?  Here is the hypothesis.  Uric acid is a potent consumer of nitric oxide.  Nitric oxide allows your arteries to be supple and response to high blood pressure.  Without it, you have stiff, rigid arteries and you get “endothelial” dysfunction.  More than that, you get all the hallmarks of the metabolic syndrome with insulin resistance, hypertension, and weight gain.  Nitric oxide is hard to measure as it’s rapidly digested and processed.  But it’s a universal signal that you need to keep your arteries functioning.  Fructose is the beginning of the chain of events that lowers its level.

All the studies are there.  You can show that on a diet of fructose we will gain weight.  The exact same diet of glucose, we don’t.  Same thing for becoming hypertensive.  Fructose does it.   On and on.  The uric acid idea is there, and the research has been done in small studies.  Time to go big time and larger studies.  This has major implications.

It’s not the sugar per se.  It’s not the calories, per se.  It’s the forced “hyper-metabolism” your liver is forced into once you eat too much fructose.  It’s almost as if our bodies were designed to go into fat storage mode when we ate too much fructose.  Well, maybe we were.  In bygone years, when the mango tree was ripe, we were designed to gorge and that sweet taste of fructose drove us to eat till we went blind.  In that era, the mango tree was ripe for 7 days of the year.  Now, we can get fructose 24/365.

This is a major new hypothesis.  It suggests we may be able to help control hypertension and adult diabetes by way of managing uric acid.  That would be unique, and is certainly untested.  We have certainly clued into not eating sugar for quite a while.  But the ring of evidence is closing in.   And it goes through fructose to uric acid to nitric oxide into endothelial dysfunction, into hypertension, into vascular damage, into a heart attack.

What Will Work for Me:  This is the last of the series on sugar and my addiction to sweet.  And this idea strikes me as being huge.  I’m now thinking about how much sugar I eat each and every day.  I like the taste of a sweet pear, or a luscious apple (6% fructose).  Apparently the threshold of metabolism isn’t reached with eating whole foods.  It’s the rush of sugar from full sugared sodas and candies that’s the enemy (50% fructose).  Or ice cream, Danish, cookies, chocolate… it goes on and on.  But this suggests to me that if I want to lose weight and keep myself lean, I’m swimming upstream each and every time I give in to my sweet tooth.  So, I’ve created a mental image.  I have a cup of gasoline over a nice campfire.  And I think of throwing it on the flames each time I eat a sugar load.  My eyebrows got singed a couple of times today.

The Trouble with Sweet: Part 5, Sucralose, the “Yellow Stuff”

The Trouble with Sweet:  Part 5,  Sucralose, the “Yellow Stuff”

Competency # 11 Sugar

Reference: Neuroimage.  20008 Feb 15; 39(4):1559-69.

Sucralose.  Made from sugar, tastes like sugar.  End the word with –ose and that means, to us chemistry majors, that it’s a sugar.  Dextose, glucose, sucrose are all sugars.  How about sucralose.  I always assumed it was just a clever combination of here-to-fore uncombined sugars with the magic of modern chemistry.  Fool our taste buds and not absorb it.  Get sweet flavor with no cost.  I’ve purchased boxes of it at Sam’s Club.  In fact, three boxes at a time so that we didn’t have to go back so often.  I’ve carried packets of it in my pocket so that I can add it to my tea at work when there is none at work.

Whoa, Nellie.  There is another side.  Let’s start with how it was invented.  At a chemical lab in London in 1975, a graduate student, Shashikant Phadnis, was attempting to make a new insecticide.  He was adding sulfuryl-chloride to sugar solutions to attach chlorine atoms to the sugar.  DDT is a compound with multiple chlorine atoms on an organic molecule.  He was asked to “test” the new compound.  He heard, “taste”.  So, he did.  Wow! It was sweet.  1,6-dichloro-1,6-dideoxy-beta-D-fructofuranosyl-4-chloro-4-deoxy-alpha-D-galactopyranoside.  Whew.  No wonder they shortened the name to something that sounds so nice.   Sucralose.  Splendid idea.  Don’t you think?  Not even close to DDT.

The problem, in my book, is that chlorine is not attached to organic molecules in nature.  We have chloride salts all over the place.  Table salt is sodium chloride.  That’s what your blood is.  This dissolves.  But chlorine, attached directly to a carbon atom – doesn’t exist in nature.  And neither of the two sugars in sucralose are a glucose so there are no enzymes in your body that can digest them, so it isn’t digested.  This is what concerns me.  Your body attempts to digest the sugars, but can’t and finds itself with a chlorine atom introduced inside your cells.  Other “organochlorines” are chemicals with names of DDT, dieldrin, aldrin, lindane, chlordane and heptachlor (All insecticides).  How about PCBs: those are poly-chlorinated biphenyls.  Used in transformers and now banned everywhere because of their persistent chemical dangers.  The problem is that these compounds sneak into your fat cells and last many, many years.  It can take years to develop signs of toxicity.  Sucralose has been on the market less than 20 years.

How long was sucralose studied?  That’s the problem.  We don’t have any long-term studies.  You are the current lab rat.  There are ONLY 6 human studies on sucralose.  One is a case report of a single migraine patient.  The longest was a 13-week study.  The only longer unpublished study was by the drug company that went for six months, and that only reviewed the blood sugar results in diabetics.  The drug company making it says that over 100 studies show its safe.  Chase them down and you find studies like how much dental decay you get.  That’s not about long-term safety.   So, how many humans were actually involved in the short studies?  191.  Your safety is now resting on the short-term studies of 191 people.  The FDA’s final ruling on sucralose is that only 11-27% is absorbed.  Only.   Search the web.  “Everyone” says it’s safe.  Go to Whole Foods.  They don’t sell it.

http://www.wholefoodsmarket.com/wholebody/ingredients/sucralose.html

WWW.  What will work for me.   Here is my fear.  Many organochlorides have long-term toxicity.  Wellness and healthy living is about preparing my metabolism for the long, healthy haul.  I grew up in the DDT era, benefiting from its fabulous ability to protect me from malaria.  And I’ve watched bald eagles almost disappear from DDT.   I’ve seen enough massively marketed “wonderdrugs” in my career that end up being withdrawn from the market.  And with the current structure change in our FDA, I’m not confident that our societal structures are robust enough to protect me.  The secrecy and manipulation on the market place seems unfortunate.  The close chemical structure of sucralose to DDT with its inclusion of chlorine makes me intensely nervous.  In the world of the internet, I would want the FDA to put its deliberations and reasons out there for all of us to see.  And until I know about longer studies in humans, I’m going to let someone else be the lab rat.  That’s a huge change for me.  I have a box of it in my basement.  Anyone want it?

The Trouble with Sweet: Part 4: The “Blue Stuff” Aspartame

The Trouble with Sweet:  Part 4: The “Blue Stuff” Aspartame

Competency # 11 Sugar

Reference: :  Sweet Deception by Dr. Mercola

We have all been assaulted by internet mail every couple months or so that circulate around stating that aspartame is dangerous.  I have routinely deleted them, thinking that it’s all just hysteria.   I get more questions about aspartame than any other sweetener.  Many of us have switched to “The Yellow Stuff” without knowing why.  I’m trying to figure out what’s the truth about aspartame.  Here is what I have found out.

Aspartame is a combination of phenylalanine, an amino acid, aspartic acid, part of an amino acid, and methanol.(alcohol)  It was discovered by accident by a researcher trying to figure out treatments for peptic ulcer disease.  A spill on the counter top, a lick of the fingers, and aspartame was born.  The two amino acids are the building blocks of proteins, and ostensibly are part of normal metabolism.  Sounds natural, doesn’t it? Some very rare individuals have a disease whereby they cannot digest phenylalanine.  They get toxic easily, hence the warning label.  We normally eat them as part of proteins.  Everything’s just peachy so far.

Here’s the hitch.  When you eat proteins, you get those two ingredients in trace amounts and in balance with a bunch of the other amino acids in the protein.  What is unique about these two is that both phenylalanine and aspartic acid are neuro-transmitters in your brain.  They are the building blocks for the chemical signals your brain cells put out to function.    Another unique feature is that the two never ever appear in nature as a combination.  They are usually spread apart from each other, separated by many other more common amino acids.  So you body doesn’t have a means of accepting and metabolizing the two when they are directly linked.  And then there is the methanol.  That’s called wood alcohol.  It’s a poison.  People who drink it come to the ER in seizures.  The EPA says 7.8 mg a day of methanol is safe.  A diet soda contains 16 mgs.   Methanol, in your body is turned into formaldehyde, AKA dry cleaning solvent or cadaver preservative.  Sounds like CSI.

Back to brain chemistry and neurotransmission.  Aspartic acid is part of major excitatory neurotransmission pathway.   Dr. John Olney showed that MSG raised blood glutamate in the brain, and resulted in danger to newborn animals.  The field of “excito-toxicity” was born.  It’s Dr. Olney that published articles in the literature showing that the rates of brain cancer have started going up faster than other cancers after the introduction of aspartame.  One FDA trial in 320 rats indeed showed that 12 of them got brain cancer.  Then there is research published by Dr. Morando Soffritti from Bologna, Italy showing that rats get high rates of lymphomas when they eat aspartame equivalent to 4 diet sodas a day.

So the question remains, what happens with the Delaney Clause of the Food and Drug act?  Remember, that’s the clause that states a substance should be banned if there is ANY toxicity in animals.  How about humans? Well, Dr. Walton of Northeastern Ohio University tried to do a study on depressed folks and the use of aspartame.  His institutional review board stopped the study because 13 of his patients dropped out for severe reactions to the aspartame.  And interestingly enough, the NeutraSweet Company refused to cooperate in the study and made him buy his sweetener on the open market.

Do you want more?  Did you know that Air Force’s Flying Safety magazine warns pilots shouldn’t use it if they want to fly: they might get “flicker vertigo” or risk of seizures.  When a hot line got set up to report acute reactions to aspartame, over 600 pilots reported suffering some symptom or another, up to and including a grand mal seizure in a cockpit.

And for a final coup.  An experiment for yourself at home.  Set out some aspartame the next time you see an ant colony creeping into your house.  You will find it to be one of the better ant killers around.  Apparently the Delaney clause does not cover ants.  But, in 1988 over 80% of the calls made to the FDA for complaints about food were about adverse reactions to aspartame containing products.  The question arises, why no action?

Finally, there is Neotame.  It’s aspartame with a slight chemical twist on it to make it sweeter and get a different name.  But its basic backbone is aspartame.  It’s new on the market and mixed in with other sweeteners.  That’s the catch.  We are now mixing our sweeteners so that no one can get the blame when there are side effects.  Shall we start again with Neotame?  This column just can’t contain all the data.

WWW:  What will work for me.  As a long time consumer of many pounds of aspartame, I am so longer sanguine.  This has been a very sad journey for me.  I regret the bland advice I have given to all the people who have asked me is aspartame is safe.  I’m not sure we have definitive human safety studies.  But it’s banned from my house.  The blue packets are gone.  I am a scientist.  I want credible science and what I’ve found is that every independent effort by non-industry employed scientists have been ignored or subverted.  What I’ve learned makes me sad about the state of our nation’s food watchdogs.  The problem is my sweet tooth.  It’s my demand for it that makes it available and gives power to the industry that supplies it.  Well, my dollars aren’t going there anymore.  And it’s back to reading labels.  Chewing gum, soda, ……..

Next week, the yellow packet.

(Now, if you are really into intrigue about behind the scenes politics, you will find that our recent Secretary of Defense Rumsfeld swore to get aspartame approved for public use.  He was then president of a certain, not to be mentioned chemical company making the stuff.  Within weeks of Reagan getting elected, aspartame was approved.  Apparently Donald Rumsfeld has gotten us into more messes than he cares to take credit for).

** Latter Correction for this Newsletter:  I was reminded by email that I had made an error.  I quoted that aspartame put two amino acids together that do not occur together in nature.  That is apparently NOT correct.  They do appear in nature, and in some cases frequently.  Pardon the error.  That’s the wonderful thing about the internet: you can get lots of folks to help steer the ship.

 

Resistance Training: What’s That? The Battle Against Sacropenia

Resistance Training:  What’s That? The Battle Against Sacropenia

Competency # 4 Activity

Reference: (Circulation. 2007;116:572-584.) Resistance Exercise in Individuals With and Without Cardiovascular Disease: 2007 Update

I can’t learn to exercise if I don’t know the facts.  How long you live can be predicted, in part, by how well you squeeze a standard hand grip.  That’s muscle strength. Different than “aerobic capacity”, it’s muscle mass and strength.  And we use it or lose it.  Resistance training is the state of the art tool in the battle of aging decline.  In addition to walking 30 minutes every day, we need to keep our muscles.   At least preserve them.  RT is it.  Resistance Training.  And the American Heart Association just released its new recommendations.  Here’s why…

Did you know that for every two days of bedrest, the heart rate increases one beat?  Were you aware that your rate of bone loss increases 50 times with bed rest, and returns 4 times slower than the rate at which you lost it?  And did you know that for every week of complete bed rest, your muscle strength drops by 10-15%?  Within 8 hours of immobilization of a muscle in a cast or a splint, muscle fibers begin to shorten, limiting full range of motion? (Same effect as after sitting in a movie theatre for just two hours – only worse and measurable).  As we are aging and living into our 80s and 90s, we need to learn the strategies with which we can do it successfully.  Unfortunately, it doesn’t come free.  (But you can do this watching Mystery on PBS!)

Sacropenia.  That’s the dread term for muscle loss with age.  Muscles burn calories, even when they are not being used.  As we get older, we lose a pound of muscle a year, and thereby lose our internal furnace.  “I feel like I’m slowing down”.   “No matter what I eat, the calories just stay.”   Those are all secret terms for sarcopenia.  So, we move less, lose muscle and the vicious cycle gets worse and worse.

Here’s the Journal Circulation’s Table of Recommendations how to do it…

Resistance training should be performed

In a rhythmical manner at a moderate to slow controlled speed

Through a full range of motion, avoiding breathholding and straining (Valsalva maneuver) by exhaling during the contraction or exertion phase of the lift and inhaling during the relaxation phase

Alternating between upper- and lower-body work to allow for adequate rest between exercises

The initial resistance or weight load should allow for and be limited to 8–12 repetitions per set for healthy sedentary adults or 10–15 repetitions at a low level of resistance, for example, <40% of 1-RM, for older (>50–60 y of age), more frail persons, or cardiac patients

Be limited to a single set performed 2 d/wk

Involve the major muscle groups of the upper and lower extremities, eg, chest press, shoulder press, triceps extension, biceps curl, pull-down (upper back), lower-back extension, abdominal crunch/curl-up, quadriceps extension or leg press, leg curls (hamstrings), and calf raise

WWW:  What Will Work for Me?  Well.  As you know.  I’m in Planning Mode still.  That’s stage 3 on the change journey.  And I just found out about this RT stuff.  So, I can hold off and deny it a bit longer.  (Denial is Stage 1 and gives you lots of time to dodge and parry)  I have walked every day this week.  That’s a tentative start on Stage 4, Action.  Let’s see if I can keep it up.  The Harvard Men’s Health study would be proud.  Walking 30 minutes a day is one of the 5 strategies they found correlate with an 87% reduction in heart disease risk.  I don’t want to just avoid a heart attack.  I want to live to be a healthy 85 year old.  And I want you there at my 85th birthday.  So, I’ll get some weights?  Someday.  Meanwhile, the table above and the table below.

Stages of Change:  This applies to all change processes.  Weight loss, smoking cessation, exercise… (Prochaska and Norcross)

1.  Stage One:  Denial   (Pretend you never heard of it)

2.  Stage Two:  Think about it.  Grudgingly admit it may be true.

3.  Stage Three:  Plan to change.  Get some enthusiasm.  At least your attitude changes and you think it might just be a good idea.

4.  Stage Four:  ACTION.  Give it a try.  Determined.

5.  Stage Five:  FAILURE.  I think the most important stage of all.  This defines how hard it is, and your determination to learn from your lapses.  The most human stage.

6.  Stage Six:  Done.  Finished.  Move on.  It’s a new habit, a new culture.  When you see me in Spandex:  I’ll be there.