Thursday, December 31, 2009

Moon day, New Year’s Eve, and habits for 2010

It’s a beautiful and snowy moon day and New Year’s Eve.

I’m working on my 2010 new year’s resolutions and trying something new this year: writing down the habits I want to develop, habits I can practice every day so that I don’t have to think about them anymore.

So, the 6 habits I want to develop in 2010:
1) Buy local and in-season food.
2) Cook 2 new recipes a week and write them down.
3) Avoid sugar.
4) Minimize purchasing things – I want to de-clutter my life.
5) Write (blog, journal) every day.
6) Practice pranayama and take long savasana at the end of practice.

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” ~Aristotle

Wednesday, December 30, 2009


It is an amazing feeling to be able to practice with no pain. I have a new appreciation for my body and I will be much more careful with it from now on!

I love what Iyengar writes about asanas, the 3rd limb of Ashtanga:
“Asanas have been evolved over the centuries so as to exercise every muscle, nerve and gland in the body... their real importance lies in the way they train and discipline the mind…
By performing asanas, the sadhaka first gains health, which is not mere existence. It is not a commodity which can be purchased with money. It is an asset to be gained by sheer hard work. It is a state of complete equilibrium of body, mind and spirit. Forgetfulness of physical and mental consciousness is health. The yogi frees himself from physical disabilities and mental distractions by practicing asanas…
The yogi never neglects or mortifies the body or the mind, but cherishes both. To him the body is not an impediment to his spiritual liberation nor is it the cause of its fall, but is an instrument of attainment. He seeks a body strong as a thunderbolt, health and free from suffering so as to dedicate it in the service of the Lord for which it is intended…
Just as an unbaked earthen pot dissolves in water the body soon decays. So bake it hard in the fire of yogic discipline in order to strengthen and purify it.”

Tuesday, December 29, 2009

A good reason to cut out sugar

study recently came out looking at the effect of sugar (glucose) on human cells. They found that glucose changes the activity of telomerase (the enzyme we’re looking at in our study). Telomerase keeps chromosomes long and helps cells live indefinitely, which we want in healthy cells, but do NOT want in cancer cells.

The study looked at both healthy lung cells and precancerous lung cells. They split the cells into two groups: One group received a normal amount of glucose, the other group received lower than normal amounts of sugar.

Results: The healthy cells exposed to lower levels of glucose lived longer, while the precancerous cells exposed to lower levels of glucose died off.

Two genes were affected by the restriction of glucose:
1) Telomerase: allows cells to continue to live and divide indefinitely
2) p16: an anti-cancer protein

The genes acted differently in healthy cells and precancerous cells:
Healthy cells: Rise in telomerase and decrease in p16 --> cells live longer.
Precancerous cells: Decrease in telomerase and increase in p16 --> cells die off.

Conclusion: A glucose-restricted diet may help human cells live longer and free of cancer.

Tollefsbol, one of the authors of the study, said:
"These results further verify the potential health benefits of controlling calorie intake… Our research indicates that calorie reduction extends the lifespan of healthy human cells and aids the body's natural ability to kill off cancer-forming cells… Human longevity can be achieved at the cellular level through caloric restriction.”
They talk about caloric restriction but the study looked at glucose levels. I’m wondering if this has more implications for sugar consumption and the resulting spikes and troughs of blood glucose. Diabetics, for example, who have high levels of blood glucose, suffer from end-organ damage, coronary artery disease, and atherosclerosis, all of which have been associated with telomere shortening.

So… as I’m working on my 2010 resolutions this week, cutting out sugar is definitely on there!

Saturday, December 26, 2009

Meditative medicine: a new distinction

This article in the Hastings Center Report, “Toward a Meaningful Alternative Medicine” by Vinay Prasad, has shifted the way I think about “alternative medicine” and health care in general. He starts by sharing this quote by Phil Fontanarosa and George Lundberg which I instinctively agree with: “There is no alternative medicine… there is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which data is lacking.” Alternative medicine is often considered unscientific and faddish. But then why are so many people drawn to it? Is there more besides “evidence-based medicine” that we are missing? Is health care more than “an unrelenting devotion to outcomes”?

Prasad suggests we think about meditative medicine in parallel with our evidence-based framework. He refers to German philosopher Heidegger’s work contrasting poetry and technology as differing ways of making sense of the world. Technology represents “calculative thinking,” using objects to achieve a purpose. Poetry and art represents “meditative thinking,” reflecting on the beauty inherent in how things are. Both ways of thinking are important. Heidegger was concerned that “the approaching tide of technological revolution in the atomic age could so captivate, bewitch, dazzle, and beguile man that calculative thinking may someday come to be accepted and practiced as the only way of thinking.”

Prasad then applies this to medicine: 
“The worry, if one takes Heidegger’s perspective, is not that health is an outcome to be optimized by cost-effective, evidence-based medicine, but that this might be the only way of thinking about health – that no alternative exists. Unfortunately, practitioners do little to provide a true alternative when they use complementary medicine in purely calculative terms: sometimes but not always relying on randomized controlled trial data, and sometimes but not always trusting anecdotal evidence. Heidegger teaches us that ‘Western’ and ‘alternative’ are not meaningful categories. A better distinction is ‘calculative’ and ‘meditative.’ And what we need is meditative medicine.”
 The point is: we can’t think of all alternative medicine in terms of the evidence-based model, just like we can’t think about art and poetry like we do technology. So, the distinction is as follows:

Calculative medicine: A medical intervention (can be ‘Eastern’ or ‘Western,’ unconventional or mainstream) that is aimed at producing an outcome (such as reduced cancer recurrence, longevity, reduced menopausal symptoms, etc.) that can be studied with evidence-based methodology. Examples of calculative medicine include giving a statin to lower cholesterol, yoga for blood pressure control, or acupuncture for pain control.

Meditative medicine: Meditative medicine includes practices (exercise, eating healthy, meditation, etc) which “are done not with a particular outcome in mind, but as part of living a healthy life… they provide a way of making sense of health, illness, and the good life. Becoming vegetarian because you wish to lower your LDL is calculative. Does it work? A well-designed trial could tell us, but it would miss the point.” Meditative medicine also applies to the patient-doctor relationship: “Allowing doctors to develop relationships with patients beyond what is necessary for good primary care is meditative.”

As Prasad explains:
“Some people exercise because studies have shown a correlation between twenty minutes of aerobic activity and longevity (a calculative view), while others do so because an active life is healthy (a meditative view). Some drink a glass of wine each night because it has been shown to decrease cardiovascular risk (calculative), while others never needed that study to know that drinking wine in moderation, as part of a broader set of practices, is healthy (meditative).”
Meditative medicine is why I’m a vegetarian, why I exercise, why I do yoga... not for a specific outcome that can be studied with randomized controlled trials, but because it feels right and is part of a healthy, balanced lifestyle. It is also why I want to do family medicine and provide both calculative and meditative health care. So much of healing and health is in the patient-doctor relationship, and that is not something that can be measured with RCTs. 

Wednesday, December 23, 2009

An amazing animal

Isn’t man an amazing animal? He kills wildlife by the millions in order to protect his domestic animals and their feed. Then he kills domestic animals by the billions and eats them. This in turn kills man by the millions, because eating all those animals leads to degenerative – and fatal – health conditions like heart disease, kidney disease, and cancer. So then man tortures and kills millions more animals to look for cures for these diseases. Elsewhere, millions of other human beings are being killed by hunger and malnutrition because food they could eat is being used to fatten domestic animals. Meanwhile, some people are dying of sad laughter at the absurdity of man, who kills so easily and so violently, and once a year sends out cards praying for “Peace on Earth.”
~C. David Coates

Saturday, December 19, 2009

Research update: Month 2

A quick update:
  • My telomere study is evolving to be much than I ever initially envisioned. Writing a grant to do real-time PCR analysis on DNA from peripheral blood mononuclear cells? I honestly never thought I would say that. I love thinking about these questions and realizing that I can actually do it. We have two grant proposals due Jan/Feb. 
  • I feel distracted from my initial goal of running a yoga clinical trial. The plan is to submit the yoga study protocol for IRB approval at the end of January. My priority right now is this telomere grant but once I finish that I’ll focus my energies on the protocol. 
  • Instead of recruiting on Fridays (meaning I “cold call” patients in the waiting room trying to persuade them to enroll in a research study – an inefficient and poor use of time), I will now be spending my Fridays seeing patients with an oncologist (and enrolling patients within the trust of the patient-doctor relationship – much more effective). I can now build a relationship with this oncologist and learn about breast cancer management, while also talking with patients about the yoga study and finding future participants. I couldn’t be happier about this. I *almost* liked wearing my short white coat again. 
  • I’ve been neglecting my interest in HIV and infectious disease and I miss it. I’ve been in touch with some HIV physicians I admire and hope to work with them on some small projects.

Thursday, December 17, 2009

Healing process and practice

I’ve been observing myself going through this healing process. At first I felt frustrated, irritable, unmotivated, etc. It’s been over a week and my rib is still hurting, stopping me from practicing normally. But over the past few days I’ve been feeling more content... and actually, I’m kind of starting to enjoy my time off.

Or maybe this new perspective is from “juicing.” I’m on my third day of JUST JUICE (pomegranate, blueberry, carrot, greens & spirulina... anything I can find that’s colorful and antioxidant-filled). I’m getting plenty of calories, but giving my GI tract a much needed rest. And I’m feeling great - energized, steady, attentive. I’d keep it up for longer if it weren’t for all the holiday food to munch on. But maybe I’ll start doing this more regularly, maybe on moon days?

Practice today was slow and tentative, I’m afraid to do anything that might hurt my body (although I did backbends for the first time in a week - they felt good). David said to be “narrow” in what I eat over the holidays, and to make sure to give my body some time without food so it can direct energy towards healing.

Wednesday, December 16, 2009

Adam Kazan, Guest Blogger Part 2

Guest Blogger, Adam Kazan
Ashtanga Alien Predator and What Is
Part 2 of 2

"you can't be anyone but you 
therefore you are that Other one you love" 
- Ikkyu

Now back to how this all has to do with Ashtanga practice? The real question is why and how we are not with what is... basically what makes us travel away from reality and ourselves? What is our relationship with that which we dislike and that which we want? And all those lovely distractions that assist (3Xper netflix, no cable). From where do these crafty creatures come from? What we repress and not acknowledge arises as Frankenstein, the creature from the black lagoon, hellraiser, sex and the city, racism. We then want to further wall ourselves off from these invaders, to not know our own suffering.

How do we release ourselves from this bondage of our own entrapment? Traditionally and presently it comes from various seemingly spiritual techniques. Like prayer, meditation, yoga, good deeds, mindfulness. Do these work...hummm? What do you think? These methods seem to make us face the suffering. There is a tale that on Buddha's ("life is a chockablock pain") deathbed he said "Work out your salvation with diligence." Yes your very own salvation. What does it take for you, yes the specific you, to wake up a bit more. Different methods for different people. Find yourself shoes that fit.

A 10-day retreat spent with violent turning nonaggresive extraterrarestials is a very particular environment, a special container for awareness. A daily practice of Ashtanga yoga is a daily training of awareness, the paying attention to what is actually happening. Ashtanga is a great way to make this happen for oneself. The force of this yoga brings my mind to reach the mechanisms of how my body is working. It brings an integration and cohesion to the mind body connection. It is an efforted training to be with the body and find out what is there. Yet....

What happens most of the time with my mind... wander and wonder. It goes away from the body, it looks about and gets interested in what is not. Those outer space visitors have all kinds of interesting ways to seek my attentions. My two favorite mind wanderers during practice is clock watching and looking at who is coming into the studio. Practice is a great place to notice the habits of the mind for distraction. Noticing the habits allows for a little more spaciousness. Those spaces give room for different choices.

Ashtanga gives me the opportunity to train the mind and body to pay attention and be focused. After a year and half of steady practice I now stay focused about 10%+ of the time, an over 150% improvement from when I started. What do I get with that...a little more awareness of the outcomes of my actions, a bit more healthy, a bit more spry, a tiny bit more compassion and as an ex-girlfriend said about me "you are less of a jerk." Overall great success.

In a way this practice helps you be you.

Tuesday, December 15, 2009


I bought Iyengar’s book “Light on Pranayama” and am taking advantage of my extra time to study pranayama -- breath control. This is the 4th limb of Ashtanga yoga.

And under my friend Xochitl’s influence, I am doing a three-day juice cleanse. Her family used to do this periodically growing up. She’s read a lot about it and thinks it might help heal my injured muscle.

So, I bought jugs of anti-oxidant filled juice (need to get a juicer!) and am starting to flood my body with it.

Monday, December 14, 2009

Inspired follies

"What is life but a series of inspired follies? The difficulty is to find them to do. Never lose a chance: it doesn't come every day."
~George Bernard Shaw

Last week I worked hard on two grant drafts -- one on the telomere study and one on the yoga clinical trial. I hope something will come out of them because so far it’s just been a lot of ideas, outlines, and drafts. 

I need to work on enjoying the process

And the same goes for yoga: it’s about the process. Fellow ashtangis have been surprised when I tell them this is my first injury that has really put me out of practice. It has happened to them, it’s part of the practice, and it’s a necessary lesson… to be humbled, to listen to my body, to protect it. 

Thursday, December 10, 2009

Yoga where it’s needed

Check this out -- daily yogic breathing in high schools.

I’d love to see how an Ashtanga practice would help high school kids… anyone know any teachers out there who might be interested in trying this?


Yoga Sutra II:30 --

Non-violence, truth, abstention from stealing, continence, and absence of greed for possessions beyond one’s need are the five pillars of yama. 

“In the effort of accumulating material possessions and wealth, in protecting the acquired, in their decline, in the latent impressions they leave on the mind, and in the unavoidable harm caused to other living beings – in all these there lies unhappiness. Thus the yogi practices nonacquisitiveness.” ~Vyasa commentary

“A mind with desires does not ignite and glow, nor does it generate light and warmth when touched with the fire of knowledge.” ~Iyengar

So… I’m working on nonacquisitiveness towards my practice. Today I spent most of my time inverted in shoulderstand and headstand, then sat in bada konasana against the wall and breathed… for a long, long time.

Wednesday, December 9, 2009

Pain empathy

This pain in my rib hurts with every breath I take. It is constantly on my mind, it makes me grumpy, it takes me out of my normal routine, and it occupies my mind making it difficult to be creative or thoughtful or compassionate. One positive outcome: it is helping me understand the experience of pain.

In Iyengar’s book Light on Yoga, he writes about the niyamas. Niyamas are the 2nd limb of Ashtanga and make up the individual disciplines (Yamas, the 1st limb, are universal ethical disciplines). One of niyamas is Santosa, meaning contentment. Iyengar says, “Santosa or contentment has to be cultivated. A mind that is not content cannot be cultivated.” And a mind distracted by pain cannot be content!

After some desperate googling I came across Epsom salts. A quick PubMed search came up with ZERO on Epsom salts for muscle pain, but I found a few answers on the Internet (though not sure of the science behind them). Epsom salts are made up of magnesium sulfate, which readily absorb through your skin helping bind “toxins” and reduce inflammation. I ran out to RiteAid and bought two big jugs, put 2 cups into hot water, and soaked for about 20 minutes. 

Tuesday, December 8, 2009

Ahimsa and my pulled muscle

Ahimsa is the first of the yamas (the 1st limb of Ashtanga’s 8 limbs). Ahimsa means non-violence. Non-violence towards other beings, and non-violence towards ourselves.

For me, ahimsa often means doing less. In my practice, it means taking some days off from the physical practice and taking some days for less asana and more breathing. In my life outside of practice, it means saying no to things and protecting my time. It applies to my internal thoughts, my actions, how I eat, the footprint I leave on the earth, etc.

And I can no longer ignore that it applies to my pulled serratus (maybe intercostal?) muscle. I think I overdid my jump-backs and now my right ribcage is terribly painful with almost every movement. Practicing through the pain has not been helping, so I have to rest.

Monday, December 7, 2009

Adam Kazan, Guest Blogger: "Everything terrible is something that needs our love." ~ Rilke

Guest Blogger, Adam Kazan
Ashtanga Alien Predator and What Is
Part 1 of 2

"Everything terrible is something that needs our love." - Rilke

What this blog is not about...Today during practice I thought of the BSG series and the Cylons and how that could be included below. During those thoughts I missed an asana and got very mucked up. Enough said about that.   

If you visit my home you may be fortunate and see the large action figures of Alien and Predator.

I suppose that most readers of this blog have not seen the movie Alien versus Predator, the one that takes place in like Antarctica. Perhaps you have seen an Alien movie or Predator. I saw the Alien versus Predator movie one week before going to a 10 day silent vipassana mediation retreat in Shelburne Falls, MA. The sits at the retreat were a hour long each. Old aches and pains visited and took a predominate seat in my body. That car accident a few years ago which strained my back. The right knee with its torn meniscus from a jujitsu sparing beatdown. Did these visit or were they always there lingering like a crocodile quietly waiting for its prey.

So sitting sitting trying trying to notice my breath coming in and out of my nose, what did I want? Not to ache and not to pain, no suffering Now!

So my lovely mind tried the not me thing, transferred the pains to images of Predator and Alien. Within the grey matter of my brain Predator and Alien fought deadly battles. Pushing the pain away and let them fight. It just kinda seemed to work for a couple of days, but alas the aches and pains were part of me and I could not get divorced from myself. Woe is me. I think a lot and thought of a solution. Aikido with bamboo swords! Like dancing. Both Alien and Predator were in those Japanese fencing uniforms. 

And I started to investigate my aches and pains. It is a very curious thing to spend time with pain. Arose not the spilling of concentrated acid (Alien's blood) or the cry of a battle won due to the severing of the other's limb, but a desire to be compassionate to myself. A warmth, a knowing of my suffering, an internal gentle hugging. I started then to be able to feel acceptance, tolerance, kindness for the frailties of the body and mind. With this knowing I also knew that others suffer within their own little and big science fiction movie hells (original series Star Trek -Mirror, Mirror, Star Trek: Next Generation - Chain of Command, The Matrix, Bridget Jones Diary, Lost in Space, Terminator ). By the end of the retreat the mental formations of Predator and Alien were sitting flanking me both crossedlegged and meditating. Once home, action figures graced the left and the right of my meditation mat. 

By now you must have already thought at least a couple of times...So what does this have to do with Ashtanga yoga practice? And so await the second installment....

Sunday, December 6, 2009

Patient attention

 I like Newton’s concept of patient attention:

"If I have ever made any valuable discoveries, it has been owing more to patient attention, than to any other talent." 
~Isaac Newton

Saturday, December 5, 2009

Weeks 3 & 4

I’ve been surrounding myself in everything telomeres. Here’s a quick update on the research front:

  • There is a promising grant that seems to fit with our research goals. Writing a draft of this grant is my main project for the next week. I’m learning that the most important part of designing a study is identifying the AIMS. As is true for many things, the key is having a clear vision and setting specific goals. 
  • I went to a research meeting with budding physician-epidemiologists where someone was presenting their R01 proposal. The group ripped it apart. It was discouraging, to say the least, and I came out of there questioning whether research is for me. Spending months investing in and developing your project, only to have it rejected. You need thick skin and perseverance in the face of unavoidable criticism. 
  • I’m beginning to really understand how hard it is to design a high quality, rigorous, scientific study. No study is perfect and there will always be critical reviewers. The western medicine framework seems inadequate to study many of the questions I’m interested in. Many people in primary care offices in America would never be eligible for randomized controlled trials. People are complicated and real life isn’t randomizable.

    Friday, December 4, 2009

    The value of yawning

    I was unaware of the value of yawning until now! This article is written by Dr. Andrew Newberg, a physician/researcher at Penn who I have admired after reading about his studies on the brain during meditation (he’s also featured in the movie “What the bleep do we know.”)

    If you read the article, you’ll see how he talks about how both yawning and yogic breathing stimulate the precuneus in the parietal lobe. The precuneus apparently plays “a central role in consciousness, self-reflection, and memory retrieval,” which helps explain why yoga/meditation can help increase self-awareness. Yawning also improves alertness: “It quickly brings you into a heightened state of cognitive awareness… it rids the brain of sleepiness, thus helping you stay focused on important concepts and ideas.”

    And yawning has a social function as well. Dr. Newberg explains how “Yawning evokes a unique neural activity in the areas of the brain that are directly involved in generating social awareness and creating feelings of empathy.” Yawning is only “neurologically contagious” among humans, great apes, macaque monkeys, and chimpanzees! 

    Thursday, December 3, 2009

    Heat your body once per day

    I did a little experiment on myself  and found that my body temperature rises about 2 degrees Fahrenheit during my morning practice (today it went from 97.7 before practice --> 99.6 in the middle, though I haven’t been able to measure it at my peak so it may rise even more than that). This isn’t really surprising, as it’s already known that exercise increases core body temperature (and your body compensates by sweating to protect you from getting heat stroke), but I like seeing actual proof of my temperature elevation.

    Pattabhi Jois said to heat your body only once per day. This is based on thousands of years of yogic study and observation. I wonder what measurable effects this has on the body -- Does it alter immune function? Does it alter our levels of inflammation? Does it reverse oxidative damage in cells? Does it help maintain telomere length? We know that exercisers have longer telomeres compared with non-exercisers, but we don’t know exactly how this happens. I wonder if it could be related to the frequent rise in core body temperature and the physiologic effects this has on cells.

    The cause of over half of our greenhouse gas emissions

    In case the animal cruelty and health factors aren’t enough:

    Wednesday, December 2, 2009

    Intense exercise keeps us molecularly young

    I was excited to see this article on the study that’s about to come out in the Dec. 15 issue of Circulation.

    The study compared telomere length in runners versus non-runners, finding that runners have cells with longer telomeres. Longer telomeres mean molecular youthfulness because as cells age, our telomeres (the DNA at the ends of our chromosomes) get shorter. The theory is that if we can stop this telomere shortening, we can slow down the aging process. They showed that professional athletes who run ~50 miles/week have telomeres the length of non-exercisers who are 10 years younger!

    I can’t wait to see the paper when it comes out. I’m also curious about people who don’t currently exercise -- if they change their lifestyle and start exercising, what happens to their telomeres then? I wonder what length of time and type of exercise is needed to start seeing molecular changes.

    Tuesday, December 1, 2009

    Exercise remodels our brains

    Here’s one explanation for why exercise works for mood/anxiety: it remodels our brains to better react to stressful situations.

    A study came out comparing rats that exercised (allowed to run) versus rats not allowed to exercise. The rats that exercised grew new neurons in their brains, which scientists called “cells born from running.” These new neurons behaved differently -- while other cells expressed “stress genes” during stressful situations, these new cells remained “biochemically, molecularly, calm.”

    Previously, the mechanism by which exercise helps with mood and anxiety has been unclear. This study helps explain that exercise actually “remodels the brain, making it more resistant to stress.” Though the rats exercised for only 6 weeks, it’s not clear how long or how intensely humans need to exercise for this remodeling process to start.