First do no harm: Listen to Freakonomics Radio Episodes Bad Medicine

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How come up to 250,000 people a year die of medical errors and is the third leading cause of death in the USA (Makary & Daniel, 2016)?

Why are some drugs recalled after years of use because they did more harm than good?

How come arthroscopic surgery continues to be done for osteoarthritis of the knee even though it is no more beneficial than mock surgery (Moseley et al, 2002)?

How come women have more negative side effects from Ambien and other sleep aids than men?

Is it really true that the average new cancer drug costs about $100,000 for treatment and usually only extends the life of the selected study participants by about two months (Szabo, 2017; Fojo, Mailankody, & Lo, 2014)?

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine”Dr. Marcia Angell, longtime Editor in Chief of the New England Medical Journal (Angell, 2009).

Medical discoveries have made remarkable improvements in our health.  The discovery of insulin in 1921 by Canadian physician Frederick Banting and medical student Charles H. Best allowed people with Type 1 Diabetes to live healthy productive lives (Rosenfeld, 2002).  Cataract lens replacement surgery is performed more than three million times per year and allows millions of people to see better even though a few patients have serious side negative side effects.  And, there appears to be new hope for cancer. The FDA on August 30, 2017, approved a new individualized cancer treatment that uses genetically engineered cells from a patient’s immune system to produce remissions in 83 percent of the children and young adults who have relapsed after undergoing standard treatment for B cell acute lymphoblastic leukemia. (FDA August 30, 2017). The one-time treatment for this breakthrough cancer drug for patients who respond costs $475,000 according to the manufacturer Novartis. Yet, it will be years before we know if there are long term negative side effects.

The cost of this treatment is much more than the average cost of $100,000 for newly developed and approved cancer drugs which at best extend the life of highly selected patients on the average by two months; however, when they used with more typical Medicare patients, these drugs often offer little or no  increased benefits (Szabo, 2017; Freakonomics Radio episode Bad Medicine, Part 2: (Drug) Trials and Tribulations).

As the health care industry is promising new screening, diagnostic and treatment approaches especially through direct-to-consumer advertising, they may not always be beneficial and, in some cases, may cause harm.  The only way to know if a diagnostic or treatment procedure is beneficial is to do long term follow-up; namely, did the treated patients live longer, have fewer complications and better quality of life than the non-treatment randomized control patients.  Just because a surrogate illness markers such as glucose level for type 2 Diabetes or blood pressure for essential hypertension decrease in response to treatment, it does not always mean that the patients will have fewer complications or live longer.

To have a better understanding of the complexity and harm that can occur from medical care, listen to the following three Freakonomics Radio episodes titled Bad Medicine.

Freakonomics Radio episode Bad Medicine, Part 1: The story of 98.6.  We tend to think of medicine as a science, but for most of human history it has been scientific-ish at best. In the first episode of a three-part series, we look at the grotesque mistakes produced by centuries of trial-and-error, and ask whether the new era of evidence-based medicine is the solution. http://freakonomics.com/podcast/bad-medicine-part-1-story-98-6/

Freakonomics Radio episode Bad Medicine, Part 2: (Drug) Trials and Tribulations. How do so many ineffective and even dangerous drugs make it to market? One reason is that clinical trials are often run on “dream patients” who aren’t representative of a larger population. On the other hand, sometimes the only thing worse than being excluded from a drug trial is being included. http://freakonomics.com/podcast/bad-medicine-part-2-drug-trials-and-tribulations/

Freakonomics Radio episode, Bad Medicine, Part 3: Death by Diagnosis.  By some estimates, medical error is the third-leading cause of death in the U.S. How can that be? And what’s to be done? Our third and final episode in this series offers some encouraging answers. http://freakonomics.com/podcast/bad-medicine-part-3-death-diagnosis/

References

Angell M. Drug companies and doctors: A story of corruption. January 15, 2009. The New York Review of Books 56. Available: http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/. Accessed 24, November, 2016.

FDA approval brings first gene therapy to the United States, August 30, 2017. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm574058.htm

Fojo, T., Mailankody, S., & Lo, A. (2014). Unintended consequences of expensive cancer therapeutics—the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: the John Conley Lecture. JAMA Otolaryngology–Head & Neck Surgery140(12), 1225-1236.

Makary, M. A., & Daniel, M. (2016). Medical error-the third leading cause of death in the US. BMJ: British Medical Journal (Online)353. Listen to his BMJ medical talk: https://soundcloud.com/bmjpodcasts/medical-errorthe-third-leading-cause-of-death-in-the-us

Moseley, J.B., et al, (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine. 347(2), 81-88.

Rosenfeld, L. (2002). Insulin: discovery and controversy. Clinical chemistry48(12), 2270-2288. http://clinchem.aaccjnls.org/content/48/12/2270

Szabo, L. (201, February 9). Dozens of new cancer drugs do little to improve survival. Kaiser Health News. Downloaded September 3, 2017.  https://www.usatoday.com/story/news/nation/2017/02/09/new-cancer-drugs-do-little-improve-survival/97712858/

 


Sitting disease is the new health hazard

sitting at computerSedentary behavior is the new norm as most jobs do not require active movement. Sitting in a car instead of walking, standing on the escalator instead of walking up the stairs, using an electric mixer instead of whipping the eggs by hand, sending a text instead of getting up and talking to a co-worker in the next cubicle, buying online instead of walking to the brick and mortar store, watching TV shows, streaming movies, or playing computer games instead of socializing with actual friends, are all examples how the technological revolution has transformed our lives. The result is sitting disease which we belief can mitigate by daily exercise.

The research data is very clear– exercise does not totally reverse the health risks of sitting. In the NIH-AARP Diet and Health Study, researchers Matthews and colleagues (Matthews et al, 2012) completed an 8.5 year follow up on 240,819 adults (aged 50–71 year) who at the beginning baseline surveys did not report any cancer, cardiovascular disease, or respiratory disease.

The 8.5 year outcome data showed that the time spent in sedentary behaviors such as sitting and watching TV was positively correlated with an increased illness and death rates as shown in Figure 1. More disturbing, moderate vigorous exercises does not totally reverse the health risks of sitting and watching television (Matthews et al, 2012).  

mortality and sitting

Figure 1. The more you sit the higher the risk of mortality even if you if you attempt to mitigate the effect with moderate vigorous exercise (Matthews et al, 2012). From: https://www.washingtonpost.com/apps/g/page/national/the-health-hazards-of-sitting/750/

The harmful impact of sedentary behavior and simple ways to improve health have been superbly described and illustrated by Bonnie Berkowitz and Patterson Clark (2014), in their January 20, 2014, Washington Post article, The health hazards of sitting,  Their one page poster should be posted on the office walls and given to all clients.  http://www.washingtonpost.com/wp-srv/special/health/sitting/Sitting.pdf

As they point out, sitting disease increases the risk of heart disease, diabetes, colon cancer, muscle degeneration especially weaker abdominal muscles and gluteus muscles, back pain and reduced hip flexibility, poor circulation in the legs which may cause edema in the ankles and deep vein thrombosis, osteoporosis, strained neck, shoulder and back pain. The effects are not only physical. Sitting reduces subjective energy level and attention as our brain becomes more and more sleepy.

The solution is both very simple and challenging. To reduce the risks, do less sedentary behavior and sitting and do more physical movement during the day.  Continuously interrupt sitting with standing and movement.  After sitting at the computer for 30 minutes, get up and move.  Even skipping in place for 30 seconds, significantly will increase your energy and mood (Peper and Lin, 2012).  There are many ways to remind and support yourself and others to move.  For example, use reminder programs on the computer such as StretchBreakTM  to remind you to get up and stretch. Employees who do episode movements, report fewer symptoms and have more energy (Peper & Harvey, 2008).  As one of the employees state after implementing the break program, “There is life after five.” Meaning he was no longer exhausted when he finished work.

Although challenging, wean  yourself away from the addicting digital screen and being a couch potato at home.  At those moments when you feel drained and all you want to do is veg out by watching another TV series, go for a walk.  After walking for 20 minutes, in most cases your energy will have returned and your low mood has been transformed to see new positive option.  Plan the walks with neighbors and friends who provide the motivation to pull you out of your funk and go out.

walking

References:

 

Berkowitz, B. & Clark, P. (Jan 20, 2014). The health hazard of sitting. The Washington Post. Retrieved July 29, 2017.https://www.washingtonpost.com/apps/g/page/national/the-health-hazards-of-sitting/750/

Matthews, C. E., George, S. M., Moore, S. C., Bowles, H. R., Blair, A., Park, Y., … Schatzkin, A. (2012). Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. The American Journal of Clinical Nutrition95(2), 437–445. http://doi.org/10.3945/ajcn.111.019620

Peper, E. & Lin, I-M. (2012). Increase or decrease depression-How body postures influence your energy level.  Biofeedback, 40 (3), 126-130.

Peper, E. & Harvey, R. (2008). From technostress to technohealth.  Japanese Journal of Biofeedback Research, 35(2), 107-114.

 


Exercise:  Improve your health, mood, and cognitive function

Through millions of years, movement was part of our biological necessity..  Movement was necessary to hunt, to escape predators, to explore and to find a mate. Organisms developed a brain (nervous system) to coordinate movement as eloquently explain by neuroscientist Daniel Wolpert in his 2011 TED talk, The Real Reasons for Brains.

It is only recently that we limit movement by sitting, driving, taking the escalator, or controlling equipment that performs the actual physical labor. We interfere with our evolutionary developed physiology when we reduce or even eliminate movement for the sake of efficiency. Lack of movement, “sitting disease”, is a significant contributor and causal factor in illness. It also increases the stress response, negative mood and depression and reduces cognitive activity. Take charge and reduce illness when you integrate purposeful exercise (walking, running, dancing, etc.) into your life style.

we fucked up

Exercise is the most effective behavioral technique for self-regulation of mood in healthy people as summarized in the superb article, The Effects of Acute Exercise on Mood, Cognition, Neurophysiology, and Neurochemical Pathways: A Review, Dr. Julia C. Basso and Wendy A. Suzuki of the  Center for Neural Science, New York University, New York, NY, USA.  The robust research findings show that acute exercise improves mood, significantly reduces depression, tension, anger, fatigue, and confusion.  In addition, acute exercise improves symptoms associated with psychological disorders such as depression, anxiety, schizophrenia, and post-traumatic stress disorder.  Exercise decreases the risk of type 2 diabetes, coronary heart disease and stress-related blood pressure response by inhibiting the sympathetic nervous system response to stress. For a detailed summary, see the blogs, What is the best single thing we can do for our health and Healthy movement is the new aging.

Finally, the authors also review the relevant neurophysiological, and neurochemical processes that are affected by exercise. What is most interesting are the findings that “acute exercise primarily enhances executive functions dependent on the prefrontal cortex including attention, working memory, problem solving, cognitive flexibility, verbal fluency, decision making, and inhibitory control. These positive changes have been demonstrated to occur with very low to very high exercise intensities, with effects lasting for up to two hours after the end of the exercise bout.”

As the authors state, “We show that the three most consistent cognitive/behavioral effects of a single bout of exercise in humans are improved executive functions, enhanced mood states, and decreased stress levels.”

Even though the findings are clear that movement/exercise is a powerful “drug” to improve our health, most health professionals focus on sitting treatment and prescribing pharmaceutical agents. Possibly, a treatment session should start with fun physical exercise and followed by therapy. Remember, if you feel blah, have lower energy, feel frustrated or irritated, get up and move.  Movement and exercise will change your mood. You will experience what Peper and Lin (2012), have shown that less than minute of skipping in place will significantly improve your subjective energy level and mood. Get up and skip in place, then observe how much better you feel. Then sit again read the article by Dr. Julia C. Basso and Wendy A. Suzuki, http://content.iospress.com/download/brain-plasticity/bpl160040?id=brain-plasticity%2Fbpl160040

 


Healing irritable bowel syndrome with diaphragmatic breathing

Erik Peper, Lauren Mason and Cindy Huey

After having constant abdominal pain, severe cramps, and losing 15 pounds from IBS, I found myself in the hospital bed where all the doctors could offer me was morphine to reduce the pain. I searched on my smart phone for other options. I saw that abdominal breathing could help. I put my hands on my stomach and tried to expand it while I inhaled. All that happened was that my chest expanded and my stomach did not move.  I practiced and practiced and finally, I could breathe lower. Within a few hours, my pain was reduced. I continued breathing this way many times. Now, two years later, I no longer have IBS and have regained 20 pounds.

                        –                       21-year old woman who previously had severe IBS

Irritable bowel syndrome(IBS) affects between 7% to 21% of the general population and is a chronic condition. The symptoms usually include abdominal cramping, discomfort or pain, bloating, loose or frequent stools and constipation and can significantly reduce the quality of life (Chey et al, 2015). A precursor of IBS in children is called recurrent abdominal pain (RAP) which affects between 0.3 to 19% of school children (Chitkara et al, 2005).  Both IBS and RAP appear to be functional illnesses, as no organic causes have been identified to explain the symptoms. In the USA, this results in more than 3.1 physician visits and 5.9 million prescriptions written annually. The total direct and indirect cost of these services exceeds $20 billion (Chey et al, 2015).  Multiple factors may contribute to IBS, such as genetics, food allergies, previous treatment with antibiotics, severity of infection, psychological status and stress. More recently, changes in the intestinal and colonic microbiome resulting in small intestine bacterial overgrowth are suggested as another risk factor (Dupont, 2014).

Generally, standard medical treatments (reassurance, dietary manipulation and of pharmacological therapy) are often ineffective in reducing abdominal IBS and other abdominal symptoms (Chey et al, 2015), while complementary and alternative approaches such as relaxation and cognitive therapy are more effective than traditional medical treatment (Vlieger et, 2008).  More recently, heart rate variability training to enhance sympathetic/ parasympathetic balance appears to be a successful strategy to treat functional abdominal pain (FAB) in children (Sowder et al, 2010). Sympathetic/parasympathetic balance can be enhanced by increasing heart rate variability (HRV), which occurs when a person breathes at their resonant frequency which is usually between 5-7 breaths per minute.  For most people, it means breathing much slower, as slow abdominal breathing appears to be a self-control strategy to reduce symptoms of IBS, RAP and FAP.

This article describes how a young woman healed herself from IBS with slow abdominal breathing without any therapeutic coaching, reviews how slower diaphragmatic breathing (abdominal breathing) may reduce symptoms of IBS, explores the possibility that breathing is more than increasing sympathetic/parasympathetic balance, and suggests some self-care strategies to reduce the symptoms of IBS.

Healing IBS-a case report

After being diagnosed with Irritable Bowel Syndrome her Junior year of high school, doctors told Cindy her condition was incurable and could only be managed at best, although she would have it throughout her entire life. With adverse symptoms including excessive weight loss and depression, Cindy underwent monthly hospital visits and countless tests, all which resulted in doctors informing her that her physical and psychological symptoms were due to her untreatable condition known as IBS, of which no one had ever been cured. When doctors offered her what they believed to be the best option: morphine, something Cindy describes now as a “band-aid,” she was left feeling discouraged. Hopeless and alone in her hospital bed, she decided to take matters into her own hands and began to pursue other options. From her cell phone, Cindy discovered something called “diaphragmatic breathing,” a technique which involved breathing through the stomach. This strategy could help to bring warmth to the abdominal region by increasing blood flow throughout abdomen, thereby relieving discomfort of the bowel. Although suspicious of the scientific support behind this method, previous attempts at traditional western treatment had provided no benefit to recovery; therefore, she found no harm in trying. Lying back flat against the hospital bed, she relaxed her body completely, and began to breathe. Immediately, Cindy became aware that she took her breath in her chest, rather than her stomach. Pushing out all of her air, she tried again, this time gasping with inhalation. Delighted, she watched as air flooded into her stomach, causing it to rise beneath her hands, while her chest remained still. Over time, Cindy began to develop more awareness and control over her newfound strategy. While practicing, she could feel her stomach and abdomen becoming warmer. Cindy shares that for the first time in years, she felt relief from pain, causing her to cry from happiness. Later that day, she was released from the hospital, after denying any more pain medication from doctors.

Cindy continues to practice her diaphragmatic breathing as much as she can, anywhere at all, at the sign of pain or discomfort, as well as preventatively prior to what she anticipates will be a stressful situation. Since beginning her practice, Cindy says that her IBS is pretty much non-existent now. She no longer feels depressed about her situation due to her developed ability to manage her condition. Overall, she is much happier. Moreover, since this time two years ago, Cindy has gained approximately 20 pounds, which she attributes to eating a lot more. In regard to her success, she believes it was her drive, motivation, and willingness to dedicate herself fully to the breathing practice which allowed for her to develop skills and prosper. Although it was not natural for her to breathe in her stomach at first, a trait which she says she often recognizes in others, Cindy explains it was due to necessity which caused her to shift her previously-ingrained way of breathing. Upon publicly sharing her story with others for the first time, Cindy reflects on her past, revealing that she experienced shame for a long time as she felt that she had a weird condition, related to abnormal functions, which no one ever talks about. On the experience of speaking out, she affirms that it was very empowering, and hopes to encourage others coping with a situation similar to hers that there is in fact hope for the future. Cindy continues to feel empowered, confident, and happy after taking control of her own body, and acknowledges that her condition is a part of her, something of which she is proud.

Watch the in-depth interview with Cindy Huey in which she describes her experience of discovering diaphragmatic breathing and how she used this to heal herself of IBS

Video 1. Interview with Cindy Huey describing how she healed herself from IBS.

Background perspective

“Why should the body digest food or repair itself, when it will be someone else’s lunch”         (paraphrased from Sapolsky (2004), Why zebras do not get ulcers).

From an evolutionary perspective, we were prey and needed to be on guard (vigilant) to the presence of predators. In the long forgotten past, the predators were tigers, snakes, and the carnivore for whom we were food as well as other people. Today, the same physiological response pathways are still operating, except that the pathways are now more likely to be activated by time urgency, work and family conflict, negative mental rehearsal and self-judgment.  This is reflected in the common colloquial phrases: “It makes me sick to my stomach,” “I have no stomach for it,”  “He is gutless,” “It makes me queasy,” “Butterflies in my stomach,” “Don’t get your bowels in uproar,” “Gut feelings’, or “Scared shitless.”

Whether conscious or unconscious, when threatened, our body reacts with a fight/flight/freeze response in which the blood flow is diverted from the abdomen to deep muscles used for propulsion. This results in peristalsis being reduced.  At the same time the abdomen tends to brace to protect it from injury. In almost all cases, the breathing patterns shift to thoracic breathing with limited abdominal movement. As the breathing pattern is predominantly in the chest, the person increases the risk of hyperventilation because the body is ready to run or fight.

In our clinical observations, people with IBS, small intestine bacterial overgrowth (SIBO), abdominal discomfort, anxiety and panic, and abdominal pain tend to breathe more in their chest, and when asked to take breathe, they tend to inhale in their upper chest with little or no abdominal displacement. Almost anyone who experiences abdominal pain tends to hold the abdomen rigid as if the splinting could reduce the pain. A similar phenomenon is observed with female students experiencing menstrual cramps. They tend to curl up to protect themselves and breathe shallowly in their chest instead of slowly in their abdomen, a body pattern which triggers a defense reaction and inhibits regeneration. If instead they breathe slowly and uncurl they report a significant decrease in discomfort (Gibney & Peper, 2003).

Paradoxically, this protective stance of bracing the abdomen and breathing shallowly in the chest increases breathing rate and reduces heart rate variability. It reduces and inhibits blood and lymph flow through the abdomen as the defensive posture evokes the physiology of fight/flight/freeze. The reduction in venous blood and lymph flow occurs because the ongoing compression and expansion in the abdomen is inhibited by the thoracic breathing and, moreover, the inhibition of diaphragmatic breathing. It also inhibits peristalsis and digestion. No wonder so many of the people with IBS report that they are reactive to some foods. If the GI track has reduced blood flow and reduced peristalsis, it may be less able to digest foods which would affect the bacteria in the small intestine and colon. We wonder if a risk factor that contributes to SIBO is chronic lack of abdominal movement and bracing.

Slow diaphragmatic abdominal breathing to establish health

“Digestion and regeneration occurs when the person feels safe.”

Effortless, slow diaphragmatic breathing occurs when the diaphragm descends and pushes the abdominal content downward during inhalation, which causes the abdomen to become bigger.   As the abdomen expands, the pelvic floor relaxes and descends. During exhalation, the pelvic floor muscles tighten slightly, lifting the pelvic floor and the transverse and oblique abdominal muscles contract and push the abdominal content upward against the diaphragm, allowing the diaphragm to relax and go upward, pushing the air out. The following video, 3D view of the diaphragm, from www.3D-Yoga.com by illustrates the movement of the diaphragm.

Video 2.  3D view of diaphragm by sohambliss  from www.3D-Yoga.com,

This expansion and constriction of the abdomen occurs most easily if the person is extended, whether sitting or standing erect or lying down, and the waist is not constricted. If the arches forward in a protected pattern and the spine is flexed in a c shape, it would compress the abdomen; instead, the body is long and the abdomen can move and expand during inhalation as the diaphragm descends (see figure 1). If the person holds their abdomen tight or it is constricted by clothing or a belt, it cannot expand during inhalation. Abdominal breathing occurs more easily when the person feels safe and expanded versus unsafe or fearful and collapsed or constricted.

Figure 1.  Erect versus collapsed posture note that there is less space for the abdomen to expand in the protective collapsed position. Reproduced by permission from:  Clinical Somatics (http://www.clinicalsomatics.ie/

When a person breathes slower and lower it encourages blood and lymph flow through the abdomen. As the person continues to practice slower, lower breathing, it reduces the arousal and vigilance. This is the opposite state of the flight, fight, freeze response so that blood flow is increased in abdomen, and peristalsis re-occurs.  When the person practices slow exhalation and breathing and they slightly tighten the oblique and transverse abdominal muscles as well as the pelvic floor and allow these muscles to relax during inhalation. When they breathe in this pattern effortless they, they often will experience an increase in abdominal warmth and an initiation of abdominal sounds (stomach rumble or borborygmus) which indicates that peristalsis has begun to move food through the intestines (Peper et al., 2016).  For a detailed description see https://peperperspective.com/2016/04/26/allow-natural-breathing-with-abdominal-muscle-biofeedback-1-2/

What can you do to reduce IBS

There are many factors that cause and effect IBS, some of which we have control over and some which are our out of our control, such as genetics. The purpose of proposed suggestions is to focus on those things over which you have control and reduce risk factors that negatively affect the gastrointestinal track. Generally, begin by integrating self-healing strategies that promote health which have no negative side effects before agreeing to do more aggressive pharmaceutical or even surgical interventions which could have negative side effects. Along the way, work collaboratively with your health care provider. Experiment with the following:

  • Avoid food and drinks that may irritate the gastrointestinal tract. These include coffee, hot spices, dairy products, wheat and many others.  If you are not sure whether you are reacting to a food or drink, keep a detailed log of what you eat and drink and how you feel. Do self-experimentation by eating or drinking the specific food by itself as the first food in the morning.  Then observe how you feel in the next two hours. If possible, eat only organic foods that have not been contaminated by herbicides and pesticides (see: https://peperperspective.com/2015/01/11/are-herbicides-a-cause-for-allergies-immune-incompetence-and-adhd/).
  • Identify and resolve stressors, conflicts and problems that negatively affect you and drain your energy. Keep a log to identify situations that drain or increase your subjective energy. Then do problem solving to reduce those situations that drain your energy and increase those situations that increase your energy. For a detailed description of the practice see https://peperperspective.com/2012/12/09/increase-energy-gains-decrease-energy-drains/

Often the most challenging situations that we cannot stomach are those where we feel defeated, helpless, hopeless and powerless or situations where we feel threatened– we do not feel safe. Reach out to other both friends and social services to explore how these situations can be resolved.  In some cases, there is nothing that can be done except to accept what is and go on.

  • Feel safe. As long as we feel unsafe, we have to be vigilant and are stressed which affects the GI track.  Explore the following:
    • What does safety mean for you?
    • What causes you to feel unsafe from the past or the present?
    • What do you need to feel safe?
    • Who can offer support that you feel safe?

Reflect on these questions and then explore and implement ways by which you can create feeling more safe.

  • Take breaks to regenerate. During the day, at work and at home, monitor yourself. Are you pushing yourself to complete tasks. In a 24/7 world with many ongoing responsibilities, we are unknowingly vigilant and do not allow ourselves to rest and relax to regenerate.  Do not wait till you feel tired or exhausted.  Stop earlier and take a short break.  The break can be a short walk, a cup of tea or soup, or looking outside at a tree.  During this break, think about positive events that have happened or people who love you and for whom you feel love.  When you smile and think of someone who loves you, such as a grandparent, you may relax and for that moment as you feel safe which allows regeneration to begin.
  • Observe how you inhale. Take a deep breath. If you feel you are moving upward and becoming a little bit taller, your breathing is wrong. Put one hand on your lower abdomen and the other on your chest and take a deep breath. If you observe your chest lifted upward and stomach did not expand, your breathing is wrong. You are not breathing diaphragmatically. Watch the following video, The correct way to breathe in, on how to observe your breathing and how to breathe diaphragmatically.  

 

  • Learn diaphragmatic breathing. Take time to practice diaphragmatic breathing. Practice while lying down and sitting or standing.  Let the breathing rate slow down to about six breaths per minute.  Exhale to the count of four and then let it trail off for two more counts, and inhale to the count of three and let it trail for another count. Practice this sitting and lying down (for more details on breathing see:  https://peperperspective.com/2014/09/11/a-breath-of-fresh-air-improve-health-with-breathing/.
    • Sitting position. Exhale by feeling your abdomen coming inward slightly for the count of four and trailing off for the count of two, then allow the lower ribs to widen, abdomen expand–the whole a trunk expands–as you inhale while the shoulders stay relaxed for a count of three. Allow it to trail off for one more count before you again begin to exhale. Be gentle, do not rush or force yourself. Practice this slower breathing for five minutes. Focus more on the exhalation and allowing the air to just flow in.  Give yourself time during the transition between inhalation and exhalation.
    • Lying down position. While lying on your back, place a two to five-pound weight such as a bag of rice on your stomach as shown in Figure 2.

Fig 12.5

Figure 2. Lying down and practicing breathing with two to five-pound weight on stomach (reproduced by permission from Gorter and Peper, 2011.

As you inhale push the weight upward and also feel your lower ribs widen. Then allow exhalation to occur by the weight pushing the abdominal content down which pushes the diaphragm upward. This causing the breath to flow out. As you exhale, imagine the air flowing out through your legs as if there were straws inside your legs.  When your attention wanders, smile and bring it back to imagining the air flowing down your legs during exhalation. Practice this for twenty minutes.  Many people report that during the practice the gurgling in their abdomen occurs which is a sign that peristalsis and healing is returning.

  • Observe and change your breathing during the day. Observe your breathing pattern during the day. Each time you hold your breath, gasp or breathe in your chest, interrupt the pattern and substitute slow diaphragmatic breathing for the next five breaths. Do this the whole day long. Many people observe that when they think of stressor or are worried, they hold their breath or shallow breathe in the chest. If this occurs, acknowledge the worry and focus on changing your breathing.  This does not mean that you dismiss the concern, instead for this moment you focus on breathing and then explore ways to solve the problem.

If you observed that under specific circumstance you held your breath or breathed shallowly in your chest, then whenever you anticipate that the same event will occur again, begin to breathe diaphragmatically. To do this consistently is very challenging and most people report that initially they only seem to breathe incorrectly.  It takes practice, practice and practice—mindful practice– to change.  Yet those who continue to practice often report a decrease in symptoms and feel more energy and improved quality of life.

Summary

Changing habitual health behaviors such as diet and breathing can be remarkably challenging; however, it is possible.  Give yourself enough time, and practice it many times until it becomes automatic.  It is no different from learning to play a musical instrument or mastering a sport.  Initially, it feels impossible, and with lot of practice it becomes more and more automatic. We continue to be impressed that healing is possible.  Among our students at San Francisco State University, who practice their self-healing skills for five weeks, approximately 80% report a significant improvement in their health (Peper et al., 2014).

References

Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: a clinical review. Jama313(9), 949-958.

Chitkara, D. K., Rawat, D. J., & Talley, N. J. (2005). The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. American journal of Gastroenterology100(8), 1868-1875.

Dupont, H. L. (2014). Review article: evidence for the role of gut microbiota in irritable bowel syndrome and its potential influence on therapeutic targets. Alimentary pharmacology & therapeutics39(10), 1033-1042.

Gibney, H.K. & Peper, E. (2003). Taking control: Strategies to reduce hot flashes and premenstrual mood swings. Biofeedback, 31(3), 20-24.

Gorter, R. & Peper, E. (2011). Fighting Cancer-A NonToxic Approach to Treatment. Berkeley: North Atlantic.

Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49.

Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160.

Sapolsky, R. (2004). Why Zebras Don’t Get Ulcers. New York: Owl Books

Sowder, E., Gevirtz, R., Shapiro, W., & Ebert, C. (2010). Restoration of vagal tone: a possible mechanism for functional abdominal pain. Applied psychophysiology and biofeedback35(3), 199-206.

Vlieger, A. M., Blink, M., Tromp, E., & Benninga, M. A. (2008). Use of complementary and alternative medicine by pediatric patients with functional and organic gastrointestinal diseases: results from a multicenter surveyPediatrics122(2), e446-e451.


Enjoy laughter-It’s healing

Joy and laughter are healing and contagious (Wang, 2006). When we laugh, our mood lightens, we feel better and our health improves (Bennett & Lengacher, 2006a; Bennett & Lengacher, 2006b; Bennett & Lengacher, 2008; Bennett & Lengacher, 2009).  As Norman Cousins, who had ankylosing spondylitis (a degenerative disease causing the breakdown of collagen) which left him in severe pain that even morphine couldn’t touch, claimed that 10 minutes of belly laughter would give him two hours of pain-free sleep.  He documented his remarkable recovery in his book Anatomy of an illness (Cousins, 2005). Laughter and joy has the ability to transform your health.

Despite the challenges you may face, the actual troubles that may occur during the day, or feeling frustrated or depressed, treat yourself to a moment of joy and laughter. Through laughing, we relax and support the intrinsic self-healing processes in our body.  Even in suffering we have a choice of what to feed our brain.  Enjoy watching the following videos.

Finally, watch Norman Cousins describe his own healing experience: https://www.youtube.com/watch?v=0LwKd68S15I

Also see the embedded videos posted on:  http://www.laughteronlineuniversity.com/norman-cousins-a-laughterpain-case-study/

References:

Cousins, N. (2005). Anatomy of an Illness: As Perceived by the Patient. New York: W.W. Norton & Company.

Bennett, M. P., & Lengacher, C. A. (2006a). Humor and laughter may influence health. I. History and background. Evidence-Based Complementary and Alternative Medicine3(1), 

Bennett, M. P., & Lengacher, C. (2006b). Humor and laughter may influence health: II. Complementary therapies and humor in a clinical population. Evidence-Based Complementary and Alternative Medicine3(2), 187-190.

Bennett, M. P., & Lengacher, C. (2008). Humor and laughter may influence health: III. Laughter and health outcomes. Evidence-Based Complementary and Alternative 

Bennett, M. P., & Lengacher, C. (2009). Humor and laughter may influence health IV. humor and immune function. Evidence-Based Complementary and Alternative 

Wang, S. (2006). Contagious behavior. American Psychological Society Observer19(2), 22-26.


Healthy movement is the new aging

Born on 26 November 1911, Mr Robert Marchand and 105 years old, managed cycling 22.55 km (14 miles) at the national velodrome and set a new record for the furthest distance cycled in one hour for riders over 105. (Reynolds, 2017).

Meet 105-year-old Robert Marchand, the centenarian cyclist chasing a new record: https://www.youtube.com/watch?v=Ey48j6dDNEo

As people age there is an increase in Western Diseases such as hypertension, diabetes, gout, cancer, dementia and  decreases in physical fitness (Milanović et al, 2013Tauber, 2016).   To assume that the cause of these illnesses is the natural process of aging may be too simplistic. Although aging does affect physiology, there are other factors that contribute to the increase in “Western Diseases” such as diet, lifestyle and genetics.

A significant contributing factor of Western Diseases is diet especially  the increase in sugar and simple carbohydrates. Whether you are Pima, Tohono O’odham, and Navajo American Indian Tribes in Arizona, Intuits in Northern Canada, Japanese Americans, or indigenous populations of Kenya, when these people stopped eating their traditional diet and adapted the western high glucose/fructose/simple carbohydrate diet, the degenerative Western Diseases exploded (Bjerregaard et al, 2004; Burkitt & Trowell, 1975; Knowler et al, 1990; Tauber, 2016). Diabetes, hypertension, and cancer which were previously rare skyrocketed within one generation after adapting the Western life style diet. In some of these populations, 30% or more of the adults have diabetes and a significant increase in breast cancer.

The reduction of episodic high intensity physical activity and being sedentary are additional risk factors for the onset of diabetes and cardiovascular disease (Dulloo et al, 2017). As Mensing & Mekel (2015) state, “Sitting is the new smoking.”  Sitting encourages more sitting which leads to nonuse of muscles and causes neural and muscle atrophy.  Our physiology is efficient and will prune/eliminate what is redundant.  This is reflected in the popular phrase, “Use it or lose it.”  As we sit for hours in front of digital devices, use escalators, elevators, or drive cars, we are not using the muscles involved in dynamic movement.  We are usually unaware of this degenerative process. Instead,  we may experience difficulty walking up the stairs  which encourages us to take the escalator or elevator. When we do not use the muscles or are limited in movement by discomfort and pain, we move less. As we move less, we become  weaker which is often labeled as aging instead of non use.

Just, because most people loose fitness, it may not represent what is possible or optimum.  Instead, we may want to emulate the diet and fitness program of Mr. Robert Marchand who at age 103 set a new world record and improved the distance bicycled in one hour from 24.25 km at the age of 101 to 26.92 km at the age of 103. A 11% improvement! As New York Times science writer Gretchen Reynolds reports, “Lifestyle may also matter. Mr. Marchand is “very optimistic and sociable,” The researcher who did the study, Dr. Billat says, “with many friends,” and numerous studies suggest that strong social ties are linked to a longer life. His diet is also simple, focusing on yogurt, soup, cheese, chicken and a glass of red wine at dinner (Reynolds, 2017).

The improvement in bicycling performance and physiological indicators such as ⩒O2max increased (31 to 35 ml.kg-1min-1; +13%), appeared to be due to a change in his training regimen (Billat et al 2016).  At age 101 he changed his bicycling training program from riding at a steady speed for one hour to riding 80% at an easy pace and 20% at high intensity.  This is a  type of interval training and includes enough recovery allows the body the recover and strengthen. This analogous to our evolutionary movement pattern of walking interspersed with short distance high intensity running.

As a hunter and gather we often moved steadily and then had to run very fast to escape a predator or catch an animal.  After extreme exertion, we would rest and regenerate (if we did not escape we would be lunch for the predator). Thus episodic high intensity activity with significant rest/regenerative periods is the movement pattern that allowed our species to survive and thrive. Research studies have confirmed that high intensity interval training offers more physiological benefits–increases cardiorespiratory fitness which is a strong determinant of morbidity and mortality– than moderate intensity continuous training (Weston et al, 2014).

Thus when Mr. Marchard changed his exercise pattern from moderate intensity continuous training to high intensity interval training with enough recovery time he set a new world record at age 103. Two years later he set a new world record at age 105.

Exercise improves brain function and interval training appears to improve brain function most.  When rats had prolonged exercise, the brain’s stores of energy is significantly lowered in the frontal cortex and hippocampus all areas which area involved in thinking and memory. If on the other hand, the animals had a single intense bout of exercise and were allowed to rest and feed than the brain levels of glycogen was 60% high in the frontal and hippocampus areas.  This suggest that the brain can then function better (Matsui et al, 2012).

This perspective is supported by the evolutionary hypothesis discussed by Neuroscientist Daniel Wolpert who points out that brains evolved, not to think or feel, but to direct movement. When movement is no longer needed the brain shrinks and gets reabsorbed which is illustrated by the sea squirt. This animal swims as a juvenile and then anchors on a rock and is passively moved by the currents. Once anchored, it no longer needed to coordinate movement and reabsorb its own nervous system. See Daniel Wolpert’s remarkable TED talk, The real reasons for brains.

The remarkable feat of Mr. Marchand offers suggestions for our own health. Enjoy healthy movement and exercise and incorporate our evolutionary movement patterns:  episodic high intensity followed by regeneration. At the same time include a healthy diet by reducing sugars and simple carbohydrates.  Finally, it helps to have the right genes.

References:

Billat, V. L., Dhonneur, G., Mille-Hamard, L., Le Moyec, L., Momken, I., Launay, T., & Besse, S. (2016). Case Studies in Physiology: Maximal Oxygen Consumption and Performance in a Centenarian CyclistJournal of Applied Physiology, jap-00569. http://jap.physiology.org/content/jap/early/2016/12/29/japplphysiol.00569.2016.full.pdf

Bjerregaard, P., Kue Young, T., Dewailly, E., & Ebbesson, S. O. (2004). Review Article: Indigenous health in the Arctic: an overview of the circumpolar Inuit population. Scandinavian Journal of Social Medicine32(5), 390-395. https://www.researchgate.net/publication/51366099_Indigenous_Health_in_the_Arctic_An_Overview_of_the_Circumpolar_Inuit_Population

Burkitt, D.P. & Trowell, H.C. eds. (1975). Refined carbohydrate foods and disease: Some implications of dietary fibre. New York: Academic Press.

Dulloo, A. G., Miles‐Chan, J. L., & Montani, J. P. (2017). Nutrition, movement and sleep behaviours: their interactions in pathways to obesity and cardiometabolic diseases. Obesity Reviews18(S1), 3-6.

Knowler, W. C., Pettitt, D. J., Saad, M. F., & Bennett, P. H. (1990). Diabetes mellitus in the Pima Indians: incidence, risk factors and pathogenesis. Diabetes/metabolism reviews6(1), 1-27.

Matsui, T., Ishikawa, T., Ito, H., Okamoto, M., Inoue, K., Lee, M. C., … & Soya, H. (2012). Brain glycogen supercompensation following exhaustive exerciseThe Journal of physiology590(3), 607-616.

Mensing, M., & Mekel, O. C. L. (2015). Sitting is the new smoking-Modelling physical activity interventions in North Rhine-Westphalia. The European Journal of Public Health25(suppl 3), ckv171-037.

Milanović, Z., Pantelić, S., Trajković, N., Sporiš, G., Kostić, R., & James, N. (2013). Age-related decrease in physical activity and functional fitness among elderly men and women. Clinical interventions in aging, 8, 549-556.

Reynolds, G. (2017, February 8). Lessons on Aging Well, From a 105-Year-Old Cyclist. Retrieved from: https://www.nytimes.com/2017/02/08/well/move/lessons-on-aging-well-from-a-105-year-old-cyclist.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=5&pgtype=sectionfront

Taubes, G. (2016). The Case Against Sugar. New York: Alfred A. Knopf.

Weston, K. S., Wisløff, U., & Coombes, J. S. (2014). High-intensity interval training in patients with lifestyle-induced cardiometabolic disease: a systematic review and meta-analysisBritish journal of sports medicine48(16), 1227-1234. http://www.rcsi.ie/files/facultyofsportsexercise/20141201122758_High-intensity%20interval%20traini.pdf

Wolpert, D. (2011) The Real Reason for Brains.  http://www..com/tatedlks/daniel_wolpert_the_real_reason_for_brains.html

Youtube video: Meet 105-year-old Robert Marchand, the centenarian cyclist chasing a new record: https://www.youtube.com/watch?v=Ey48j6dDNEo

 

 

 


We are more alike than we sometime would like to think

The short three minute video Three Beautiful Human Minutes by Asger Leth is a reminder that we are more alike than we sometimes would like to think.  Enjoy.