Category Archives: Physiology

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.

stressed outI 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:

  1. 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.
  2. 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.
  3. 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.
  4. 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).
  5. 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.
  6. 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.
  7. 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).
  8. 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.)
  9. 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.
  10. Men and women respond to stress differently based on evolutionary pressures and cultural norms.

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.

  1. human skeletonWork 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.
  2. 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,
  3. Fuel muscles and bones with high quality protein to sustain muscle mass and strength.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Watch your salt intake as excess intake increases calcium loss through urine, contributes to low-grade metabolic acidosis, and increases bone resorption.
  9. Do weight bearing exercise and strength training to improve bone health. Areas of weakened bone can only repair if the body is active.
  10. 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!

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?

What Dr. Greger Says About Osteoporosis

I regularly avail myself of the short videos available on Dr. Michael Greger’s website His group of researchers scour and vet peer-reviewed scientific journals to present best evidence on a variety of health-related topics. A recent series on osteoporosis caught my attention. Here are high-level findings that I gleaned from it:

thin boneWeak bones do not present issues in the absence of excessive load caused by a fall or heavy lifting. They generally don’t break in the course of normal life activities. Only 15% of bone fractures can be tied to osteoporosis in women. Roughly 40% of hip fractures are due to impaired balance. Not surprisingly, hip fracture risk increases 13-fold between the ages of 60 and 80 when muscle weakness and loss of balance tends to become commonplace.

The best advice for preventing hip fracture: Don’t fall. Keep things within easy reach; avoid using step stools. Use non-stick mats in the bathroom and add grab bars to showers and toilet areas. Keep floors clutter free. Get rid of decorative throw rugs. Use hand rails when going up and down stairs. Don’t walk outdoors during inclement weather.

Balance and strength training reduces the risk of falls by 34% and cuts fracture rates by half. They combat age-related risk factors for falls. Moreover, weight-bearing exercise and impact training at moderate-to-high intensity encourages bone growth when pursued consistently. Want a simple bone-building exercise to add to the daily regimen? Hop up and down on each foot 50 times!

Dr. Gregor recommends 9 servings of fruit and vegetables daily. They decrease inflammation and oxidation and promote a healthy acid-base balance in the blood stream. (The body leaches calcium from bones when the blood gets too acidic.) Foods that are especially good for bone health include prunes, onions, leeks, garlic, cruciferous vegetables, and tomatoes.

Stop smoking. It’s bad for the bones and bad for health overall. Enough said.

Even though they are routinely recommended by general practitioners, calcium supplements may not be beneficial. To be sure, the body needs a steady supply of calcium to support bone growth and other metabolic functions. However, supplementation may cause unhealthy calcium spikes in the bloodstream. Dr. Greger cited a study in which 1,000 people used calcium supplements for 5 years. While their usage prevented 26 fractures, participants reported 14 heart attacks, 10 strokes, and 13 deaths that were attributed to calcium supplementation.

Dr. Gregor invites us to get the recommended daily dose of calcium through the diet. Food presents calcium in combination with other substances that aid in absorption while spreading the required amounts throughout the day. Put dark leafy greens such as kale, collard greens, and Bok choy on the menu. Avoid milk due to the presence of galactose (sugar) which causes bone loss due to oxidative stress and inflammation. In fact, studies show that hip fracture rates correlate positively with milk consumption. If a fan of daily, switch to yogurt or cheese; the fermentation process reduces sugar.

Vitamin D supplementation appears to support healthy bones when taken in amounts between 1600-3200 daily. Vitamin D increases calcium absorption in the intestines and stimulates the kidneys to reabsorb calcium from urine. Supplementation more than 4000 IU daily has been associated with higher fall risk.

Dr. Greger takes a dim view of pharmaceutical intervention, listing the most popular medication (Fosamax) by name. Fosamax disrupts normal bone remodeling by killing off osteoclasts (a.k.a. the bone demolition team) and thereby diminishing osteoblast activity (a.k.a. the bone building team). Physicians typically prescribe this medication when osteoclasts outpace osteoclasts, resulting in sustained bone loss year by year. Clinical trials showed that it cut the 5-year hip fracture rate by half. Dr. Gregor argues for a natural approach to reducing fracture risk while avoiding complications associated with disrupting the body’s normal bone remodeling processes.


It has been nearly 6 years since I first stumbled upon the term epigenetics. It’s the study of how our behaviors and environment regulate the way our genes work. One might refer to it as the science of living DNA. Thanks to a wonderful lecture series by Dr. Charlotte Mykura entitled Epigenetics: How Environment Changes Your Biology, I have a little better understanding of how this mechanism works.

In my rudimentary understanding of DNA, I pictured pristine, straight-edged, double-helix strand with a left twist. When called into action, I assumed that it “unzipped” to allow its code to be copied and then “zipped back up” to its previous state. The latter is mostly right, the former not so much.

DNA with attachmentsAcetyl groups, methyl groups, and proteins of all shapes and sizes bind to DNA causing portions of it to remain open and active, and other portions to lie dormant. Scientists refer to DNA with all its molecular attachments as chromatin. Euchromatin refers to open DNA that expresses its genome; heterochromatin refers to tightly packed, “sleeping” DNA. Far from the neat and tidy lines of genetic code, DNA contorts into wild 3-D shapes, takes on and shakes off attachments, and wiggles around in response to neighboring organic material.

In addition to the influence of molecular attachment, DNA expression can be affected by what happens outside the cell’s nucleus. DNA relies upon messenger RNA to carry information its codes to ribosomes for protein synthesis. MicroRNA in the cytoplasm can break down mRNA such that no protein gets made. Or, another RNA string might get spliced into the mRNA strand and alter expression of the gene. And PRotein infectIONs (PRIONs) within the cytoplasm can manipulate proteins after they’ve been formed, generally not for the better. (Apparently, this mechanism was at play with the outbreak of Mad Cow disease.)

In short, if you think your genes determine the life you will lead – for better or worse – think again. While a subset of your encoding remains active and stable, a whole lot can be influenced epigenetically by your environment.

Here are some examples of how epigenetics plays out in our bodies:

  • While every cell in the body contains the same DNA, epigenetics impacts how the cell behaves based on its location. For example, if it’s in the gut, it will use its programming to digest food, produce vitamins, support healthy immune function, and eliminate waste. It knows not to grow hair, teeth, or toenails in that environment even though it has access to the codes to do so!
  • The brain is a hot bed of epigenetic activity. It’s the mechanism through which the brain learns and grows, building complex neural networks and pairing back connections that are rarely used.
  • Our immune system also provides a stellar example of epigenetics in action. It has the ability to adapt dynamically to new pathogens and develop targeted responses that will eliminate them.
  • The fetal environment exerts a profound influence on a child’s epigenetic structure. If the mother starved during pregnancy, the child’s DNA will have far less DNA methylation, causing excess conservation of fat and elevated risk of diabetes type 2. If the mother produced high levels of cortisol during pregnancy due to stress, the child will develop more cortisol receptors and be predisposed to anxiety, schizophrenia, and/or autism.
  • Persons living with obesity have a different epigenetic signature in their guts than thin persons, making it more difficult to process fat and sugar. Moreover, when fat accumulates in the blood vessels, it influences the surrounding cells epigenetically, making them proinflammatory.
  • Food is the largest environmental impact on epigenetics. When we eat healthfully, we promote a healthy expression of our genes. While an obese person may face a steep climb to reverse years of poor dietary choices, the body will respond favorably in time.
  • Exercise is good for epigenetic health. DNA methylation has been correlated with muscle loss and frailty in older adults. Methylation shows signs of removal after just 20 minutes of cardio exercise. Moreover, biochemical signaling molecules released during exercise travel to the heart and lungs, exerting a positive epigenetic effect that decreases the risk of disease.
  • Pollution damages DNA epigenetically by overwhelming our natural cellular repair mechanisms and disrupting DNA methylation. Both lead to increased risk of cancer. While it may be difficult to avoid external pollutants, we can certainly minimize our exposure by not ingesting contaminants. (In other words, don’t smoke!)
  • We experience epigenetic drift as we age. Formerly tight coils of DNA can become open and floppy; formerly active DNA can curl up and go to sleep. Both influences can lead to random gene expression with adverse health consequences.

I really found the lecture series fascinating and would encourage those who have Wondrium subscriptions to view it. I am truly amazed by the marvel of the human body and how it works. I’m also encouraged to sustain healthy habits to encourage forwarding epigenetic expression.

Why I Believe in Colonoscopies

As a college junior, I got an ominous call from my mother one day. Dad had gone in for a routine colon screening and wound up with a cancer diagnosis. Mercifully, his malady was confined to a set of polyps that the gastroenterologist removed skillfully. Other than the inconvenience of more frequent screenings, he was expected to live a normal life. Mom informed me that as his progeny, I could expect to have this family history influence my diagnostic screenings.

Fast forward a few decades and a high school friend of mine wound up with colon cancer. Unlike my father, he had not gone in for any screenings until he experienced abdominal pain and bleeding. He was diagnosed with Stage IV colon cancer and died within a year and a half, leaving a wife and two young children. He was a great guy. I can begin to tell you how sad I felt about his predicament.

Colorectal cancer is a silent killer, yielding few (if any) symptoms in the early stage of the disease. It typically starts as small, benign clumps of cells (polyps) that turn malignant over time. As they grow, afflicted individuals may notice changes in their bowel habits, rectal bleeding, abdominal discomfort, weakness, fatigue, and/or weight loss. However, their symptoms may come on so gradually that they fail to pay the appropriate attention to them and take action.

The American Cancer Society estimates that 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer were diagnosed in 2022. Risk factors include age, genetic predisposition, family history, personal history of colorectal cancer or polyps, inflammatory intestinal condition, diet (low fiber, high fat), sedentary lifestyle, diabetes, obesity, smoking, and alcohol abuse. When caught early, 9 out of 10 folks can expect to survive at least 5 years. That’s why screening is so important!

Given my family history, I take colorectal screening seriously. I went in for my colonoscopy just last week. During this procedure, a gastroenterologist uses a long, flexible, tubular instrument to explore the length of the colon. It blows air into the colon to expand its field of vision and transmits images back to the doctor. If he or she detects abnormal tissue, it can be extracted and sent to a laboratory for analysis. An anesthesiologist sedates the patient during the procedure and monitors vital signs throughout. In my experience, the only discomfort occurred with the placement of the IV in my wrist and the injection of the sedative, both of which were transient.

Of course, one must empty one’s intestinal tract of all materials to give the doctor a clear look at the lining of the colon. That’s the “fun” part of the whole ordeal. My latest prep entailed:

  • Seven days without nuts, seeds, or whole grains in my diet
  • No dietary supplements for seven days (though prescription medications were AOK)
  • A clear liquid diet the day before my procedure
  • Use of SuTab tablets to induce diarrhea – 12 at 6:00pm the night before and 12 at 4:30 the day of my procedure consumed with a gaggle of water
  • Nothing by mouth after 6:30am

My pre-procedure evening wasn’t all that pleasant, and I didn’t get a whole lot of sleep. But the stuff worked exactly as they’d said it would. My check-in time was 9:30am for a 10:30am procedure; I was out of there by 11:30am. My darling husband provided transportation services as the sedative rendered me ill-equipped to operate machinery or make critical decisions.

Suffice it to say, I wouldn’t invest a whole blog post on the subject of colonoscopies if I didn’t believe in their ability to save lives. The CDC recommends that persons 45 and older get screened. If coloscopies aren’t advised, CT colonography, flexible sigmoidoscopy, and/or stool test might prove insightful. A frank discussion with a primary care provider can shed light on one’s individual circumstances. I dearly wish that my high school friend had availed himself of that.

Of course, cancer prevention should also be top of mind. The Mayo Clinic offers the following guidelines for lifestyle choices to reduce the risk of colorectal cancer:

  • Eat a high fiber diet with plenty of fruits, vegetables, and whole grains
  • Drink alcohol in moderation (if at all).
  • Don’t smoke.
  • Get at least 30 minutes of exercise daily.
  • Maintain a healthy weight.

Placebos, Nocebos, and Hypnosis

“A mind is fundamentally an anticipator, an expectation-generator.” – Daniel Dennett, AI pioneer

In 1978, a young couple faced a crisis of conscience. As practicing Christian Scientists, they believed in the power of faith healing and eschewed modern medicine, but their infant son was gravely ill. With his life in the balance, the mother considered taking him to the hospital. Her Christian Science healer reminded her of God’s love for the boy and encouraged her to hold fast to her faith. Moments later, the boy’s condition turned around.

That young lad (Erik Vance) heard the story of his miraculous salvation many, many times during his formative years in the Christian Science community. Faith healing was the only form of medicine that he knew, and he witnessed its beneficial effects time and again. Though he eventually fell away from the church, his fascination with the practice stayed with him. He became a science writer and traveled the world to understand the physiological underpinnings of this seemingly magical phenomenon. He captured his findings in Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.

As noted in prior posts, our minds are not computers rooted in logic and facts. They are survival machines geared toward keeping us alive as efficiently and effectively as possible. Expectation serves as a primal survival skill – i.e., anticipating what lies in the immediate future and mounting a swift reaction. Experience guides our expectations. When missing information, we fill in the gaps and move forward, sometimes outside of conscious awareness.

placebo, noceboExpectation plays a substantive role in the body’s capacity for healing. When ill or injured, most of us have been trained to trust in medical professionals to make us well. In the Western world, we visit clinics where caregivers in scrubs and/or white lab coats discuss our ailments and then prescribe drugs, shots, or procedures to make us well. But it turns out that for certain conditions, we can generate the same degree of healing with sham medications and procedures. Scientists refer to that phenomenon as the placebo effect. So, why does it work?

Our brains are adept at pattern recognition; it feeds our “expectation-generator.” Famed neuroscientist Ivan Pavlov explored this capacity in canines by ringing a bell every time he offered them food. Pretty soon, the dogs would salivate whenever they heard the bell. Humans also experience conditioned responses. In one experiment, test subjects were given an immunosuppressant drug in a sweet drink to lower their immune response. After a few iterations, their bodies produced the same reduction in immune response with out the drug even though participants were told in advance that their drinks contained no pharmaceuticals!

Our brains can induce a gaggle of physiological responses without prescription drugs. We’re walking pharmacies with the capacity to produce effective treatments for certain conditions – notably, pain, anxiety, depression, irritable bowel, addiction, nausea, insomnia, and Parkinson’s disease. But several factors influence this healing effect:

  • We need conditioning, a credible backstory, and appropriate environmental cues to engender a belief in the treatment. [Note: Placebo injections prove more effective than placebo pills because we believe that they are more powerful. Likewise, sham surgeries work better than sham pills.]
  • We need a favorable emotional response to our circumstances. Hope yields positive results; despair exaggerates suffering.
  • Social pressure can lessen symptoms or speed recovery – e.g., “If it works for millions of people, it’ll probably work for me.” In fact, the peer pressure placebo effect is twice as strong as an individual placebo response. It feeds into our primal need to go along with the herd.
  • Our genetic maps may make us more (or less) susceptible to placebo responses. As a case in point, folks with the met/met variation of COMT (which, among other things, sweeps up excess dopamine) are far more placebo sensitive than those with the val/val or val/met variations.

Unfortunately, a susceptible brain can make bad things occur without cause – a.k.a., the nocebo effect. One’s mental state can cause physiological suffering. It’s generally driven by fear and can be initiated with a few well-placed words – a report of a contagious disease, a belief that one’s misdeeds will engender cosmic revenge, a curse levied by a supernatural being. A wise person blocks all aggressive suggestions that could cause harm.

Hypnosis represents another form of suggestibility that can drive real physiological change. Its efficacy relies upon the skill of the hypnotist in painting a picture of the magical place that relaxes the participant and opens the door to suggestion, using appropriate pacing and tone of voice to sustain the “trance,” and implanting a credible story that sticks. Roughly 10% of the population responds strongly to hypnosis. Early evidence suggests these folks have naturally higher theta and alpha brain waves than their busy-minded beta and gamma brain-waved counterparts. The latter benefit from meditation to calm their “monkey minds.”

So, what should we make of all of this?

Vance asserts that expectation and suggestibility are a part of all forms of healing. As he says; “Everyone’s door to expectation has a different key, and everyone is suggestible in a slightly different way. But once the door is unlocked, we have amazing power to heal ourselves.” His guideposts for leveraging this capability:

  • Don’t endanger yourself. While some maladies may respond to self-healing, take advantage of modern medicine when you need it.
  • Don’t go broke. Be sensible and follow the evidence before emptying your wallet.
  • Don’t send any creature to extinction no matter how compelling the backstory. They have a right to live, and their sacrifice may do no material good.
  • Know thyself. “For most, suggestibility is a cocktail of genetics, personal beliefs, experience, and personality.” Figure out which pathways hold the most promise for you and be open to the power they hold

Gut Health

My journey of well-being has provided a glimpse into the inner working of my digestive track. I’ve shared my newfound knowledge in posts entitled Our Guts Have Minds of Their Own, The Marvelous Microbiome, and SIBO and Leaky Gut. I added to my intestinal intelligence through Wondrium’s Gut Health with Dr. Mary Pardee. This 26-lesson course covers the mechanics of digestion, strategies for maintaining a heathy gut, gut pathologies, and gut testing and treatment. While there was a fair amount of overlap with what I’d read previously, I managed to come away with a few new insights.

digestive systemIf you’re curious about your gut health, your daily constitution provides a pretty good indication on how things are going. A healthy poop should be soft, brown, S-shaped, and the length of the wrist crease to elbow crease. It might be tinged red, orange, or green based on foods eaten recently –  e.g., red beets, squash, dark leafy greens. It should not be particularly malodorous or greasy. And it should not be bloody. Dietary adjustments and fluid intake can cure a multitude of sins. Bloody stools should be brought to a doctor’s attention.

As covered in the post Drink Water, there’s all kinds of reasons why we should consume an adequate amount of fluid daily (though not to excess at any one time). Dr. Pardee suggests that we take in most of our water between meals. The liquid we drink at meal time can dilute our stomach acid and make it less effective for processing food and killing off bacteria. Older adults are particularly vulnerable in this regard as stomach acid drops as we age. It’s best to confine meal time beverage intake to a handful of sips just to keep things moist.

How we eat is as important as what we eat. Digestion begins with the sight and smell of food; they make our mouths water. Saliva moistens food upon entry into the oral cavity and also starts the process of breaking it down chemically. Of course, chewing represents the most effective form of breakdown. We should transform solid food into the consistency of baby food before swallowing. Big chunks of food are challenging for the stomach to process into a form acceptable by the small intestine.

Meals should benefit from focused attention. When we’re mindful of what we’re eating, we’re more likely to sense satiety and less likely to overeat. Mindful eating also helps us notice whether we’re actually hungry or eating for some other reason – e.g., boredom, stress. It also provides the means to really savor our food and be grateful for its nourishing presence.

Speaking of stress, it’s not a good idea to chow down when in the grips of a fight, flight, or freeze response. In this state, the body shuts down nonessential functions and directs its energy and blood supply to the muscles. It does not want mess around with digestion until the threat has passed. As such, stress eating really, really does not make sense!

Regular exercise supports strong motility along the digestive track. As we move, our food moves through our bodies. This movement prevents an overgrowth of bacteria in the gut and can avoid painful elimination. Dr. Pardee suggests that we aim for 10,000 steps per day. A good night’s sleep also supports motility by elevating cortisol first thing in the morning to a level that stimulates bowel movement. For those with chronic motility issues, fresh ginger, ginger capsules, and ginger tea (2-3 tea bags per cup steeped 10 minutes) may prove helpful.

As with other experts in the field, Dr. Pardee is big on a healthy eating to promote a healthy gut microbiome. Ideally, three-quarters of the plate for every meal includes a varied array of non-starchy vegetables. Daily fiber intake should trend upwards of 100 mg daily through natural sources. (The average American only consumes 15 mg of fiber!) A generous supply of herbs provides potent antioxidants (e.g., polyphenols) to quell systemic inflammation. Fermented foods help the gut garden thrive. And for good measure, eliminate dairy and go easy on nuts.

While probiotics have become a staple of the microbiome conscious, they don’t colonize the gut; they’re transient. They may help reduce anxiety, lower cortisol levels, or support pain management while working their way through the system, but they’re not a panacea for a gut that’s off kilter. Healthy eating, regular exercise, and good sleep habits are the gut’s best friends.

How Your Five Senses Can Help You Sleep

My last post covered all the things we should consider during the day to give us the best possible chance of getting restorative sleep at night. Now, it’s time to focus on our five senses and what they need to support a good night’s sleep.

According to sleep expert Dr. Michael Breus, our bedroom environment matters – big time – when it comes to sleep. First and foremost, make sure you have a really good mattress and pillow. If you’ve had yours for quite some time, it may be time for an upgrade. You may also have reached the end of life on the existing equipment if it has been exposed to dust, mites, sweat, and bodily fluids long enough to produce allergens. That kind of spending may not induce a great deal of enthusiasm, but remember: It’s where you spend a third of your life!

TOUCH: Buy high quality products that feel good on your skin. Use natural, breathable fibers – wool, cotton, down – not synthetic. Dr. Breus likes Egyptian cotton sheets, Pima cotton sheets, Modal fiber, and Lyocell at 200-400 thread count that fit the mattress. bedroomA removable pillow cover separate from the pillow case helps with pillow hygiene and potential allergens. Keep things moderately warm to cool; the ideal ambient room temperature for sleep is 65˚-70˚F. Lean toward the lower.

SIGHT: Ideally, bedrooms should be relatively dark (to boost melatonin) and feature a tranquil color scheme. Forty-watt, blue-light blocking bulbs work quite well. Dimmer switches support those who want the option of a bright light during the daytime. Red or amber night lights can provide illumination for nocturnal bathroom visits. Use a sleep mask if sensitive to light, but wash after each use to prevent eye infections. (I rotate through my collection of 10 inexpensive masks.)

SMELL: While our bodies like freshness, they can make the bedroom fragrance anything but fresh. Open windows at least weekly to circulate some fresh air – and fresh smells – into the boudoir. Regulate humidity, and circulate clean, filtered air when the windows are closed. If you like aromatherapy, try lavender or chamomile, but avoid minty scents.

SOUND: If you cohabitate with a sonorous bedfellow, try using ear plugs rated for a noise level of 32 dB or below. At the other extreme, if the room is too quiet, it may make the ears more sensitive. Try using a sound machine set to a low volume. And don’t settle for an old fashioned alarm clock with its jarring blast of sound. You can awaken to a pleasant sound, a light, or vibration and start your day in a happier frame of mind.

TASTE: Though eating is discouraged within 3 hours of bedtime, a sleep-supportive beverage could be just what the doctor ordered. Try making a cup of banana tea by immersing a whole banana in boiling water and discarding the pulp after brewing. It contains three ingredients that can help improve sleep: potassium, magnesium, and tryptophan. If that doesn’t strike your fancy, brew some guava leaf tea and add a teaspoon of raw honey. It tastes good and helps stabilize blood sugar until morning.

How To Prepare for A Good Night’s Sleep

sleeping man

For those of us who struggle with falling and staying asleep, sleep guru Dr. Michael Breus serves up a lot of good advice. This post shares a host of things we need to do during the day to make sure we’re ready for “lights out” at night.

Set a regular schedule for when you sleep and when you rise to support your body’s natural sleep-wake cycle (a.k.a., circadian rhythm). The adrenal gland works in tandem with the pineal gland to manage this biological rhythm. The adrenal gland produces cortisol which acts as a stimulant; the pineal gland produces melatonin, which makes us sleepy. They function best within a context of consistency.

Start the day with a morning routine to send your body a clear signal that it’s time to start the day. As you open your eyes, sit up straight and take in five deep, slow, deliberate breaths. Consider doing a few morning stretches to clear your head and get your body moving. Grab 15 minutes of sunlight within 30 minutes of awakening (or use a full-spectrum light source) and drink 16-20 ounces of water before your morning coffee or tea. (We lose about a liter of fluid while we sleep!) Put on some high energy music and feast on a high protein, low carbohydrate breakfast.

Get aerobic exercise, preferably in the morning. It gets the blood pumping, improves blood pressure, reduces stress and anxiety, and helps you fall and stay asleep at night. Fitness buffs also produce more growth hormone which improves cellular repair and boosts immune function. All of these benefits kick in over time. (Yep – you’ve got to work out consistently a minimum of 20-30 minutes per day!) Avoid evening workouts as they prove stimulating and do not allow for sufficient time for the elevated core body temperature to drop back down.

Go outside at midday to stop a premature surge in melatonin. It will help you stay alert during the afternoon while continuing to maintain your body’s sleep-wake rhythm. If tempted to nap, wait for 7 hours after waking and give yourself a 25-minute cat nap (light sleep) or a full 90-minute sleep cycle. However, if you struggle with insomnia, don’t nap! It’ll hurt your chances of falling asleep at bedtime.

Watch what you eat and drink in the afternoon and evening. Stop drinking caffeinated drinks by 2pm (although it’s best not to use caffeine at all). Eat sparingly at dinner and go easy on protein and spices to avoid indigestion. Our metabolism slows during sleep and doesn’t have the means to process a heavy meal. Include whole food plant based carbs to increase serotonin. No meals or snacks within 3 hours before bedtime.

Shut yourself off from alcohol at least 3 hours before bedtime and drink a full glass of water for each alcoholic beverage consumed. It takes roughly an hour to metabolize one alcoholic drink. In the United States, one such drink contains roughly 14 grams of pure alcohol, which is found in 12 ounces of regular beer (~5% alcohol), 5 ounces of wine (~12% alcohol), or 1.5 ounces of distilled spirits (~40% alcohol).

Create a bedtime routine to shut down your brain and help your body relax. There’s no one-size-fits-all formula; you’ll have to experiment to see what works for you. Dr. Breus offers the following suggestions:

  • Shortly after dinner, capture what you need to do tomorrow (or the next few days) and anything about which you might be concerned. Jot down a few ideas to address your worries, and then set all such thoughts aside. They’re on the list; you don’t need to think about them until tomorrow.
  • Take a hot bath 90 minutes before bedtime, leaving enough time for the body to cool down again. (Our body temperatures drop when we sleep!) Or, take a cool down shower 30 minutes before bed.
  • Turn off screen time at least 90 minutes before bedtime. The blue light that these devices emit shuts down melatonin. If that won’t work for you, use blue blocker glasses.
  • Create a “Power Down Hour” right before bed that consists of 30 minutes of mindless chores, 15 minutes of hygiene, and 15 minutes of calming activity (e.g., stretching, yoga, meditation, guided imagery).
  • Spend 30 minutes connecting with loved ones right before your power down hour… but don’t launch into any serious, upsetting, or tension-filled conversations.
  • If you enjoy reading a good old fashioned book right before bed, use an amber reading light. If you read on an iPad, Smartphone, or the like, use blue blocker glasses.
  • Write in a gratitude journal right before bed.