“EMBODIED COGNITION,” in its most common and practical meaning, occurs when the state of your body — sensory information about your physical state or “embodied self” – modifies the state of your mind. Standing in a power pose – like that of Wonder Woman (hands on hips, feet apart) – can increase your feelings of power to prepare for a speech or meeting. Holding a warm cup when you meet someone unfamiliar can help you trust that person more quickly.
Metaphors help explain embodied cognition. We say “I’m warming up to her” because early experiences of affection when we were babies were often accompanied by sensations of warmth; later we both physically and literally warm up to people. Or we say something is “over our heads” about an idea that we don’t understand, referring to our physical inability to see something that is literally over/in back of our heads.
“Posture has a HUGE effect on how you feel, think and behave,” according to Nicholas Steadman writing on Quora.com. “’Keep your head up!’ ‘Stand tall!’ Have some backbone!’” (In the most radical meaning of embodied cognition, our cognitive resources for solving problems include not just the brain but also the body, as best demonstrated by the “outfielder problem.” With a fly ball heading for the outfield, the brain can try to predict where the ball will land by creating a model of the projectile motion of the ball along with information as it came off the bat about speed and direction. Alternatively, the embodied solution begins with the outfielder running toward the ball, in which case his act of running, by itself, along with the comparable forward movement of the ball, provides him with information about where the ball will land.
Embodied cognition came into popular usage with a 2012 TED talk by Harvard Business School professor Amy Cuddy. In research with Dana Carney and Andy Yap at Columbia University Business School, Cuddy showed how high-power postures not only change the way people feel but actually “produce power” by altering the hormones testosterone and cortisol. Assuming two high-power poses — both with chin lifted and forward, and either sitting with arms and legs stretched out or standing with the body leaning forward against a podium or table — for one minute each increased testosterone (dominance) by 20 percent and lowered cortisol (stress) by 25 percent.
By contrast, low-power poses — sitting slumped with hands together in the lap, and standing with arms wrapped around the body and legs intertwined –- caused a drop in testosterone levels along with a rise in cortisol. “That a person can, by assuming two simple on-minute poses, embody power and instantly become more powerful has real-world, actionable implications,” according to the researchers. “These findings suggest that that the effects of embodiment extend beyond emotion and cognition, to physiology and subsequent behavioral choice.”
Power posing, however, should be restricted to preparation before the interaction or event. “You want to feel powerful going in,” Cuddy told Huffington Post. On the other hand, what’s important during the experience can be the more difficult challenge: projecting warmth. “Trust is the conduit for influence,” Cuddy said. “If they don’t trust you, your ideas are just dead in the water.” People judge trustworthiness before anything else because “it answers the question, is this person friend or foe?”
Women have a difficult time being seen as both competent and warm, Cuddy added, because of what she calls a “treacherous double bind…Women are much more likely than men to be seen as high on one dimension and low on the other. Women in the public eye are really penalized for deviations from what society has prescribed…to be a warm, soft caretaker.”
Slouching is the “ultimate low-power pose,” Jacqueline Howard writes in her HuffPost science column, with its ability to sap your energy and even bring on depression. Crossed arms, in addition to reducing your power, might also make you appear less approachable. But research conclusions are not always consistent: crossed arms – as opposed to hands resting in the lap — have also been shown to boost persistence while working on a task, according to a study at the University of Rochester.
Gesturing while you talk can help you retain what you learn, according to Howard. And clenching your fists can help you endure unpleasant experiences, such as skipping desert. Different research found that women sitting in an expansive position were less able to restrict their eating.
And then there’s the old pencil trick. Holding a pencil or chopstick sideways in your mouth can produce a smile, which in turn brings on happier feelings. These, in turn, can lower the heart rate and increase the endorphins that contribute to more good feelings. Holding a pencil sideways made a cartoon appear to be more amusing in one study, according to Steadman. In contrast, holding a pencil lengthwise between the lips created a pout, and that made the cartoon seem less funny.
A forehead smoothed by Botox can help someone resist negative feelings. But an unfurrowed brow has also been shown to impair reading comprehension when negative emotions are described, because botox interferes with the ability to empathize, according to Steadman. That study demonstrated a “causal role of involuntary facial expression in the processing of emotional language.” Finally, inducing physical nausea can increase the intensity of moral judgments, especially disgust.
Amid these conflicting conclusions, taking a power pose in a bathroom or elevator prior to a demanding encounter should be successful. And warming your hands before meeting new people can help boost their trust in you, but watch out: everyone’s sense of warmth is different, and too warm might be creepy.
CHOLESTEROL EXPERTS are throwing out the numbers and changing the restrictions. Those serving on the 2015 U.S. Dietary Guidelines Committee agree: “in itself, cholesterol in food doesn’t appear to raise blood cholesterol levels,” according to a summary report in U.S. News.
In 2013, the American Heart Association (AHA) raised its daily upper cholesterol limit from 160 mg/dl to 300 mg/dl (one egg has about 200 mg of cholesterol). The guidelines advisors, who previously agreed with the 300 mg/dl limit, now recommend dropping the cholesterol guideline entirely. (Going one step farther, the International Network of Cholesterol Skeptics denies that cholesterol has anything to do with cardiovascular disease.)
Meanwhile, the fortunes of eggs have been rising. Not only no longer forbidden, they are beginning to be seen as healthy. In fact, the beneficial nutrients in egg yolks may “counter the effects of cholesterol,” according to Dr. Frank Hu, professor of nutrition at the Harvard School of Public Health, in the New York Times. “Starting your day with a breakfast of scrambled eggs will have a better impact on your overall cholesterol profile than a bagel or bowl of sugary cereal.” Eggs are also seen as a good source of nutrients such as choline, which may contribute to lowering inflammation and improving memory.
Among the more serious dietary villains causing high blood cholesterol, number one is sugar, when it exceeds the body’s need for energy and storage capacity and is converted to fat in the liver, according to New York nutrition expert Marion Nestle. Once converted, the fat circulates in the blood and can block arteries.
Saturated fats are also enjoying a better reputation. Of 150 participants in a NIH study published in 2014, those on the diet lower in carbohydrates and higher in fat saw their HDL (good) cholesterol levels rise more sharply, along with a lowering of their Framingham risk scores (the gold standard for predicting heart attacks) compared to participants on the lower-fat, higher-carb diet. All were instructed to limit either carbs or fat but not overall calories. The higher-fat group also lost more weight, on average eight pounds, possibly because the lower-fat group lost more muscle than fat.
The higher fat group consumed a little more than 13 percent of their calories from saturated fat (compared to the 5 to 6 percent recommended by the AHA), although the majority of the fat consumed was unsaturated – from fish, nuts and olive oil. This group had a total fat intake of more than 40 percent of daily calories, compared to less than 30 percent for the other group.
Both groups were encouraged to eat vegetables but only “some” beans and fruit. “I’ve been a strong advocate of moving saturated fat down the list of priorities in dietary recommendations,” Dr. Ronald Krauss, past chair of the American Heart Association’s dietary guidelines committee, told the New York Times. The reason: the role carbohydrates play in causing metabolic syndrome problems such as diabetes.
While diets high in saturated fat can increase LDL (bad) cholesterol levels, there’s another wrinkle in the cholesterol numbers game. Similar LDL concentrations in different people can create a higher risk if the LDL particles are small and dense, the kind of particles that increase with the consumption of refined carbohydrates (in processed foods). These particles are more often found in patients with heart disease and other metabolic syndrome issues. Saturated fat, on the other hand, tends to make LDL particles that are larger, more buoyant and less likely to clog arteries, according to Dr. Krauss.
And then there’s the issue of statins (cholesterol-lowering drugs like Lipitor), which are being recommended for more and larger categories of people with every study. Statins appear to prevent heart problems even in people with high LDL levels but no sign of clogged arteries, benefits that grow over time. A Scottish study followed 6,600 men, ages 45-64 with high LDL levels, for more than 20 years, with only half the men taking statins during the first five years. Among that group, 20 years later, the risk of heart-related deaths was 27 percent lower, and death from other causes 13 percent lower, compared to the group who delayed taking statins for the first five years.
Recent recommendations call for giving statins to healthy people who have LDL cholesterol levels of 190 mg/dl or higher, and to those with lower LDL levels who have other risk factors – in what is now called “preventive cardiology.” In other statin news, they seem to spur surgical wound healing by promoting the growth of blood vessels and lowering inflammation, which reduce healing time. Their inflammation-reducing effects can also help prevent gum disease and suggest the possibility of beneficial effects in the brain to reduce the risk of dementia.
A few outlying nay-sayers still worry about side effects of statins, such as muscle pain, and a Huffington Post blog suggest statins might be unnecessary for many as well as unsafe because of side effects. For those who can’t bear the side effects of statins, a vaccine that controls blood cholesterol has worked well in animal studies and might be much more effective.
When the 2015 Dietary Guidelines are published, more of this information should be clarified, although diet advice has done so many flip-flops to date that the future may remain unpredictable.
AS AN EAGER journalist many years ago, I arranged to interview the medical examiner of New York City and thought it a great privilege to get inside the morgue and see his operation first-hand. I had never felt squeamish dissecting frogs or cleaning up dog poop. But just a few minutes into my interview, as the ME was opening and closing those long stainless steel drawers and discussing the pasty corpses inside, my vision began to blur and sweat rolled down my face. I felt nauseous and hurried from the room.
Such physical responses can precede loss of consciousness in what’s called “vagal nerve fainting” or “vasovagal syncope” — syncope meaning loss of consciousness — the main causes of fainting (besides that caused by seizures, vertigo, hypoglycemia and serious illnesses). The vagal nerve, which runs from the brain stem towards the chest and abdomen, communicates between the brain and organs including the heart and stomach, with its main function to direct blood toward the digestive system after eating. It also directs the hiccup reflex. The vagus nerve is responsible for involuntary activities that regulate the body’s organs: activating the vagus nerve via slow, deep breathing is known as the “relaxation response.” (See MyLittleBird story “Just Breathe.”)
But overstimulation of the vagal nerve can decrease the heart rate and/or the heart’s output, both of which make it difficult for sufficient blood and oxygen to reach the brain. The result can be loss of consciousness and fainting. This overstimulation occurs with an array of triggers, among them heightened emotions, including anxiety, fear, pain, hunger or squeamishness, for example, from seeing blood or those pasty corpses. (Alternatively, anxiety and panic can also cause hyperventilation, breathing in too much oxygen and breathing out too much carbon dioxide too quickly, which can also cause fainting.) Fainting due to vagal nerve overstimulation can also occur with vomiting or straining to have a bowel movement.
An overactive vagal nerve can result from heat exposure, when extra blood goes to peripheral vessels to cool the skin, leaving less blood going to the heart and brain — as well as from anything that causes blood to pool in the legs, such as after running and other strenuous exercise or prolonged standing. As for the idea that locking your knees for too long can make you faint, medical experts say that’s a myth because prolonged standing would be the main villain – though, in people for whom knee-locking increases blood pooling, it becomes a related cause.
The other main cause of fainting is orthostatic or postural hypotension from standing up too quickly, for those people whose bodies have difficulty adequately regulating blood pressure. Standing up causes a downward shift of about two cups (500 mL) of blood to the abdomen and legs, which results in less blood returning in veins to the heart and a consequent lowering of blood pressure. These effects of standing are normally countered by the body, but when the response doesn’t happen fast enough, the amount of blood going to the brain and thus blood pressure in the brain fall below a critical threshold. Symptoms accompanying this loss of consciousness can include: lightheadedness, tremulousness, “visual graying” and “coat-hanger” neck (caused by reduced oxygen to the shoulder and neck).
Countermeasures include standing slowly and contracting the calf muscles when standing to spur movement of blood away from the legs. Fainting that occurs on getting out of bed can be countered by tilting your bed, if it’s fancy enough, to keep your head elevated. The rest of us should add pillows.
Fainting is only harmful when it causes a fall that results in injuries. Falling into a supine position restores effective blood flow to the brain, although if the head remains elevated, loss of consciousness can be prolonged. For anyone prone to fainting, drinking plenty of water can help maintain a high blood volume — and appears to bestow an array of benefits for everyone.
AS A SUGAR LOVER, I have tried to ignore the increasingly negative publicity about its health hazards until I recently read about possible effects on the aging brain. And then when I started to pay attention to ingredients labels, I was shocked to find how mistaken I’d been–for example, about my favorite San Pellegrino “sparkling grapefruit beverage,” just water, right?–and began to choose my sugary treats more carefully.
Although there is still no definitive evidence that sugar causes change in the brain, recent evidence suggesting that dysfunctions associated with diabetes–hyperglycemia, hypertension, insulin resistance and elevated cholesterol–might also contribute to dementia has led some experts to call Alzheimer’s “Type 3 diabetes” (that is, a third type of diabetes, one that affects the brain). Damage to blood vessels from hyperglycemia, resulting for example in retinopathy, is seen as an early indicator that sugar affects the brain.
Increased blood sugar levels were associated with higher risk of dementia in a 2013 study of about 2,000 adults across the country, average age 76, most of whom did not have diabetes. The study, published in the New England Journal of Medicine, established “for the first time, convincingly, that there is a link between dementia and elevated blood sugars in the non-diabetic range,” according to study author Dr. David Nathan, director of the Diabetes Center at Mass General Hospital; and that the higher the blood sugar, the higher the risk of dementia.
This research “offers more evidence that the brain is a target organ for damage by high blood sugar,” UCLA endocrinologist Medha Munshi, another study author, told the New York Times. “And everyone is still working on the ‘why’.”
Insulin, the hormone that controls blood sugar levels, also strengthens synaptic connections between brain cells, thereby enabling the formation of stronger memories. In a 2012 study at UCLA, rats that consumed large quantities of fructose developed insulin resistance that affected synaptic activity in the brain and impaired cognition. This study suggested that the effects of sugar on nerve cells’ ability to communicate “could have repercussions in how well we remember instructions, process ideas and handle our moods,” according to Fernando Gomez-Pinilla, PhD, who suggested that while insulin in the body controls blood sugar, it may play a different role in the brain.
And then there’s inflammation, which has been linked to progressive damage in the brain. Even mild elevations of blood sugar over time can increase the ability of blood sugars to bind with proteins, in turn increasing the production of inflammatory chemicals – although it’s still unclear whether inflammation can cause dementia.
Attaching sugars to the proteins in collagen and elastin can also spur aging effects on the skin. And excess sugar may also be implicated in bone health as it can inhibit calcium absorption and deplete phosphorus, which facilitates the absorption of calcium.
The FDA recommends that no more than 10 percent of one’s daily diet should come from sugar – about 12.5 teaspoons or 50 grams/day — including not just the fructose and glucose in white table sugar (sucrose), but coconut sugar, agave and corn syrup as well as fruit juice, honey and other sugary foods. Confusion arises, however, when quantities of “natural” and “added” sugars are combined, both in recommendations and in food ingredients labels (see examples from my kitchen in list below). The FDA has said it would like to change the labels to distinguish between the two. While some dieticians argue that our bodies don’t differentiate among kinds of sugars, others point out that added sugars represent “empty” calories devoid of nutrients, while foods like milk and fruit containing natural sugars are nutrient-dense, providing calcium, protein, vitamins and/or dietary fibers. The World Health Organization also recommends a 10 percent cap on sugars but excludes those in fresh fruits, vegetables and milk.
While much remains tentative and unclear about sugar risks and recommendations, everyone seems to recommend consuming less sugary food and drink. “Sugar detox” appears in the title of at least three books featured on Amazon. In a UCLA study showing actual improvement in mental function (see MyLittleBird story on reversing memory loss) for subjects who selected among 36 changes to make in their lives (including eliminating gluten, red meat, etc.), “eliminating simple carbohydrates” is listed as #1.
PREVIOUS MYLITTLEBIRD COLUMNS on the effects of light on wakefulness and mood have appeared in the spring, when the” blue” morning light that wakes us up and makes some of us happier is increasing every day. So-called blue light inhibits the creation of melatonin in the brain so that the body knows it’s time to wake up, and early morning light contains more wavelengths in the blue portion of the spectrum than light at other hours. On dark winter mornings, late sunrise can interfere with circadian rhythms, causing melatonin levels to remain high for hours after waking — which in turn can cause fatigue and depression. These winter blues affect about 14 percent of Americans, with another 6 percent suffering the more severe seasonal affective disorder, or SAD. An estimated 10 to 20 percent of all cases of recurrent depression follow a seasonal pattern, according to Medical News Today.
Women are more likely to be affected than men, and January and February are the most difficult months. Besides fatigue and depression, symptoms of SAD include weight and appetite changes, difficulty concentrating, loss of interest in social activities and feelings of anxiety and irritability. In the past, the best solution has been “light therapy,” either heading outdoors as early as possible in the morning or using a light box like the Verilux, with light measuring 5,000 lux – compared to 500 lux at sunrise, the 10,000 lux of full daylight and up to 100,000 lux for direct sunlight.
But in a recent study, six weeks of light therapy for 30 to 60 minutes upon waking worked about the same as an alternative, cognitive behavior therapy (CBT) in twice-weekly sessions over the same period. CBT taught participants to challenge negative thoughts about dark winter months and resist behaviors like social isolation. The study at the University of Vermont, published in the American Journal of Psychiatry, followed 177 subjects over three years. During the second winter, those in both treatment groups initially experienced “large improvements,” but these dwindled after a while, according to the study’s leader psychology professor Kelly Rohan. And in the third winter, 46 percent of those using light therapy had a recurrence of depression compared to 27 percent of those who had undergone CBT.
Rohan compares light therapy to blood pressure medication, a palliative treatment that requires you to keep using it to be effective, versus CBT, which is preventive: once learned, the impact should last because CBT teaches skills, Rohan said. And with some research showing that thoughts and behaviors play a role in SAD, CBT gives patients a sense of control, Rohan told the Washington Post. “We can think outside of the light box. The good news is we can change our thoughts and behaviors.”
Giving CBT patients an even greater sense of control is CBT online. In recent literature reviews, some studies showed that people using internet-delivered CBT had equal or better outcomes than those using traditional in-person CBT, although study leaders caution against internet-based therapy for people with severe mental illness. An Australian study found that the free internet-based MoodGym CBT program, accompanied by brief face-to-face support from a psychologist, was an “effective treatment of depression” in a small sample of patients.
Among alternative weapons against SAD are the timing of exercise and diet. Because decreased body temperature signals the body that it’s time to sleep, 20 to 30 minutes of vigorous exercise in the morning can stave off sleepiness by raising the body temperature as much as two degrees for up to five hours. Meals high in protein also increase wakefulness, compared to high-carb meals, which make it easier to fall asleep – even when undesirable, such as at the opera. And getting protein from fatty fish like salmon can help you face winter like the Icelanders, who seem never to suffer from SAD — armed with high levels of omega-3 fats, which may stabilize mood and keep depression at bay, along with vitamin D, the “sunshine vitamin.”
But you might not want to abandon bright lights entirely, especially if body mass index (BMI) is a concern. In a Northwestern University study, for every hour that exposure to bright light was delayed, the subjects’ body mass index rose 1.28 points. Also, compared to CBT, there is nothing like the immediacy of that Verilux glow – or even better, of those first sunny springtime mornings some of us are already looking forward to.
Amid all the confusion about taking drugs like Actonel and Boniva to fight bone loss (there is evidence that these drugs can make bones brittle), we decided to rerun Mary Carpenter’s story from last fall about diagnosing and treating osteopenia and osteoporosis.
SARAH S. WAS diagnosed with osteopenia based on a comparison of bone density measurements a few years apart, with a “big jump” down in the more recent measurement. Although her bone density had not been terrific for several years, she was taking steps inconsistently. Since the latest test, Sarah has made an effort to consume 1,200-1,500 mg/calcium per day in a combination of supplements along with “trying to up my milk and yogurt and cheese.” She also focuses more on weight-bearing exercises, including walking, biking and dancing, along with weight training. For Sarah, knowing the risk has been upped is “scary,” but the knowledge that she could forestall osteoporosis gives her hope. Her next step is a 24-hour urine test to see if there’s any improvement.
Osteopenia–decreased bone density which has not decreased sufficiently to be deemed osteoporosis–is considered an early warning sign for osteoporosis and the need for immediate action. Women who receive this diagnosis are generally grateful for the heads-up.
Osteopenia is defined by taking the “normal young” score–that of an average 30-year-old white woman–and measuring how much her bone density deviates from that norm, which is called a T-score. Bone density is most accurately measured by DXA (for dual-energy X-ray absorptiometry), or DEXA, which can detect as little as 2 percent bone loss per year, and the radiation dose is much lower than with standard X-rays.
“Normal” includes bone density within one standard deviation (SD) of the “young normal.” Osteopenia, also called low bone mass, begins at 1 to 2.5 SDs away from the norm; and osteoporosis is diagnosed with 2.5 SDs or more. One estimate has the risk for broken bones increasing by 50 to 100 percent for every standard deviation below the young-normal standard; with osteoporosis, even simple movements can break bones, especially in the hips. A problem with this system, however, is that some people naturally have a lower bone density–so it can help to have a baseline measurement from when you were closer to “normal young.”
Also, osteopenia–defined only recently in 1992–is considered by some physicians to be not only arbitrary and irrelevant but creating unnecessary worry along with unnecessary medical responses. Steven R. Cummings of the University of California, San Francisco, said, “There is no basis, no biological, social, economic or treatment basis whatsoever” for using one standard deviation. “As a consequence, more than half the population is told arbitrarily that they have a condition they need to worry about.” According to the National Osteoporosis Foundation, osteoporosis affects 10 million Americans, mostly women, while an additional 34 million have osteopenia.
Low bone mass is most often the result of aging. Beginning after age 30, existing bone cells are reabsorbed by the body faster than new bone is made; during the same period, bones begin to lose minerals, especially calcium, which makes them weaker. The number-one risk factor for decreased bone density is being female, and in particular being small-boned, because women start off with less bone mass than men. And hormonal changes at the time of menopause can speed loss of bone mass. Other top risk factors include being Caucasian or Asian, and having a family history of low bone mass.
Then there are the usual suspects: lack of exercise, smoking, drinking excessive amounts of alcohol. And one more unusual suspect: regularly drinking cola drinks –a Tufts University study found that women who drank three or more cola-based sodas a day had 4 percent lower bone mineral density in the hip, with caffeinated sodas doing the most damage. While caffeine is known to interfere with calcium absorption, the main culprit would be phosphoric acid, a major ingredient in most sodas–although the amount is minimal compared to that in chicken or cheese. Alternatively, the problem may simply be that people drinking so much soda are drinking less milk, or consuming less overall nutritional food and drink.
Treating osteopenia with medication has been shown to have marginal benefits. The more common recommendation is to increase calcium and weight-bearing exercise. However, there is the daunting statistic that almost 80 percent of bone density is determined by heredity and only 20 percent by lifestyle.
The nay-sayers feel that the added worry is unnecessary, and that additional testing and treatment is both unnecessary and costly. But they may not personally be up against the small bones and heredity shared by people like Sarah S.
Editor’s Note: This story is from Mary Carpenter’s series last winter, sampling local healthy-body experiences.
THE FIRST TIME I tried acupuncture was years ago for a minor complaint, but mostly I was curious. I found it surprisingly restful to lie on my back with no possibility of moving, no interruptions, for 20 minutes in the midst of a hectic day. But the minor complaint remained after three sessions, and my life became too busy.
Then when my 9-year old son suffered almost a year of almost constant dizziness, unimproved by dozens of doctors and medical tests, six acupuncture treatments completely cured him. The explanation: alternative treatments like acupuncture can sometimes cope better than traditional Western medicine with symptoms that are subtle and chronic.
When it was suggested that acupuncture might improve what I considered a non-symptom, because I couldn’t feel it — decreased sensation in my legs and feet — I began to investigate. Also, I knew that my idiopathic (no known cause) peripheral neuropathy (malfunctioning nerves in the extremities) could be contributing to my clumsiness — though I have never been graceful — and an improvement would be welcome.
In a 2007 study by researchers in Germany and Portugal on 47 patients with peripheral neuropathy (PN), the 21 who received acupuncture improved “symptomatically and objectively” — objectively based on measurements of nerve conduction.
I felt silly seeking treatment for something that didn’t bother me: most PN sufferers experience unpleasant tingling and/or pain, which can include sharp shooting pain that interrupts sleep and affects mobility. Common causes are diabetes and alcoholism as well as heart disease and various infections and toxicities. Because ordinary analgesics often have no effect on nerve pain, the best drugs are those that target nerve cells, such as Cymbalta; anticonvulsants and antidepressants, especially Elavil; and topical treatments and injections — most of which have side-effects.
Acupuncturists believe that PN is due to trauma, “dampness” and anything else that obstructs the flow of Qi (chi – energy) and blood — and that it “is a symptom for many different patterns of disharmony within the body.” Energy flows through the body along meridians, or channels, which extend in either direction between the body’s organs and its extremities. The goal of acupuncture for PN is both to treat underlying causes of the blockage and to improve circulation, so that the “tissues of the affected area can be nourished to repair the nerve functions and reduce pain.”
Retired after 25 years, acupuncturist Steve Phillips writes on his website that he treated peripheral neuropathy more often than any other condition, amounting to more than 3,000 treatments. While almost 90 percent responded “very well to acupuncture,” Phillips says that “results are generally not immediate — the effects of acupuncture…are cumulative. Usually the patient will be feeling some benefit by the end of the fourth treatment.”
The acupuncturist I chose, Nic Buscemi — recommended by experts and friends — estimated three months of regular, weekly sessions. Buscemi has a four-year degree from the National College of Naturopathic Medicine and has practiced for ten years. Every day, he said, he studies to learn more about Chinese medicine, which includes acupuncture and Chinese herbs along with nutrition and exercise.
The majority of Buscemi’s patients come for relief from pain, mostly related to exercise injuries and aging. He also treats people with symptoms that linger after Lyme disease, which affects different organs depending on where the spirochetes cause the most infection and which Buscemi thought might explain my PN. Other patients come with stress-related issues, anxiety and specific sensitivities, for example, to seasonal changes. Acupuncture helps “stimulate the body’s defenses and healing abilities,” he said. “I try to get everything to function on a high level.”
Buscemi said his estimated time for my PN treatment was based on his experience, on the length of my complaint and on my coming to regular weekly appointments. For longer-lasting problems, more time is needed for acupuncture to work, whereas “if it’s acute, the body usually responds more quickly,” he said. But Buscemi repeatedly emphasizes that each individual responds differently. My PN may have been going on for years: the reduced sensation was only detected when I spied my GP, during a regular physical exam, sticking needles in my leg which I didn’t feel.
Buscemi’s first step was to check my pulse — actually six pulses, three locations on each wrist that correspond to different organs. On the left wrist, for example, the top pulse is the heart; the middle, the liver; and the bottom, the kidney. “If one of the pulses is off –“soft, weak, wiry,” he said — that organ and that channel will be the focus of treatment. In my case, blockages in the liver and spleen meridians were preventing energy from moving to my extremities.
Acupuncture from Buscemi was not painless, and I was not a good patient: I couldn’t go every week. After three months, I felt no different, meaning no increase in feeling – which would have been subtle since I hadn’t noticed its absence. On the final check of my pulses, however, Buscemi said things were flowing much better in my channels; also, the balance was better between my yin and yang, and among the five elements — earth, wood, water, fire and metal. As a result I should have more energy — also subtle.
I did feel pretty good, though that could have many explanations — including saying goodbye to the needles. But I left believing I could turn to acupuncture in the event of future issues too subtle for traditional MDs to diagnose or treat, or maybe for a tune-up as needed.
If you do not respond to the ministrations of mainstream medicine, you’re not alone. For anyone interested in pursuing a different approach, we decided to reprint LittleBird Mary Carpenter’s story about integrative health centers published here last February.
READING LOCAL HEALTH magazines, such as “Pathways” or “Natural Awakenings,” reaffirms what you may already know : the D.C. area offers a host of unconventional healthcare possibilities. While some people turn to these to improve their general health, many go because they’re suffering from severe, often chronic, symptoms that their MDs were unable to diagnose, treat or cure.
For them, a comprehensive approach is offered at centers of “integrative” medicine, where conventional MDs work together with specialists in acupuncture, nutrition, yoga, etc. – treatments that often work well for subtle or chronic conditions where conventional medicine has failed. (In contrast, “alternative” refers to a non-mainstream approach used in place of and “complementary” in addition to conventional medicine.)
At the George Washington Center for Integrative Medicine, now in its 16th year, evaluation begins with conventional blood and urine tests as well as a toxicity profile and/or a genetic profile, which is based on the commercial genetic test “23andMe.” These profiles can be cornerstones for the detailed and individualized treatments which the center provides — especially for its “Detox Program,” prescribed for patients suffering from chronic immune or infectious conditions, including Lyme disease or from exposure to toxic substances such as mold.
The GW Center’s treatments include such far-out-sounding options as aromatherapy and infrared light therapy along with exercise and nutritional prescriptions. According to Medical Director Mikhail Kogan, the center’s list includes only those approaches that are evidence-based. It does not include, for example, “ionic foot baths,” found at other health practices in the area as well as at health spas.
Kogan is frustrated by how often these treatments are provided without sufficient prior patient evaluation. When asked about naturopathic advice offered by practitioners of individual treatments, like massage, as well as by purveyors of naturopathic supplements, he points out that the practice of naturopathy — based on the concept that removing internal obstacles to treatment will allow the body to heal itself — requires a four-year degree in Naturopathic Medicine, during which an important focus is detox programs.
One patient at the GW Center, a woman in her early 20s, dropped out of college because of Lyme- and mold toxicity-related “brain fog,” nausea, night sweats and hair loss – for which she had been in treatment with a Lyme disease specialist and had been taking three antibiotics and three anti-depressants. After several months in the center’s Detox Program,” she was able to stop all medications except one anti-depressant, and is now planning a trip to Central America.
Anywhere from one-third to one-half of patients at the center are referred by MDs, and a large percentage come for weight loss or for symptoms related to chronic fatigue and fibromyalgia, as well as for cancer and neurological diseases, such as Parkinson’s and Alzheimer’s.
The center also has a program of “Healthy Aging.” According to Kogan: “We can determine which parts of the system are the weak links and work to strengthen them.” If there’s oxidative damage, for example, which is thought to contribute to Alzheimer’s disease, “treatment is usually simple,” he says. “Change the diet and teach about reducing stress, which can affect the entire body.”
A GW Center patient, a man now in his 80s, had used a wheelchair since his 60s because of difficulty walking, and he recently began losing speech and becoming confused. After the center diagnosed late-onset Celiac disease, he was put on a gluten-free diet and within a few weeks began walking and talking with ease.
According to NCCAM (National Center for Complementary and Alternative Medicine) at NIH, about 38 percent of American adults use some form of CAM, the vast majority for back pain (17.1 percent), neck pain (5.9 percent) and joint pain (5.2 percent). Comparing 2002 and 2007 (the most recent years for which statistics are available), CAM therapies with the largest growth included meditation (7.7 to 9 percent); and massage (5 to 8.3 percent); while the biggest decrease occurred in the use of CAM for head colds: 9.5 to 2 percent.
Self-described “quackbusters” David Gorski and Steven Novella in a recent “quackademia update” jumped on integrative health centers for the “continued infiltration of quackery into medical academia” – although in turn they have been accused of receiving support from the pharmaceutical industry.
But for people whose suffering has not been allayed by mainstream medicine, integrative centers can offer real hope by bringing together the brainpower of practitioners trained in many different disciplines. Dr. Kogan makes the comparison to “palliative medicine,” hardly known 40 years ago and now an accredited specialty with several mainstream academic training programs.
What seemed clear during a weekly staff meeting at the center was how personalized each patient’s treatment is, and also how it can change over time depending on practical concerns, such as time and money; although some treatments are better covered by insurance than others, the bill can rise very quickly. Also clear was the willingness of the center’s staff to bandy suggestions back and forth, with input from complementary practitioners, both respected and added to by MDs, to come up with the best treatment.
Dr. Kogan explained the difference in care at integrative centers like GW: “We don’t just prescribe treatments, we think about and look at the whole person, then we think some more.” Because most doctors today, even primary care doctors, have specialized interests, Kogan believes: “It takes a village to care for a sick person today.”
MEMORY LOSS MIGHT NOT be not just preventable but reversible, according to the first research to document such a phenomenon. The sample was very small–10 patients, ages 55 to 75. Six of them, who had quit work or were struggling at their jobs because of problems with memory loss, were able to return to work or improve their work performance within three to six months by participating in a program developed by UCLA neurologist Dale Bredesen. Three others improved; and one, who had shown the most serious deficits beforehand, did not.
The program includes 36 interventions that were assembled for each patient based on extensive testing as well as personal preferences. “Think about it like 36 holes in the roof,” Dr. Bredesen explained. “You can’t just plug one hole.”
The 36 include many things anyone can do: changes in diet (eliminating simple carbohydrates, processed food, gluten and/or increasing vegetables and fruit); fasting periods (see below); stress reduction, using methods from yoga to music; oral hygiene; exercising 4 to 6 times/week; adding supplements that include vitamins B, C, D and E, antioxidants, omega-3 fatty acids and probiotics as well as spices and herbs such as turmeric. Also: coconut oil, fish oil and blueberries.
There are also several that require a doctor’s prescription including HRT (hormone replacement therapy); cortisol (steroid) and changing current medications such as anti-depressants.
Dr. Bredesen believes that memory loss associated with conditions that include early Alzheimer’s disease may not have a single cause. Instead, as with other chronic illnesses like heart disease and cancer, cognitive changes might be due to an array of contributing imbalances–an “extensive network of molecular interactions,” according to Bredesen’s paper, “Reversal of Cognitive Decline: A Novel Therapeutic Program,” published in the September 2014 Aging.
Disorders of the brain have been increasingly linked to metabolism. Insulin has been shown to play a role in plasticity, the brain’s ability to respond to a myriad of chemicals and other forces from within and outside the body. Individuals with increased insulin levels or insulin resistance, associated with Type 2 diabetes, have a higher risk for Alzheimer’s disease.
Of two fasting periods included in the program, the first is a three-hour fast between dinner and bed to allow time for after-meal insulin levels to go down. “You don’t want to sleep with elevated insulin,” Dr. Bredesen says.
A longer fasting period of 12 hours between dinner and breakfast allows time for amyloid beta proteins–of which elevated levels affect the balance in the remembering-forgetting mechanism toward more forgetting– to be flushed out of the brain, a process aided by melatonin.
Each of the ten patients underwent extensive testing to determine exactly which lab values affecting the plasticity network were out of balance and then received individualized regimens with common goals, for example, reducing inflammation in the brain and balancing metabolic parameters such as blood sugar.
With supplements, Dr. Bredesen explains, there’s a big difference between normal and optimum levels: “Vitamin B12 levels around 300 (pictograms per milliliter) is considered normal, but it’s horrible if you want to optimize.”
Stress raises the body’s levels of cortisol, the “stress hormone,” which can lead to cortisol levels that are either too high or too low (because too much has been used by the body). In either case, the solution is minimizing stress–by whatever means “works for you, whatever gives joy,” according to Dr. Bredesen. While some patients chose meditation or music, Patient One began doing yoga, was so enthusiastic she became an instructor, and now –after two and a half years in the program –is 70 and doing very well.” Dr. Bredesen said.
Patient One had considered quitting her job because she often forgot the information she had just read as well as the location of light switches in her house, and mixed up the names of her pets. Besides yoga, she included minimum exercise, the fasting regimens and supplements; increased her sleep from four to five hours per night to seven to eight hours; and eliminated simple carbohydrates as well as gluten and processed food. Patient Two, who had begun forgetting once-familiar faces at work, exercised strenuously six or seven days a week with a combination of swimming, cycling and running–but chose none of the stress-reduction activities.
Patient Three, an attorney, commonly lost her train of thought mid-sentence and often asked her children whether they had done things she had forgotten to ask them to do. Her program included meditation and relaxation, and she worked with her internist to reduce her anti-depressant medication. (Of the three, only Patient One eliminated gluten; and both Patients One and Three either began or restarted hormone replacement therapy.)
Patients followed for two and a half years continued to “show sustained and marked improvement,” according to Dr. Bredesen. He also writes that “the major side effect of this therapeutic system is improved health and optimal BMI.” He admits, however, that the program is “not easy to follow, and none of the patients followed the entire protocol.” They had trouble with the diet and lifestyle changes, and the multiple pills required each day. On the other hand, they had the strong motivation of knowing that “their prognosis was poor and their cognitive decline essentially untreatable.”
Dr. Bredesen considers the results “very encouraging,” although because the sample is small, they are “anecdotal and therefore a more extensive, controlled clinical trial is warranted.”
Even if we’re not going back to school, how many of us still have the unsettling, anxious dream about how we forgot to do a paper or didn’t study for the final exam? What does it mean? Well-being editor Mary Carpenter talked about the importance of being sensitive to your bad dreams in this story first published here in April.
NIGHTMARES CAN BE RICH fonts of learning about yourself as well as helpful for working through difficult issues – especially if you “dialogue” and “practice courage” with your demons in those dreams, according to Rubin Naiman,* sleep and dream specialist at the University of Arizona.
Speaking at a recent Psychotherapy Networker conference in DC, Naiman disagreed with familiar treatments of dreams, from the use of “dream dictionaries” to psychoanalysis and Freud. Interpreting dreams when we’re awake, he believes, is a “utilitarian perspective” and involves taking the dream out of context, like looking at a fish out of water: “You can’t understand it.”
Naiman pointed to anti-depressants and sleep medications along with addictions and over-exposure to light at night as wreaking havoc with our dreams by suppressing them.
“Dream loss is the basis of the modern epidemic of depression,” according to Naiman, who traces many problems commonly blamed on sleep loss to dream loss instead. “Most of us are significantly more dream-deprived than we are sleep-deprived,” he said: Rats die in experiments where they are prevented from dreaming.
Dreams occur throughout the night, but it’s during REM sleep that we are most aware of them, Naiman said. He compared dreams to stars in the sky: they are always there but not always visible to us. REM sleep occurs every 90 minutes or so throughout the night in ever-lengthening periods. Because the longest REM periods occur in the final third of the night, Naiman is opposed to using wake-up alarms, which can snip off the end of an important dream.
When we suppress REM sleep with drugs or by sleeping too little, dreams move to earlier in the night and interfere with normal sleep patterns, according to Naiman. With PTSD, nightmares come earlier in the night and during non-REM sleep. But he said, you work with all nightmares in the same way.
“Morning grogginess,” Naiman considers “an exquisite hybrid state of consciousness” – part waking, part sleep, and part dream — and tapping into that state can help us access our dreams. If we are more sensitive to the importance of our dreams, he believes, we will have an easier time recalling them – especially if we practice “arising slowly” in the morning. Upon waking completely, Naiman recommends “bridging our dream experiences and the waking world” by journaling or jotting notes about the dreams, also by talking about them with a “receptive bed partner.”
Nightmares give us an important opportunity to practice courage, Naiman said, and that generalizes to our waking life. Image Rehearsal Therapy (IRT) is one approach to nightmares, based on the idea that we can change our dreams. If you dream of a dragon in the closet, ask yourself what you wish to say to it, or take up a weapon or turn it into a fruit tree. Rehearse this new script during the day, or write a description of the new dream and read it over.
“Lucidity” is another approach, in which the dreamer makes an effort during the dream to remember that they are in a dream – where everything is therefore harmless — and to maintain an attitude of “intrepid curiosity” towards the dream content. Studies on particularly adept lucid dreamers have found more activity in the part of the brain that enables self-reflection (the anterior prefrontal cortex) than in those less skilled.
“Conciliatory dialoging” with dark dream characters is a third approach, which can turn “demonic beings into puppies,” Naiman said. He recommends treating demons as equals and asking them: who are you, who am I and why are you here? By “conciliatory,” he means friendliness — not submission — to encourage dark dream characters to transform.
Finally, the approach Naiman is personally most involved with is shadow work. “The shadow is everything we wish not to be,” he said. For example, a woman who dreamed about a shadow figure slicing her open with a knife was struggling with fears of opening her heart. Naiman advised: “Even when it’s painful, stay in dialogue with the bad sides of yourself.”
Before going to sleep, “it is helpful to set an intention to become receptive to our dreams by first considering that there is something worthy of our attention in our sleep,” Naiman wrote in the Huffington Post. “As we slip into bed, turn out the lights and close our eyes, it is helpful to be mindful of where our attention goes. Most of us routinely think about the next morning…What will I wear? What do I need to get done tomorrow? We can instead allow ourselves to consciously descend into the sea of sleep with our ‘third eye open.’ Rather than setting our sights on the shoreline of tomorrow morning’s awakening, we can allow the deep currents of our dreams to carry us through the night.”
People have trouble remembering their dreams either because they don’t sleep well, because they allow lifestyle factors (worrying about the next day, using alarms to wake up) to get in the way or because they don’t “offer [dreams] sufficient regard.” Naiman believes that “to dream well, we must first sleep well.”
While REM-suppressants include alcohol and mind-altering drugs, Naiman also believes that suppressing our dreams is an important reason why we consume these: “when we lose our ability to naturally expand consciousness through dreaming, we inadvertently seek to do it with excessive indulgence in alcohol, drugs, food, sex or work. Addictions can be viewed as a spiritual quest gone awry.”
To help counter REM suppression, Naiman recommends melatonin, because it “appears to support REM sleep and dreams.” He advises consulting a knowledgeable health professional because side-effects can include serious drowsiness the next day.
As for psychoanalysis, Naiman queries: “Might some patients be better off napping on their therapist’s couch?” In answer to an email noting the risks of scheduling his lecture at 3 p.m. after a long lunch break, he responded: “The nice thing about presenting on sleep is that it doesn’t matter if people stay attentive or nod out. In either case, I feel like I’m doing my job.”
*Rubin Naiman has written several books on dreaming, including “Healing Night,” “Hush” and “The Yoga of Sleep.” He conducts week-long “Healing Sleep Retreats” at spas like Rancho La Puerta.
The jury is out on the effects of a gluten-free diet on your health. Well-being editor Mary Carpenter advises not rushing to judgment in her column first published early this year.
MOST OF THE MOTIVATION to eliminate gluten from our diets comes from books like “Wheat Belly” and “Grain Brain.” The latter, by David Perlmutter, links high-gluten consumption to dementia, and he advises limiting carbohydrates including fruits, while increasing consumption of fats to 50-60 percent of daily calories. One-third of Americans now aim to be gluten-free.
Everyone agrees that eliminating gluten is essential for the 1 percent of Americans who have celiac disease, in which gluten spurs the body’s immune system to attack the small intestine, leading to serious nutritional deficits. An additional 6 percent of the population believes they have “non-celiac gluten sensitivity” (NCGS) and that gluten-free eating makes them feel better.
In a small study, 37 people who blamed NCGS for their digestive ills, including bloating and stomach pain — symptoms collectively known as irritable bowel syndrome (IBS) — were put on three similar diets with levels of gluten ranging from none to a lot: gluten had no measurable effect on their symptoms. Instead, the differentiating variable was a substance called FODMAPS (fermentable, oligo-…you don’t want to know) found in foods such as wheat, apples, garlic and milk — considered possible instigators of IBS and other “gut problems.”
Critics of Perlmutter’s thesis point out that conclusive research pinpointing a clear cause of dementia would make an enormous splash among health professionals and media outlets around the world, which has not yet occurred. In the Mayo Clinic study often cited by Perlmutter as linking high-carbohydrate diets to dementia, healthy whole grains like wheat were not distinguished from refined carbohydrates like white flour — which has been stripped of fiber, protein, vitamins and minerals — although the two have remarkably different effects on the body over time.
In addition, while some subjects had episodes of mild cognitive impairment, no one in the study developed dementia. The Mayo Clinic, along with most medical experts, recommends limiting dietary fat to 20-35 percent of daily calories. Meanwhile, Perlmutter himself has authored no peer-reviewed paper on the topic, and much of his “Grain Brain” book focuses on exercise and sleep, rather than on grains.
Then there is the issue of which ingredients replace gluten in the gluten-free diet. Just as “low-fat” foods often contain lots of sugar, salt and refined carbohydrates, the labels of gluten-free products include rice starch, corn starch, tapioca starch and potato starch – highly refined carbohydrates that release high levels of sugar into the bloodstream. In a recent New Yorker article, Dr. Peter Green, Director of the Celiac Disease Center at Columbia University Medical School, asks, “…what are the things that sell food? Salt, sugar, fat and gluten. If the makers take one away, then they add more of another.”
Perlmutter’s advice on diet could in fact be dangerous. “Ignoring LDL [consuming too much of the “bad” cholesterol] could absolutely result in heart attacks and strokes,” says Dr. David Katz, epidemiologist and nutrition expert at Yale University, in James Hamblin’s article, “This is your Brain on Gluten,” in The Atlantic. Katz points out another drawback to high-fat diets: “people who are eating more meat and dairy…are eating fewer plants.”
Meanwhile, among thousands of studies on risks for dementia, gluten is not a factor. Among the most important risks: lack of exercise, high blood pressure and high cholesterol, poorly controlled diabetes and lack of social engagement – also being over 65, genetics and being a woman, because women live longer. In the U.S. News and World Report list of healthiest diets, those at the top – DASH, TLC, Mayo Clinic and Mediterranean – recommend whole grains, while high-fat diets like Paleo are at the bottom.
In a rare health claim, the FDA announced, “Diets rich in whole grain foods…low in saturated fat and cholesterol, may help reduce risk of heart disease.” And in 2011, the American Society for Nutrition published the statement that whole grains lower the risk of heart disease, diabetes and cancer and contribute to weight management and gastrointestinal health. For a healthy brain, the only super-foods contain high levels of omega-3 fatty acids, especially those in fatty fish like salmon.
The truth is that eliminating any major component of your diet — gluten, meat, dairy, fat — makes you pay closer attention to what you eat, and that in turn often results in eating more healthily. Eliminating gluten, for example, might mean you replace breakfast foods like cereal, toast or pastries with yogurt or eggs, high-protein foods that may increase your energy levels. And paying more attention to your diet can result in weight loss.
When you hear friends touting their gluten-free lives, listen to their specific food choices and calorie counts. If you give it a try, don’t load up on fats, think carefully about your personal nutrition needs and observe how you feel over the course of several weeks before giving your final verdict.
If the proliferation of ads for Nexium, Prilosec, Prevacid and other proton-pump inhibitors is any indication of our national disease du jour, then my vote goes to acid reflux disorder. Here’s what our Well-Being Editor Mary Carpenter had to say last fall.
OVER THE PAST FEW YEARS, friends have begun suffering from GERD— a nicer-sounding name than the real one, gastro-esophageal reflux disorder, or the more familiar, acid reflux. Also known as heartburn and acid indigestion, GERD can cause burning pain felt internally around the lower chest area, as well as trouble swallowing and a dry cough. One friend with GERD who had the dry cough needed to eat very small meals to avoid nausea; another had to sleep in an almost-upright position and had trouble getting enough rest.
According to a 2011 Norwegian study, in the previous ten years the incidence of at least once-weekly acid reflux symptoms rose nearly 50 percent. Women were the least likely to have acid reflux under age 40, but by ages 60 to 69 were the mostly likely sufferers. The American College of Gastroenterology estimates that at least 15 million Americans experience acid reflux daily. Currently acid reflux is one of the top health-related internet search queries.
GERD results when the ring of muscle that normally protects the esophagus from the contents of the stomach weakens. Stomach acid can then flow up the esophagus and into the gullet, which moves food down from the mouth. Stomach acid, composed partly of hydrochloric acid, helps with efficient digestion and protects the stomach against bacteria. Excess stomach acid in the esophagus can lead to painful and irritating inflammation, called esophagitis, and rarely to more serious problems including ulcers and increased risk of esophageal cancer.
Triggers of acid reflux vary from person to person, with the most common being rich food such as meats as well as fats, oils and sweets; fruits, vegetables and juice, especially tomatoes; grains; and beverages including liquor, coffee and tea. According to WebMd, larger and higher-fat meals “tend to stay in the stomach longer before moving into the small intestine,” creating longer periods of exposure to stomach acid. GERD is commonly a result of excess weight: increased incidence of obesity over the past few decades may help explain the soaring incidence of acid reflux. GERD can also be triggered by lying down too soon after eating, and by increased pressure on the abdomen from wearing tight belts or doing too many sit-ups.
My friend who couldn’t sleep had some temporary relief from a gluten-free diet, but, after reading New York Times columnist Mark Bittman’s blog, switched to eliminating all dairy– including the slightest smidge of butter for cooking–and after several years of suffering seems completely cured. For years Bittman had relied on Tums and Prevacid, which blocks some of the stomach’s acid production, until his doctor convinced him to “break the Prevacid addiction.”
Among over-the-counter drugs, many people take Gaviscon, which creates a mechanical barrier against the stomach acid. But the most common recommendations include watching portion size, reducing consumption of high-fat foods, and if needed, losing weight.
Sleepless in Washington? 20 Tips for Better Shuteye
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The CDC has called the lack of sleep a public health epidemic. “Persons experiencing sleep insufficiency are also more likely to suffer from chronic diseases such as hypertension, diabetes, depression, and obesity, as well as from cancer, increased mortality, and reduced quality of life and productivity.” Just last week NBC News ran as series called “Sleepless in America,” citing our dependence on tech devices as one of the culprits of sleep deprivation. We’ve got some tricks to keep under your pillow. Here’s what Mary Carpenter advised in a column she wrote last July:
START BY LYING on your back with your eyes closed.
1. Math: My favorite sleep trick used to be counting backwards from 100 by 7s. When I got very good at it, I would go below zero to -100, then back up – often missing a number or two so that I rarely ended up back at 100, and could keep trying. A friend swears by complicated multiplication and division problems, but my poor math skills get me too lost and muddled for those to help.
2. Breath: Then I discovered “mindful breathing,” which sounds very simple but I needed a short class in mindfulness and an accompanying meditation CD to nail it. Simply follow your breath as it moves in and out. If your mind wanders, notice that and bring your attention back to your breathing, in and out. Possible additions: focus on the chest area below your collarbone, filling with air, then emptying; focus on bodily sensations; focus on ambient sounds.
3. Sun: An old favorite is to imagine strong sunshine beating down on the top of your head until it starts to feel warm. Then imagine that warmth moving down through your head into your neck, then arms, then torso, then legs to the feet. Imagine those warm feet. Do this as slowly as possible, and then repeat even more slowly.
4. Air: During my childhood, my father was rarely available but often made it to our bedrooms right after lights out to open our windows as loudly and far as possible while declaiming the benefits of fresh air. I still find fresh air very helpful, except in D.C. heat; for reasons of both allergies and comfort, I keep the air conditioning running from May through August and sometimes longer.
5. White noise: On breezy nights, a fan helps aerate your room and produces a soothing sound; white noise machines can also help.
In addition to my own experiences, here are some others from WebMD, Oprah, The Wall Street Journal and the controversial WDDTY (What Doctors Don’t Tell You) magazine/website:
6. Progressive Relaxation: Tighten the muscles in your toes for several seconds. Then relax them for 30 seconds and focus on how relaxed they feel. Repeat this all the way up your body, ending at your neck and face. (WebMD)
7. Prepare for sleep: An hour before bedtime, unplug electronic devices to reduce “electrosmog,” or electromagnetic pollution, which some believe contributes to poor sleep. (WDDTY).
8. Breathing patterns: For “4-7-8 breathing,” recommended by holistic medicine guru Andrew Weil in Oprah magazine, keep the tip of your tongue just behind your upper teeth while you exhale completely through your mouth with a “gentle whoosh” sound. Then close your mouth and inhale quietly through your nose for a count of four. Then hold your breath for seven counts, and follow with an eight-count “whoosh exhale” through the mouth. Continue completing cycles until you drift off.
More, for before you head for bed…
9. Exercise: Blow off steam to reduce both mental and physical stress, which can interfere with sleep. Exercise should be completed at least two hours before bedtime so your body temperature can return to normal.
10. Unwind Your Body: Exercise, stretch or do something physically relaxing, because feeling completely exhausted may actually mean you are too revved up to sleep.
11. Unwind Your Brain: To get anxiety out of your system before bed, plan “worry time” right after dinner to answer e-mails, tie up loose ends and prepare for the next day.
12. Relaxation: Visualizing a calming image, such as the seaside at night, using all your senses to make the image as vivid as possible.
13. Evening snacks: Milk with either whole-grain toast or an oatmeal raisin cookie can increase levels of the sleep-inducing amino acid tryptophan.
14. Turn off: TVs, computers, tablets and smartphones, because at around 9 p.m., your body starts releasing melatonin to make you drowsy, but this release is blocked in the presence of bright lights.
15. Sleep more in general: When over-tired, you are more easily stressed, which interferes with sleep.
16. Diet: Keep your intake of caffeine and alcohol low to promote health and reduce stress.
For getting sufficient rest once you’ve gotten to sleep …
17. Time the cycles: Because each sleep cycle includes five stages and lasts 90 minutes altogether, set a wake-up time that is a multiple of 90 from the time you anticipate falling asleep. If you go to bed at midnight, for example, you might feel more refreshed waking up at 7:30 than if you got a full eight hours of sleep.
18. Lights: If you get up in the night, keep the lights low, because bright bathroom lighting blocks the release of melatonin and interferes with sleep patterns.
19. Electricity: Use incandescent bulbs in your bedroom, because fluorescent and LED bulbs can emit “dirty electricity.” And keep your cell phone out of the bedroom entirely; if you need the alarm, keep the phone at least one yard away from you. (WDDTY)
20. Lavender: Pillows and sleep masks filled with lavender, candles and room diffusers have been shown to slow heart rate, lower blood pressure and create a relaxing effect; and there is some evidence that it “facilitates restful sleep,” Yale sleep researcher Vahid Mohsenin told The Wall Street Journal. In a 2005 study, subjects who smelled lavender before bedtime had an increased amount of deep or slow-wave sleep and reported feeling more vigorous the morning after compared to the nights those same subjects sniffed distilled water.
AS A PILATES INSTRUCTOR, clients plead with me on a daily basis to help them “get rid of this gut.” Most are coming to me with the notion that Pilates is all about core strengthening and that this will somehow give them flat tummies. After explaining that we cannot spot reduce but that core strength will help them move in other ways that will enable them to shed pounds as well as prevent injury and back pain, they are ready for me to give them a workout they can do at home. This is the part where I look them in the eye and say “NOT YET!!” Working the core is something that your average gym rat (and even some personal trainers) gets very wrong. I’m not just talking wrong as in wasting time–I mean as in you-could-prolapse-an-organ wrong.
Lets talk about “core.”
The definition is somewhat open-ended these days and can pretty much refer to any muscles not attached to your extremities. Pilates practitioners, however, define the core as the deep muscles that surround the contents of the abdomen. These muscles are the transverse abdominis, the deepest layer of the abdominals; the multifidi, small muscles that connect to the spine; the diaphragm, a dome-shaped sheet of muscle that separates the chest from the abdomen; and my personal favorite, the pelvic floor. Why is this my favorite? Well, it’s a muscle that a lot of people do not know they have because it’s in a part of the body we don’t usually discuss in polite company. It is also the muscle we can hurt the most by doing core stuff wrong!
The pelvic floor is located at the base of the pelvis, and its primary purpose is to prevent your organs from, well, spilling out on to the floor. Think of a cylinder with a dome at the top and bottom. The diaphragm is at the top and the pelvic floor makes up the base. These muscles contract together and keep in all the contents of the abdomen as you breathe in and out. Maintaining adequate strength of the pelvic floor can help prevent some types of urinary incontinence and can even be helpful during and after pregnancy. Also, let’s not forget the benefits a strong pelvic floor can bring to the bedroom (I’ll let your imagine run with that one).
So, we all want flatter tummies–that’s a given. But did you know that almost a quarter of women over 35 experience some trouble with incontinence? In theory, strengthening our core muscles should be the solution to both problems but unfortunately, overworking the wrong core muscles can make incontinence problems worse.
For example, I often see both men and women doing abdominal crunches or trying to simulate exercises they learned in Pilates, including hundreds, criss-cross or single leg stretch. What they do not realize is that their tummy muscles are almost always pushing outward, overly activating the rectus abdominus and the external obliques. If these muscles become overdeveloped, this excess pressure can lead to organ prolapse. This is particularly true if the pelvic floor, meant to hold the organs in, is concomitantly underdeveloped. These exercises may satisfy people’s desire for that “next day soreness,” but the problem is that they are not usually connecting to the deep core muscles but instead overtightening the externals. This will eventually squeeze everything downward toward an unprepared pelvic floor and can lead to a prolapsed organ or an incontinence issue.
A quick way to tell whether you’re engaging externally or internally is to place your hands on your lower belly, right above your pubic bone. Engage your abs and feel what happens. If you find your tummy pushing up against your hands, you are over-engaging the external muscles.
Here are a few techniques to try:
All fours abdominal “kittens in”: Kneel on all fours with the hands right below the shoulders and keep weight on the index finger knuckle to keep pressure off the wrists. Imagine that you are a pregnant cat. Without changing the position of your pelvis or spine AT ALL, drop your pregnant cat belly toward the floor. Then, on your exhale, pull the kittens in. DO NOT MOVE ANYTHING. As you pull the kittens in and out, become aware of any extra movement happening in other parts of the body and try to keep very still, focusing on pulling the kittens up and in.
Single arm and leg reach (spinal balance): Take the kittens exercise above, continue to keep the “kittens” in, square the hips and reach the right leg back. Then reach the left arm to the front (DON’T DROP THE KITTENS). Hold 10 seconds and then switch sides.
Hip bridge: Try this with a squishy ball or yoga block between the knees. As you lift your sacrum off the mat, reach the ball or block away from you, feeling the stretch in the front side of the body. In the bridge, try to connect the ribs together. Do not let them splay out to the sides. Roll back down one vertebra at a time. Variation: Try this on your tippy toes.
Squat: Here’s an oldie but a goodie. As a society we have somehow convinced ourselves that squats are bad for our knees. However, it is almost impossible to get through life without this motion and it happens to be one of the best deep core exercises you can do. Stand with the legs a bit wider than hip width. While maintaining a straight line in the spine, reach your booty to the back of the room while bending the knees like you are sitting in a chair. Keep the kittens in and keep the chest somewhat upright. When the hips are below the knees, rise back to the starting position.
Working one on one with a Pilates instructor or another certified strength and conditioning coach will help you tap in to many muscles you never knew you had, including everything discussed above. A strong, properly functioning core is the perfect start to a long and successful relationship with fitness. All other types of exercise will become more efficient. Your posture and balance will improve and your back will be safer from injuries. In addition, you can avoid prolapsed organs AND little accidents during hysterical fits of laughter.
–Jessie Marshall Jessie Marshall is a certified Pilates instructor and Mind/Body Director of Bethesda and Northwest Sport & Health clubs.
ALMOST 10 PERCENT OF WOMEN in the United States are iron-deficient, according to the CDC, and low iron is the most common nutritional deficiency in the U.S., according to Stephanie Watson on WebMd.
At my last physical exam, among all the blood test results, the only one my doctor mentioned doing anything about was iron, measured by the level of ferritin — a protein that stores the body’s iron and releases it in a controlled fashion, to make up for the iron our bodies lose constantly in the course of daily bodily functions: “urination, defecating, sweating and sloughing off skin cells,” as well as bleeding.
My ferritin level was 13 ng/ml, in a normal range of 10 to 291, according to my printout, although my doc said that a better “normal” for women is 18 to 160. A web literature search on HealthBoards found different sources citing “iron depletion” levels that ranged from less than 12 to less than 20 — and referred to a British Medical Journal study that showed iron supplements helped alleviate fatigue in women whose levels measured as much as 50.
Iron is necessary for the body to produce hemoglobin, the component of red blood cells that carries oxygen from the lungs to the heart and the rest of the body – as well as for many other bodily functions. The end result of prolonged iron deficiency is anemia, which occurs when either the number of red blood cells is too low or those blood cells contain too little hemoglobin.
In the evolution of iron-deficiency anemia, ferritin levels fall first, followed by hemoglobin (below 12 g/dl is considered anemic) – for which the first signs can be pale or sallow skin, fatigue and difficulty exercising due to muscle weakness. Other symptoms include paleness in the palms of the hands and eyelids, caused by the decreased levels of oxygenated, red-colored hemoglobin; cold hands and feet; restless leg syndrome; a sore tongue; difficulty swallowing; and heart failure.
When my second child was three months old, his terrible colic made it hard for me to sleep, and I developed a staph infection accompanied by anemia – about which that doctor informed me with a very stern look. Also sternly, he told me I must take iron supplements every day, and I must get retested before stopping them. I was definitely tired, but unsure about how seriously to take his warning and apprehensive about the main side effect of iron supplements: constipation. By the time I got retested, the colic was finished. I was better rested, and my levels were fine.
Until menopause, women need 18 mg. of iron/day, while post-menopausal women and men need only 8 mg. Iron levels can be boosted by diet — red meat, liver, egg yolk, shellfish, beans, nuts and cereal that is fortified and/or contains bran. Increasing vitamin C levels can enhance the body’s ability to absorb iron, while milk and cheese can limit absorption. Vegetarians might need to take iron supplements because the iron found in plants is absorbed less well by the body than that in meat.
Anemia does, however, have another face. In people infected with malaria, tuberculosis or HIV, the body appears programmed to reduce iron production “so that bacteria or viruses don’t have enough of this nutrient to grow,” Marta Zaraska wrote in the Washington Post.
High intake of dietary iron has also been linked to colon cancer. Too much iron can disturb “the delicate balance of bacteria in the gut,” according to Zaraska. She quotes Dr. Ryan Zarychanski at the University of Manitoba saying “anemia is a body’s genetically programmed response to illness” and calling it “our innate antimicrobial strategy.” Zarychanski believes the anemia that commonly accompanies cancer, heart disease and autoimmune disorders “helps us fight illness.”
The World Health Organization stopped recommending iron supplements for children in malaria-infected areas. More startling, a 2008 trial showed that bloodletting decreased cancer risk among otherwise healthy people with peripheral artery disease. The great hope for treatments that involve reducing iron levels is to combat antibiotic-resistant bacteria.
My doc’s advice: stop my once-a-day aspirin, which could be causing minute amounts of bleeding – though my main reason for taking it was familial risk of colon cancer, which might be countered by low iron levels. Also: take iron gluconate supplements, but only twice a week to reduce the risk of constipation. My personal effort: occasionally adding clams to my pasta.
WHY, IF IT’S DESCRIBED AS a lovely string of pearls, does the body’s lymphatic system seem too amorphous or extraneous for most people, at least in the United States, to pay it much attention – compared to Europe, where treating lymphatic disturbances is a high priority for preventive health care, for post-surgical care and for dealing with many ailments?
The lymph system works to continuously cleanse every cell in the body and when necessary to initiate an immune response. Hence, possible consequences of its dysfunction are endless: from joint pain, arthritis and headaches to food sensitivities, cold and flu infections including sinusitis, fatigue, depression – and, of course, cellulite.
“In general, you may feel tired and toxic, with a heaviness in your abdomen,” writes Marcelle Pick, OB/GYN, author of “Is it Me or My Hormones?” and founder of the website Women to Women. “In Chinese medicine, practitioners call this “excessive damp.”
The lymphatic system is made up of glands and lymph nodes, as well as the spleen, thymus gland and tonsils, strung along a system of vessels – hence the string of pearls allusion — containing lymph fluid in a quantity twice that of your blood. However, unlike blood, which is kept moving by the heart, the lymph system has no pump. What gets lymph moving is muscle contractions during deep breathing and physical activity, and manual manipulation.
As it progresses through the body, lymph fluid collects the byproducts of cellular activity and infection, and transports these through “filtration and collection” points — lymph nodes, found throughout the body — heading toward the spleen, the largest organ in the lymph system. Although you can function without a spleen – which is sometimes removed when swollen from diseases like mononucleosis — your immune responses might not work as effectively.
Lymph “bathes our body’s cells and carries the body’s cellular sewage away from the tissues to the blood where it will be filtered by two of the body’s main detoxification organs: the liver and kidneys,” explains Michelle Cook on the care2 website.
Much of the lymph tissue is located around the digestive tract – the main entry point for toxins or infection, or, as Pick calls it, “a kind of tasting room for pathogens:” the healthier your lymph tissue, the less sensitive you will be to food-borne bacteria and chemicals.
Diminished flow and blockages in the lymph system can cause nausea and toxicity, and may play a role in creating cellulite. The decreased flow of lymphatic fluid to certain areas, like the thighs, can lead to accumulated pockets of fat cells, where additional lymph fluid then accumulates. Liposuction and invasive procedures can reduce the appearance of cellulite but are not permanent solutions: the cellulite will return.
Inactivity is the main villain, seriously impairing the flow of lymph fluid – for which the solution is deep breathing and increased exercising, also lying on a slant board or otherwise hanging upside down. Ann Louise Gittleman, author of “The Fat Flush Plan,” who “estimates that 80 percent of women have sluggish lymphatic systems,” has several suggestions to keep the lymph moving: besides breathing deeply, exercise on a mini trampoline or do any kind of stretching or aerobic exercise; and drink lots of water. Also eat raw fruit: “the enzymes and acids in fruit are powerful lymph cleansers,” especially if eaten on an empty stomach.
Manual manipulations and movements for lymphatic drainage are considered routine treatments in European hospitals, especially before surgery “to improve healing by readying the system for recovery,” writes Pick.
Also advised is everyday “lymph massage,” especially around the abdomen, along with several minutes of vigorous rubbing at a “reflex point” at the bottom of the sternum; and “milking,” to help drain the lymph nodes, especially in the case of a sore throat or sinus congestion: start under the jaw or at the base of the skull and massage downwards toward the heart.
For cellulite, Pick points to only “two successful ways to diminish cellulite from the inside out:” improving the circulation of lymph and reducing the toxic burden, once again by following the now-familiar advice: more exercise and a better diet.
Is there anyone who’s not wearing a fitness band or competing with friends or office workers on how many steps they’ve taken that day?In light of that, the new Apple watch and FitBit filing to go public, we wanted to look back on what Well-Being editor Mary Carpenter had to say about this technology in April 2014. See her story below.
WHEN WEARABLE TECHNOLOGY began appearing on the wrists of “early adopters”–people who buy new gadgets hot off the design table– they looked only slightly lovelier than black carpel tunnel braces, and they caught on slowly. Still, in 2013, Americans paid about $290 million to sport the devices.
A recent Wall Street Journal article described more fashionable models of metric-collecting bracelets in gold, silver and black, but some believe that wearing any tracking band is sufficiently appealing because it demonstrates your commitment to fitness.
The jury is out on how well fitness bands work. Activity trackers rely on an accelerometer, usually combined with a website or app to produce data collected about your movements–from intensive exercise to cooking–as well as measurements of your downtimes and often of your sleep patterns.
For walking, the devices assess the number of steps taken and then use your estimate of stride length to determine your daily achievement. But taking shorter or longer strides can lead to faulty readings. Blogger Albert Sun also notes that the trackers don’t measure fidgeting, while some research suggests that fidgeting can keep you lean. (A 10th-grader I know figured out a way to rack up steps by moving her arm around while lying in bed.)
Reacting to another criticism–that activity trackers measure movement but not exertion–manufacturers point out that intense exercise is only a small part of the wearer’s day, while the bands measure all additional activity. A study at Arizona State University found the trackers least successful at measuring subtle movements–light pedaling on a stationary bike, sweeping the floor–and very effective only at measuring brisk walking or jogging. Sun found the bands most useful for comparing activity on different days: After 16,000 steps on some weekend days, seeing only “6,000 or 7,000 on a typical workday made me work harder to move more” on those days, he reported.
For assessing sleep, some say the devices are prone to mistakes, and that they cannot measure deep sleep versus the lighter states. Critics argue that a band’s assessment might lead to missing serious problems because they are less accurate than hospital sleep labs. On the positive side, a band’s record of excessive movement during the night can indicate that a more professional evaluation is needed.
What might be most useful is to reveal how little a person has been sleeping, which can motivate them to get more sleep. “A lot of people are more sleep-deprived than they realize,” says Dr. David Claman, director of the sleep disorders center at the UCSF Medical Center.
According to its manufacturers, the Jawbone band with its “today I will” feature got 72 percent of wearers going to bed early enough to achieve their goals, and 26 percent were more likely to get seven to eight hours of sleep than those who hadn’t set goals.
Experts agree that people should wear trackers until they have assessed and learned to combat bad habits. After trying out many models for his blog, Sun said, “I’ve become keenly aware of how active I am…I don’t need a monitor anymore. I’m tracking me.” Dr. Albert Kamal Jethwani, head of research at Boston’s Center for Connected Health, agrees that the goal is to “wear it when it’s meaningful,” when bad habits begin creeping in.
The center’s study, which followed subjects wearing trackers over six to nine months and then assessed changes in behavior, found that: For about 10 percent of users, the bands’ numbers motivated them to become more active; for 20 to 30 percent, additional encouragement from friends or health professionals was needed to change their behavior; for the rest, the data were confusing and “social motivation” from friends or teammates might work better, according to Dr. Jethmani. A review of studies on the bands showed that those who benefit most from trackers are athletes–those who need the least encouragement–to create training regimens or recovery programs for team sports.
For me, the main drawback is that friends who wear these bands check them frequently and turn to them to make decisions. For example, based on how many more steps are needed to achieve their daily goal, they’ll choose a restaurant–not always my top criterion for eating out. On the other hand, I could really use the “inactivity alert”: Getting up every hour or so from the computer to stretch, lie down and do a few exercises is recommended for almost everyone, especially when dealing with physical issues from poor posture to arthritis.
How to choose which fitness tracker is best for you? (Very high ratings go to the Fitbit Force, but that has been recalled due to reports of allergic reactions to the band.) The Basis models often get highest marks because of the heart monitor, but that interests me less than other variables: ease of syncing, battery life and price. (I would love waterproof, but among the highly rated models, that leaves me with the Misfit Wearables Shine disc , while I prefer wristbands.)
After reading and comparing, I would choose the Fitbit One. My friend who owns one complains that it came with no directions, and its two wristbands soon broke–although the company did send her another one –but she likes the motivation and positive reinforcement. When she reaches her daily goal of 10,000 steps, the band buzzes. I might prefer a different reward.
“ELECTROCEUTICAL” DEVICES THAT USE electrical currents from batteries or magnets – many outside the body — promise improvements in learning, attention, creativity, memory including recall of proper names, and reading efficiency as well as boosting the brain’s plasticity. In addition, these devices can relieve chronic pain, depression and fatigue, and treat tinnitus, PTSD, autism, addiction and bladder issues. And the list goes on.
For serious, intractable conditions, implanted devices provide deep brain stimulation (DBS) to relieve symptoms of severe depression and Parkinson’s disease; vagus nerve simulation (VNS) to treat autism and severe depression; and sacral nerve stimulation to improve bladder and bowel control. According to the International Neuromodulation Society, the most common of these treatments is spinal cord stimulation (SCS) for chronic neuropathic pain.
More recently, external devices – some of which can be purchased online or made at home for about $50 — provide “therapeutic neuromodulation,” altering nerve activity in the brain and elsewhere in the body, in the same way that electro-convulsive therapy (ECT) is used to treat severe depression, but at much lower doses.
As a brain-zapper, the “transcranial direct current stimulation” (tDCS) headset transmits low doses of electricity into the brain. DCS is thought to create or strengthen neural pathways in the same way that repetitive practice – swinging a tennis racquet or speaking a foreign language – eventually makes a behavior more automatic, and works best if used while practicing the desired skill. Biomedical engineer Marom Bikson at the City College of New York considers tDCS a way to “make the brain function more effectively, or improve plasticity and make it more able to learn…you sort of prime the brain” for whatever training or treatment you are undergoing.
The Foc.us device, marketed originally for video gamers, has been available for several years, costing from about $250 to $300; the first production run of 3,000 sold out in less than a month. One reviewer noted that “the general feeling of alertness was indisputable,” and other fans claim the device improves reaction time, mood, computational ability and memory, writes Kate Murphy in The New York Times.
The soon-to-be-marketed Thync apparatus claims “to bypass the brain and instead use pulsed currents to stimulate peripheral nerves closer to the surface of the skin,” according to Kira Peikoff in The New York Times. Thync company representatives say their product will produce “calm vibes” greater than that produced by taking three Benadryls, and “energy vibes” stronger than drinking a 20-ounce can of Red Bull. Both kinds of vibes last about 45 minutes with no subsequent crash.
DCS is already being used to train drone pilots. In a study using software called “Vigilant Spirit,” sleep-deprived volunteers spent hours looking at images of a crowded village square trying to identify people carrying guns: those who received DCS performed about twice as well as those who had caffeine or no stimulation, and the effect lasted about three times as long as caffeine. Most DYIers assemble their own “transcranial stimulators” using nine-volt batteries to use while playing video games; most are male, with a wide range of ages.
Another kind of neuromodulator uses pulsed energy from magnetic coils — called “magnetic resonance therapy” (tMRT) or transcranial magnetic stimulation (TMS) — to realign and synchronize the firing of neurons depending on the condition to be treated, similar to an MRI, which uses much stronger pulses of energy. FDA-approved for drug-resistant major depression, MRT has been used by The Brain Treatment Center in Newport Beach, California for more than 1,000 patients, the majority for autism – in previous studies, it helped about 90 percent of cases. The Newport Beach center has also used MRT for Alzheimer’s disease, addiction, anxiety and sleep and eating disorders. Of more than 100 veterans treated there for PTSD, “one hundred percent responded with very visible change,” according to the center’s medical director Yi Jin. One vet described the experience as taking a 10-minute nap and feeling as if he’d slept 16 hours!
While an array of companies are leaping ahead to produce and market these devices, the medical community remains hesitant. Dr. Roy Cohen Kadosh, neurologist at the University of Oxford, believes that at the right intensity and timing, tDCS can improve cognitive abilities including attention. But he cautions: “You need to know how long to stimulate… and what intensity to use.” The dose can vary depending on age, sex, and other drugs such as antidepressants being taken, as well as the thickness of the skull and hair.
Others point to the dearth of controlled studies, to the possibility of effects accumulating over time with unknown long-term consequences, and to the question about whether you’re zapping your brain in the best location. Most worrisome is whether enhancing mental function in one area can have a negative impact on another: one study showed improving some math skills made other skills deteriorate. Users have complained of temporary side-effects including discomfort or burn where the magnets or electrodes are placed, mild headaches, lightheadedness, and irritability. People with epilepsy should not use these devices.
One better-accepted use of neuromodulation is for treating bladder problems, such as “urge incontinence,” which involves inserting a slim needle – very carefully, in a neurologist’s office — into the heel near the tibial nerve, from which an electrode sends impulses up the leg to the sacral area responsible for bladder control. Marketed by Uroplasty, Inc., the “Urgent PC” procedure takes 30 minutes and is performed in a series of 12 treatments – although a patient of Chevy Chase neurologist Mary Dupont reported some improvement in urgency after a few sessions and a “complete cure” after only eight. According to Uroplasty, Inc. more than 80 percent of patients have a positive response; and in a double-blind placebo study, 71 percent of patients had a greater than 50 percent reduction in “voids per day.”
A remaining mystery about neuromodulation: why some uses must be accompanied by cognitive tasks, such as working on math problems, while others do not. According to the New Yorker article, ”Electrified,” tDCS “makes depressed people feel better even if they’re just sitting there.”
“EMBODIED COGNITION,” in its most common and practical meaning, occurs when the state of your body — sensory information about your physical state or “embodied self” – modifies the state of your mind. Standing in a power pose – like that of Wonder Woman (hands on hips, feet apart) – can increase your feelings of power to prepare for a speech or meeting. Holding a warm cup when you meet someone unfamiliar can help you trust that person more quickly.
