Metabolic syndrome is intimately associated with stress. Chronic stress raises cortisol levels, leading to central obesity. Chronic stress raises blood pressure. And hypertensive individuals suffering from chronic stress have an increased likelihood of developing heart disease (1). So it stands to reason that those of us with metabolic syndrome and insulin resistance need to have some good stress-reduction strategies.

I really enjoy doing Rabbit Pose (sasangasana) for stress reduction. For many years now, I haven't been able to do headstand due to neck problems. Rabbit is my headstand substitute, providing many of the benefits of inversion.  Rabbit pose relieves stress on the spine. But most of all, Rabbit Pose provides a womb-like experience of deep grounding and relaxation. I feel a mellow, parasympathetic state induced, which naturally helps lower blood pressure. The crown of my head is sensitive, so I use a lot of padding for my head, so I can enjoy hanging out in the pose. And because of blood pressure medication I'm prone to dizziness, so I have to be careful to come out of the pose gently and slowly. We usually do four repetitions of Rabbit Pose during our daily stretch routine. And our necks and backs are warmed up before we get to Rabbit.

Of course, if your blood pressure is really high, ask your doctor before doing any inversions. People who are new to yoga should see a yoga teacher before trying anything at home. That aside, enjoy rabbit pose!

1. A Path Model of Chronic Stress, the Metabolic Syndrome, and Coronary Heart Disease PETER P. VITALIANO, PHD, JAMES M. SCANLAN, PHD, JIANPING ZHANG, MS, MARGARET V. SAVAGE, PHD, IRL B. HIRSCH, MD, AND ILENE C. SIEGLER, PHD, MPH

phyllanthus niruri (Photo credit: Wikipedia)

So today I'd like to share my experience with a herb that is a natural gift for people with metabolic syndrome. Since my recent telephone appointment with Dr Vasant Lad, I've been taking bhumyamlaki daily. Also known as Chanca Piedra, bhumyamlaki is an important herb in both the Ayurvedic and Western pharmacopoeia, growing both in India and in the Brazilian rainforest. Its Latin name is phyllanthus niruri.

Bumyamlaki is famous for its hepato-protective actions, meaning that it helps keep the liver safe from internal and external enemies. People with hepatitis B or C should use this herb to protect the liver. It is also antiviral for hepatitis and HIV. But those of us with obesity or metabolic syndrome face danger to the liver too, in the form of our increased incidence of non-alcoholic fatty liver disease. So we too can use this herbal superhero to defend our liver cells.

And that's by no means all bhumyamlaki does for metabolic syndrome. In fact, bhumyamlaki is well established to lower blood sugar, lower cholesterol and lower blood pressure (1). Remember those markers of metabolic syndrome we discussed in a previous blog? Raised blood sugar (above 100mg/dl), hypertension, high triglycerides and low HDL (good cholesterol) were among the markers, along with abdominal obesity. So how amazing is it that one herb can help you out so much, stepping into the place of metformin plus statins plus ACE inhibitors? No wonder I called bhumyamlaki a superhero!

Many of my patients take bhumyamlaki at bedtime and claim it helps their sleep. I've been taking mine in the morning an hour after my thyroid medicine and actually along with blood pressure medication (hydrochlorthiazide). In due course I hope to take only the bhumyamlaki and not the blood pressure medication, but herbs do act more slowly than drugs. Bhumyamlaki is an energizer and I'm finding it helps me feel energized in the morning. In either case, you can take a teaspoon of bhumyamlaki, steep for ten minutes or more (I do an hour) in boiling water, strain and drink. The first sip tastes bitter and then it's OK, I just gulp it down knowing I'll feel good afterwards!

As I'm getting clearer about why I'm writing this blog, I can see that it could be extremely helpful to a lot of people. So spread the word, subscribe to the blog, share on Facebook, tell your friends with PCOS, metabolic syndrome or thyroid problems etc. about the blog, so we can help as many people as possible.

1. G. Bagalkotkar, S. R. Sagineedu,  M. S. Saad,  J. StanslasPhytochemicals from Phyllanthus niruri Linn. and their pharmacological properties: a review. Journal of Pharmacy and Pharmacology Volume 58, Issue 12, pages 1559-1570, December 2006

English: bitter gourd Deutsch: Bittermelone (Photo credit: Wikipedia)

First of all, for all of us with metabolic syndrome, PCOS and other manifestations of insulin resistance, bitter gourd increases insulin sensitivity and reduces weight. There are over 100 studies to this effect, I've just cited one (1). In addition, bitter gourd is antibacterial and antiviral. It's antiviral effects work against HIV and Hepatitis C (2). Bitter gourd is also anti cancer with efficacy on breast and prostate cancer, skin cancer, melanoma, leukemia and other common malignancies.

There are two varieties of bitter gourd. A darker green karela, looking like a warty cucumber, can be bought at Indian markets and a smoother, ligher green one at Oriental markets. The oriental variety is less bitter and cooks faster but the Indian one is probably more medicinal precisely because more bitter. Here's a picture of the Oriental  variety and the other photo, above, shows the Indian variety,

English: Bitter melon Tiếng Việt: Khổ qua, mướp đắng (Momordica charantia) (Photo credit: Wikipedia)

Back when we were wandering sadhus in India, Sadananda and I would sit down by the roadside, set up our three stone and three stick cooking 'stove' and simply steam our bitter gourds on top of rice. We thought of ghee and spices as decadent luxuries and felt fortunate even to have salt! Today we still eat bitter gourds every week, but our recipes are more sophisticated now we have decided spices are an Ayurvedic necessity rather than a luxury. You can stir fry or steam bitter gourds and spice with turmeric, cumin and hing (asafetida). Or here's a recipe I created using another vegetable that lowers blood sugar--eggplant.

White Eggplant sabji  (Purple Eggplant works, too)

Eggplants are valuable in reducing cholesterol. White eggplant is said in Ayurveda to be very beneficial in diabetes. Here is  a recipe combining two vegetables revered in Ayurveda for their antidiabetic properties. White eggplant is seasonally available  and bitter gourds are available at India's Grocery.

1lb white eggplants

1lb bitter gourds

1 medium tomato, chopped

1 bunch cilantro, chopped

1 inch piece fresh ginger, finely chopped

2tsp turmeric

1tsp mustard seeds

1tsp cumin seeds

½ tsp fenugreek seeds

1tsp garam masala

1tsp salt

1Tbsp ghee or sunflower oil

Cube the eggplants and marinade for at least an hour in the tumeric. Meanwhile, slice the bitter gourds and remove the seeds. In a wok, heat the oil or ghee and then fry the mustard seeds ,cumin seeds and fenugreek until the mustard seeds turn grey and pop.Add the ginger. As soon as the ginger begins to pop, add the tomato. Cook for a few minutes, then add the bitter gourds. Stir-fry the bitter gourds for about 20 minutes, than add the eggplants and garam masala. Continue cooking until the vegetables are soft. Remove from the flame and add the salt and cilantro. Enjoy!

(1)M. G. Sridhar*, R. Vinayagamoorthi, V. Arul Suyambunathan, Z. Bobby and N. SelvarajBitter gourd (Momordica charantia) improves insulin sensitivity by increasing skeletal muscle insulin-stimulated IRS-1 tyrosine phosphorylation in high-fat-fed rats British Journal of Nutrition (2008), 99, 806-812 doi: 10.1017/S000711450783176X q The Authors 2007

2. J.K Grover  S.P YadavPharmacological actions and potential uses of Momordica charantia: a review Journal of EthnopharmacologyVolume 93, Issue 1, July 2004, Pages 123-132

Lateral view of the human ankle (Photo credit: Wikipedia)

But what about exercise? Only a couple of days ago, Dr. Weber told me that for insulin resistance I needed an hour a day of cardio. So now I'm having anxiety about exercising enough, even though as a spontaneous, loose and natural person, who also happens to be a pedestrian, it works better for me to get my exercise within the flow of life. I'll also note that while cardio has been found highly effective in insulin resistance generally, (1) a 2012 study indicates that exercise may NOT improve outcomes in women with PCOS (2). Only a low-carb high protein diet seems to help. This is borne out by my personal experience--after all,  I walk a lot and go on twelve mile hikes too. In fact, I decided to see Dr Kamath, my endocrinologist,  based on not being able to lose wight on a weight-loss plan even when I was running regularly as well.

Anyway, a sprained ankle was clearly going to turn me into an unwilling couch potato, so I found some seated workouts and followed along. I certainly wasn't attracted to Senior Fit videos showing extremely old people, nor to chair aerobics to rap music (just not my generation). But I did find a pretty good seated cardio workout http://www.youtube.com/watch?v=LAeZZbpi8Ow and seated core workout http://www.youtube.com/watch?feature=player_embedded&v=d2-B-BPmlPA#! , so I did two rounds of the cardio and one of the core, and so for today I'm officially NOT a couch potato!

1. Med Sci Sports Exerc. 2004 Jul;36(7):1196-201.Improvements in insulin resistance with aerobic exercise training: a lipocentric approach.

In today's blog I'd like to discuss Metabolic Syndrome, insulin resistance and PCOS (Polycystic ovarian syndrome).

Many of us older women have gone untested and undiagnosed with regard to PCOS. Although the syndrome was first identified in 1935, it wasn't on the radar for most doctors when I was a young woman.  Whenever I would complain of irregular menses, I would be brushed aside with a pat answer, 'It's because you're so young," or, "It's the stress of medical school," or "It's because you're travelling," or "It's perimenopause." The fact that my hair had thinned, I had facial hair and was infertile (all important markers for PCOS) were similarly ignored, perhaps because I never complained of infertility, choosing to experience it as God's particular blessing for me.   Excessive menopausal weight gain was of course brushed aside as quite typical.

It wasn't until I met recently with an endocrinologist specializing in women's concerns, Vinaya Kamath, that the topic of PCOS and insulin resistance was brought up, although I had suspected it myself for a long while. After some research on the Internet, I now appreciate that PCOS may remain both symptomatic and problematic for post-menopausal women. In fact, because of its relationship to insulin resistance, PCOS is a dangerous condition.  After a lifetime of ignored PCOS, I now have the key markers of metabolic syndrome: elevated fasting plasma glucose, central obesity and hypertension. The other two markers are elevated triglycerides and low HDL with three out of five markers required for a diagnosis. In general, my lipids have stayed pretty good, perhaps a testament to diet and lifestyle efforts.

Insulin resistance syndromes like PCOS and metabolic syndrome are dangerous because they are associated with increased likelihood of stroke, heart disease, non-alcoholic fatty liver disease, diabetes mellitus and breast cancer. And insulin resistance is a vicious cycle, with heredity leading to insulin resistance syndromes including central obesity and obesity itself leading to insulin resistance.

The best chance of reversing some of these changes include diet, exercise and weight reduction, along with either metformin, a drug that improves insulin sensitivity, and/or herbs with similar actions. Medical literature recommends chocolate for its beneficial effects on this syndrome, but as I mentioned in a previous blog, sugar isn't helpful, so choose wisely how you eat your cacao.

http://www.alandiashram.org/school/school_html/articles/blood_sugar.html

Welcome to the Sixties!" That was the message from my doctor today. Sixty years old, fifty pounds overweight, elevated blood pressure, sugar and cholesterol and a thyroid nodule that requires surgery. What kind of outcome is that from following a brilliant diet and lifestyle for the past thirty years?

Of course, one can only imagine how dismal the outcome could have been, if I hadn't  followed an Ayurvedic diet and lifestyle  for all these years. Heredity, which stalks me even now, would surely have played out to the full extent. Instead of a slow progression of insulin resistance and borderline hypertension, I'd probably be diabetic with heart disease and malignant hypertension. And one can't even guess how heavy I might have become on a standard American diet.

So now for some small but significant steps to fine-tune things. Dark chocolate lowers LDL (bad cholesterol) and supports mood. Not something I would really want to quit, because of the health benefits, not to mention yumminess. And for a younger person, without insulin resistance, Green and Black's chocolate, sweetened with raw cane sugar, is a good way to go.  But now it seems that even raw sugar is not working. So today I received in the mail a case of Chocoperfection, sweetened with inulin, zero effect on blood sugar, a prebiotic and source of fibre. That's step one.

The next point was to appreciate the distinctions between different kinds of exercise. While yoga and chi gong are exercise, they are not aerobic exercise. And although my levels of aerobic exercise certainly exceed the recommended three hours a week for a healthy person, they need to be increased to an hour a day because of insulin resistance.

Step three is to alter the carbohydrate protein ratio--hard to do as a vegetarian. But basically it means a kapha-soothing diet emphasizing lighter grains or grain substitutes like quinoa and buckwheat.

My doctor, Dr Phil Weber, reminded me that the Sixties are not all bad news. The mind, he says, becomes sharper. Diagnostic skills  for us doctors are at their peak. But a health challenges tend to play out, and it's time to pay more attention to self care.