Tammera J. Karr, PhD, BCHN®. CNW®, CDSP®
Pacific College of Health and Science
with Kathleen Bell, RN, MSN
Holistic Nutrition for the Whole You
During the last ten years, there has been ongoing conversation within the healthcare sector about the dangers of sitting for extended periods. The authors recently decided to explore this assertion and reviewed research with consideration for individuals who cannot stand for prolonged periods. These individuals include those with a multitude of health challenges, injuries, pregnancy and age. Foremost, when looking at research, it must be stated that correlation does not equal cause. Differing perspectives are lenses we will use frequently in this conversation. According to trendy blogs, academic sites, and media sources, people who spend prolonged periods sitting have a greater chance of developing a wide range of diseases — diabetes and deep vein thrombosis, muscle pains and cancer. Engineers and scientists have offered various solutions to combat the adverse effects of a sedentary lifestyle. One suggested solution is replacing a regular table/desk with a standing desk in schools and offices.
The Design Institute of San Diego has found evidence dating back to the Neolithic period of humans elevating themselves above the ground. The earliest known seating was the Neolithic village of Skara Brae, Scotland, dated to 3,200 BC. (HESS, 2014) Historical records support the fact that the modern chair design has been used since about 3100 BC in Egypt. By the Tang dynasty (618–907 AD), the Chinese gave up the custom of sitting on floor mats and adopted the foreign custom of sitting on chairs and stools. (Evarts, 1997–2023)
Approximately one-third of the world’s population chooses to squat while waiting, kneel or sit cross-legged on the ground while waiting, working, reading, meditating, or eating instead of employing chairs. Although cultural perspectives are ever-changing, long-standing gastronomic traditions involve slowing activity, breathing, and relaxing before, during,
and after a meal. In the ‘go-go-go-go’ current culture of North America, eating on the run is common, and the seats in cars have replaced dinner chairs at any table for many.
The authors of this paper found that popular opinions purported that standing at a desk results in higher energy expenditure were not supported by research study conclusions. In a frequently cited 2016 study titled The effects of standing desks within the school classroom: A systematic review, the conclusion reads: “Interventions utilizing standing desks in classrooms demonstrate positive effects in some key outcomes, but the evidence lacks sufficient quality and depth to make strong conclusions. Future studies using randomized control trial designs with larger samples, longer durations, sitting, standing time and academic achievement as primary outcomes, are warranted.” (Sherry, 2016)
Part One: A look at eating, standing or sitting.
Physically, standing while eating can cause blood to ‘pool’ in your legs due to gravity. Standing can also decrease blood flow to the gut, which digestion needs. As a result, digestion won’t be efficient, which can result in gas and indigestion. Similarly, moving your body directly after eating can promote faster digestion, resulting in poor nutrient absorption. When we look at modern habits, it is common for individuals to “wolf down their food” or eat quickly (without slow, relaxed breathing) while standing. Eating quickly and inadequate chewing can result in abdominal cramping or discomfort, as your stomach will require more working time to break down and digest unchewed food bites. (Berookim, 2022)
A 2019 Journal of Integrative Medicine review looked at intuitive, mindful eating (I/ME) as a mind-body practice that can maintain parasympathetic nervous system dominance (PSNS), helping to cultivate autonomic nervous system (ANS) homeostasis vital for optimal digestive function. Stress is proven to disturb gastrointestinal function; keeping your body calm and relaxed — along with dining at a leisurely pace and under conditions that promote full enjoyment of the food in front of you — supports various mechanisms to encourage proper digestion. (Cherpak, Aug. 2019)
Another review from 2023 found Intuitive and Mindful eating (I/ME) improved a multitude of important body functional markers: glucose levels among pregnant women with or without gestational diabetes, lipid profile among adults with obesity, blood pressure among overweight participants, and inflammatory markers among post-menopausal women with obesity. The positive impact of I/ME on each of these cardiometabolic parameters was not consistent across studies. Six studies were reviewed for glucose regulation; two demonstrated positive outcomes for the I/ME group, whereas four found no effect compared to the control. Three out of five studies had positive lipid effects, one out of five demonstrated systolic blood pressure (SBP) improvements, and one of two showed improved metabolic markers. (Hayashi, Benasi, & Aggarwai, Dec 2021)
The view from a Traditional Chinese Medicine (TCM) perspective is comprehensive, making no division between ‘mental health’ and ‘physical health’ and recognizing the human organism’s interlinked nature. (Clapp, 2017 Sept 15) TCM divides the human organic system differently than mainstream Western medicine, relating five main organ systems to the five elements that make up all physical substances in the Universe. These governing organs include the heart, liver, pancreas/spleen, lungs and kidneys. (Marshall, 2020)
Research has shown that gut health is intimately connected to mental well-being and overall wellness. (Lucas, 2018) TCM points to irregular eating habits, such as skipping breakfast or eating the ‘wrong’ types of foods, as problematic. Overeating, not chewing properly and/or rushing to empty your plate are causes of spleen energy weakening. Too much fat, gluten and sugar-rich food can cause energetic blockage within the digestive system, and undigested food accumulates in the bowels. The mental demands of intense brainwork in the modern workplace (for both blue and white-collar workers) impact the spleen. Whenever the spleen’s energy is out of order, digestion is affected. (Yu, 2023) An imbalanced spleen represents overthinking and worrying. Sticky stools, having to wipe more, and diarrhea are some examples. In relatively short periods of stress and worry, when a person is in good health, the spleen can recover quickly. However, during prolonged concerns: children, family troubles, money worries, career issues… in 2024’s demanding society, a lot is asked of the spleen. (Meulemans, 2024)
Dr. Sun Shen Miao of the Tang Dynasty (618-917 AD) declared that the physician should first correct the client’s eating and lifestyle patterns, and only if these changes fail to bring about the desired results should acupuncture and herbal medicine be utilized.
药 补 不 如 食 补
In a nutshell, regarding sitting or standing in relation to meals, modern research supports the view of ancient healing cultures of Asia, which encourage sitting during meals.
Part Two: The benefits of standing versus sitting.
Before the computer age of industry, the adoption of Henry Ford’s assembly line had workers routinely standing long hours. One and a half hours for a meal on the job was necessary back in the day to stand in line, purchase, or prepare food. The lengthy lunch break allowed for a much-needed pause for the body, allowing the back, legs, knees, hips and feet to rest. It was also a necessary break for the mind, especially for nurses who spent long periods on their feet and benefited mentally from the time away from the demands of nursing. (Karr & Bell, 2020) Unfortunately, these days, the long lunch break has been replaced with grabbing processed foods from vending machines, fast food franchises and high-calorie caffeine drinks, all linked to obesity and all-cause mortality. (Karr T. B., 2023)
Long periods of sitting by philosophers, yogis, priests, monks, shamans, seamstresses, tailors, educators, scholars, clerks, bankers, authors, scientists, equipment operators, and truck and cab drivers, for example, are described in historical documents. Research from 2012 launched the conversation on the health dangers of prolonged sitting, reporting a significant increase in caloric expenditure in subjects standing at a standing classroom desk compared to sitting at a standard classroom desk. (Reiff, Marlatt, & Dengel, September 2012) Retailers began marketing standing desks shortly afterward, and their popularity has continued. A study from 2018 looked at energy expenditure and mechanisms to alleviate sedentary behavior, finding that sitting-standing alternations may be an effective intervention to interrupt prolonged sitting while working. (Wang, Song, Baker, Fekete, & Gu, June 2018)
But wait a minute; a study published in 2015 showed prolonged standing at work was shown to be associated with several serious health outcomes, such as lower back and leg pain, cardiovascular problems, fatigue, discomfort and pregnancy-related health outcomes. The study authors concluded that the literature supported specific interventions that effectively reduce the hazards of prolonged standing. Suggestions included using rubber shock absorbing mats, sit-stand workstations/chairs, supportive shoes, shoe inserts, and support hosiery or stockings. (Waters, 2015)
The effectiveness of softer flooring and cushioned shoe insoles on reducing musculoskeletal discomfort amongst workers who are required to stand for prolonged periods to work, as well as the impact of factors such as age and gender in 2018, was reviewed ― with evidence found supporting the use of cushioned materials in reducing discomfort/fatigue among standing workers. (Speed, 2018) A 2022 study confirmed that rubber shock-absorbing mats tend to alleviate fatigue in the lower limbs induced by prolonged standing, optimize plantar pressure distribution, and maintain stability. (Zhang, 2022)
A study released in 2017 confirmed that the difference in energy expenditure for tasks carried out sitting compared to standing is negligible. These researchers concluded that standing instead of sitting does not produce a clinically meaningful increase in energy expenditure. (Burns, Forde, & Dockrell, November 2017) A randomized controlled trial of 46 healthy men found that a 12% difference from sitting to standing did not represent an effective strategy for treating obesity. (Betts, April 2019)
A follow-up study in 2018 on standing desks in the workplace concluded that there is currently little evidence that sit-stand desks reduce workplace sitting of short and medium-term durations. Additionally, there is no evidence of the effects of standing desks on health compared to sitting over extended periods. The quality of evidence ranks as low to very low for most interventions in the workplace regarding improving human movement or energy expenditure. (Shrestha, 2018) A comparative study from 2020 on adolescent girls standing and sorting papers sitting versus standing at a desk did not demonstrate positive metabolic health benefits in the short term. (Dockrell, Forde, & Gormley, 2020)
Back to sitting on the floor. There is a lasting tradition in many countries for sitting on the floor, but there is little scientific evidence on health from sitting on the floor. While research is limited, the benefits of sitting on the floor for the spine are significant. The lumbar lordosis is
relatively low when sitting on the floor, which is closer to our natural position and posture. (Cho, 2015) Cross-legged sitting also brings about the natural and correct curvature at the upper and lower back, stabilizing the lower back and pelvis region. (Cho M. H., 2023) Studies correlate the “ability to sit and rise from the floor without support” with a longer life expectancy. Sitting on the floor also develops musculoskeletal fitness. (Brito, 2014)
When reviewing Blue Zone information from Okinawa, individuals may go up and down from sitting positions on the floor upwards of 50 times a day. (Zones, 2024) These motions strengthen legs, hips and core muscles and improve spinal alignment, balance and spatial awareness. (Hey, 2017) The book Built to Move advocates for sitting on the floor with your legs crossed. 
Why is sitting on the floor so important? It may undo some of the effects of compensatory positions adopted by the body when sitting in a chair or couch and in a car for hours. The authors of Built to Move assert bodies are built to sit in ground-based positions. (Starrett, 2023)
For the authors, emphasis on posture was stressed at home and school. In the 1960s, sitting straight with shoulders and heads up was practiced. Movement in our youth entailed walking, climbing stairs, lifting and carrying books or medical bags, and pushing open heavy doors in hospitals and schools. However, in the 21st century, many activities formerly associated with educational and work facilities have diminished.
Solutions include setting timers to alert individuals to take movement breaks — think of the class bell notifying students that it is time to change locations. Alarms or timers can help you build the habit of rising from wherever you sit every hour for 5–10 minutes.
Learning and focus at work may require diverse postures and desk options; by utilizing sitting and standing opportunities in the work, academic and home environment, the preferences can be met based on the needs of the individual.
Utilize rubber shock-absorbing mats in areas where standing occurs for more extended periods.
Practice posture awareness. Check-in with your body—what are your neck, back, hip, feet, leg, shoulders, and arm positions? If an area is uncomfortable, change position or straighten spinal posture.
Stretching, reaching for your toes and walking around the premises will invigorate your stiff limbs.
Taking a deep breath, taking a moment to inhale and slowly exhale, does more than reduce stress; it also allows fine chest and back muscles to stretch, lubricative fluids and lymph to circulate, and the brain to oxygenate.
Limit screen time away from work or school or establish “no screen breaks.” These benefit the eyes, allowing them to change their focus range and lubricate through eye movement and blinking. Time away from a screen is more likely to include activity.
Conclusion
From a historical perspective, sitting versus standing is only one aspect of the quest for modern health. Current trends do not allow for learning diversity based on individual needs — some individuals are more focused on computation while standing or employ a blend of sitting and standing for creative composition. Research is inconclusive, with results divided regarding the influence sitting and standing have on energy and health. Additional compounding factors associated with gastronomy, gender and lifestyle appear to influence health far more than standing or sitting. How lifestyles have changed over the last four decades, increased toxicity from plastics, combined with the rapid industrial processing of everyday foods, and the apparent loss of an individual’s resiliency in managing stress are new constants in the equation that influence health in modern society. (Karr, Bell, & Guptha, Our Journey with Food 3rd edition, 2023) To assert sitting is equal to cigarette smoking and high sugar consumption is unsupportable by evidence-informed science. The additional trend supporting standing over sitting to increase energy expenditure, leading to reductions in obesity and diabetes, is equally unsupported.
* Tammera Karr and Kathleen Bell do not work for, consult, own shares in, or receive funding from any company or organization that would benefit from this article. They have disclosed no relevant affiliations beyond their academic appointment.