Hemp milk

I thought I’d share my recent love of hemp milk. It’s good cold (plain, vanilla, or chocolate) but my new discovery is *hot* hemp milk. And if you heat it with a peppermint tea bag it makes the perfect winter holiday drink.

Hemp milk is a good alternative to cow or soy milk. It can usually be found in the soy/almond milk section of grocery stores (not yet at Trader Joe’s). It’s basically just made up of hemp seeds and water… and it's so good for us! Just one cup has:

~900mg Omega-3 Fatty Acid & 2800mg Omega-6 Fatty Acid (this is apparently the ideal ratio of Omega 3: Omega 6)

~All 10 essential amino acids

~4g protein, >40% daily calcium, 0 cholesterol, Potassium, Phosphorous, Riboflavin, Vitamin A, Vitamin E, Vitamin B12, Folic Acid, Vitamin D, Magnesium, Iron, Zinc…

Iyengar: Keep it pure and clean

“The body is your temple. Keep it pure and clean for the soul to reside in.” ~B.K.S. Iyengar

I’ve been reading Iyengar’s book, Light on Life, and like this excerpt on “The True Nature of Health:"

“Most people ask only from their body that it does not trouble them. Most people feel that they are healthy if they are not suffering from illness or pain, not aware of the imbalances that exist in their bodies and minds that ultimately will lead to disease. Yoga has a threefold impact on health. It keeps healthy people healthy, it inhibits the development of diseases, and it aids recovery from ill health.

But diseases are not just a physical phenomonenon. Anything that disturbs your spiritual life and practice is a disease and will manifest eventually in illness. Because most modern people have separated their minds from their bodies and their souls have been banished from their ordinary lives, they forget that the well-being of all three (body, mind, and spirit) are intimately entwined like the fibers of our muscles.

Health begins with firmness in body, depends to emotional stability, then leads to intellectual clarity, wisdom, and finally the unveiling of the soul. Indeed health can be categorized in many ways. There is physical health, which we are all familiar with, but there is also moral health, mental health, intellectual health, and even the health of our consciousness, health of our conscious, and ultimately divine health. These are relative to and depend upon the stage of consciousness we are at.

But a yogi never forgets that health must begin with the body. Your body is the child of the soul. You must nourish and train your child. Physical health is not a commodity to be bargained for. Nor can it be swallowed in the form of drugs and pills. It has to be earned through sweat. It is something that we must build up. You have to create within yourself the experience of beauty, liberation, and infinity. This is health. Healthy plants and trees yield abundant flowers and fruits. Similarly, from a healthy person, smiles and happiness shine forth like the rays of the sun...

As long as the body is not in perfect health, you are caught in body consciousness alone. This distracts you from healing and culturing the mind. We need sound bodies so we can develop sound minds.”

Ashtanga in Rwanda - Project Air

Check out this video about a medical NGO which started using yoga to help rape victims in Rwanda.

And this interview with Deirdre Summerbell who started it all.

Deirdre said yoga in Rwanda is a "conceptual void" so the women had no anticipatory skepticism. Deirdre started by doing some demonstrations and the women "were horrified!" But they threw themselves into it and loved it.

They teach Ashtanga yoga, taking the women through the fixed routine. It helps the women heal and reconnect with their bodies, as well as make them strong. She said "Yoga is slow medicine, but it is medicinal in character."

It's gone so well in Rwanda that they're now seeking funding to bring it to other places... (how about Penn!)

Project Air: http://www.project-air.org/

Week 2

It’s looking like measuring telomerase might actually be a real possibility! But there’s a lot of work to do. I applied the 80/20 rule (80% of outcomes come from 20% of the input) to finish a draft of the protocol yesterday. I’m glad I didn’t spend too much time perfecting it because getting my mentor's initial feedback today was incredibly helpful. He gave me some much needed guidance and focus.

Key points from our meeting today:

• Become an expert in ONE thing. The more you put into the study the more you have to defend. I had put about 20 different ideas into the protocol and am now narrowing it down.
• Take the next 2 weeks to become the expert on telomerase. This is the time to focus and be a scientist. Read EVERYTHING about telomerase.
• Don’t get too attached to one idea, research is a lot of back and forth. Try not to get frustrated. If I spend time doing something that doesn’t work out in the end, it doesn’t mean it’s a waste of time -- in 5 years I could come back to a lot of these things.
• Don’t involve too many other people in the study just yet. Be careful of people who want me to do their work for them. This is my year to learn clinical research and pursue MY project.
• Within 6 weeks, write a grant to get funding for the telomerase enzyme assays.
• By mid-January, submit protocol for IRB approval and begin enrolling in March.

Yin yoga

I’m still processing the Yin Yoga class that I went to last night. It was completely different from the Ashtanga practice. The teacher talked the entire class, about nadis and chakras and opening up our connective tissue to let prana flow (prana = energy, life force). Her voice was calm and soothing and nonjudgmental, and I found it incredibly relaxing. We did a total of about 8 poses, holding each for ~4-5 minutes (surprisingly hard to be still for that long). The idea is to relax into the position and allow gravity to take you deeper.

The idea behind yin yoga is that it works on the deeper connective tissue and joints, while hatha/vinyasa yoga (the yang of yin yoga) works more on muscles. Yin yoga can be practiced in addition to our regular practice, and can help increase flexibility when muscles reach their limits.

Nadis and chakras are concepts I still have a hard time grasping but they pique my curiosity… for another post another time.

The palm of one hand

Pattabhi Jois instructed his students that meals should not be bigger than what can be held in the palm of one hand (and it's okay to eat every hour if necessary).

I am going to try this.

Endure

"Yoga teaches us to cure what need not be endured and endure what cannot be cured."

~B.K.S. Iyengar

Yoga at the cancer center?

I had an idea today. Instead of providing the yoga classes at a studio in Philadelphia, why don’t we start classes in the hospital at the cancer center? The building is new, huge, bright, and beautiful. 

I would think (hope) that Penn would be interested in offering services such as yoga to patients (not to mention medical staff), especially since major cancer centers are already doing this. Having a small room there for integrative medicine would not only be much more convenient for patients, but also a great service for the cancer center to be able to offer.

Hip openers and partner yoga

One thing I got out of the yoga anatomy workshop with David Keil last weekend was hip-opening. I’m trying to do this sequence every night (for each one, hold center then right then left - each for a few minutes). Thank you, Caitlin, for posing!

We also talked about handstands at the workshop and I have a lot to work on. I need to have much more engagement of my psoas muscles (psoas engagement = uddiyana bandha) and serratus anterior in order to lift up.

Caitlin and I did our first “partner yoga” session last night! We practiced jumping up into handstands, backbends, and then this chair inversion that releases the traps and makes my neck feel about two inches longer:

Week 1

My mentor is giving me the perfect combination of freedom to be creative with my research questions, structure of specific tasks and goals, encouragement of idealism, and reminders of practicality. This week has been busy and engaging and I love how my life and my “work” are beginning to blur.

Check out this article about the status of research on the health benefits of yoga about the following:

• The article is about the growing body of research on yoga and how several major cancer centers are now offering yoga to patients. “A word of caution, though,” says the article, “the studies that have been done so far have yielded soft findings, with little hard data to back up the conclusions. That said, there is no denying that yoga is becoming a presence even in the ivory towers of academic medicine.”
• The article explains that most of the research has proven the efficacy of yoga for emotional and social well-being such as improving stress, anxiety, sleep, quality of life, mood disturbance, and chronic pain. Despite this evidence, there is still little in the way of physician guidelines/recommendations to prescribe yoga.
• Our current plan for the clinical trial is to look at biomarkers before and after an 8-week yoga program. I really want to look at telomerase activity but it seems to require a complicated assay process which I don’t think we’re capable of just yet.
• The problem with the research on yoga thus far is that the interventions studied all fall under the umbrella of “yoga,” yet they are widely variable. Some are gentle restorative yoga classes, some are Iyengar classes focusing on alignment, some are simply vaguely described as “hatha” yoga. But this is important! The interventions have to be consistent and reproducible. This is why I like the idea of studying Ashtanga yoga as intervention because it is the same no matter where you are or who is teaching. I also like the idea of looking at Ashtanga because in addition to the yogic mind-body awareness practice, it is also a vigorous physical exercise.
• Another question I’m thinking about is whether it is possible to study yoga with our gold-standard randomized controlled trial model. Randomization doesn’t really work here. In the study and in real life, people are going to have to want to do yoga and want to make the lifestyle change. Perhaps a better model is a non-randomized controlled trial, where we compare a more self-selecting yoga group and control group. This would introduce confounders and open us up to more criticism, but I also think it’s more realistic for this study and for real life.
• As the article points out, in order for yoga to become more credible among physicians, there need to be more studies on its effectiveness. These studies need funding. And they need to be published in major medical journals so that physicians begin to see yoga less as an “alternative” medicine and more as a tool to improve health and well-being. As one of the doctor’s in the article said, “Research on yoga for therapeutic benefits really is in its infancy, and to look at how many studies are ongoing and being published the temptation is to think that’s a reflection of how good yoga is, and it may not be. We certainly need more research.”

The whole point

Noah (one of Philly's new teachers) talked about the whole point of the ashtanga yoga practice: to quiet the mind.

He explained that our mind is like a lake, our never-ending thoughts are ripples in the lake, and we see and interpret the world through these ripples. The purpose of the ashtanga practice is to clear the ripples so we can see the true reflection.

He talked about the three ways this occurs through the ashtanga practice:

1. Breathing. Slow, conscious breathing through the nose.

2. Gaze (dristi). Our mind follows our eyes so we must control our gaze. Gaze should be at the nose (most of the time), or third eye, toes, thumbs. It should not wandering around the room or looking in the mirror.

3. Physical postures (asana). The word “asana” is translated to “chair.” Asana is the chair from which we practice breath and gaze in order to quiet the mind.

I like this explanation because it takes the emphasis away from the physical yoga postures, and focuses it on the larger purpose of the practice which is to quiet the mind, and the physical postures are just a tool to get there.

Creating habits

While at the CDC, I went to a workshop on behavior change and I’ve been thinking about this for the yoga study. Are we really going to be able to get a group of busy women to start up a yoga practice? It will require creating new habits and new patterns of behavior, and I am wondering if and how that can be taught.

Below are a few of the social science theories discussed that I found useful for thinking about this:

The 11 variables that influence behavior

1. Intention to perform a specific behavior
2. Environmental factors
3. Necessary skills to perform the behavior
4. Beliefs about the behavior
5. Opinions about consequences or outcomes from the behavior
6. Peer pressure
7. Self-standards -- how someone wants to perceive themselves
8. Emotional reactions towards the behavior
9. Perceived self-efficacy -- self-confidence
10. Cultural believes
11. Contextual factors -- including the “social capital” present in communities such as strong churches, a network of moms, etc… any resources in the community that can be mobilized

Stages of Change

When making behavior change, people go through the following pattern of change:

Pre-contemplation --> Contemplation --> Preparation --> Action --> Maintenance

The “Chain of Causation” in public health

Large scale factors (historical, cultural, political, economic, etc) --> Behavioral Predictors --> Risk behaviors --> Proximate Determinants (pathogens, carcinogens, toxins, etc) --> Disease outcomes.

Medical school focuses us on the last two parts of that chain.

One thing missing from the 11 variables list is the power of good leadership. 

Un-numbed at family medicine conference

After studying to numbness for the past three weeks, it was really wonderful being at the family medicine conference in New York this past weekend. It reaffirmed that family medicine is what I want to do with my life. It’s about relationships. It’s about treating the whole person. It’s about inspiring, motivating, and encouraging. And it’s about service.

I just wish family medicine doctors were more visible. I wish they published more influential research. I wish they made themselves indispensible. One of the speakers said, “Family Medicine is the best kept secret.” But why are we keeping ourselves a secret?

Some favorites from the workshops:

• "Every time someone asks you to do something, ask yourself if you have room for it and what you’ll take off your plate in order to do it. Say ‘no’ to a bigger ‘yes.’”
• "How you spend the first hour of each day acts as a rudder to your ship."
• Only 30% of doctors advise patients about exercise and nutrition.
• “We should be giving more “thought” and less “care” (treatment). Exercise should be prescribed as a drug, as medicine.”
• “If you have a body, you are an athlete.”
• “Doctors are trained to fight disease, not prescribe health.”
• The Magic 6 of Healthy Aging: Don’t smoke. Take to exercise daily. Maintain your weight. Eat close to the earth and sea. Give care and belong. Have moderate alcohol intake (1-2 drinks/day).
• When running (or any exercise), always focus on learning something to keep from getting bored – have good postural alignment, lean forward (using gravity to move forward, like you’re going down a ski slope), lift heals instead of pushing off, relax your body while running, practice belly breathing (relax the diaphragm, exhale belly-button to your back).