June 2012 Archives

bhakri served as a part of indian meal

bhakri served as a part of indian meal (Photo credit: Wikipedia)

Diet has certainly been a perplexing topic for me over the years. After all, I give Ayurvedic nutritional advice to others and they lose weight. Why not me?

One of the big debates I see in diet is the dichotomy of the calories in/calories out view versus the diet composition view. What's important--how much you eat or what you eat?
 
According to sources such as Web MD, losing weight should be pretty simple as it's just a matter of eating fewer calories than you burn. I decided to test this for myself, so for a month I used an online calorie counter. At the outset, let me
say that I do recommend this to anyone dealing with overweight or obesity, as an exercise. Many of my obese patients do in fact consume far more calories than they burn. Bags of corn chips, one pound bags of M&M's, quarts of ice cream, visits to McDonald's or Burger King, sodas etc do often form part of the diet of someone first presenting for Ayurvedic care. Although I don't eat such things myself, still I  I found it quite helpful to review my diet, look for any excess calories and make simple changes.

But what I learned for myself was that I do in fact, on a daily basis, consume significantly fewer calories than I burn. And despite cutting calories even more, I didn't lose an ounce.  This was a fascinating exercise in disproving, for myself, the calorie myth. Of course, now I could wade into other diet controversies--low fat vs low carb. etc. But, I had Ayurveda to guide me. According to Ayurveda, there is no one diet that is right for everyone. It's mandating 'one size fits al
l' that makes any diet a fad. A person's diet is determined by their constitution, current imbalance and the condtion they are dealing with. As a pitta, I've naturally gravitated to a pitta-soothing diet, focusing on the sweet, bitter and astringent tastes. I' m not into desserts or sweet baked goods, but the sweet taste includes grains such as rice and wheat, as well as fruits. Vegetables such as greens and bitter gourd provide the bitter taste, while salads and legumes are astringent. So there it was, salads, rice, dal and veggies--my perfect meal! Of course, in recent years I've cut back the quantity of rice, but still its been a staple.

Understanding that I have insulin resistance and undiagnosed PCOS has helped me appreciate that kapha is at the root of my current concerns. (It's hard, by the way, to be your own doctor. I 'm up too close to see myself in perspective). The composition of a kapha diet focuses on bitter, pungent and astringent. Now, my inherent pitta rules out much pungent, so that leaves bitter and astringent. That's most of what I already eat--except for the grains! It was a short leap from there to deciding that, with insulin resistance, I simply need to leave off the dense starches--the grains, endowed with the sweet taste.

Of these grains, wheat is the densest, heaviest and most kapha provoking, so I decided to go off wheat and gluten grains altogether and leave rice as a occasional treat (or something to eat when I'm not in charge of my own menu). Instead I'm using the lighter, astringent grain substitutes like quinoa and buckwheat.

I was happy to see that with a strict kapha-pacifying diet, the scale is actually starting to move. It was a relief to see that something can actually work and I'm not condemned to obesity as  life sentence. I recommend a grain-free diet to anyone with insulin resistance. And I'm thrilled to see that Ayurveda is yet again proved right!
English: cooked red quinoa

English: cooked red quinoa (Photo credit: Wikipedia)








 
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A detail from a miniature painting in the Raja...

A detail from a miniature painting in the Rajastani style, made by the artist LaLa in Udipur, ordered pecially by user:F16. Painted in September 2004. shows the Hindu god Dhanvantari. (Photo credit: Wikipedia)

Today I wanted to blog about attitudes to health and sickness and how they change through the years. I can recall being a young medical student and thinking of my body pretty much as Brother Ass, able to take any kind of punishment. That included living on cheese on toast because I didn't know what vegetarians ate, trying to find out how much wine I could drink at "firm parties" with our medical teachers, even accidentally drinking the rum punch thinking it was fruit punch!

 

As junior doctors, we attended to the health of others while sacrificing our own. We began work at 9 am Friday and got off at 5 pm Monday.  I recall falling asleep on my feet while watching a monitor in ICU. If we were sick, we still worked, accompanied by a box of tissues.  Health was important--other people's health. We were supposed to be invincible.

 

And when I was a sadhvi or wandering renunciant, it was still the Brother Ass paradigm.  Instead of belaboring Brother Ass with alcohol, cheese on toast and long work hours, we fasted, slept in cremation grounds and contacted pretty much every tropical disease known, from amoebas to giardia to hepatitis to typhoid.

 

For the last quarter century I've been an Ayurvedic Practitioner, committed to optimal wellness, prevention and practicing what I preach. Healthy home cooked food, exercise, and techniques of Ayurvedic self-care became my life, as I was determined never to ask my patients to do what I wouldn't do myself. I had complete confidence in diet, lifestyle, yoga, meditation and herbs and sincerely believed that nobody who used turmeric every day would get degenerative diseases. I wasn't doing these practices to get well from an illness, but to maintain my status of  'twenty years younger than my chronological age.'

 

Then the sixties dawned, and little genetic time bombs started ticking anyway. I wasn't twenty years younger after all. (well, maybe ten? Five?) I was quite agitated by the sudden transformation from a fit, forty-something fifty-nine-year-old to a sixty year old with prescriptions and doctor visits. Although it was a relief when Dr. Kamath pointed out to me that I was really healthy for my age because although I had concerns, I didn't have any actual diseases. Of course, efforts at self-care motivated by anxiety and overwhelm are unlikely to prove successful. But it was a stage and an important one.

 

Then I started writing this blog, and I knew that my natural residence had resurfaced. True, I wasn't approaching self-care the same way as before. Before I was just setting a good example and living what I believed in. Now I am approaching self care with specific concerns in mind. I'm not just a doctor now, but also a patient. And I approach each day with a sense of curiosity, interest and adventure. It's exciting to find out what works, what doesn't. It's inspiring to share my journey with others and think that they can benefit. So you, dear reader, contribute to my wellbeing as I do to yours. We're in this together!

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Setubandhasana - Bridge Pose सेतुबंधासन

Setubandhasana - Bridge Pose सेतुबंधासन (Photo credit: Wikipedia)

One of the asanas that figures in my regular practice is setubandhasana or bridge pose. For example, this morning I did nine repetitions of bridge pose as part of a female energy rejuvenation series that I do regularly. Of course, I started wondering why I like setubandhasana so much and what other benefits it has, aside from toning and rejuvenating the female reproductive system.

 It turns out that setubandhasana is ideal for obesity, overweight and metabolic syndrome. First of all, it is one of the very best asanas to rejuvenate and stimulate the thyroid, thus improving metabolism. Secondly, setubandhasana helps lower the blood pressure. As an important anti-hypertension asana, setubandhasana addresses one of the key components of metabolic syndrome.  Thirdly, setubandhasana is great for reducing stress. And as I have discussed in several blog posts, stress is an important co-factor in the development of insulin resistance and metabolic syndrome. As an added benefit, setubandhasana is helpful in preventing osteoporosis, a condition that often affects women at about the same age that insulin resistance and hypothyroid make themselves known.

Setubandhasana is a pose suited to all ability levels--as long as you can get down on the floor.  As always, don't try yoga at home without first seeing a yoga teacher to be sure the pose is right for you and you're doing it correctly.

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Yoga and metabolic syndrome

 

People in various yoga asanas. Original title ...

People in various yoga asanas. Original title and description: "AsanAthon 2" Participants in Diamond Mountain's first AsanAthon. (Photo credit: Wikipedia)

Like many of you who are reading this blog, I enjoy practicing yoga or chi gong as a part of my daily exercise programme. These contemplative movement arts are meditative and centering, so I appreciate doing them. Imagine my consternation when Dr Weber explained that yoga and chi gong are not aerobic and so won't meet my exercise needs, even though they are good to do. Or to put it another way apparently I still need an hour of exercise a day aside from yoga or chi gong. Her's a quote from the study I imagine Dr Weber was referring to "Sixty minutes or more of continuous or intermittent aerobic activity, preferably done every day will promote weight loss and weight maintenance. The latter include multiple short (10-15 minute) bouts of activity (walking breaks at work, gardening or household work), jogging, swimming, biking, golfing, or team sports. An equal balance between aerobic exercise and strength training is advised."

It's taken me a while to digest and process this. And here are a few things I've realized along the way.

 

First of all, yoga and chi gong provide deep relaxation and release of tension even in the midst of exercising. It's not only shivasana (corpse pose) that offer a deepening into the parasympathetic state, but also many asanas, as we discussed a few days ago when talking about rabbit pose. And not just asanas, but pranayama also offers significant stress reduction benefits. Stress is a key element in metabolic syndrome, particularly where hypertension and belly fat are concerned.

 

Another point that has become clear to me recently is that musculoskeletal degenerative conditions are associated not just with age and wear and tear but also with impaired microvascular blood flow (I wrote about this in my last blog, on shoulder injuries). And impaired flow in small blood vessels is related to diabetes, pre-diabetes and insulin resistance. In other words, those of us with insulin resistance are at increased risk of musculoskeletal degenerative disorders. Degeneration of joints such as the knees can make it difficult to walk upstairs, what to speak of doing aerobic exercise. So here comes a vicious cycle--lack of exercise/metabolic syndrome/knee degeneration/lack of exercise/worse metabolic syndrome. And this is compounded by obesity giving the knees more to carry and lack of exercise increasing obesity. Yoga offers an excellent path to move and energize all the joints, providing increased blood flow and maintaining flexibility. And today, with yin yoga, restorative yoga, chair yoga, bed yoga--all mobility levels can do some asanas and pranayama.

 

After mentally designing a study to prove that I really do need to do yoga and chi gong, I found that a lot of researchers have beaten me to it! A 2008 pilot trial at the University of California determined that, "Restorative yoga was a feasible and acceptable intervention in overweight adults with metabolic syndrome. The efficacy of yoga for improving metabolic parameters in this population should be explored in a larger randomized controlled trial." (2) In 2005 a literature review article published in the Journal of the American Board of Family Medicine noted that "collectively, these studies suggest that yoga may reduce many IRS-related risk factors for CVD, may improve clinical outcomes, and may aid in the management of CVD and other IRS-related conditions." (Note: IRS = insulin resistance syndrome) (3).A 2008 study from India notes that "Participation of subjects with T2DM (Type 2 diabetes) in yoga practice for 40 days resulted in reduced BMI, improved well-being, and reduced anxiety." (4). And the study cited above in reference to aerobic exercise goes on to say, in the next paragraph, "Thus, it is clear that a comprehensive approach consisting of weight reduction, regular physical exercise and yoga is crucial in control of the insulin resistance state that characterizes the metabolic syndrome."

I'm sure that was what Dr. Weber, who is a holistic physician, meant to convey. Sometimes we hear what we hear, and go through our own process. And the studies I've cited are only referring to the benefits of yoga on markers of metabolic syndrome and not even to the added musculoskeletal piece I mentioned.

So, walk more but don't substitute walking for yoga!

 

1. PC Deedwania, R Gupta, Management Issues in the Metabolic Syndrome JAPI 2006

2..Beth E. Cohen, A. Ann Chang, Deborah Grady, and Alka M. Kanaya. Metabolic Syndrome and Related Disorders. September 2008, 6(3): 223-229. doi:10.1089/met.2008.0016.

3. Kim E. Innes, Cheryl Bourguignon, and Ann Gill Taylor, Risk Indices Associated with the Insulin Resistance Syndrome, Cardiovascular Disease, and Possible Protection with Yoga: A Systematic Review J Am Board Fam Pract November-December 2005 18:491-519; doi:10.3122/jabfm.18.6.491

4. Madhu Kosuri Ph.D.Gumpeny R. Sridhar M.D., D.D., F.A.C.E.. Metabolic Syndrome and Related Disorders. December 2009, 7(6): 515-518. doi:10.1089/met.2009.0011.

 

 

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Dealing with setbacks

Robert the Bruce kills Sir Henry de Bohun on t...

Robert the Bruce kills Sir Henry de Bohun on the first day of the Battle of Bannockburn. (Photo credit: Wikipedia)

 

My sprained ankle has naturally led me to reflect upon setbacks in our pursuit of health and fitness. The moment I decided to increase my exercise (which, incidentally, already exceeds the generally suggested guidelines), I immediately sprained my ankle.  And I can think of so many similar incidents. I get really fit and vigorous, doing a lot of sprinting, and then break my arm.  I get fit again, start running, and there's a heat wave and I can barely move. I pick up from the heat wave and get h1n1 and have to build back up again. Once I get over the sprained ankle I'll have to deal with getting fit again after surgery.

I'm sure each reader can tell a similar story. Fortunately, I won't be competing in the Olympics, so fitness setbacks are not catastrophic. Setbacks invite a philosophical view. According to madhyamika Buddhist philosophy, we need to have a union of the relative and absolute view. From the relative perspective, I'm responsible for this body and the precious opportunities embodied life offers me to practice the dharma and benefit beings. So following guidelines of self-care is inherent in the dharma.  But from the absolute point of view, this body is impermanent, inevitably painful and void of any real essence. It arose and it will pass away. Whether I' m a junk food eating couch potato or an Olympic athlete, the only thing certain in life is death.  Life's setbacks and ups and downs are determined by karma, not by my wishes or efforts.

There are two curves in effect in my life and they move in opposite directions. One is the curve of constant efforts to enhance wellness through Ayurvedic self-care, leading to increasing general wellbeing. The other curve is the ageing process leading to degeneration decay and death. And as part of the ageing process, various genetic time bombs go off despite our efforts to defuse them.  It's a matter of having

"the serenity to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference."

To put it another way, choiceless awareness, no preferences. Staying present with what is helps us not to get discouraged by setbacks.

My father used to tell a story of Robert the Bruce of Scotland and the spider. After six defeats by the English army, Robert retreated to a cave, utterly discouraged. As he lay in the cave he watched a spider spin her web. Time and again she tried to throw her thread across the cave, only to fail. Yet she just kept trying until at last she was able to bridge the cave with her thread. The spider inspired Robert Bruces' eventual defeat of England at the Battle of Bannockburn. May she inspire us to face our setbacks and continue the path of wellness!

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Age and metabolic syndrome can affect us in unexpected ways. Up to 39% of people over sixty have full-thickness rotator cuff tears (1) in one or both shoulders, which often come on gradually with no history of shoulder injury. Such rotator cuff tears in elders are thought to be a degenerative age-related condition due in part to impaired blood supply (2,3). And the cause of impaired blood supply leads us back to metabolic syndrome and diabetes, where elevated blood sugar levels cause damage to small blood vessels.

Last year Sadananda had  very painful rotator cuff tear, triggered by the repetitive motion of spooning ghee into the fire during a month-long Vedic fire retreat. It was treated by PRP injection--platelet rich plasma, a very painful and debilitating but quite successful treatment. While I've not had shoulder pain myself, I do notice that my shoulders pop excessively, which could be pointing to some degree of rotator cuff degeneration.
We exercise our shoulders with a simple chi gong practice. First we extend the arms out horizontally, pushing out stale chi and pulling in fresh chi. Then we push forward, pushing out stale chi, and pull back, drawing in fresh chi. With this exercise, I hope to protect my shoulders.

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1.Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

2. Yamanaka K, Fukda H. Aging process of the supraspinatus tendon in surgical disorders of the shoulder. In: Watson N, ed. Surgical Disorders of the Shoulder. New York, NY: Churchill Livingstone; 1991:247.

3.  Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. May 1990;254:35-8.


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