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Thanks Gopakumar Nair and Gopikrishnan Mukundan for the questionWhy is Kerala ranked as the most morbid state in India by the National Sample Survey (NSO) 2019? What can be done to overcome this crisis?Well, there is a mistake in the terminology. It's not unhealthiest, rather it's the state with the highest morbidity. Though morbidity and sickness/ill-health is close by terminologies, unhealthy as such in this case is a wrong terminology. Infact, it's just a few weeks back, Kerala declared as the HEALTHIEST STATES in India by Niti AyogKerala is India’s healthiest state; UP, Odisha worst: Niti Aayog | India News - Times of IndiaWhy Kerala is India’s healthiest stateThe concept of study taken by Niti Ayog and NSO are of different levels. Niti Ayog’s study was based more on a qualitative approach, ie the level of existence of sound health infrastructure and frequency of its usage by people. On the contrary NSO’s study was a quantitative study on the percentage of people seeking hospital services.If you look NSO study, the key highlights as followsThe key areas of NSO’s study as followsMorbidity, nature of ailments, treatment-seeking behaviour- Ailments prevailing during a specified period- Hospitalization during a specified periodAverage medical expenditure- per spell of ailment experienced- per case of hospitalization excluding childbirth casesMaternity and childbirth: details of care, place of birth and expenditurePopulation aged 60 and above: living arrangement and mobilityImmunisation of childrenThe entire study focuses on how many people approach a medical facility identifying themself as a sick person (naturally, a healthy, fit person needs not to go to the hospital). It's based on the hospital’s POV, the study is conducted.One key terminology used is to identify the number of Proportion of Persons that Responded as Ailing (PPRA)It defines the proportion of persons that responded as ailing (PPRA) in a 15-day period as the ‘estimated number of persons in the population reported ailing’ as a proportion of ‘estimated total population’ obtained on the basis of the survey data. The proportion was expressed as a percentage.PPRA = 100 × (Estimated no. of persons in population reported as ailing ÷ Estimated population)So in a 15 day study period, they check, how many people came to a hospital facility/medical facility identifying them as sick/ill patient.And there is no suprising, Kerala has the highest PPRA, with almost 24.5% reporting PPRA in the study period, while at the national level, its just 7.5%. Just to understand, only 4.3% of the population of Karnataka (estimated, not absolute) actually went to the hospital seeking treatment for their illness, while 24.5% of Malayalees went to Kerala hospital for treatment.Another indices in this survey are Number of people treated in-patient in last one year. The figures are quoted on per 1000 people basisIf you look, Kerala ranks highest across India. Almost 105 people out of 1000 people seek hospital services and admit themself for treatment. In percentage terms, its 10.5% of the total population. The next in rank is for Lakshadweep where 5.7% of its people admit them in hospital for treatment (we can consider Lakshadweep as quasi Malayalees as they speak Malayalam and have mostly Malayalee sensibilities in every way).On the contrary, the nearby states, say TN reports only 3.3%, while Karnataka reports only 2.9%.But did you notice one thing- the third in this position is actually Tripura with 5.5%. I will explain this in detail in later part.Well, is the data suprising?No!!!Why?Because when you call best in health care index, it actually means people using health care facilities and treating even the minor ailments professionally and curing it, rather hiding it.If one checks Niti Ayog’s data as well as other data, Kerala has the highest out—pocket medical expenditure on per capita basis among Indian states.Kerala spends maximum ‘out of pocket’ on healthcare - ET HealthWorldAs per last reports (2015 data), an average Malayalee spends Rs 244 in rural areas while around Rs 275 in Urban Areas per month for medical purposes.In another figure published by Govt of India in 2015, the following data can be seenIn per capita basis, approx 5023 Rs is spent by Public as out-of-the-pocket expenditure for healthcare, while in many states like TN etc, the expenditure is half of Kerala. Only Punjab stands somewhere close to Kerala.That explains one thing which is well known in Kerala Health circles for a long time. Kerala has a unique medical condition called HIGH MORBIDITY-LOW MORTALITY condition. Why low Mortality? Because when you have healthcare facilities, people use it and get their illness cured. It won’t be kept within.The figures arise because people report their illness, rather keeping it private. The first step to cure an illness is to acknowledge that one is sick or suffers from an ailment. In many states I have been too, people tend to hide it or don't acknowledge it.I remember, one of my neighbours' daughter in Chennai used to have skin excema. But they never acknowledged that (my mom happened to see accidentally one day when that girl’s skirts lifted slightly up). They never went to any hospital as such, as the aunt used to say, its normal and can be cured with some ointments and home remedies, which obviously won’t work for sure. But that's somewhat the mentality of many people. Why go to hospitals for many illnesses? Many try to manage at home.This is not seen much in Kerala. Even for a mild fever, people rush to the hospital which is manageable with home remedies. Last day I was having dry cough and I went to the hospital for it, which is definitely not a serious, but a social habit.There was a study done by Dr.Thejus TJ, Dr. Jeeja MC, Dr. Jayakrishnan T for KSSP project and presented in a medical conference. As per their study, the second most common reason for Morbidity was due to infectious diseases like Fever, Infection, diarrhoea etc. Kerala has made rapid progress in reduction of these infections morbidity from 77% in 1996 to 21% by 2006 which is radical progressBut the biggest factor of Morbidity is actually- NON INFECTIOUS COMMUNICABLE DISEASESThe biggest of lot are Hyper-tension, followed by Diabetics, Asthma, Cardiology and Cancer.If you look, most of these morbidities is part of lifestyle changes as experienced in any industrially advanced western countriesHospitalization trendsKerala is a bit unique when comes to hospitalization. There is a case of over-utilization of the facility in Kerala and the state records highest hospitalization rates across India as per an analytical study conducted in 2004 and published by Havard Medical School in 2018.As per Havard Medical review, the probability of getting admitted in a hospital in Kerala is nearly 10% of total visits to the doctor, while its only 4% in TN which is the second-highest.https://www.globalhealthdelivery.org/files/ghd/files/ghd-042_kerala_as_a_positive_outlier_2018_09_05.pdfNow the reasons for these two conditionsThe higher number of Hospitals: Kerala has one of the country’s largest number of hospitals. As the number of hospitals and medical care facilities is highest, it often encourages people to take medical help even for the mildest issue.Literacy awareness:- Social and literacy make people extremely aware of the seriousness of medical issues and conditions which forces them to take medical help even for smaller cases. One better example is the case of Dengue. Dengue is a very common disease in Western ghats region due to abundance of water sources and a strong eco-system that pushes a lot of mosquitoes to push this diseases. If we look, in 2017, Kerala had 19,973 dengue cases out of which we recorded only 37 deaths (meaning mortality rate was 0.1%) while Maharashtra reported only 7442 dengue cases, but recorded 41 deaths (mortality rate was 0.5%). The higher degree of mortality happened in MH even though less number of cases (primarily because only 1/4th of MH has Western Ghats eco-system, rest are Deccan Plateau) because of less literacy and social awareness. Dengue is not that life-threatening disease and it can be cured if medications did in advance, which rarely happens in many states where hospitalizations happen at last stageHigher rural hospitals: In India, private hospitals is more of an Urban affair while the so-called tertiary hospitals are more metro centric. This means rural folk often end up very much under-equipped PHCs or clinics or even often scrupulous practitioners. I still remember my days in Lamba Jatan near Jodhpur where my senior professor had a cardiac arrest and we had to travel nearly 20 KMs to reach Mertha town to get some sort of medical help. What's more surprising, that fairly large town which had few hospitals didn't have any hospital with fairly equipped ICU etc, so after some basic aid and ventilation support, he was taken in an ambulance to Jodhpur, almost a 3-hour ride. This is not very specific to Rajasthan case, rather very much Pan India as our rural areas and tier 3/4 towns lack serious medical facilities. This is very contrary in Kerala, where every small town and village mostly have equipped hospitals and medical facilities. Even the so-called backward Wayanad has its own tertiary hospital brought up by international company- Aster. Take a very rural area like Kattappana in Idukki, much comparable to Mertha or similar towns, the town itself has more than 10 multi-speciality hospitals including 2 tertiary hospitals with all major facilities. I have been to St.Johns in Kattappana recently and quite surprised to see a very premium large hospital in that very rural town, heavily patronized even by people across the border. When you have such a higher number of medical facilities, people automatically get used to such facilities. This increases the number of people recorded as patients.Communicable diseases: Though the numbers have declined in last couple of decades, Kerala has its own fair share of communicable diseases like Dengue, Chikungunya, typhoid, regular fever etc, because of its tropical environment. Its hard to resist these diseases in such an environment, so the numbers are larger and as people report these diseases in hospitals, it increases the number.Lifestyle diseases: In recent years, the biggest factor of morbidity is the increase in lifestyle diseases, particularly diabetics, Hypertension, cardiac arrests and now more serious- CANCER. As Kerala’s prosperity increased in the last 30 years, the higher income pushed for massive consumption trends, altering the lifestyle of people in a big way. Bakery foods, regular consumption of junk/restaurant food, increased alcohol consumption of IMFLs by switching from traditional toddy drinks, smoking all pushed serious health issues in public. Diabetics are the worst among all, as 1 in every 5 Kerala citizens have this condition which needs regular medical attention. So as now cancer rates are also increasing. The lifestyle changes, massive import of food from other places, heavy urbanization all factors for these medical conditions which is commonly seen in most of the western countries as prosperity also brings a new set of problems. We are number 1 when comes to all these kind of illness too, fuelled by our set of Number 1 wrong habits.Accident rate: Kerala is one among the top 5 states that report road accidents. Approx 31,611 people have been injured in road accidents just last year, ie 2018. Approx 1 Lakh people have been injured in the last 3 years. This means, there will be a larger number of trauma/casualty/medical facilities across Kerala to cater to these rising numbers.Traditional Habit: One thing I noted among Malayalees is that we often highlight our sickness and illness more often than our healthiness. If we ask someone- how are you, the answer would be- somehow surviving (Angene okke pokkunnu) or otherwise- living without any major illness (Asukam illathe pokkunnu). Malayalees always highlight even minor illness they face as the biggest illness in the world. My aunt has some minor swelling in her feet (primarily due to her age which is common), but the way she says it to others as if she is having some sort of cancer or deadly diseases. If anyone watches Malayalam movies, it's common to see older people sitting and discussing their back pains or leg pains, massaging themself with some ayurvedic oils etc which is a perfect depiction of Kerala’s social psyche. Historically and culturally, we are always trained to highlight our illness, even the pettiest one as if life-threatening. Its because of this attitude, we rush to a doctor or ayurvedic physicians even for very minor ailments, which otherwise can be treated with some in-home remedies. Such attitudes are lower among the rest of the Indians.The high cost of nursing/home support: One reason why most of the people rush to hospitals even for small illness is that our social system doesn’t support much of cheaper at-home care. We don’t get cheaper maids or home cleaners easily (getting an engineer in easy in Kerala, but getting a house-maid is as difficult as scouting for an astronaut) to do home chores. It's so expensive to get a home-nurse (also serious issue of trust and reliability factors exists) and lack of traditional home-care systems as seen in many other states. So many middle-aged/elderly people rush to the hospital as soon as they find some illness as they fear, in case if they fall down, getting help would be seriously difficult. I often have seen, even in cities like Mumbai or Ahmedabad, elderly people get very cheaper maids or care-takers etc (sometimes provided by community organizations etc) and they don’t worry much on their health conditions. Here in Kerala, that inner fear of no-one there to support makes the elderly to seek medical help to ensure, they always stand on feet.Government support: The Govt of Kerala focuses much of its attention always on two things- Education and Healthcare. Approx 6% of Kerala’s GDP is earmarked for public healthcare, the highest among all major states of India. Kerala Govt constantly work on promoting public health care, thus you always see only increase in the number of PHCs, Family clinics, ambulatory services, hospitals etc. Infact, last UDF govt even made a ridiculous decision of having one medical college in every single district (ie one govt tertiary medical facility in every district) which is so ambitious (above all the financial capabilities of the state) which got partially roll backed once LDF came to power due to financial limitations. But still, a lot of hospitals, subsidized pharma and other medical care are coming up. Kerala has invested a lot in community medicine (one key reason why the deadly Nipah outbreak could be controlled due to extensive medical investigations of the source), thus a lot of interactions between medical fraternity-public happens on day to day basis which is an enabler to use medical facilities for any minor illness.Wide-spread of low-priced missionary healthcare: One key difference between Kerala’s healthcare model from the rest of India’s that, ours is heavily decentralized and mostly works in an evangelistic fashion. Almost 1/3rd of Kerala’s healthcare facilities are primarily missionary hospitals (both Christian, Hindu and even few Islamic organizations). Infact, within the private sector, almost half of these hospitals are missionary ones which aren’t strictly meant for profit-making. This results in lower medical bills in the private sector compared to the rest of India (as noted in this NSO survey as Keralites pay lesser Private medical bills than the rest of India). The presence of corporate hospitals in Kerala is very low, so we don’t have cases of extremely high medical bills generating facilities. For example, consultation charge in Lissy Hospital (one of the biggest tertiary medical facility in Kochi) is just Rs 50, while in the nearby corporate Aster Medcity, its around Rs 300. As the medical bill is lower, even for smaller illness, people rush even to these missionary private hospitals.These are some of the reasons why Kerala experiences a high morbidity rate. In a way, its good as regular medical check-ups and hospital going also helped Malayalees to increase their life expectancy. An average Malayalee’s life expectancy is 75 years old, almost 3 years ahead than average American and 6 years ahead than fellow Indians. So definitely its not that bad….I am not saying, its all prefect in Kerala. There is a lot to be done. Better waste management, better disease control mechanisms, better environmental protection and more sustainable preventive healthcare can make things better than the current curative model.For detailed readinghttp://www.mospi.gov.in/sites/default/files/publication_reports/KI_Health_75th_Final.pdfhttps://www.researchgate.net/publication/259382012_Morbidity_and_health_Care_expenditure_in_Keralahttps://kerala.gov.in/documents/10180/2926ef37-1cff-452b-83f3-69473c1a7707https://cdn.downtoearth.org.in/pdf/NHP-2018.pdfhttps://mohfw.gov.in/sites/default/files/National%20Health%20Accounts%20Estimates%20Report%202014-15.pdfHow Kerala's robust healthcare system helped avert crises during the floodsBest Place to Be a Kid: Kerala District’s Healthcare Model Can Match Any Developed Nation!

TL;DR - Yes and you should if you can and have time. The positive effects are many and include: increasing lifespan, increasing HGH (human growth hormone), increasing hypertrophy (muscle growth), increasing red blood cell count (and in turn, endurance, improved insulin sensitivity.As John points out below - drink a lot of water, so as to not become dehydrated.---So what sort of gains can you anticipate?One study demonstrated that a 30-minute sauna session two times a week for three weeks POST-workout increased the time that it took for study participants to run until exhaustion by 32% compared to baseline.4The Effects of Hyperthermic Conditioning on Muscle Hypertrophy (Growth)Exercise can induce muscular hypertrophy. Heat induces muscular hypertrophy. Both of these together synergize to induce hyper-hypertrophy.Here are a few of the basics of how muscle hypertrophy works: muscle hypertrophy involves both the increase in the size of muscle cells and, perhaps unsurprisingly, an accompanying increase in strength. Skeletal muscle cells do contain stem cells that are able to increase the number of muscle cells (called “hyperplasia”) but hypertrophy instead generally involves an increase in size rather than number.So what determines whether your muscle cells are growing or shrinking (atrophying)?A shift in the protein synthesis-to-degradation ratio…and an applied workload on the muscle tissue (of course). That’s it.At any given time your muscles are performing a balancing act between NEW protein synthesis and degradation of existing proteins. The important thing is your net protein synthesis, and not strictly the amount of new protein synthesis occurring. Protein degradation occurs both during muscle use and disuse. This is where hyperthermic conditioning shines: heat acclimation reduces the amount of protein degradation occurring and as a result it increases net protein synthesis and, thus muscle hypertrophy. Hyperthermic conditioning is known to increase muscle hypertrophy by increasing net protein synthesis through three important mechanisms:Induction of heat shock proteins. 89Robust induction of growth hormone.1Improved insulin sensitivity. 10...Heat Stress Triggers Heat Shock Proteins That Prevent Protein DegradationOxidative stress is a major source of protein degradation....Heat shock proteins (or HSPs), as the name implies, are induced by heat and are a prime example of hormesis. Intermittent exposure to heat induces a hormetic response (a protective stress response), which promotes the expression of a gene called heat shock factor 1 and subsequently HSPs involved in stress resistance.HSPs can prevent damage by directly scavenging free radicals and also by supporting cellular antioxidant capacity through its effects on maintaining glutathione.8,9HSPs can repair misfolded, damaged proteins thereby ensuring proteins have their proper structure and function.8,9Okay, let’s take a step back from the underlying mechanisms and look at the big picture of heat acclimation in the context of increasing muscle hypertrophy:It has been shown that a 30-minute intermittent hyperthermic treatment at 41°C (105.8°F) in rats induced a robust expression of heat shock proteins (including HSP32, HSP25, and HSP72) in muscle and, importantly, this correlated with 30% more muscle regrowth than a control group during the seven days subsequent to a week of immobilization.8Heat Stress Triggers A Massive Release of Growth Hormone...Another way in which hyperthermic conditioning can be used to increase anabolism is through a massive induction of growth hormone. 1415, 1 Many of the anabolic effects of growth hormone are primarily mediated by IGF-1, which is synthesized (mainly in the liver but also in skeletal muscle and other tissues) in response to growth hormone. There are two important mechanisms by which IGF-1 promotes the growth of skeletal muscle:It Increases protein synthesis via activation of the mTOR pathway. 16It decreases protein degradation via inhibition of the FOXO pathway.16...In fact, growth hormone administration to endurance athletes for four weeks has been shown to decrease muscle protein oxidation (a biomarker for oxidative stress) and degradation by 50%. 19My point is good news. You don’t need to take exogenous growth hormone. Sauna use can cause a robust release in growth hormone, which varies according to time, temperature, and frequency.1,15For example, two 20-minute sauna sessions at 80°C (176°F) separated by a 30-minute cooling period elevated growth hormone levels two-fold over baseline.1,15 Whereas, two 15-minute sauna sessions at 100°C (212°F) dry heat separated by a 30-minute cooling period resulted in a five-fold increase in growth hormone.1,15 However, what’s perhaps more amazing is that repeated exposure to whole-body, intermittent hyperthermia (hyperthermic conditioning) through sauna use has an even more profound effect on boosting growth hormone immediately afterward: two one-hour sauna sessions a day at 80°C (176°F) dry heat (okay, this is a bit extreme) for 7 days was shown to increase growth hormone by 16-fold on the third day.14 The growth hormone effects generally persist for a couple of hours post-sauna.1 It is also important to note that when hyperthermia and exercise are combined, they induce a synergistic increase in growth hormone. 20Increased Insulin SensitivityInsulin is an endocrine hormone that primarily regulates glucose homeostasis, particularly by promoting the uptake of glucose into muscle and adipose tissue. In addition, insulin also plays a role in protein metabolism, albeit to a lesser degree than IGF-1. Insulin regulates protein metabolism in skeletal muscle by the two following mechanisms:It increases protein synthesis by stimulating the uptake of amino acids (particularly BCAAs) into skeletal muscle. 21It decreases protein degradation through inhibition of the proteasome, which is a protein complex inside cells that is largely responsible for the degradation of most cellular proteins. 22In humans, there is more evidence indicating that the major anabolic effects of insulin on skeletal muscle are due to its inhibitory action on protein degradation....For this reason, hyperthermic conditioning may also lend itself to promoting muscle growth by improving insulin sensitivity and decreasing muscle protein catabolism. Intermittent hyperthermia has been demonstrated to reduce insulin resistance in an obese diabetic mouse model. Insulin resistant diabetic mice were subjected to 30 minutes of hyperthermic treatment, three times a week for twelve weeks.This resulted in a 31% decrease in insulin levels and a significant reduction in blood glucose levels, suggesting re-sensitization to insulin.10The hyperthermic treatment specifically targeted the skeletal muscle by increasing the expression of a type of transporter known as GLUT 4, which is responsible for the transporting of glucose into skeletal muscle from the bloodstream. Decreased glucose uptake by skeletal muscle is one of the mechanisms that leads to insulin resistance.-------------------------------------------------------------.:CONCLUSION:.To recap and drive the point home: acclimating your body to heat stress by intermittent whole-body hyperthermia via sauna use (“hyperthermic conditioning”) has been shown to:Enhance endurance by:Increasing nutrient delivery to muscles thereby reducing the depletion of glycogen stores.Reducing heart rate and reducing core temperature during workload.Increase muscle hypertrophy by preventing protein degradation through the following three means:Induction of heat shock proteins and a hormetic response (which has also been shown to increase longevity in lower organisms).Cause a massive release of growth hormone.Improving insulin sensitivity.Hyperthermic conditioning also has robust positive effects on the brain:Increases the storage and release of norepinephrine, which improves attention and focus.Increases prolactin, which causes your brain to function faster by enhancing myelination and helps to repair damaged neurons.Increases BDNF, which causes the growth of new brain cells, improves the ability for you to retain new information, and ameliorates certain types of depression and anxiety.Causes a robust increase in dynorphin, which results in your body becoming more sensitive to the ensuing endorphins.How long should you go in the Sauna? Well, the studies seem to show that hotter and longer is generally better, but realistic number for most people that should provide most of the benefits is:30-minute sauna session two times per week for three weeks POST-workout to start seeing the benefits (as hot as you can reasonably tolerate).Start slow - most people can't make it 30 minutes on the first few attempts. And that older guy in the corner who has been in there longer - don't try to keep up with him - he's probably been coming to the sauna for 20 years!Life is stressful.When you exercise, you are forcing your body to become more resilient to stress (somewhat paradoxically) through stress itself.Hyperthermic conditioning is a novel and possibly effective tool that can improve your resistance to the sort of stress associated with fitness pursuits as well as some that are not traditionally associated with fitness such as the protective effects of HSPs on various types of stress. That being said, deliberately applied physical stress, whether heat stress or ordinary exercise, is something that requires caution.You shouldn’t avoid it altogether, but you should use good common sense, not overwhelm yourself, and make sure to know your limits. (NOTE: you should not drink alcohol before or during sauna use as it increases the risk of death). Personal variation probably comes into play when finding your own sweet spot for building thermal tolerance while avoiding over-extending yourself.I believe that hyperthermic conditioning in general may be worth a closer look as a tool in the toolbox of athletes. Perhaps it can be used for much more than just relaxation?But no matter how enthusiastic you might be, remember:Heat responsibly and with someone else, never alone.Never heat yourself while drunk, and friends don’t let friends sauna drunk.If you are pregnant or have any medical condition, saunas are not for you. Speak with your doctor before starting this or any regimen involving physical stressors.Be careful, ladies and gents.ABOUT THE AUTHOR: Dr. Rhonda PatrickYou can find more video and writing from Dr. Rhonda Patrick at her website, FoundMyFitness.com.NOTE: This is a summary of a fantastically detailed article from Tim Ferriss' blog, which can be found in it's entirety here:Are Saunas the Next Big Performance-Enhancing “Drug”?References:Hannuksela, M. L. & Ellahham, S. Benefits and risks of sauna bathing. The American journal of medicine 110, 118-126 (2001). This is actually an important review article that covers some of the benefits of sauna use including the cardiovascular advantages and hormonal changes such as the boost in GH levels. I also like it because it covers some of the risks of alcohol use before or during the sauna. [↩]Ricardo J. S. Costa, M. J. C., Jonathan P. Moore & Neil P. Walsh. Heat acclimation responses of an ultra-endurance running group preparing for hot desert-based competition. European Journal of Sport Science, 1-11 (2011). The sample sizes in both studies referenced here and in #4 have small sample sizes but they are two independent studies that compliment each other. This study also reinforces the endurance enhancements in #5. [↩]King, D. S., Costill, D. L., Fink, W. J., Hargreaves, M. & Fielding, R. A. Muscle metabolism during exercise in the heat in unacclimatized and acclimatized humans. J Appl Physiol 59, 1350-1354 (1985). This study shows that glycogen utilization is decreased in runners after heat acclimation. The sample size is small but ref #7 (another small sample) is an independent study that shows the same effect. [↩]Scoon, G. S., Hopkins, W. G., Mayhew, S. & Cotter, J. D. Effect of post-exercise sauna bathing on the endurance performance of competitive male runners. Journal of science and medicine in sport / Sports Medicine Australia 10, 259-262, doi:10.1016/j.jsams.2006.06.009 (2007). This study shows the effect of preconditioning the body to heat stress by using a sauna for at least 30 min directly after after training session. While the study sample is small, other studies referenced in #2, #5 reinforce and compliment this. I also have some anecdotal data. I did some serious experimentation with the sauna a couple of years ago when I had access to a sauna. I would sit in the sauna for up to 60 min. until I pushed myself to extreme physical discomfort about 4-5 times a week. I substantially (and I know this is just anecdote) increased my running PRs. [↩]Michael N. Sawka, C. B. W., Kent B. Pandolf. Thermoregulatory Responses to Acute Exercise-Heat Stress and Heat Acclimation. Handbook of Physiology, Environmental Physiology (2011). This is a good review article that covers many of the mechanisms that underly the endurance enhancements as a consequence of heat acclimation. [↩]Garrett, A. T., Creasy, R., Rehrer, N. J., Patterson, M. J. & Cotter, J. D. Effectiveness of short-term heat acclimation for highly trained athletes. European journal of applied physiology 112, 1827-1837, doi:10.1007/s00421-011-2153-3 (2012). [↩]Kirwan, J. P. et al. Substrate utilization in leg muscle of men after heat acclimation. J Appl Physiol (1985) 63, 31-35 (1987). The findings in this study reinforce the data in ref #3. Both small sample sizes but multiple studies showing the same effect makes the argument stronger. [↩]Selsby, J. T. et al. Intermittent hyperthermia enhances skeletal muscle regrowth and attenuates oxidative damage following reloading. J Appl Physiol (1985) 102, 1702-1707, doi:10.1152/japplphysiol.00722.2006 (2007). This is an important paper because it shows that intermittent hyperthermia can enhance the regrowth of skeletal muscle in rats after disuse via induction of heat shock proteins. Having a quantitative way to non-invasively measure muscle mass in humans is difficult. Even though the experiment was done in rats (N=40) this is a good study because it also shows mechanism. [↩]Naito, H. et al. Heat stress attenuates skeletal muscle atrophy in hindlimb-unweighted rats. J Appl Physiol 88, 359-363 (2000). This study demonstrates that HSP induction by intermittent hyperthermia in rats can prevent muscle atrophy during muscle disuse. Again, this study was in rats but it shows mechanism has has a good sample size (N=40). [↩]Kokura, S. et al. Whole body hyperthermia improves obesity-induced insulin resistance in diabetic mice. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group 23, 259-265, doi:10.1080/02656730601176824 (2007). This study was done in mice (N=20) but it demonstrates a very important mechanistic finding that hyperthermia increases the expression of glucose transporters in skeletal muscle, thus improving insulin sensitivity. Exercise (which elevates core body temp.) is known to improve insulin sensitivity. This is a cool mechanism by which this can occur. [↩]Yamada, P. M., Amorim, F. T., Moseley, P., Robergs, R. & Schneider, S. M. Effect of heat acclimation on heat shock protein 72 and interleukin-10 in humans. J Appl Physiol (1985) 103, 1196-1204, doi:10.1152/japplphysiol.00242.2007 (2007). This study includes a relatively small human sample size (N=12) but it is a very important because it demonstrates that heat acclimation causes a higher induction of heat shock proteins upon later exercise. This is the fundamental concept behind hyperthermic conditioning. [↩]Moseley, P. L. Heat shock proteins and heat adaptation of the whole organism. J Appl Physiol (1985) 83, 1413-1417 (1997). This is a review article that explains some of the functions of HSPs and reinforces the data from reference #11 demonstrating that heat acclimation can increase the expression of HSPs. [↩]Kuennen, M. et al. Thermotolerance and heat acclimation may share a common mechanism in humans. American journal of physiology. Regulatory, integrative and comparative physiology 301, R524-533, doi:10.1152/ajpregu.00039.2011 (2011). This study is another small human sample size (N=8) but it reinforces the data from ref #11 because it demonstrates that some of the positive effects of heat acclimation are due to increased expression of HSPs. The study even shows specificity here by administering an HSP inhibitor, which ameliorates the positive effects of heat acclimation. [↩]Leppaluoto, J. et al. Endocrine effects of repeated sauna bathing. Acta physiologica Scandinavica 128, 467-470, doi:10.1111/j.1748-1716.1986.tb08000.x (1986). This is a very important study because it shows the profound hormonal responses to repeated sauna use in humans (N=17). By day 3, growth hormone increased 16-fold, highlighting the importance of hyperthermic conditioning. [↩]Kukkonen-Harjula, K. et al. Haemodynamic and hormonal responses to heat exposure in a Finnish sauna bath. European journal of applied physiology and occupational physiology 58, 543-550 (1989). Even though the human sample size in this study is small (N=8), it shows that varying temperatures and durations differentially affect hormones. Small sample or not, the fundamental chemical changes in this study are reinforced from the data referenced in #1 and #4. [↩]Velloso, C. P. Regulation of muscle mass by growth hormone and IGF-I. British journal of pharmacology 154, 557-568, doi:10.1038/bjp.2008.153 (2008). [↩]Coleman, M. E. et al. Myogenic vector expression of insulin-like growth factor I stimulates muscle cell differentiation and myofiber hypertrophy in transgenic mice. The Journal of biological chemistry 270, 12109-12116 (1995). In this study mice were engineered to constitutively express high levels of human IGF-1 in their muscle stem cells. This caused the proliferation and differentiation of myoblasts and caused muscle hypertrophy. [↩]Barton, E. R., Morris, L., Musaro, A., Rosenthal, N. & Sweeney, H. L. Muscle-specific expression of insulin-like growth factor I counters muscle decline in mdx mice. The Journal of cell biology 157, 137-148, doi:10.1083/jcb.200108071 (2002). [↩]Healy, M. L. et al. High dose growth hormone exerts an anabolic effect at rest and during exercise in endurance-trained athletes. The Journal of clinical endocrinology and metabolism 88, 5221-5226 (2003). [↩]Ftaiti, F. et al. Effect of hyperthermia and physical activity on circulating growth hormone. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme 33, 880-887, doi:10.1139/H08-073 (2008). This study shows that hyperthermia SYNERGIZES with exercise to increase growth hormone levels in humans. So you can feel the burn from your routine and then jump immediately in the sauna for amplified effects. Again, small sample (N=8) but its conclusion is logical and intuitively follows the other studies. Anything that substantially increases core temperature should increase growth hormone and the effects should potentiate each other. [↩]Louard, R. J., Fryburg, D. A., Gelfand, R. A. & Barrett, E. J. Insulin sensitivity of protein and glucose metabolism in human forearm skeletal muscle. The Journal of clinical investigation 90, 2348-2354, doi:10.1172/JCI116124 (1992). This study demonstrated that insulin stimulated BCAA uptake in the forearm (post-absorptive and insulin infusion) The sample size in this human study was good (N=39). [↩]Lecker, S. H., Goldberg, A. L. & Mitch, W. E. Protein degradation by the ubiquitin-proteasome pathway in normal and disease states. Journal of the American Society of Nephrology : JASN 17, 1807-1819, doi:10.1681/ASN.2006010083 (2006). This is a review article that covers the mechanism by which insulin decreases protein degradation: proteasome inhibition. [↩]Chow, L. S. et al. Mechanism of insulin’s anabolic effect on muscle: measurements of muscle protein synthesis and breakdown using aminoacyl-tRNA and other surrogate measures. American journal of physiology. Endocrinology and metabolism 291, E729-736, doi:10.1152/ajpendo.00003.2006 (2006). This study used multiple different methods to measure protein synthesis and degradation in 18 humans after insulin infusion. The insulin levels were raised to physiologically relevant postprandial levels. [↩]Guillet, C., Masgrau, A., Walrand, S. & Boirie, Y. Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation. Obesity reviews : an official journal of the International Association for the Study of Obesity 13 Suppl 2, 51-57, doi:10.1111/j.1467-789X.2012.01037.x (2012). [↩]Selsby, J. T. & Dodd, S. L. Heat treatment reduces oxidative stress and protects muscle mass during immobilization. American journal of physiology. Regulatory, integrative and comparative physiology 289, R134-139, doi:10.1152/ajpregu.00497.2004 (2005). This study just reinforces and compliments the protective effect that HSPs have on muscle mass during disuse. It reinforces data referenced in #9. [↩]Nath, K. A. et al. Induction of heme oxygenase is a rapid, protective response in rhabdomyolysis in the rat. The Journal of clinical investigation 90, 267-270, doi:10.1172/JCI115847 (1992). This reference is relevant to the mechanism by which hyperthermic conditioning may protect against rhabdomyolysis: induction of HSP32. [↩]Wei, Q., Hill, W. D., Su, Y., Huang, S. & Dong, Z. Heme oxygenase-1 induction contributes to renoprotection by G-CSF during rhabdomyolysis-associated acute kidney injury. American journal of physiology. Renal physiology 301, F162-170, doi:10.1152/ajprenal.00438.2010 (2011). [↩]Khazaeli, A. A., Tatar, M., Pletcher, S. D. & Curtsinger, J. W. Heat-induced longevity extension in Drosophila. I. Heat treatment, mortality, and thermotolerance. The journals of gerontology. Series A, Biological sciences and medical sciences 52, B48-52 (1997). This reference, as well as the two immediate ones following, back up the notion that heat shock extends lifespan in lower organisms via HSP induction. [↩]Lithgow, G. J., White, T. M., Melov, S. & Johnson, T. E. Thermotolerance and extended life-span conferred by single-gene mutations and induced by thermal stress. Proceedings of the National Academy of Sciences of the United States of America 92, 7540-7544 (1995). [↩]Tatar, M., Khazaeli, A. A. & Curtsinger, J. W. Chaperoning extended life. Nature 390, 30, doi:10.1038/36237 (1997). [↩]Singh, R. et al. Anti-inflammatory heat shock protein 70 genes are positively associated with human survival. Current pharmaceutical design 16, 796-801 (2010). This study was a longitudinal cohort of a Denmark population (N=168) that found a slight increase in longevity (1 year) in females that had a polymorphism in the HSP70 gene that was associated with increased HSP expression upon heat stress. [↩]Yenari, M. A., Giffard, R. G., Sapolsky, R. M. & Steinberg, G. K. The neuroprotective potential of heat shock protein 70 (HSP70). Molecular medicine today 5, 525-531 (1999). [↩]Duveau, V., Arthaud, S., Serre, H., Rougier, A. & Le Gal La Salle, G. Transient hyperthermia protects against subsequent seizures and epilepsy-induced cell damage in the rat. Neurobiology of disease 19, 142-149, doi:10.1016/j.nbd.2004.11.011 (2005). [↩]Lundgren, J., Smith, M. L., Blennow, G. & Siesjo, B. K. Hyperthermia aggravates and hypothermia ameliorates epileptic brain damage. Experimental brain research. Experimentelle Hirnforschung. Experimentation cerebrale 99, 43-55 (1994). [↩]Laatikainen, T., Salminen, K., Kohvakka, A. & Pettersson, J. Response of plasma endorphins, prolactin and catecholamines in women to intense heat in a sauna. European journal of applied physiology and occupational physiology 57, 98-102 (1988). This study reinforces ref #15 in terms of the norepinephrine response but this demonstrates it in women. Also, the smaple size is small (N=11), so it good to have multiple studies showing similar effects. [↩]Salbaum, J. M. et al. Chlorotoxin-mediated disinhibition of noradrenergic locus coeruleus neurons using a conditional transgenic approach. Brain research 1016, 20-32, doi:10.1016/j.brainres.2004.03.078 (2004). [↩]Gregg, C. et al. White matter plasticity and enhanced remyelination in the maternal CNS. The Journal of neuroscience : the official journal of the Society for Neuroscience 27, 1812-1823, doi:10.1523/JNEUROSCI.4441-06.2007 (2007). [↩]Christman, J. V. & Gisolfi, C. V. Heat acclimation: role of norepinephrine in the anterior hypothalamus. J Appl Physiol (1985) 58, 1923-1928 (1985). [↩]Wigal, S. B. et al. Catecholamine response to exercise in children with attention deficit hyperactivity disorder. Pediatric research 53, 756-761, doi:10.1203/01.PDR.0000061750.71168.23 (2003). [↩]Goekint, M., Roelands, B., Heyman, E., Njemini, R. & Meeusen, R. Influence of citalopram and environmental temperature on exercise-induced changes in BDNF. Neuroscience letters 494, 150-154, doi:10.1016/j.neulet.2011.03.001 (2011). This study had an N=8 (okay, tiny) but… it demonstrated that hyperthermia and exercise synergize to elevate BDNF. This is awesome. Who doesn’t want more BDNF? [↩]van Praag, H., Christie, B. R., Sejnowski, T. J. & Gage, F. H. Running enhances neurogenesis, learning, and long-term potentiation in mice. Proceedings of the National Academy of Sciences of the United States of America 96, 13427-13431 (1999). [↩]Maniam, J. & Morris, M. J. Voluntary exercise and palatable high-fat diet both improve behavioural profile and stress responses in male rats exposed to early life stress: role of hippocampus. Psychoneuroendocrinology 35, 1553-1564, doi:10.1016/j.psyneuen.2010.05.012 (2010). [↩]Pedersen, B. K. Muscle as a Secretory Organ. Comprhensive Physiology (2013). [↩]Koltyn, K. F., Robins, H. I., Schmitt, C. L., Cohen, J. D. & Morgan, W. P. Changes in mood state following whole-body hyperthermia. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group 8, 305-307 (1992). [↩]Liu, X. L. et al. [Therapeutic effect of whole body hyperthermia combined with chemotherapy in patients with advanced cancer]. Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences 31, 350-352 (2006). [↩]Narita, M. et al. Heterologous mu-opioid receptor adaptation by repeated stimulation of kappa-opioid receptor: up-regulation of G-protein activation and antinociception. Journal of neurochemistry 85, 1171-1179 (2003). This study was done in mice but shows that repeated activation of kappa opioid receptor causes mu opioid receptor to become more sensitive to beta-endorphin. This study provides a mechanism by which the dysphoric feeling from exercise or heat stress can ultimately result in a better “endorphin high.” [↩]Xin, L., Geller, E. B. & Adler, M. W. Body temperature and analgesic effects of selective mu and kappa opioid receptor agonists microdialyzed into rat brain. The Journal of pharmacology and experimental therapeutics 281, 499-507 (1997). [↩]Heckmann, J. G., Rauch, C., Seidler, S., Dutsch, M. & Kasper, B. Sauna stroke syndrome. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 14, 138-139, doi:10.1016/j.jstrokecerebrovasdis.2005.01.006 (2005). This reference is only an N=1 where a a man had consumed several glasses of wine before he got in the sauna and was, subsequently, found dead. Alcohol consumption while in the sauna can cause severe dehydration, hypotension, arrhthymia, and embolic stroke. This is also reviewed in reference #1 [↩]

11 Interesting TripAdvisor AlternativesAirplane landing at the Princess Juliana Airport.This list of alternatives to TripAdvisor is not a TripAdvisor put-down or in any way meant to bash them. I LOVE TripAdvisor and have benefitted from the hundreds of millions of user-submitted reviews for many years. I’ve even left my own travel reviews on the site.However, TripAdvisor has evolved over the years; it’s expanded into booking homestays, flights, and more. Its restaurant review section is massive as well. What that means is, TripAdvisor offers both information and services that are matched by many other online sites. When it comes to getting informed, booking services, and leaving reviews, it’s good to know your options… and options is what this is all about.Here’s our list in no particular order (although I’m admittedly a huge Expedia fan and user)For the travel booking lists, I’m biased having been a long-time Expedia user. However, for this article, I did a round trip flight price check (non-stop) from Vancouver to Maui for November 3 and returning November 10, 2018. I also checked prices for a 2 bedroom partial ocean view unit at the Honua Kai Resort (my favorite Maui resort in part because of the amazing 2 and 3 bedroom units which are great for families). I set out the prices generated by each booking service. Prices checked on September 21, 2018.Please note that one flight price comparison is certainly not indicative of which service is best or cheapest. I did it merely as an example.TripAdvisor flight and hotel cost quote:Cost of sample non-stop flight (Vancouver, BC to Maui, Hawaii): $519 CADCost per night for 2 bedroom suite at Honua Kai: Merely provides a list of other providers including Otel, Priceline, and HotelQuickly.1. ExpediaExpedia is my go-to travel booking website. Just yesterday I booked a hotel in Bellingham, Washington and to my delight, I had accrued sufficient Expedia Rewards so that the hotel was free. It was a Best Western, while not luxurious, would have cost me a tad above $100.Thanks, Expedia. Plus, I always book everything on my American Express card which accrues loads of points for trips.Expedia is another comprehensive trip planning site that can help with booking airfare, reserving hotels, and identifying things to do.Cost of sample non-stop flight (Vancouver, BC to Maui, Hawaii): $519 CADCost per night for 2 bedroom suite at Honua Kai: $610/night CADPros of Expedia:Expedia features a robust airfare search function. Airfare can be searched on Expedia and purchased directly through Expedia’s website.Expedia offers a range of bundled packages, allowing you to book a hotel, buy a plane ticket and rent a car simultaneously.I love the itinerary system so I can see all my upcoming travel details very quickly.Once your account is set up with payment details, it’s super easy to book your travel.I live in Canada and all travel bookings report price in Canadian dollars which is great so I know how much the trips cost me in my currency.Cons of Expedia:Expedia does not have a robust review system as TripAdvisor does. While Expedia does have some reviews, this is not the website’s specialty and the number of reviews for any given property is typically much lower.Cost: Expedia is free to use; however when making reservations Expedia may charge a service fee depending on the product.2. HotelsTripadvisor: Read Reviews, Compare Prices & Book alternative that focuses on hotels. This website allows you to search for hotels in any given city and provides comprehensive reviews of hotels in any given area with easy-to-understand side-by-side comparisons.Cost of sample non-stop flight (Vancouver, BC to Maui, Hawaii): not availableCost per night for 2 bedroom suite at Honua Kai: $610/night CADPros of Hotels:Hotels have a comprehensive booking system that makes it easy to reserve hotels directly from its website.Hotels offer an internal point system that competes with hotel property-level rewards points. After every ten nights spent at a hotel, Hotels will pay for the tenth night free. This eliminates some of the downsides of booking hotels through a third-party agent.Cons of Hotels:Hotels focus only on hotels, so to comprehensively plan a trip you will need to visit more than one website.Hotels do not have as prestigious and robust a review system as Trip Advisor. offers reviews but they are typically fewer in number and only come from customers, unlike Trip Advisor where many hotel properties solicit their reviews from all guests.Cost: Hotels are free to use although the website may charge a service fee when booking hotels.3.Bookingcom: The largest selection of hotels, homes, and vacation rentals..(“Booking”)Booking com: The largest selection of hotels, homes, and vacation rentals is an excellent resource for identifying non-chain hotels and lodging. The website features over two million hotels, motels, pensions, bed and breakfasts, and hostels around the world which is a great resource when planning trips.Cost of sample non-stop flight (Vancouver, BC to Maui, Hawaii): $511 CADCost per night for 2 bedroom suite at Honua Kai: $675/night (CAD)Pros of Booking:Booking features the most comprehensive listing of independent hotels on the internet. If you are planning a trip and are looking for a unique experience, offers the most comprehensive directory of lodging to find the perfect hotel for you.Booking has a large international presence. If you are looking for a hotel in cities anywhere in the world, likely has that hotel listed on their website.Many smaller hotels use it as their primary internet presence. A lot of smaller hotels and bed and breakfasts do not have their own website and exclusively rely on to generate online reservations.Cons of Booking:Booking does not act as a middleman when you make a reservation for a hotel. While many competing websites will take your money and pay the hotel on your behalf, simply forwards your payment information to the property, and you are held to their policies.Booking does have links on their website for flights and car rentals, but you will be direct.4. Google FlightsI’ve not used Google Flights for actually booking airfare, but I’ve checked it out.Cost of sample non-stop flight (Vancouver, BC to Maui, Hawaii): $449 CAD (wow… I’m impressed)Cost per night for 2 bedroom suite at Honua Kai: not availablePros:Typical super simple interface that Google is famous for.Appears to offer good deals (I’m not one to scour the Web for hours trying to shave off every dollar… I prefer getting it done in the least amount of time possible).If you have a Gmail account, your account automatically is set up and you’re ready to book. I loathe setting up profiles and accounts.It’s fast; blazing-fast – searches load super quickly which is awesome.Great mobile phone interface.Offers a price tracking service.Cons:No rewards system.You can only book flights. Usually, I like booking everything in one go.5. KayakKayak is a meta-searching booking engine that looks at dozens of different websites to find the lowest price on flights, hotels, rental cars, and more. This can make it an excellent way to find good deals on all types of travel products.Cost of sample non-stop flight (Vancouver, BC to Maui, Hawaii): $512 CADCost per night for 2 bedroom suite at Honua Kai: routed me to ExpediaPros of Kayak:Kayak will search the internet for you to find the best possible price on hotels, flights, and rentals cars. It provides the option to simultaneously search for deals on Priceline, Orbitz, and Expedia which are other competitors to Kayak.Kayak offers a clean map interface for viewing the location and availability of hotels.Cons of Kayak:Kayak is very price-focused and offers little in the way of reviews of a given facility. Because of this, Kayak is probably best used when paired with another travel website for more in-depth research.Sometimes it is unclear if items are booked through Kayak or a third party. Because Kayak aggregates all price results across the internet and identifies the best available price, it is necessary to read the fine print on every transaction to be aware of that particular deal’s cancellation fees and other terms and conditions.Kayak does not offer a listing of restaurants or other things to do.I find the user interface way too cluttered.Cost: Kayak is free to use.6. SkyscannerSkyscanner is very much like TripAdvisor in that it lets users submit reviews on all kinds of places – hotels, restaurants, etc. You can also book hotels, flights, etc. It’s your regular full travel site offering.Cost of sample non-stop flight (Vancouver, BC to Maui, Hawaii): $778 CADCost per night for 2 bedroom suite at Honua Kai: I was routed to Trip.com Official Site‎‎ | Travel Deals and Promotions so not helpful.Trip Advisor offers a range of reviews on restaurants and things to do. Yelp offers a similar experience, with in-depth reviews and entries on restaurants and other activities, making it one of the best Trip Advisor alternatives.7.Pros of Yelp:Yelp has great coverage of restaurants. Yelp often offers more reviews and more detail than Trip Advisor and has emerged as the go-to website for finding restaurants.Yelp offers a deep variety of filters, making it easy to develop a custom search query to find the restaurant you are looking for – whether it’s an inexpensive street food cart or a fancy steakhouse.Yelp offers a range of sorting features to be as transparent as possible. Yelp sort ranks restaurants with weight given to some of its better-regarded reviewers while other sorting options give weight equally to all reviews to ensure a truly balanced set of opinions.Cons of Yelp:Yelp remains a primarily restaurant-focused website. While it does offer coverage of other services, these typically are lacking in comparison to Trip Advisor or other websites.Cost: Yelp is free to use.8. ZomatoZomato is another food review website that serves as a good alternative to TripAdvisor for restaurant identification and selection.Pros of Zomato:Zomato is very concise, with simple and accessible reviews. When you open a Zomato page it contains the key features of the restaurant with a simple numerical ranking.Zomato often has a menu posted for the restaurant.Cons of Zomato:Even more so than Yelp, Zomato is limited to just food reviews so it is not as comprehensive as TripAdvisor.Cost: Zomato is free to use.Information and Reviews9. Google MapsI absolutely love Google Maps. I remember when Google launched it; I thought to myself “why do that?” It turned out that it’s a huge success in that it integrates with search, especially locally-oriented online search and info beautifully.Google Maps has emerged as a worthy alternative to Trip Advisor. While Google Maps is not entirely focused on trip planning, it offers many of the same features in an integrated interface. Google Maps offers an increasingly robust review platform that allows customers to review and rank businesses and restaurants.Google Maps offers the ability to view and compare hotels side-by-side. This website also offers comprehensive directions between locations and recommends the best travel mode – be it anything from flying to driving to mass transit to walking.Pros of Google Maps:Google Maps is intuitive to use. Because Google Maps is used by a large number of people already, these users are likely already familiar with the Google Maps interface. With everything located on a single map screen, Google Maps helps users to clearly understand where their preferred destinations lie geographically relative to other destinations. For instance, if I book a hotel and am looking for somewhere to eat, I can easily search for “restaurants near my hotel” and find the best restaurants in the area. No other travel website currently has this function.Google Maps helps to identify the most efficient routings between locations. Rather than assume that the fastest way to get from Point A to Point B is to fly, Google Maps offers alternatives such as driving or transit that may be more interesting and less expensive. Google Maps also offers the Google Flights function which contains a very robust booking engine that makes it easy to view and compare a wide variety of flights.Cons of Google Maps:Google Maps is not as catered towards tourists. While TripAdvisor actively seeks reviews from travelers and tourists, Google Maps often receives more reviews from local customers. While this can be an advantage – it may offer users a more localized perception of how good a restaurant is, it also means the location may not be as used to or comfortable with catering to tourists.Google Maps does not easily categorize other activities. Google Maps is great for identifying a hotel, somewhere to eat, and the best way to arrive at your destination, but it does not provide a robust way to identify various things to do if you are unfamiliar with the city. If I knew little about a new place I would want to do research on some of the key things to see outside of the Google Maps setting.Cost: Google Maps is free to use.10. WikiTravelIf it’s information about a place you seek, WikiTravel is solid. It’s the Wikipedia of travel and locations.Pros:Lots of information about most places.Limited fluff – it’s edited and organized unlike the myriad of repetitive reviews on TripAdvisor.Information is more objective. Not a complaint frenzy.Cons:Not the nicest looking website.Few, if any, photos.11. TripExpertTripExpert addresses a big problem with user-submitted review sites like TripAdvisor, and that’s a lack of editorial oversight. TripExpert includes “professionals'” opinions for its ratings. You either like this oversight or prefer to rely exclusively on regular travelers’ opinions. travel review web site