Sunday, January 31, 2010

Mind of a scientist, Soul of a poet

Iyengar has illuminated much of the yoga practice and philosophy for me. The more I learn, the more I am drawn to him.

A teacher, scientist, poet. His body is his laboratory. On his 80th birthday he did 108 dropbacks in a row. He holds kapotasana for 15 minutes.
Kapotasana... for 15 minutes.

If you have ~8 minutes, I highly recommend watching this video below. (So grateful to Grimmly’s blog for sharing this!)

Why practice:
“Freedom. From each and every part of our body. Until freedom is gained in the body, freedom of the mind is a farfetched idea.” 
The 8 limbs can all be found in the practice of asana and pranayama:
“These two steps of Patanjali are the ladder for you to reach the rightness in your wisdom.” 
The practice of asana:
“Our practice of asana is not for the sake of the body -- that is only a support. If that is not there you cannot walk. Can you walk on water? So, asanas are the foundation… they make us the light of the soul.” 
Purpose of practice:
“No doubt I have said, “My asanas are my prayers.” But now I say “practice is my mantra.” The purpose will come as one goes on practicing. So practice practice practice.” 
I also really liked this essay that Grimmly posted, written by one of Iyengar’s students, Patricia Walden. I love her description Iyengar:
“With the mind of a scientist and the soul of a poet, he has spent thousands of hours using his body as a laboratory, experimenting, exploring, observing, and creating.” 
And a few more gems from Iyengar…
“When I was young, I played. Now, I stay.” 
"Make the mind feel the stretch. Awaken the mind of the little toe." 
“If you keep your armpits open, you won’t get depressed.” 
“When confronted with difficulty, take an action, no matter how small." 

Saturday, January 30, 2010

Three passions

Three passions have governed my life: 

The longings for love, the search for knowledge, 
And unbearable pity for the suffering of [humankind]. 

Love brings ecstasy and relieves loneliness. 

In the union of love I have seen 

In a mystic miniature the prefiguring vision 

Of the heavens that saints and poets have imagined. 

With equal passion I have sought knowledge. 

I have wished to understand the hearts of [people]. 
I have wished to know why the stars shine. 

Love and knowledge led upwards to the heavens, 
But always pity brought me back to earth; 
Cries of pain reverberated in my heart 
Of children in famine, of victims tortured 
And of old people left helpless. 
I long to alleviate the evil, but I cannot, 
And I too suffer. 

This has been my life; I found it worth living.

~Bertrand Russell

Friday, January 29, 2010

Long-term exercise for telomeres

We can influence the length of our telomeres,* as discussed in this recent NYT Well blog.

This study highlights the importance of long-term exercise. They compared telomere length in both young athletes (average age ~20, running ~45 miles/week) and aged athletes (average age ~51, running ~50miles/week) compared with non-athletic controls.
  • Young athletes and young controls had no difference in their telomere lengths. Not surprising since all young people will have relatively long telomeres - they haven't lived long enough for their cells to "age."
  • Sedentary older subjects had a significant decrease in telomere length. Their telomeres were 40% shorter compared with their sedentary young counterparts.
  • Aged athletes maintained their telomere length -- aged runners had telomeres only 10% shorter compared to the young runners. Long-term running reduced telomere loss by 75%! 
The conclusion: Long-term continuous exercise maintains telomere length. And as one of the authors of the study, Dr. Christian Werner, said, exercise "at the molecular level has an anti-aging effect."

As discussed in this earlier post, the same group published a related study with findings from both mice and human studies on how physical exercise works at the molecular level:

1) Mice were randomized to voluntary running on a wheel or no running for 3 weeks. Running mice had increased telomerase activity (and other proteins influencing telomeres and cell longevity) in the aorta and circulating blood cells. 

2) Young and middle-aged track and field human athletes were compared with non-athletic controls, looking at telomere length in circulating blood cells. Athletes had increased telomerase, increased telomere-stabilizing proteins, and decreased shortening of their telomeres. 

We now know that long-term exercise keeps our cells molecularly young, and also keeps us looking younger – this study found that people who simply look younger have longer telomeres. And as Dr. Werner said:
"[It] was striking, to see in our study that many of the middle-aged athletes looked much younger than sedentary control subjects of the same age."  
There are still so many questions… how much do we have to exercise to influence our telomeres? What is the effect of other factors like diet, stress, sleep, illness, medications? Is this the same in women, and what role does estrogen play?

*Brief recap on telomeres & telomerase
Telomeres are the pieces of DNA that cap the ends of chromosomes and provide stability. Long telomeres are associated with longevity, while short telomeres are associated with many diseases associated with aging including heart disease, cancer risk, Alzheimer’s, and osteoporosis. Telomerase is the enzyme that helps maintain telomere length. Cancer cells with dysfunctional telomere/telomerase activity leads to unregulated growth and immortality (and we do not want cancer cells to be immortal).

Thursday, January 28, 2010

Eating microbes for health

Eating microbes in soil might be good for us -- and necessary for our health and wellbeing (thanks to Seth’s blog for posting about this).

This study from 2007 (press release here) showed that mice fed the bacteria Mycobacterium vaccae found in soil, had similar effects as antidepressant drugs. The study started after cancer patients given M. vaccae reported improvements in their quality of life, leaving scientists wondering if these bacteria might alter serotonin levels. The lead author of the study said:
“These studies help us understand how the body communicates with the brain and why a healthy immune system is important for maintaining mental health. They also leave us wondering if we shouldn’t all be spending more time playing in the dirt.
It makes sense that our bodies are meant to ingest some dirt. It may be that we clean our food a little too well. It's a widely held belief that vegans can’t get enough vitamin B12, but if we simply left some dirt on our fruits and vegetables we'd get plenty of B12 from the soil.

Wednesday, January 27, 2010

Forgetting our learning

It is only when we forget all our learning that we begin to know.  
~Henry David Thoreau 
It seems like I’ve been practicing the jump back for months, and with little progress. I’m starting to wonder if maybe my body simply isn’t built to do it.

Then yesterday, my teacher pointed out that when I attempt to jump back, my elbows are too close to my body as I land in chaturanga.

He said I have to move my arms away from my side about two inches -- and that I won’t be able to jump back until I can do this! This tiny shift turns out to be much harder on my arms and I am SORE today.

I like having this new focus. My practice has been feeling static lately, but last night and this morning I recognized that feeling of anticipation and excitement that I had lost.

This is why we need teachers (including doctors)… to point out what we cannot see, help us forget what we have learned, and teach us to build the correct habits.

Tuesday, January 26, 2010

A man's practice?

My older sister, Kim, first got me into Ashtanga about six years ago. When she got married, she stopped practicing except for the occasional post-run yoga poses in the living room. She recently had a baby and is now starting to get back into yoga (partly motivated by wanting to strengthen her "core” after pregnancy/labor).

Over Christmas, she asked me if I thought Ashtanga was more of “a man’s practice.” The feminist inside of me reacted immediately (almost in anger!). These were her points and my responses:
Kim: Ashtanga emphasizes being lean and light, but women are curvy and it’s harder to be lean. 
Me: It’s healthy for everyone regardless of gender to be lean and light. I think it’s possible for women to be lean, light, AND curvy. 
Kim: Postures seem to squish women’s body parts (i.e. breast and belly). 
Me: What's wrong with that? I don't think that is harmful (and may even be beneficial – many postures are meant to put pressure on/massage various body parts and organs). 
Kim: You aren’t supposed to practice when menstruating. Does this go back to an idea that having your period is dirty? 
Me: This is a time of rest for the woman's body (if I don’t rest during this time I definitely feel a difference in my practice). I think this is a sign of respect for the woman and her ability to have children, rather than because she is “dirty.” Also, there's an *unproven* idea that inversions may lead to endometriosis from backwards menstrual flow. 
Kim: The practice seems out of sync with women’s life cycle of having babies – you can’t do twists, etc, when you are pregnant or recently had a baby. 
Me: The entirety of a woman's life is not about having babies! Women practice Ashtanga right up until they give birth. You can continue to practice throughout the whole of pregnancy (with modifications, of course). 
Though my sister seemed to accept my answers as adequate, her question stuck with me and I sometimes wonder about this. The Ashtanga practice was developed by men, many of the advanced practitioners/teachers are men, and much of the physical practice does seem to come more easily to men.

But... that definitely does not mean women cannot or should not practice or teach it... though the practice may need to be modified sometimes (as Saraswati, Guruji’s daughter, discusses in this interview.)

One thing I love about Ashtanga is how it attracts strong, yet feminine, women. And maybe the intensity of the Ashtanga practice helps women to be intense in other aspects of their lives, be it a career, mothering, creativity, or other pursuits.

Monday, January 25, 2010

Prescribing practice

As Sri Pattabhi Jois, founder of Ashtanga yoga, said:
“Yoga is 99% practice and 1% theory.” 
I’ve been thinking about how this 99% practice idea applies to so many things in life. And how doctors should really be prescribing practice to patients: practice healthy eating habits, practice exercise, practice good relationships, practice discipline, practice creativity, practice confidence, practice learning, practice working hard.

Because everything takes practice. Health, contentment, love, good relationships, success… these don’t come easily to anyone.

I love this idea that “habits are first cobwebs, then cables” (Spanish proverb). Developing the right kinds of cables takes practice.

Sunday, January 24, 2010

Omega 3's for telomeres

This study that just recently came out in JAMA, shows a relationship between high dietary intake of omega-3 fatty acids and reduced telomere shortening in coronary heart disease patients.

It has already been shown that upping the intake omega-3’s improves survival in patients with coronary heart disease, but it wasn’t known exactly how this worked. This study shows that it may work at the cellular level by helping keep telomeres long (possibly by decreasing oxidative stress and/or increasing the activity of the enzyme telomerase).

The researchers measured telomere lengths of over 600 patients with coronary artery disease at study enrollment and then again after 5 years. They looked at baseline omega-3 levels and changes in telomere length over the 5 year period.

Those patients with the lowest omega-3 level had the fastest rates of telomere shortening, whereas those with highest levels of omega-3 had slowest rates of telomere shortening (after adjusting for risk factors and potential confounders).

How can we get more omega-3 fatty acids in the diet? Fish, yes. And many other sources as well: flaxseeds, walnuts, soybeans, navy beans, kidney beans, tofu, squash, olive oil, hemp milk… lots of places.

As more studies on telomeres are coming out, I’m starting to wonder if one day we’ll be measuring telomere length as a marker of health, similar to how we measure LDL today.

Saturday, January 23, 2010

Exciting collaboration

We had a very exciting meeting with a basic scientist yesterday who knows a lot about telomeres and telomerase and wants to do more clinical studies… a perfect collaboration!

One thing I admired about this scientist was his curiosity – and willingness to experiment on HIMSELF! He was going to have his wife draw his blood every few hours so he could test one of his questions... I love it!

I get frustrated and discouraged with all of the time and effort that goes into actually getting a clinical study done: the grant writing, waiting, IRB approval, waiting, subject recruitment, waiting, and on and on. I am attracted to the simplicity of experimenting on oneself for certain questions (but of course, not every question could be answered this way).

Friday, January 22, 2010

Yoga to get out of jail

Check out this BBC video and article about a policy in the Indian state of Madhya Pradesh where inmates have the opportunity to be released from jail 15 days early for every 3 months of yoga practiced (along with some other requirements and superintendant recommendation).

The authorities there say the yoga practice helps “to improve the prisoners’ self-control and reduce aggression.” Already 4,000 inmates are part of this program...

Thursday, January 21, 2010

Community-based yoga

My mentor and I talked today about this idea of partnering with a community organization in Philadelphia to offer yoga to cancer patients. While it would be nice to have a dedicated space at the cancer center for yoga, turning this into a community initiative is better in many ways (not to mention the fact that the “politics” at the cancer center may have us waiting a long time for it to actually happen there).

I think patients may even prefer to have yoga in a space and community that is separate from where they get their medical treatment.

If we do a clinical study on yoga, it has to be scientific, rigorous, and provide useful and new information. Right now, I want to focus on improving access. A criticism I’ve had with yoga is that people who could really benefit from the practice are not doing it (for many reasons including time, money, and availability of classes). But at the same time, I’m still drawn to yoga for its potential to be accessible, inexpensive, and provide a new dimension to communities.

Family Medicine research stats

I learned these numbers in a Family Medicine research meeting today:
  • Family medicine receives 0.20% of the NIH budget (compare this with 11.3% supporting pediatric research). 
  • 10 Family Medicine departments (7.6%) earn ~50% of all NIH Family Medicine awards. 
  • The average Family Medicine faculty member publishes less than 1 article per year and spends half a day or less each week on research. 

Wednesday, January 20, 2010

Low points

Grant proposal #1 was rejected.

My mentor’s response: “That’s ok! Please get rejected!” Because rejection is part of the process… because to be successful you have to risk failure… because you have to learn to persevere. It will make you better. And as he walked away, “HAVE FUN! This should be fun!”

This rejection may be coloring my attitude towards research today, but I was frustrated and disappointed with a lunchtime lecture on obesity. The presenter’s research revolves around how to change our environment/communities to help solve the obesity epidemic. This is a very important topic and one I think we need to take more seriously. My reactions from the talk:

1) One of the major research accomplishments discussed was a finding that high-income communities have more fruits and vegetables available compared with low-income communities. Did we really need an NIH-funded study to prove that?!

2) A second major research accomplishment discussed was the development of methods to measure “healthful food," but this study included potato chips as a “healthful choice.” I think we first need to figure out how to correctly define this!

3) The issue of fructose was not discussed (though calories, fat, and portion size were).

4) If we’re talking about making change in communities, we should look at what we're doing here at this hospital to change our environment. What are our patients eating in this hospital? Why is there a McDonalds at the children’s hospital? How come there is not a gym at the medical center for patients, family members, and medical staff? And why did they serve greasy potato chips and sodas for this lunchtime lecture? 

If I am going to do research for my career, here are some questions I want to make sure I remember to think about:
  • What does this research contribute to society?
  • Is it worth everybody’s time (not only your time, but that of your patients and your collaborators)? 
  • What new interventions or clinical practices will come out of this? 
  • Is the study worth all the money going into it (or could that money be better spent on something else to benefit society?) 
Running underneath all of this, my mind kept going back to a patient I met this morning in clinic. 31 years old and she has metastatic breast cancer (currently getting chemo and radiation). She came in today because of bad headaches that have been keeping her up at night for the past week.

This may be metastatic cancer to her brain. I watched as the oncologist talked with her about what this would mean. She was calm, quiet, rational. She was beautiful. I wanted to know everything about her.

She's 31. How does this happen???

Tuesday, January 19, 2010

Richard Freeman on the physician-patient relationship

I was really excited to come across this clip by Richard Freeman about the physician-patient relationship (less than 2 minutes if you have the time).

How the physician should educate patients -- give them a self-knowledge so that they then turn into their own doctor.

How people who are healing or have been healed know their bodies and know their disease.

How a new model of equal partnership between physician and patient is replacing the archaic model (of doctor as the authority figure and patients as little children).

Creative extremists

"The question is not whether we will be extremists, but what kind of extremists we will be... The nation and the world are in dire need of creative extremists."

~Martin Luther King, Jr.

And some other favorite MLK quotes...

Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that."

"Faith is taking the first step even when you don't see the whole staircase."

"Almost always, the creative dedicated minority has made the world better."

"Every man must decide whether he will walk in the light of creative altruism or in the darkness of destructive selfishness."

"Human progress is neither automatic nor inevitable... Every step toward the goal of justice requires sacrifice, suffering, and struggle; the tireless exertions and passionate concern of dedicated individuals."

"Human salvation lies in the hands of the creatively maladjusted."

"I have decided to stick with love. Hate is too great a burden to bear."

"Injustice anywhere is a threat to justice everywhere."

"Life's most persistent and urgent question is, 'What are you doing for others?'"

"Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity."

"Our scientific power has outrun our spiritual power. We have guided missiles and misguided men."

"Rarely do we find men who willingly engage in hard, solid thinking. There is an almost universal quest for easy answers and half-baked solutions. Nothing pains some people more than having to think."

"The hottest place in Hell is reserved for those who remain neutral in times of great moral conflict."

"We must use time creatively."

"When you are right you cannot be too radical; when you are wrong, you cannot be too conservative."

Monday, January 18, 2010

Almond nut banana mix

I can't help sharing my new snacking discovery! It's perfect for compulsive time managers -- it takes 5 minutes to make and is great snack food for the next day/week.

Just mix together uncooked oats, sunflower seeds, pumpkin seeds, raisins, walnuts, almond butter, honey (enough to make sticky), cinnamon, vanilla extract, and mushed up banana (banana was a new experiment tonight – really good).

Hmm not too pretty now that I'm seeing it up here...
(but, it's GOOD! And good for us.)

Hard practice

It was a hard practice today. I was distracted, my eyes were wandering, and my foot ached. I felt impatient, tired, sore, and bored. (And I think I may have irritated a little intercostal muscle in kapotasana… ugh!)

I thought a run might help clear my head and re-energize. But my running mind was stuck on how de-conditioned I have gotten over the past few winter months (trying to keep it more of an observation rather than self-criticism). You would think doing yoga every day would help keep me in shape for running… but they are so different!

Sunday, January 17, 2010

Forget Paleo...let's get on the Gorilla Diet!

Rather than revert to cavemen on the “Paleo” stone age diet, how about we learn from our gorilla ancestors and go on the gorilla diet.

Foliage: shoots, stems, flowers, roots, leaves, berries (I should also mention insects and caterpillars).

I bet that would cure diabetes. A study already proved it drops cholesterol as much as a statin.

What would Jane Goodall think of this?!


This diet would lengthen our telomeres, I'm almost sure of it.

The Paleolithic Diet & Type 2 Diabetes

The “Paleolithic Diet” has piqued my curiosity lately, both when discussed in this recent New York Times article about modern "cavemen" in NYC, and when mentioned in Dr. Robert Lustig’s lecture as a cure for type 2 diabetes. While the NYT article slightly repulsed me with the (over) emphasis on raw meat, the idea of going back to our ancestral diet is intuitively appealing to me.

This “Paleo” diet, also known as the “Old Stone Age” diet, is very high in fiber as it is based on lean meat, fish, fruits, vegetables, eggs, and nuts. A recent study compared the Paleolithic diet with the standard diabetic diet in patients with type 2 diabetes.

Though the sample size is small (N=13), it’s a start. They found that after a 3-month period, patients on the Paleolithic diet had lower levels of HbA1c (a marker of long term blood sugar levels – the lower the better), lower triglyceride levels, lower blood pressure, lower BMI, and a decreased waist circumference.

We need to do more studies like this. Diet and lifestyle changes will help people be independent from the health care system and avoid expensive medications, hospitalizations, and surgeries.

I can’t help wondering what the Paleo diet would do to telomerase activity...

Saturday, January 16, 2010

Bringing back house calls

Great NBC Nightly News “Making a difference” piece on doctors making house calls (thanks to Lizzie for sharing this!)

Each year, Medicare patients with multiple illnesses (3 million people) see an average of 13 different doctors, receive 50 different prescriptions, and account for 76% of hospital admissions.

House calls will help keep people OUT of the hospital, and save Medicare as much as $50 billion.

Let’s hope the health reform bill happens. Encouraging house calls has bipartisan support and will be beneficial for all involved...  patients, physicians, and the health system.

Loving winter

"Let us love winter, for it is the spring of genius." 
~Pietro Aretino 

Loving winter: Less socializing means more time for writing, reflecting, cooking, nesting. Coffee dates. Deep sleep. Herbal teas. Root vegetables. Baths. Practicing while the sun rises. Immense gratitude on warm(ish) sunny days like today.

It's good to be reminded to love our other winters (winters of our moods, winters of our bodies during illness and injury, winters of relationships). Because denial of things, either self-imposed or external, makes their return so sweet.

Friday, January 15, 2010

Eddie Stern on Ashtanga

Loved watching Eddie Stern talk about Ashtanga! (on the Martha Stewart show) 

Why Eddie practices Ashtanga: it helps him answer the questions ‘who am I’ and ‘what am I doing here.’ It’s not just about physical poses -- it’s a lifestyle.

Yogic texts talk about the 6 things necessary for success yoga (*none of which are being flexible*):
  • Enthusiasm 
  • Perseverance 
  • A sense of adventure 
  • Not being afraid
  • Going slowly and carefully
  • Enjoying the physical postures

Wednesday, January 13, 2010

“The nature of academia”

In my day full of research meetings, I received some lessons from my mentor(s) about “the nature of academia.”
  • You have to set boundaries with people. Always be nice, but learn how to say no. People will want you to do their work for them. 
  • Clinical research is not just about the idea. It’s about organization, building relationships, and learning how to collaborate with people. 
  • There WILL be low points in research. You have to persevere through them. 
  • Your research life will change once you have your own dataset. Without it, you will always be dependent on other people’s work. 
  • To know statistics = power. Otherwise, you will always need someone else to analyze your data. 
Speaking of statistics, I had my first biostats class today. When I’ve had these kinds of classes in the past (both in undergrad and medical school) I’ve found them incredibly difficult, resulting in minimal interest.

But now! Now I see how I will use it! While I am still very far from understanding it, I can see the potential.

If one day, I can:

1) Have my own dataset
2) Know how to analyze that data

... THAT would be exciting.

“Knowledge of statistics is like a knowledge of foreign languages… it may prove of use at any time under any circumstances.” ~A.L. Bowley 
“A poorly designed study can never be saved, but a poorly analyzed one has the possibility of being re-analyzed.” 

Tuesday, January 12, 2010

The fructosification (and poisoning) of America

Here’s a “Mini medical school” lecture by Dr. Robert Lustig from UCSF:

In case you don’t have 90 minutes to watch this, this is what I learned:
  • The obesity epidemic in the U.S. has coincided with our drastic increase in consumption of SUGAR (both from fructose in high fructose corn syrup, and sucrose in regular table sugar. See structures below -- sucrose is fundamentally fructose). We now have an epidemic of obese 6 month olds (pregnant women eat more sugar --> crosses the placenta --> changes adiposity in fetus before birth).  

Molecular structure of glucose (in pasta), fructose (in high fructose corn syrup, fruits), and sucrose (table sugar, from sugar cane): 
Sucrose = fructose + glucose --> Sucrose IS fructose. 

  • Our biggest mistake is thinking that calories in = calories out. This is NOT TRUE and we have to stop thinking this way. A calorie is not a calorie. Different molecules act differently in our bodies. There exists good protein and bad protein, good fats and bad fats, good carbohydrates and bad carbohydrates. Glucose (the carbohydrate in pasta) is a good carb, while fructose/sucrose (the carb in high fructose corn syrup and table sugar) is a POISON
  • When we took fat out of our diets (to prevent cardiovascular disease), we replaced it with fructose. High fructose corn syrup is cheap, sweet, and we like it. It is now in nearly all processed foods: snack foods, buns, breads, sauces, ketchup, gatorade, chocolate milk, the list goes on (check out the ingredients list on your food at home – shocking!). There are only 7 things on the menu at McDonalds that do not contain fructose: French fries, hash browns, chicken mcnuggets, sausages, diet coke, coffee, iced tea. (And if you add ketchup or dipping sauce or a sugar packet, it’s off the list.) 
  • Fructose, in particular, is bad for us because:
    • Fructose causes “browning” from advanced glycation end-products. This is why some fruits will turn brown when left out, and this is what it does to our arteries.
    • Fructose does not suppress the hunger hormone, ghrelin. 
    • Fructose does not stimulate insulin, so insulin doesn’t go up, and leptin (the hormone that signals to your brain that you are full so stop eating) does not go up, so you feel hungry despite having adequate calories. 
    • The metabolism of fructose is different. While glucose is used by every cell, fructose can only be metabolized by the liver. Because of the way fructose is metabolized, it eventually turns into fat, and chronic fructose exposure leads to metabolic syndrome (high blood pressure, insulin resistance, obesity, leptin resistance, lipogenesis). It increases lipogenesis while your brain still thinks you’re hungry. 
Summary so far:
***Fructose is poisoning us*** 
  • The ancestral human diet is termed the “Paleolithic Diet” (more on this in a later post, but it basically means eating like a hunter-gatherer: eating everything as it came out of the ground RAW). On this ancestral diet, the fructose intake from fruits and vegetables is about 15 grams/day and fiber intake about 100-300 grams/day. Today, the average fructose intake is over 70 grams/day, and fiber is about 12 grams/day. Dr. Lustig claims that going on this Paleolithic Diet -- and thus increasing intake of fiber to about 300 grams/day -- would CURE Type 2 diabetes. And it would take about a week. 
  • So, what to advise patients (and ourselves): 
    1. CUT OUT SUGARY DRINKS. For all the reasons above. 
    2. EAT FIBER WITH CARBOHYDRATES. Wherever there is fructose in nature, there is fiber (think about how much fiber is in natural sugar cane). Fiber makes us feel satiated, it inhibits absorption of free fatty acids, it suppresses insulin, and it reduces intestinal carbohydrate absorption. This is why eating fructose in fruits and vegetables is okay. 
    3. EXERCISE. But NOT because it “burns calories.” It has nothing to do with that! It’s because exercise improves skeletal muscle insulin sensitivity, increases metabolism, and reduces stress (which reduces appetite). 

Natural sugar cane = fiber. 
Eat fiber with sugar. 

Monday, January 11, 2010

Guest Blogger, Alex Whitehead: Time management (only a little compulsive)

I’m always curious about other people’s daily rituals and routines. Especially how people balance busy professional/personal lives with their Ashtanga yoga practice. Here is how Alex does it (he’s an IT guy at law firm).

Guest Blogger, Alex Whitehead 
Time management (only a little compulsive) 

The advantage of compulsive time management is that I get a lot done in my day. The downside is that I sometimes feel like a robot. I know that coming to practice every morning is a luxury and not a penance. Sometimes I forget though.

Daily schedule (Monday-Friday):
4:30am -- rise, bathe, caffeinate, cleanse
5:54am -- leave house
6:12am -- arrive studio
8:20am -- end practice, bathe, change, toil on death star
5:15pm -- leave work
5:50pm -- home, shoes off, slouchy clothes applied, feed self
6:30pm -- guitar practice
8:00pm -- pack clothes, yoga bits in bag, pack lunch etc
8:30pm -- bed

*Tuesdays: all of the above plus my guitar lesson at 5:30
*Fridays: often have booze programmed in the evening especially since no work/yoga in morning.

• The only day I sleep in past 7 am.
• Saturday is good for making up missed guitar practice time during the week, doing laundry etc. The more housekeeping done on Saturday allows for a more relaxed Sunday. Time after yoga for coffee, for example.
• Saturday evening is the ideal time for getting groceries (have awesome red granny style grocery cart I pull behind me. People in cars look on jealously.)

• Up at 7 am to allow for pre-yoga caffeination, bathe, etc.
• Practice and then coffee with some delightful humans.
• Home, 2 hrs guitar.
• Prepare food for the week: salad and fruit salads. 

• Salad includes mixed greens, spinach, green beans, broccoli, cherry tomatoes, cabbage, feta, pepper, carrots, onions, radish, grilled chicken, turkey bacon, home made croutons.
• Fruit salad - cantaloupe, pineapple, strawberries, blueberries, kiwi, mango, grapes. This varies depending on season and quality of fruit available. No strawberries this week. Mango’s will break your heart -- they are so beautiful when good and so so so sad when bad or mediocre. Any fruit salad leftover gets frozen and turned into smoothies later.

*** NOTE: There is a cost to this approach. The cost is a slight monastic lifestyle. I am mostly fine with that but many may find it austere.*** 

Alex's office:

Total underdesk inventory: Boots - worn and slightly soiled; Shorts - (not visible); Bumble bee yellow sleevless shirt; Yogitoes - green, threadbare and frankly, nasty; Teatowel - principally used to facilitate the least graceful marichyasana D ever. 

Practicing through illness and injury

While I had a really hard time getting out the door to yoga this morning, I do like practicing through illness and injury. It’s a way to monitor my body and see how it changes and heals itself from one day to the next. Our bodies are amazing in that way.

If it weren’t for this toe injury, I would never have known that it is possible (though not easy or graceful) to have a good practice with only one fully functional foot!

Sunday, January 10, 2010

The importance of toes

After falling down the stairs and injuring (questionable breakage) of my left big toe, I now have a much greater awareness and appreciation for this previously neglected body part. The TOE turns out to be central to much of yoga… standing postures, balance, vinyasas, backbends… who knew?! I hope my little guy heals fast.

Saturday, January 9, 2010

Research update: Month 3

  • Accomplishment of the week: Submitted one of the three grant proposals for the telomere study. 
  • Next on to-do list: Submit the two other grant proposals and write yoga study protocol for IRB approval. 
  • When I feel pessimistic about actually being awarded one of these grants, I think of my mentor telling me “If you don’t apply, your chance of getting it is 0%.” 
  • I really like my Fridays with the oncologist in the breast cancer clinic. I’ve met some amazing patients. Beautiful, strong women. And incredibly devoted husbands, friends, and family members. I like watching the oncologist work. I like seeing his responses to various questions (and in my head, comparing them to what I would say): When can I dye my hair? When can I start exercising? What can I do about my fingernails? Should I change my diet to improve my bone density? Yesterday he even recommended Epsom salt baths for a patient with fingernail infections (chemo can make the skin under the nail bed slough off which predisposes it to infection). I do wish there was more talk about diet and exercise. They have “nutrition after breast cancer” discussions for patients – I’m really curious to go to one of these and see what they say. 
  • One of the best parts of this research year is having relative autonomy to make my own schedule. When else in my life will I be able to indulge in a two and a half hour yoga practice every morning?! This will probably never happen again except on vacation (if pre any potential babies) or retirement. But I have to say, the workshop last weekend and practice every day this week has really wiped me out (so glad to have a rest day today). My sacroiliac joints are especially feeling it… I must be careful with these! 
  • A bunch of Ashtangi friends are in India right now and I’m feeling the itch to go back… 

Friday, January 8, 2010

Real health reform (Part 4 or 4): Personal responsibility & Self-care

4) Personal responsibility & Self-care
  • There needs to be a paradigm shift so that people start taking health into their own hands -- by practicing healthy habits like a plant-based diet, regular exercise, not smoking, positive relationships, less stress, etc. 
  • Brian Berman, Director of the Center for Integrative Medicine at the University of Maryland, said: 
“About 40% of the illnesses that we have today are behaviorally based. How do we move toward more self-care?”  
Is it really only 40%? Thinking about the reasons patients are hospitalized, it seems like that number is much higher. 
  • Christie Mack, cofounder and president of the Bravewell Collaborative, said: 
“[Patients need to] realize that they are the primary caregivers for themselves. And health care should provide the support systems to encourage behavior change toward healthier lifestyles.”

Thursday, January 7, 2010

Real health reform (Part 3 of 4): Integrative care

3) Integrative care:
  • As discussed in the earlier post on meditative medicine, we need to shift away from the division between “conventional” and “alternative” medicine. 
  • There are cost-effective alternatives to expensive medications and interventions. Andrew Weil said: 
“As long as medicine remains this costly, it’s going to sabotage any system we create. You just can’t do statin therapy and stents and angioplasties on everybody; we can’t afford that. And there are low-cost alternatives to that kind of intervention.”  
The alternatives? Diet changes. Exercise. Stress reduction. 
  • Unfortunately, these alternative approaches are often marginalized as “Complementary and Alternative Medicine (CAM),” when they are not complementary or alternative at all, but rather part of simple, fundamental health care. Mimi Guarneri said:
“I used to be called the ‘alternative cardiologist’ because I talked about nutrition, exercise, and stress relief. I thought, ‘Alternative to what? A bypass?’ [Nutrition, exercise, and stress relief] are not CAM, they’re not conventional, they’re basic health care, and they should be available to everybody.” 
  • We need to stop calling basic health habits “CAM” when there is plenty of evidence behind them. Not to mention the fact that they are low-cost and have few, if any, side effects. 
  • Integrative methods need to be part of medical school training in order to become part of our health system. James Gordon, MD, Director of the Center for Mind-Body Medicine, said: 
“When doctors, medical students, and residents experience these approaches themselves, then it will become part of practice.”

Wednesday, January 6, 2010

Guest blogger, Alicia Maxwell: My practice through cancer

My practice through cancer 
Alicia Maxwell

On January 16th, 2010 I will be celebrating my two-year anniversary of surviving breast cancer. I was diagnosed with Stage IIA breast cancer at the young age of thirty, finding the lump myself while showering. Needless to say I was shocked because of my age, no family history of the disease, and my overall healthy lifestyle. However, cancer does not discriminate. You cannot control cancer, but you can control how you react to it. My reaction to my diagnosis was to survive and not let this cancer thing get me down. I wanted to continue striving for the things I had planned and continue doing the things I loved. There would be no quitting anything while going through treatment, only modifications. 
My ashtanga practice played an integral role in my recovery, mentally and physically. At the time of my diagnosis, I was just a few poses away from finishing the primary series. I was looking forward to transitioning into second series and gaining a deeper understanding of my practice. As I got closer to treating my cancer, I knew that my practice would have to be modified significantly. My treatment plan included a lumpectomy followed by months of aggressive chemotherapy and radiation. 
The first practice after my diagnosis, I rolled out my mat and worked on quieting my mind. It was difficult. My surgery date was approaching and I needed to prepare for battle. My first vinyasa was the most difficult, thoughts flooded my mind and I was bombarded by every emotion imaginable. By the end of my practice I was calmer and more at peace with facing the challenges ahead. Surgery day came, the cancer was removed from my breast and lymph nodes. But it was just the beginning of my journey. 
The lumpectomy decreased my shoulder range of motion and I had paresthesias in my arm, and pain in my breast. I couldn’t do certain poses and my practice was modified significantly. I felt like it was my very first time on the mat. I was frustrated. As I sat in child’s pose, I let go of my frustrations and took this as an opportunity to find myself in each posture. My range of motion slowly started coming back, thank you sun salutations, and I was getting closer to starting chemo. 
My long silky black hair would be gone. The thought brought tears to my eyes. My hair always seemed to come undone during my practice, sweeping my face, and I would become distracted. Now, it had a completely different meaning. I would begin my practice with my hair long, feeling it brush across my shoulders and face. Midway through my practice I would place my hair in a bun, enjoying the texture of my hair. I just wanted to remember. 
I started chemo and my doctor said my hair would fall out in fourteen days. I noticed a few strands of hair in the shower and on the floor, but wasn’t ready to shave it off yet. On day thirteen, I looked down at my mat and the surrounding floor and my hair was everywhere. I came to terms with losing my hair during that practice. The next time I stepped on the mat I would be bald, but still me. Adorning a vintage scarf, I began my practice. The silkiness of the scarf now brushed my neck and shoulders. I took a depth breath and I was at peace. 
Chemo is tough and it’s the hardest thing I’ve ever had to do, but you get through it. I practiced as much as I could during treatment and it helped keep my body and mind strong. At times I could only do a few postures, leaving the remaining time to meditate and pray. It was obvious to my fellow yogis that I was sick. One day a gentlemen I had never spoken to before approached me after class. He said he dedicated his practice to me. It was such a kind and loving gift, I will never forget it. Just speaking of it now brings a smile to my face. 
My journey benefited from placing my bare feet on the mat and allowing my practice to just happen.

Tuesday, January 5, 2010

Real health reform (Part 2 of 4): Individualized Care

2) Individualized care
  • Providers need to see each patient as a unique human being, not simply as a collection of symptoms.
  • This approach requires time and a trusting patient-provider relationship. And, it requires more primary care physicians who are trained to look at the wider picture of a person.
  • Brian Berman, Director of the Center for Integrative Medicine at the University of Maryland said: 
“Individualization – what’s appropriate for that person at that point in time – is what integrative medicine is really about. Someone may come in with a symptom, say, back pain. Perhaps as you start to talk with her, you realize she’s not satisfied with her job, which is a big predictor of continuing pain. Then you talk further and learn because she hasn’t been able to exercise and play with her children, her self-worth has taken a beating, and she’s been overeating. And because she’s gained weight, she has inflammation within the body that perpetuates that pain,"...  it’s really the whole person – mind, body, and spirit – that is out of balance.” 

Monday, January 4, 2010

Caitlin White Guest Blogger: Epsom salt hypotheses

Caitlin’s findings on our Epsom salt question! Thank you, Caitlin (and Caitlin's mom)!

So I asked my mom (high school chemistry teacher) for any ideas she had on why bathing in Epsom salt/magnesium sulfate is supposedly so healthy. 
Here is what she hypothesized: 
1) Magnesium is a cofactor for a lot of enzymatic reactions in the body (including enzymes used for detoxification). It is also a component of synovial fluid. 
2) Sulfate binds heavy metals more avidly than magnesium, so theoretically would exchange magnesium for a heavy metal it came in contact with. When sulfate binds a heavy metal it becomes insoluble and precipitates out of solution (which would drive the reaction further towards completion). 
3) The super-saturated salt bath acts as a disinfectant (similar to honey because they are both hypertonic solutions) on open wounds by lysing bacterial cells. 
Number 1 seems plausible to me since your skin can definitely absorb nutrients/chemicals, so I guess bathing in magnesium sulfate would increase the amount you have available in your body? Number 2 seems a little far-fetched, since I don't know that we really carry a lot of heavy metals in our body (any of you know about this?), and Number 3 also definitely seems likely... but I wonder if frequent baths would change your natural skin flora for the better or the worse? 
Also, during her "research" she said she stumbled upon an article on the benefits of fasting combined with vigorous exercise (she is always giving me a hard time about practicing yoga on an empty stomach). Apparently this combination promotes detoxification because a lot of toxins are stored in fat cells (where they can hide out for long periods of time), but when you fast, your body is forced to metabolize fat to provide energy, thereby releasing the stored toxins to then be metabolized or excreted in your sweat. I wonder, should I be showering immediately after yoga to wash off my sweat then, otherwise these toxins will be reabsorbed through my skin if I don't?

Real health reform (Part 1 of 4): Health care, not disease care

I read a great article in Body & Soul magazine on the future of medicine, where they interviewed several leaders in the field of integrative medicine.
“Somewhere beyond the endless health-care debates could lie real reform: A future where we – an our doctors – will take a more balanced approach to keeping ourselves well...” 
There are 4 main parts to this, but today I’ll just address the first...

1) Health care, not disease care
“We don’t have health care: we have disease care.” ~ Mimi Guarneri, director of the Scripps Center for Integrative Medicine 
  • Our health system is good for emergency care – heart attacks, strokes, trauma, and serious infections – but not great for keeping people healthy in the first place. 
  • The preventive care provided is not really prevention. Guarneri said, “Prevention isn’t having a mammogram… Prevention is eating an anti-inflammatory diet rich in greens and whole grains and exercising.” 
  • The current fee for service structure reimburses physicians for providing treatment. Physicians should be reimbursed for their time teaching about prevention and lifestyle change. 
  • Medical schools need to expand their curriculum to teach about nutrition, exercise, and stress reduction. Andrew Weil, founder of the Arizona Center for Integrative Medicine, said: 
“There should be a course on the body’s healing system, on all the mechanisms from DNA on up, by which it can self-diagnose, repair, regenerate, and adapt… It seems odd to me, when you look at the NIH, that there’s really nothing there about health: it’s all about diseases… and that’s representative of what’s off in our whole way of thinking about the body.”

Sunday, January 3, 2010

Some notes on second series

Great second series workshop with David this weekend… I am incredibly sore!

David described second series as a “wild” series… while primary is very grounding and introverted with a lot of forward-bending, second series is more energizing and extroverted with a lot of back-bending and opening of the spine. He said this is why when people start second series they notice changes in their energy levels, and especially trouble sleeping.

I wonder why back bending has this effect -- more blood flow and oxygen to the spinal cord stimulating the sympathetic nervous system? Or maybe compression of adrenal glands and stimulation of cortisol release? Any other ideas?

Friday, January 1, 2010

A perfect way to start the year

Awesome led primary class this morning at the new Y2! A perfect way to start the year.