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!
A Path Model of Chronic Stress, the Metabolic Syndrome, and Coronary Heart
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
The great thing about a
personal health blog is that, for the first time in my career as an author, I'm
writing from a patient's point of view, sharing my personal journey with
fellow-sufferers in the most educational way I can. And when it comes to insulin
resistance and metabolic syndrome, there are all too many fellow sufferers--a
quarter of the US population, and about the same figure for Europe and Latin
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
In creating a personal health
blog, I'm thinking, of course, as in everything I do, about benefit for others.
So I'll be sharing what works for me, what doesn't work, tips, strategies,
ideas. Today I'd like to share regarding a very important vegetable, known
variously as bitter gourd, bitter melon and Karela. Bitter gourd deserves its
name. For some, it's an acquired taste--but worth the effort.
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,
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 isa recipe combining two
vegetables revered in Ayurveda for their antidiabetic properties. White
eggplant is seasonally availableand
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
1tsp mustard seeds
1tsp cumin seeds
½ tsp fenugreek seeds
1tsp garam masala
1Tbsp ghee or sunflower oil
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!
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
Lateral view of the human ankle (Photo credit: Wikipedia)
Okay, Universe, so when I decided to
write an interesting health blog, I wasn't really hoping for new problems to
make it more interesting...
So yesterday wewent for a hike at Chautauqua, to see
was a nice hike, quite a bit of uphill and on the way down I did several jogs.
We were strolling towards the car when my left ankle suddenly gave way and
twisted under me, throwing me to the ground. My ankle was
definitely sprained and I couldn't even walk to the car. Some treatments of
alternate ice and mustard seed tea relieved the ankle situation, and now I can
get around with an elastic bandage and a cane.
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.
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
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.
Second Life: National Health Service (UK): (Photo credit: rosefirerising)
At the outset of this post, I want to share that seeing the word carcimoma on a pathology report is extremely unsettling. Even if it's more likely to be an adenoma and even if you know it would be curable anyway, the limbic system does its little freakout. Carcinoma is a big scary word--and fear is bad for your immune system. So after seeing that scary word, naturally you want to get your surgery as soon as possible--or that's how I felt.
Another pertinent point here is that I'm from the UK and so I view healthcare as a right, not as a privilege. I was in for a rude awakening. In the UK it's simple. You get the pathology report and your doctor refers you to a London teaching hospital for specialist surgery and you don't pay for anything.The beauty of universal coverage came home to me when I did my Accident and Emergency rotation at Barts Hospital. On several occasions, the police brought in an old tramp (hoboe) who was in a bad way. We would admit them to the wards, where they would be cared for by the finest doctors, nursed back to health and discharged to transitional housing. I was soon to find out that as an uninsured American citizen, I had fewer rights than an English tramp.
My friend Renu had given me a list of thyroid surgeons in Colorado--none in Boulder and a couple in Denver at University hospital. So began a tortuous process of trying to get seen by one of these surgeons on CICP (indigent care). We jumped through various hoops trying to get information. My sister-in-law even drove to university hospital to get find out the facts. But the situation remained confusing until I called GITES Center, the specialist surgery centre, myself. The answer was crystal clear. They would not accept me on CICP "unless it was life-threatening" as evaluated by their centre. I could not get a payment plan, nor any form of charity from the government-funded hospital. The surgery would cost tens of thousand of dollars and basically, " Show us the money and we'll do the surgery."
I was so astounded that I simply thanked the receptionist politely, by name, for providing the information, hung up the phone and had a meltdown. I felt oppressed, for I was being denied the right to care that had been mine for my earliest youth. The surgery was supposed to be done within three months of the biopsy and I had lost several weeks getting nowhere at all. So began my search in the medical tourism direction. That too was quite difficult; at lot of web searching and going down blind alleys. How could I check the thyroid surgery credentials of a doctor in India or Mexico? Would my emails even get a response? Often not. But my web searches revealed to me that medical costs for a private patient in the UK would be about 15% of the US costs.
The next red herring was provided by my beloved mother, who told me I could be treated free on the NHS (National Health Service). By visiting her GP's website, I learned that you have to be 'ordinarily resident' in the UK to be treated free. That means you have to prove that you will be living there for at least six months. If you can prove that, everything covered by the NHS is free from day one. However, with the 85% difference in costs, it made sense to be treated as a paying patient at one of the big London teaching hospital NHS trusts.
At this point I still don't have a surgery date, but on August 8th I'll be meeting with Mr Fausto Palazzo http://www.londonendocrinecentre.co.uk/fpbio.php at Imperial Centre for Endocrinology. He is one of the best thyroid surgeons in the UK if not in the world. The procedure will still be expensive but, of a different order of magnitude to US costs. I learned that our healthcare system here in the US is broken, that I have less healthcare rights than an English tramp, but also that every problem has a solution if you are determined and keep going.
After reading my previous blog, some of you wanted more details about the thyroid situation. For some years I have been aware of a goitre with a nodule on the left. However, previously it was not diagnosed correctly. I recently saw an endocrinologist, who did an ultrasound and then a biopsy, since it was a large nodule.
It was while I was at the NAMA (National Ayurvedic Medical Association) conference that I received a telephone call about the biopsy results. Turns out it's a follicular neoplasm, which has about a 15-20% chance of being malignant. Before any friends get worried--thyroid cancer is totally curable, but at the cost of losing your entire thyroid and being dosed with radioactive iodine, neither of which are very appealing. In order to determine if the neoplasm is benign or malignant, it has to be removed.
Meanwhile, at the conference I was introduced to Renu, a thyroid surgeon. She was quick to point out the hazards of thyroid surgery. The main concern is the recurrent laryngeal nerve, which enervates the vocal cords. If that is damaged, the voice becomes hoarse and you lose the ability to sing. In addition, there are the parathyroids, which are responsible for regulating calcium balance. If thyroid surgery is done by a non-specialist, there's a 20% chance of permanently losing your voice. As a singer, I found that risk unacceptable. However, if the operation is done by an expert thyroid surgeon, outcomes are very good. My meeting with Renu showed me how important it would be to have the surgery done by an expert.
Ironically, as a junior doctor, I was apprenticed to a master thyroid surgeon! Mr Barnabas (surgeons in the UK are called Mr, not Dr.) was a Hungarian emigre, vascular surgeon and thyroid expert. He took tremendous pride in his thyroid work and was a brilliant craftsman in this regard. We used plastic surgery sutures to sew up the neck so as to leave no visible scar. So I've assisted at many thyroid surgeries and have an intimate understanding of the truth of Renu's words.
The lessons here are not only about the thyroid and its delicate anatomy. Synchronicity, Grace, call it what you will, was clearly at play here. By the will of Ram I was introduced to Renu and came to understand how important it would be to find expert treatment to preserve the 'angel voice' that has inspired many.
In the next installment, I'll talk about my journey as an uninsured person seeking specialist care. It has been an Odyssey.
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'tfollowed an Ayurvedic diet and lifestylefor 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
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