Stress and Illness

Stress. Most of us feel it with some regularity. We typically think in terms of difficult life circumstances – e.g., financial reversals, work-related challenges, loss of social standing, relationship issues, illness. But it can also accompany welcome life events – e.g., marriage, promotions, buying houses, retirement, vacations.

I don’t like to admit to feeling stressed. I prefer to think that I have everything under control. That whatever life is throwing at me, I’ve got it covered. And I don’t like slowing down when I’ve got a full head of stream or taking things off my plate when I’m busy. Stress can be an unpleasant wake-up call that I’m not interested in answering.

Back in the 1960s, folks started taking an interest in the relationship between stress and illness. Psychiatrists Thomas Holmes and Richard Rahe examined the medical records of thousands of patients and correlated the incidence of illness with various life events. They published the following Holmes and Rahe Stress Scale through which the sum of change units in a given year provided an indication of the relative risk of illness. A score of 300+ suggested a high risk of illness, 150-299 moderate, and <150 slight.

Life Event	Change Unit	Life Event	Change Unit
Death of a spouse	100	Child leaving home	29
Divorce	73	Trouble with in-laws	29
Marital separation	65	Outstanding personal achievement	28
Imprisonment	63	Spouse starts or stops work	26
Death of a close family member	63	Beginning or end of school	26
Personal injury or illness	53	Change in living conditions	25
Marriage	50	Revision of personal habits	24
Dismissal from work	47	Trouble with boss	23
Marital reconciliation	45	Change in working hours or conditions	20
Retirement	45	Change in residence	20
Change in health of family member	44	Change in schools	20
Pregnancy	40	Change in recreation	19
Sexual difficulties	39	Change in church activities	19
Gain a new family member	39	Change in social activities	18
Business readjustment	39	Minor mortgage or loan	17
Change in financial state	38	Change in sleeping habits	16
Death of a close friend	37	Change in number of family reunions	15
Change to different line of work	36	Change in eating habits	15
Change in frequency of arguments	35	Vacation	13
Major mortgage	32	Major holiday	12
Foreclosure of mortgage or loan	30	Minor violation of law	11
Change in responsibilities at work	29

The system purportedly had value for folks like me who might ignore the signs of stress but rack up sufficient stressors to warrant a moment or two of consideration. Having run across this system recently, I got to thinking: Has their research stood the test of time?

An article by Cohen, Murphy, and Prather on stressful life events and disease risk provided several insights based on 70 years of research on the subject. Here are their findings:

Stressful events may arise based on the amount of adaptation or change required of an individual, the imminence of threat or harm, a level of demand exceeding resources, an interruption of goals, or any combination thereof.
Stressful events influence disease onset through a variety of mechanisms. As discussed in a prior post, excess stress may lead to hypertension, high cholesterol, disrupted digestion, bone disintegration, suppression of immune function, and neural network damage. The affected individuals may also adopt poor health behaviors as coping mechanisms – e.g., faulty nutrition, poor exercise habits, substance abuse, dysfunctional sleep patterns.
Most people exposed to stressful events do not get sick. And despite increased risk for mental disorders, stress does not necessarily lead to depression. People with greater perceived control, self-efficacy, and a generally optimistic outlook tend to be resilient.
Excluding natural disasters, stressful event exposure correlates with socioeconomic status (i.e., low status yields more events) and personality factors (e.g., agreeableness, conscientiousness, positive or negative attitude, attachment styles, neuroticism).
Stressful events may not cause disease in otherwise healthy people. Nonetheless, biological wear and tear caused by chronic stress may result in increased disease risk, and stress may tip the balance toward disease in a system made vulnerable by other causes.
Certain stressors are more impactful than others, notably those which threaten an individual’s sense of competence or standing in areas that reflect the individual’s core identity. These stressors generally fall within the domains of interpersonal problems, social status, and work difficulties. In particular:
- Stressful interpersonal events have been associated with heightened risk of depression, upper respiratory infection, hypertension, heart disease, physical disability, and premature mortality.
- Folks experiencing social rejection have shown decreased anti-inflammatory gene signaling and increased asthma symptoms.
- Unemployment and underemployment has been associated with increased risk of depression, cardiovascular disease, and premature mortality. Even a month’s worth of unemployed and underemployment increases susceptibility to cold-causing viruses.
As a rule, persistent stress and chronic intermittent stress prove more deleterious than acute stress. Acute stress proves problematic when it accelerates a pre-existing disease process or sets off longer-term trauma (e.g., rape).
Multiple events may or may not be more potent than individual ones. Studies have not done a good job accounting for multiple distinct stressors versus several events tied to a single root cause (e.g., divorce and associated changes in financial status, residence, church, social circles, recreation, etc.)
The impact of stressful events varies as a function of when they occur during a life. For example, the death of a spouse at middle age with teenaged children proves more impactful than in one’s senior years. Moreover, there are sensitive periods in life when stressors exact a higher toll, notably childhood.
Men and women respond to stress differently based on evolutionary pressures and cultural norms.

The Breath

The rule of threes for survival:

You can survive three minutes without breathable air.
You can survive three hours in extreme heat or cold.
You can survive three days without drinkable water.
You can survive three weeks without food.

Each one presumes that the preceding requirement has been met. Ample food and water make no difference if the individual has no air to breathe or has been plunged into the icy depths of artic waters. Higher temperatures increase the speed at which dehydration occurs. And individuals might train themselves to extend their capacity for survival. Magician David Blaine famously held his breath for 17 minutes, setting the world record for such a feat. Nonetheless, ordinary folks need be mindful of these “rules” should they wish to keep living.

I raise this issue simply to note the primacy of air. The breath. It’s the singular sign of life when we exit our mother’s womb to become part of this world. And the absence of breath is a clear marker of the end of life. I know. I was at my father’s side when he took his last breath.

We use the breath as an “anchor” for meditation practice. Breathing in, and breathing out. Breathing in, and breathing out. In writing about mindfulness of the body, I noted that I use mindfulness of the breath to steady my mind and sustain focus – noticing the length of each breath, attaching a word to an inhale and another to an exhale, and counting the breaths. It gives me an object of attention to quell my tendency toward distraction. But the breath is more than simply a place to “tag up” when the wandering mind takes flight.

The breath provides the means to be present to direct experience, the essence of mindfulness practice. It opens us up to noticing bodily sensations:

Cool air passing through the nostril and exiting with a degree of warmth
A tingling sensation at the back of the throat at air passes into the lungs
The rise and fall of chest, perhaps with a hint of expansion of the rib cage
The movement of the belly as if it is an expandable bellows that stokes the fire of life

Those of us who play wind instruments or train as singers have become quite familiar with the latter. Breath control makes all the difference in producing a quality sound and sustaining musical phrases. We must be conscious of it to ply our trades. Mindfulness practice helps… though I’ve often quipped that my next instrumental skill will not require breath control!

So, the next time you find a quiet moment to meditate, be curious and attentive to the breath – to the various sensations it evokes while providing life-sustaining energy for the body. It’s a simple yet powerful means of experiencing mindfulness.

Sleep and the Brain

A few years ago, I wrote a post entitled Why Sleep Matters while drawing attention to the fact that 40% of Americans do not get the recommended 7 minimum hours of sleep per night. As noted, sleep plays a critical role in physical regeneration, memory consolidation, emotional regulation, and longevity. When falling short on restorative sleep, we have difficulty sustaining alertness, absorbing new information, and thinking clearly when making decisions. And given slower reaction times, driving while sleepy can be as dangerous as driving alcohol-impaired.

If we’ve struggled with sleep or found occasion to pull an all-nighter, we’ve experienced what’s it’s like to operate at less than full capacity. Yet it’s easy to brush it off under the guise of simply powering through. After all, we’re made of tough stuff! But we may well pay a hefty price in later life for the bad habits we instill today.

Recognizing the importance of our brains to sustain all manner of physiological function, our bodies have been designed to protect them from unwanted or harmful substances in the blood. A blood-brain barrier allows passage of small molecules by passive diffusion and selective transport of nutrients, ions, organic atoms, and macromolecules (e.g., glucose, amino acids) crucial to neural function. While it’s clearly beneficial to filter out toxins from fluids entering the brain, the question remains: How does the brain get rid of its waste material?

In 2012, scientists discovered a transport system that provides the means to remove the brain’s waste products. Dubbed the glymphatic system, these fluid-filled tunnels collect unwanted materials and “milk” them via pressure variances associated with arterial heartbeats into the cerebral spinal fluid surrounding the brain. This pulsating mechanism does most of its work at night with the greatest activity during slow wave sleep (SWS). These tunnels clamp down when we’re awake, reducing glymphatic flow by 90%.

As discussed in an earlier post, sleep consists of a five-stage cycle that takes 80-120 minutes and repeats 4-6 times per night. We need the experience of all five stages to be mentally and physically restored upon awakening to start a new day. We now know that it’s also an imperative to eliminate potentially neurotoxic waste products like amyloid-beta which is implicated in Alzheimer’s disease. Perhaps that’s why folks who consistently get less than 7 hours of sleep per night are at greater risk of cognitive disorders.

Glymphatic brain filtration declines with age. Tests on old mice show that they have 10-20% the filtration capacity of young mice. Older adults enjoy about half the slow wave sleep of young adults, and age-related arterial thickening reduces the pulsation that drives the glymphatic pump. As such, we need to take steps to counteract these physiological deficits if we wish to maintain good cognitive health.

Roughly 1 in 10 individuals globally and up to 30% of the elderly experience sleep apnea. This disorder causes repetitive pauses in breathing, periods of shallow breathing, and/or collapses of the upper airway during sleep which results in sleep disruption. A positive diagnosis of sleep apnea attends to persons with 5 or more events per hour. Beyond the deleterious effects of daytime sleepiness, the afflicted likely sustain an above-average accumulation of brain toxins… and that can’t be good!

A continuous positive airway pressure (CPAP) device helps keep the airway open and significantly reduces disruptive events during sleep. My husband’s device sits on the nightstand and connects to a facial mask via a flexible tube. The first few nights of usage were a bit rocky while he became acclimated to air pressure and the mechanics of working the system. But he now enjoys a precipitous drop in wakeful events and the attendant boost in sleep quality and daytime energy.

For those with or without sleep apnea, sleeping on one’s side allows for improved glymphatic transport. For those used to sleeping on one’s back or front, positional training is possible though use of night shirts that have tennis balls affixed to the front and/or back.

Of course, simply getting enough quality sleep matters greatly. I’ve summarized evidence-based tips in How to Prepare for a Good Night’s Sleep.

Putting Down Roots

I’ll confess. I’ve been feeling rather rootless for a time now.

Going on 2 years ago, my husband and I experienced the glowing embers of realization that our life in Beaverton needed to change. We’re getting on in age, and a 2-story, 5-bedroom house with a big yard didn’t make sense for the next chapter in our lives. So, we started exploring possibilities throughout the Pacific Northwest. While we didn’t reach any conclusions, we elected to sell our home in a favorable market last summer. We downsized big time and found a lovely townhouse to rent while we sorted things out.

For a time, I thought we could just chill out here until the clouds parted and a blinding ray of light illuminated the path forward. I kept doing bits of research here and there all the while mulling over our life circumstances. Far from receiving a grand gesture from the heavens above, things just seemed to get murkier the longer I sat with the decision process. It got me to thinking: What is it about buying a home that makes me feel so anxious and (dare I say) indecisive?

The obvious: A home represents the largest single investment in our portfolio… and a somewhat illiquid one at that. We don’t make these decisions often, and I want to make sure we make the right one. (My husband stresses about it far less than I do!) But it’s a bit more than that. Buying a home makes a strong statement about our lives. It says: Here’s where we stand. Here’s the community to which we belong. These are our people. Here’s where we’ll set down roots. And at our age – with the prospect of becoming more dependent on others in the coming years – those statements carry added weight.

Also obvious: Having lived in the same place for 15+ years, we have networks of connections that sustain us and would be effortful to rebuild – e.g., friends, social outlets (e.g., master gardening, choral groups, square dancing clubs, theater groups), doctors, dentist, hairdressers, et al. While I’ve built these relationships before and could do it again, medical care turns out to be a sticky wicket. With a nationwide physician shortage, it’s hard to get care as a new patient, and we may or may not wind up with folks we like. We’re pleased with our current care team, and we’re covered so long as we stay with them. Given the breath of our needs, that’s a major decision factor.

A couple of weeks ago, our realtor and dear friend suggested we dip our toes in the waters of three new construction subdivisions that are within a few miles of our old homestead. We had nothing better to do and always enjoy her company. So, off we went for a look-see. Wonder of wonders, we wound up making an offer on a not-quite-perfect-but-close-enough single-story home within a mile-ish of a shopping center, medical center, and fantastic gym. Having signed a gaggle of papers and made selection for interior finishes, we’ll likely move around the time that our lease ends. Whew!

I had a moment while processing this turn of events and very nearly took a walk from the deal. But when I looked at the decision logically and saw how much my husband was looking forward to living there, I settled right down. I knew it was the right choice at the right time. And now that we’ve sorted out the financing side of things, we just need to cool our jets for 3-4 months while they finish building the house.

I’ve already started thinking about the ways in which I can make our home a place for social gatherings. For the first time in our marriage, we’ll reap the benefits of having a great room that will accommodate goodly-sized crowds and a large kitchen island around which food preparation and consumption will go hand-in-hand with lively conversation. And given that I’ll be within a few miles of my choral group’s rehearsal space, I’d like to reinstitute pre-rehearsal dinners for folks who’d like to socialize before we sing. We used to do that pre-COVID when I sang with ISing Choir, and I loved camaraderie forged at meal time while watching The Great British Baking Show.

For now, life has afforded me the opportunity to exercise one of my least favorite “muscles”… patience!

Is Mindfulness Always a Good Thing?

I believe in mindfulness and count myself among its practitioners. Through the twin aspects of awareness and kindness, it helps me relate to and cope with what’s happening in my inner and outer worlds with greater freedom and ease. I feel more connected to my body and listen more attentively to the signals it provides. I’m less likely to get stuck on repetitive thoughts or vexing emotional states. I’m gentler on myself and others. And the research would suggest that I’m realizing improved health with reduced stress, lower blood pressure, less inflammation with the attendant calming of immune response, and so on.

It all sounds so great. Yet, are there times when mindfulness isn’t such a grand practice? Well… yes.

It turns out that mindfulness may be contraindicated when undergoing emotional trauma. When I speak of emotional trauma, I’m talking about a threatening, overwhelming experience that robs us of our sense of security and safety. It takes away our capacity for being the “observing self” that can explore such sensations with openness and curiosity. And in lieu of placing these emotions amidst a vast ocean of experience, we may feel caught up in a patch of seaweed, unable to extricate ourselves and breathe. In short, asking ourselves to connect mindfully with trauma may escalate anxiety and suffering rather than quell it.

The vast majority of us experience trauma at some point in our lives. Ideally, we find our way through it without undue harm or risk of triggering it in response to future stimuli. We may need to avail ourselves of professional help, or the love and support of trusted associates. We may heal with the passage of time.

We don’t have to forego meditation or mindfulness entirely when processing trauma. In reading David A. Treleaven’s book Trauma-Sensitive Mindfulness, I came across several strategies that can help us remain in practice while exercising appropriate self-care.

FIRST: Stay within the window of tolerance, avoiding the extremes of agitation (aroused, hypervigilant) and numbness (foggy, listless). Be aware of bodily sensations, feelings, and thoughts during practice and apply the brakes, as needed, to stay within the window. Return to the breath, perhaps taking deep breaths to calm an agitated state (hyperarousal), or trying short, intense breaths to counteract listlessness (hypo arousal). Consider use of a soothing touch (e.g., hand to the heart) while breathing. And, of course, it’s always an option to open your eyes and be OK with a shortened practice.

SECOND: Direct your mind and energy to neutral stimuli versus sustained focus on the trauma. Where possible, use stable anchors of attention when meditating (breath, sound, bodily sensations). Open your eyes and focus on the objects around you to ground yourself in the present. Try focusing attention on what makes you feel safe, loved, resilient, strong, energized. If you connect a place, activity, memory, or person to a state of well-being, lean into it. Consider taking a walk or sitting with a friend. Note that these activities are not intended to bypass or put a band aid on the trauma; they simply provide resources to get back to the window of tolerance.

THIRD: Stay with the body even though it might be tempting to dissociate from it. Trauma can make us uneasy with bodily sensations. We lose sight of what’s safe versus threatening and may tend toward shutting down. A waking meditation may prove useful as movement makes it easier to reconnect with sensation. It also provides a neutral focus of attention.

FOURTH: Cultivate trusted relationship. Trauma proves challenging when processed in solitude. It’s difficult to get unhooked from it when facing it alone. Other people can be a wellspring of support, both trained professionals and level-headed, compassionate laypersons with whom you feel seen, heard, and safe. I feel immeasurably blessed to have several people in my orbit who have lovingly provided just the right support when I’ve needed it.

FIFTH: Learn the flashback halting protocol: “Right now I am feeling __________ and am sensing in my body __________ because I am remembering __________. At the same time, I am looking around where I am now in [month or year] and can see __________ and so I know __________ is not happening now/anymore.”

More on Mindfulness of the Body

In an earlier post, I talked about how mindfulness practice directs us to connect with the body and bodily sensations, NOT transcending it. When we are awake in the body, we live life in the here and now – not reflecting on the in the past, not anticipating the future, and not lost in thought or imagination. The body confers several other benefits as well.

The body can help steady the mind. My go-to resource is mindfulness of the breath using the body’s natural rhythm. Admittedly, it can be easy to get distracted after two or three breaths. I take advantage of several practices to sustain focus:

Naming the length of the breath – e.g., “breathing in short, breathing out short, or breathing in long, breathing out long. Not forcing the breath to be short or long, but simply being an attentive observer.
Adding words to inhalations and exhalations – e.g., thinking PEACE while breathing in and EASE while breathing out.
Simply counting the breaths.

Sound can serve as an alternate anchor – noticing what’s in the foreground, what’s in the background, perhaps giving names to them. Noticing what arises and fades away. In all cases simply observing and not getting caught in thoughts of what might be causing the sounds, or what they mean.

The sense of touch can also serve as an anchor – the touch points with the floor, chair, body parts against each other – and naming the sensations (warmth, coolness, hard, soft, lightness, heaviness, moisture, dryness). I regularly sense the touch points in the car seat and my hands on the wheel when I find myself distracted while driving. It’s a quick way to drop out of being lost in thought and focus on what I’m doing.

The body can be a place of refuge. When caught in a rising tide of worry, a flood of frustration or irritation, or hailstorm of anger, connecting to the body can have a profoundly calming effect. To break out of spinning in my head, I stop and notice the touch points of the body with my surroundings and then glance around the room and whisper the name of things around the space I’m in. It’s grounding and gives me a chance to experience the ever-powerful PAUSE.

The body can be a kind of barometer. When sensitive to the body, it provides a wealth of information. Standing at a fork in the road: Do I take (or keep) this job? Should I tackle this project? Should I invest in this relationship? The body provides a more truthful response than the mind as it’s not weighed down by shoulds, peer pressure, guilt, etc. Also, checking in with the body and asking: Does this possibility make me feel relaxed, open, interested? Or is my heart in my throat, my stomach churning, my temperature rising?

The body can be a teacher. It provides an ongoing lesson in impermanence. Those of us with a few years under our belts know that bodies do not stay the same. But when we pay attention in the moment, we even notice that sensations in the body change. Itching comes and goes. Cravings rise and fall. Pain changes in nature if we are patient enough to sit with it and observe it.

Physical sensations also provide an object lesson in making the distinction between direct experience and the add-ons we bring to it. For example, we may feel tension in our backs and think to ourselves, “I’m always stressed out. I’ll never relax. I’m too uptight!” In reality, we are just feeling tension in our backs. We don’t need to pile on absolutes or character assessments.

Beyond focusing on the breath, sounds, or touch points, what are ways that we can experience mindfulness of the body?

We can be attentive to our posture, finding positions that give us comfort, ease, and stability. Our postures can be lying down, sitting, standing, walking, running. And we can be mindful of transitions from one posture to another.

We can be mindful in our daily activities. Showering. Dressing. Fixing a meal. Eating. Washing dishes. Doing chores. We can ask: Am I putting any unnecessary tension into this activity? Am I rushing to get through it, as if to say: “This moment doesn’t matter; let me get it out of the way so I can get to my real life!” Or, can I welcome every activity as part of the here and now?

We can experience the body as being part of nature, sharing in the ancient elements of earth, water, fire, and air. Tissues, bones, teeth. Blood, saliva. Temperature. Breath. As we read in Ecclesiastes 3:19-20:

“For what happens to the children of man and what happens to the beasts is the same; as one dies, so dies the other. They all have the same breath, and man has no advantage over the beasts, for all is vanity. All go to one place. All are from the dust, and to dust all return.”

We are all connected. A part of the great circle of life.

10 Steps to Great Bones

I just finished reading Dr. R. Keith McCormick’s latest book, Great Bones: Taking Control of Your Osteoporosis. Since joining the “thin bones club,” I’ve read several books on the subject. This latest entry is by far the best. It provides a comprehensive review of the subject matter and associated research in a way that’s accessible to the novice while still whetting the appetite of medical practitioners (and nerds, like me).

If you’re not interested in wading through all the material, you could skip to the final chapter and avail yourself of Dr. McCormick’s 10 steps to great bones.

Work with your doctor to get a comprehensive set of labs to see if your current diet and supplements are providing all the nutrients you need to support bone health. They’ll also tell you whether or not your bone remodeling has stayed in balance. Use the reference materials in the book to review your own numbers and take action, as needed.
Create an anabolic body by pursuing a diet high in fruits and vegetables, low in sugars and processed foods, and replete with good, clean water. Add fermented foods to keep the microbiome happy,
Fuel muscles and bones with high quality protein to sustain muscle mass and strength.
Optimize cellular metabolism by eating minimally processed, bioactive foods, and supplementing with bioactive compounds. Plants are loaded with phytochemicals that limit free-radical damage and reduce oxidative stress. Get a rich variety of them by eating produce across all the colors of the rainbow.
Ensure good digestion and bowel heath. Eat slowly; savor as you chew. Get plenty of fiber. Consider HCl supplementation if older and experiencing bloating after meals as HCl decreases with age.
Reduce free radical exposure and oxidative stress to minimize damage to cells and tissues. Eat food rich in antioxidants (fruits and vegetables), consider antioxidant supplementation (e.g., alpha-lipoic acid, NAC, CoQ10, resveratrol, quercetin, vitamin C), limit alcohol consumption, and don’t smoke.
Improve body acid-alkaline balance. The blood serum likes to be slightly alkaline and draws calcium from bones should it become acidic. Diets high in fruits and vegetables with adequate protein generally does the trick.
Watch your salt intake as excess intake increases calcium loss through urine, contributes to low-grade metabolic acidosis, and increases bone resorption.
Do weight bearing exercise and strength training to improve bone health. Areas of weakened bone can only repair if the body is active.
Get adequate sleep. Folks who consistently get only 5 hours of sleep per night tend to have lower bone density. It makes sense. The body needs sleep to rest, restore, and repair. Give it the time it needs to get the job done!

I’ll add an 11th step: Buy the book and read it. You’ll get a clear sense for why all of these recommendations make sense and have a superb reference manual to answer questions as they arrive. As I said earlier, it’s excellent!

A Tearful Good-Bye to Bakie

In the wake of several weeks of declining health, my dear friend Bakie Ward left her earthly body this morning. My heart is breaking.

We met in early 2001 as a group of eight women joined together to read Cheryl Richardson’s Life Makeovers and see where that journey might take us. We called ourselves Chicks in Change (and eventually just Chicks) and met every other week.

From that auspicious beginning, our little book group brought forth treasured friendships that have seen marriages, divorce, and other adventures in romance; graduations, career explorations, and job changes; relocations, road trips, and vicariously enjoyed travels; aging and spirited discussions about health; and, a myriad of joys and sorrows freely shared. These women have been an incalculable blessing in my life.

As I hold Bakie in the light, I feel the warmth of love reflecting back on me. For indeed, Bakie was love incarnate.

She loved her family and reveled in all the moments they shared together.
She loved her friends – those with whom she shared a life time, those who entered later in life, and those who had the privilege of more recent acquaintance.
She loved books and the beauty of language. She dedicated her life to supporting those who enjoy the written word.
She loved bridge and was a skilled card player and enthusiastic (and patient) teacher.
She loved learning and pursued with enthusiasm anything that piqued her curiosity.
She loved life and sustained hope, gratitude, and optimism even when things weren’t rosy.

No doubt the gates of heaven have opened wide to welcome its newest angel.

“But should the angels call for [her],
Much sooner than we’ve planned.
We’ll brave the bitter grief that comes,
And try to understand.” – Edgar A. Guest

Why I Miss Estrogen

As I transitioned into menopause years ago, I was happy to have been relieved of the monthly menstrual cycle and grateful to have experienced relatively minor symptoms. Hot flashes were not fun, but they weren’t all that bad either, especially when maintaining a sense of humor about them. My doctor never raised the possibility of hormone replacement therapy (HRT) based on findings from the Women’s Health Initiative (WHI) which deemed risks (stroke and breast cancer) greater than benefits (bone density).

I’ll confess that I knew very little about estrogen at the time. I was certainly aware that its presence governed my monthly cycles and likely contributed to sustaining a youthful appearance. But I had no sense that its loss would be implicated in my struggle to sustain adequate bone mineral density.

Estrogen stimulates bone building in several ways:

It increases the efficacy of Vitamin D in promoting calcium absorption in the intestine and limits calcium loss through urine.
It acts as a “switch manager” in the differentiation of mesenchymal stem cells. These cells reside in bone marrow and assume responsibility for production of adipocytes (which specialize in storing fat), cartilage (connective tissue), and osteoblast (bone-building cells). Estrogen tips the scales in favor of osteoblasts.
It helps regulate parathyroid activity to ensure the proper levels of calcium, phosphorus, and Vitamin D in the blood.
It increases production of Insulin-like Growth Factor 1 (IGF-1) which stimulates growth of all cell types.
It lowers sclerostin levels which would otherwise dampen osteoblast activity.

Estrogen also works to keep a lid on bone resorption (a.k.a. demolition) activity. Osteoclasts secrete acid phosphatase to dissolve bone crystals. They trace their origin to hematopoietic (blood-oriented) stem cells located in the bone marrow. These cells can differentiate into red blood cells, immune response cells (T-Cells, dendritic cells, microphages), and osteoclasts. Elevated levels of inflammation and oxidative stress stimulates hematopoietic stem cell activity, which in turn lets loose the bone demolition team. Estrogen tamps this down by:

Helping maintain a healthy gut biome and, thereby, reducing the risk of gut permeability. This action ensures proper absorption of essential vitamins and minerals and keeps toxins from entering the blood stream.
Calming the immune response by limiting the presence of proinflammatory cytokines (IL-1, IL-6, and TNf-α) and RANKL, a messenger molecule that activates immune cells and osteoclasts.
Stimulating mitochondrial production of glutathione, a powerful antioxidant.
Minimizing Reactive Oxygen Species (ROS) and oxidative stress.

Beyond the bones, estrogen increases muscle mass and strength, improves the speed of muscle regeneration, protects against muscle damage, increases the collagen content of connective tissue, and decreases stiffness of tendons and ligaments. All of the foregoing promotes an overall level of fitness and reduces risk of injury. It also contributes to a health cholesterol panel by increasing HDL and decreasing LDL.

I wish I’d had the opportunity for a spirited discussion about HRT when I went through menopause. We now know that HRT risks differ depending on type, dose, duration of use, route of administration, timing of initiation, and use of progestogen. According to my naturopath, low dose, transdermal applications of bioidentical hormone carry far less risk than oral ingestion of synthetic hormone. Per the North American Menopause Society, the risk-benefit profile also improves for women within 10 years of menopause onset who have no contraindications for their use. Beyond age 60, the absolute risk of coronary heart disease, stroke, venous thromboembolism, and dementia make such treatment ill-advised.

It’s likely too late for me to do much about the foregone menopausal opportunity. But all is not lost. I simply have to work harder on diet and exercise to maintain a healthy gut biome, minimize inflammation and oxidative stress, and sustain good muscle tone.

A healthy lifestyle always seems to come back to diet and exercise, doesn’t it?

Mindfulness of Thought

I attended my first meditation class in the early 1990s. At the time, I had a high-stakes, high stress job that had me fully absorbed by day and haunted me by night. I kept thinking about work after hours and had a hard time shutting down my brain at bedtime. A friend suggested that I try a meditation class. From what little I knew, I assumed that it would help me clear my mind and get much-needed rest. So, even though it was a hassle to get to the center and one more thing on my busy schedule, I figured it would be worth it.

Walking into the center, I was encouraged by how peaceful it seemed, reinforcing my expectations for a mind-clearing class. I had on my corporate clothes and noticed that pretty much everyone else was dressed casually which planted a seed of: “You’re different. I don’t think you belong here.” It bothered me. I sat in the back and listened attentively to the dharma talk. I liked it. It was interesting.

As we began the meditation, my mind started darting around all over the place. I could hardly get through a single breath without my attention being drawn away to a random thought. With the teacher’s encouragement, I kept returning to the breath, but I could not hold it there. Far from clearing my mind, it felt as though it was getting busier. At the end of 20 minutes, the hoped-for blank slate looked like a Jackson Pollack painting.

I was confused and mad at myself. How could I be so laser-focused at work in a chaotic environment and yet unable to sustain attention on the simple act of breathing in a calm one? It didn’t help when the feedback period was populated by those who had thoughtful commentary about the dharma talk and a Buddha-like experience of their meditation. I gave myself a failing grade and left discouraged.

I stayed with the for several more weeks but continued to have frustrating experiences with meditation. In the end, I decided that I was bad at meditation and would never get better at it. It was something that other people mastered, not people like me. It took me 20 years before I gave it another go.

I now know that many people share my inaugural meditation experiences, and that there are sound physiological reasons why. When our minds are not occupied with something specific, they tend to engage in introspective activities such as contemplating the past or future, running simulations of prospective activities, and daydreaming. This activity is mediated by a system of connected brain areas known as the Default Mode Network (DMN). It does not go silent when we go silent; it starts thinking!

Experienced meditators have quieter DMNs than inexperienced ones, but they still regularly experience these spontaneously generated introspective thoughts. That being said, even new meditators – with a modicum of training and a real-time bio feedback – can decrease their DMN activity so long as they just let their thoughts be rather than try too hard to shut them up.

With that in mind, I try to be an observer of my thoughts rather than identify myself as the thinker of them during meditation. I treat my thoughts like the ticker tape of the New York Stock Exchange. I watch them stream pass as though I’m just curious and interested, not an engaged investor with money on the line. From that vantage point, here are a few things that I’ve noticed:

Sometimes, it’s an active trading day and lots of stuff breezes by. Other days, it’s slow. Either way, I just allow it to be what it is.
I don’t feel a sense of ownership over everything in that stream of consciousness. Sometimes I find myself thinking: “Hmmm. I wonder where that thought came from!”
Whatever shows up on the ticker tape doesn’t last long when I hold the entire stream lightly. Thoughts only seem to stick when I let them. Otherwise, they just pass by.

Whether engaged in formal or informal mindfulness practice, I remind myself that my thoughts may not be true. A thought is just a thought. It often helps when I add the prefix “I’m having the thought that…” I notice it without getting attached to it or needing to react to it.

We each think thousands of thoughts per day, a high percentage of which are the same thoughts we had the prior day. I bring an interested and compassionate attention to the Top 10 Hits on my internal radio network. It gives me a road map as to where I might make changes in my life to relieve anxiety or simply tune the dial elsewhere. The great thing about the brain – we can quite literally change our minds!

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