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The “Back Whisperers” — Back Pain Part 3

Like everything else, it’s better to prevent back pain than to have to treat it. But what do you do if you already have chronic non-specific back pain? The simple answer, according to several experts, is to strengthen weak back muscles and change bad habits, but this can be easier said than done…

What about surgery and steroid injections?

An estimated 38% success rate is reported for back surgeries, with some patients actually worsening after the surgery instead of improving. Steroid injections, which can give temporary reductions in pain and inflammation, can also cause side effects of bone loss and weakened muscles in the injected area. Misplaced injections have caused serious injury, including paralysis (referred to as a spinal “stroke”). Because several existing treatments have not been highly successful, new programs have been developed, some by back surgeons who were disillusioned by their inability to help their patients through surgery. Investigative reporter and author of Crooked, Cathryn Jakobson Ramin, refers to these non-surgery back experts as “Back Whisperers”.

The “Back Whisperers” – Exercise specialists

One such doctor is Brian Nelson, a former back surgeon who decided to develop a different method to heal chronic back problems, and he founded the Physicians Back and Neck Clinic. Recognizing the need to strengthen the weakened muscles of the back and that many people do exercises incorrectly (using gluteus “butt” muscles or leg muscles instead of the muscles of the back that need strengthening), he invented an exercise machine called MedX that made his patients do their exercises correctly as part of a broader rehabilitation program. The machine is now used in many high-end back rehab programs world-wide.

Canadian University of Waterloo kinesiology professor, Stuart McGill, made a career of studying the mechanics of why back muscles, bones and ligaments fail so commonly. While he recommends customizing exercise according to what is “mechanically” malfunctioning in each individual, he did design “Stuart McGill’s Big 3 Exercises” to develop core stability, supporting the back. You can view these strengthening exercises on You Tube. Ask your doctor or therapist if they are right for you. He also recommends walking, even for short periods of time, several times a day as an excellent exercise. He recommends doing this in a somewhat “military” style, swinging the arms to loosen tightened back muscles.

Movement techniques to correct posture, such as Feldenkrais, the Alexander Technique, Tai Chi (tie-chee), and Qigong (chee-gung) are designed to help you undo unconscious habits, helping you to develop “conscious control” and bring your system and posture back into balance. Some of these techniques can help you to realize which bracing, “protective” postures that you may be unconsciously holding that create pain and spasms, and can teach you how to relax and let go. And some forms incorporate an element of active meditation that can help reduce stress. Here’s a small example on YouTube of simple Qigong exercises… but ideally you would want to join a class to be instructed properly.

Yoga, while helpful for relaxation, can often tend to overwork lumbar and cervical regions of the spine with forward bends that load extra pressure on the spine that can be painful in those who are already deconditioned and weakened. Low back trauma is reported to be the most common type of yoga injury. However, two styles of yoga, Viniyoga and Iyengar, are considered more suitable for people with joint and muscle problems. A skilled instructor can help to identify and correct problems that are causing chronic pain.

Using the mind/body connection

One of the worst things for the back is to tighten and guard against painful movements. A diagnosis of “degenerative disc disease” can frighten a person into avoiding any kind of exercise, in case they further damage their “fragile” spine. However, most people benefit from exercise and learning not to fear possible pain once they have a proper diagnosis and treatment program. Some of the most effective programs include “cognitive behavioural therapy”, where patients are taught to take a positive view of their condition: that their situation is not hopeless and that they can learn to manage their pain.

Ron Seigel describes the central issue of chronic non-specific back pain as being the fear of back pain in his book, Back Sense. “Pain causes distress, which causes muscles to tighten, which causes more pain” in a downward spiral. Dr. John Sarno observed that emotions caused the unconscious mind to create painful spasms in many of the back pain patients he treated over the years, as described in his book Healing Back Pain. He claimed that many patients could make a dramatic recovery once they realized the source of their chronic pain.

Red flags

But before you would consider an exercise program for a chronically painful back, you should have your doctor assess for “red flags” — symptoms that suggest the possibility of a serious problem. These include long-standing pain that is unaltered by a change in position (possibly suggesting a tumor and a need for imaging such as an MRI), or a history of fever and chills (suggesting the need for a bone scan to rule our low-grade infection).

However, scans to diagnose back problems are generally not recommended, especially early in the course of an episode and barring any “red flags”, as changes in spine structure do not correlate well with the cause of the pain, leading to unnecessary surgery in many cases. Degeneration of discs between vertebrae is common as we age, and is often seen in images of spines of people who have no back pain. Ruptured discs are reported to heal when pressure on them is avoided for a period of time, eliminating the need for surgery to correct the problem.

In summary…

If you have chronic back pain, ask your clinician about non-surgery options and specialized back rehabilitations programs. If you are taking opioids for long-term back pain, ask your doctor how you can transition off these, perhaps to an anti-inflammatory medication if it’s safe for you to take.

The main reasons to avoid NSAID anti-inflammatory medications is existing stomach problems or kidney disease. However, because the dose needed is much lower, when anti-inflammatory creams are used , they can often be substituted for the pill version.

Be aware that these creams need to be applied to specific areas, known as the “trigger point” for your particular muscle spasm, and it may not be the most obvious painful area. Ask a therapist who is familiar with the work of Drs Travell and Simons to show you exactly where to massage the cream. A self-help book I’ve used for many years that explains these well is The Trigger Point Therapy Workbook by Clair Davies.

Acute back pain

If you have an acute (less than 1 month) or a sub-acute (less than 3 months duration) back problem, realize that most will recover from this. The worst thing you can do is stiffen and guard against painful movements, or take opioids that could cause side effects and long-term problems, and could even eventually worsen your pain. Remember from Part 1 of this blog series that anti-inflammatory medications (by mouth or as a cream) and sometimes short-term muscle relaxants can give relief. Total bed rest is no longer recommended and, instead, gentle rhythmic exercise as tolerated, such as walking, has been found to help improve the problem more quickly. Applying heat or ice can also provide some relief. A visit with a physiotherapist or skilled massage therapist can set you on the right track for a full recovery. If the pain is severe, you may benefit from an assessment by your physician. Once you’ve recovered, work with a therapist for a visit or two to strengthen muscles that support the back to prevent future episodes.

In response to my first article in this series, a reader who is an occupational therapist described to me how they recommend their patients strive for a balance in work (purposeful activity), rest and play, and in mind, body and spirit. It seems that the cure for back pain is not the same for everyone, but it’s all about strengthening without overworking, avoiding painful activities unless being supervised by a professional, addressing stress and associated muscle tension, and learning to move without fear. Several experts have stated that 90-95% of back pain sufferers can recover without surgery.

Additional reading:

Crooked by Cathryn Jakobson Ramin

Healing Back Pain by John Sarno

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Health

The “Sitting Disease” — Back Pain Part 2

If you think your latest back problem was caused by lifting a heavy object, or from twisting the wrong way, or whatever the event was that brought it on, you would likely be wrong. Most back problems don’t just happen “all of a sudden”. They are the result of things you’ve been doing (or not doing…) for many years. Here’s what the experts say…

Posture

First, your posture can set you up for back problems. How we sit and stand can set us up for pain down the road. For example, when you cross your legs knee over knee, your back twists to compensate. Since humans are creatures of habit, we tend to assume a posture we find comfortable frequently, sometimes for hours at a time. Chronically twisting the back, even if it feels comfortable at the time, eventually results in shortened muscles on one side and a back that doesn’t quite straighten out when you stand up. But you are unlikely to notice the change yourself. Other positions like slouching with the neck extended, shoulders rounded and back curved to compensate also set you up for future pain.

The Sitting Disease

Second, just sitting for long periods of time means there are muscles that aren’t being used. And these can become weak over time, setting you up for painful muscle spasms when you do try to use them to lift or twist. It isn’t really the “lift” that is the true cause of the pain, it’s the fact that your muscles have withered from lack of use. Humans were designed to move, not to sit for hours at a time at a desk!

Stress

Third, many people notice that their back “goes out” more frequently when they are stressed. And there is definitely a connection between the mind and the body… I’m sure you’ve heard the term “tension headache” — it’s a headache caused by spasm of the muscles in the scalp, usually brought on by stress or fatigue. Other muscles can spasm for the same reason, including muscles of the back and shoulders, causing back or neck pain. Back expert, Dr. John Sarno, calls this “Tension Myositis Syndrome” and cites it as a major cause of back, neck, shoulder, buttocks and limb pain in the many patients he has treated over the years of his practice. His book, Healing Back Pain written in 1991, still has valuable information for back pain sufferers.

I’m certainly “guilty” of tensing my shoulders when I’m stressed, and too frequently have a stiff neck that I blame on a car accident 40 years ago or on having spent too much time with my head turned to one side or upward the day before (or all of the above…). Like many writers, I sometimes study and write about subjects I am personally concerned about, while also helping my readers! I’ve already put some of what I learned for this article to use…

And constipation?

Fourth, constipation can make low back pain worse for some people too! The bowel is suspended from the lower spine by a web called the mesentery. When the bowel gets full and heavy because the contents aren’t moving along as they should, it tugs on the lower sections of the spine, compressing nerves and causing discomfort. Also, when you consider that opioids cause constipation, for some the “cure” could be making the pain worse! And treating the constipation may help to improve low back pain.

What can you do?

Taking a break from sitting regularly can help prevent back problems. Shifting position frequently while sitting can also help. And avoid sitting in a twisted, cross-legged position. Some researchers have suggested that the ideal chair should have a seat that slants forward, putting some weight onto the legs, and should allow you to wiggle and move around to vary your position, but I’ve never seen anything that looked like that in an office furniture store!

The conventional 90-degree office chair actually puts high pressure on the discs between the vertebrae of the back, researchers say, and can lead to tight hips and psoas (the muscles that run inside the hips and need to extend to stand up), weak gluteus (your “butt” muscle), poor circulation causing swollen ankles and varicose veins, and a strained neck. The ideal hip angle, they tell us, is about 135 degrees, halfway between sitting and lying down, which brings to mind anti-gravity patio chairs! If your chair has an adjustable back, you might be able to tilt it back for part of the day, depending on the type of work you are doing, to create the ideal hip angle for at least a little while.

Until they invent the perfect workstation, the best suggestion is to take a break and move around every hour, and to change your sitting position frequently while you’re sitting. As one expert says, “The best posture is always the next one”. (Rethinking Sitting by Peter Opsvik)

As you see in the photo above, I’m trying out a new desk configuration… with my chair back slanted close to the ideal 135 degrees and using a second elevated screen, at least for some of my work… but taking a break now will help! I may even try doing some writing on the couch where I can elevate my feet and relax in another position for variety, and using dictation to give my arms, shoulders and hands a rest is definitely on my list.

So, pay attention to what you do while reading emails or watching TV — it might make a difference in how your back feels in the future.

Next week, I’ll share what I’ve learned about how experts treat these problems if you already have them… Sign up by clicking the “Subscribe” button if you want to be sure to get Part 3 of my Back Pain series!

Suggested reading:

Healing Back Pain by John Sarno

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Health

Back pain – Part 1

Problems with a sore back or neck? You’re not alone. It’s estimated that over 80% of people experience this pain some time in their lives. But how these problems are treated and what medications are used is changing…

Why?

First, many treatments in the past have resulted in high failure rates. Complete bed rest, disk replacements, steroid injections and spinal fusions have not delivered the success rates that were claimed and sometimes had nasty side effects. Some patients actually became worse instead of better…

Secondly, too many people are dying from overdoses of narcotics prescribed for pain – nearly 4,000 in Canada last year – and it’s not just drug-abusers living in the streets. In spite of having told us years ago that these drugs were safe when used for pain with less than 1% becoming addicted, 4 out of 5 heroin users in one government study reported having started opioid use with a prescription. And many of these started with pain relief for muscle or joint pain that just didn’t get better. Canadians are the highest users of opioids in the world.

The Centers for Disease Control (CDC) in US stated that overall one out of every 550 patients started on opioid therapy died of opioid-related causes, an average of 2.6 years after their first prescription. This statistic increased to 1 in 32 patients who were taking the equivalent of 200mg a day of morphine or more. These same statistics were observed in Ontario residents on Social Assistance. The CDC stated “We know of no other medication routinely used for a non-fatal condition that kills patients so frequently.

So, how did all this happen?

One defining characteristic of opioids is “tolerance”, where your body adapts to the effects of narcotics. This means you require increasing doses over time to achieve the same pain relief. However, these drugs have another property that was not widely recognized initially and is rarely discussed with patients, called “central sensitization”. This is a condition where the brain becomes sensitized to pain and eventually even non-pain messages coming in. Levels of pain messaging chemicals (like NMDA) increase, sending even more pain messages whirling around the brain’s central nervous system (CNS). This results in the perception of pain from sensations that would normally not be painful, and the person is on his way to long-term chronic pain with seemingly no real cause.

Essentially, the brain, when exposed to opioid drugs, “learns” to experience chronic pain in response to sensations that are not normally painful. Unfortunately, with long-term use of opioids, these changes can be very difficult to reverse when the drug is stopped.

Treatment for muscle and joint pain is changing…

Governments are responding to these alarming statistics. In Canada a new guideline was created: The 2017 Guideline for Opioids for Chronic Non-Cancer Pain. In it, they strongly recommend optimizing treatment with non-opioid drugs (anti-inflammatory medications like naproxen and ibuprofen, and in some cases muscle relaxants) and non-drug therapies (like heat and exercise), rather than giving a trial of opioid drugs.

The American College of Physicians (ACP) responded by creating similar pain medication guidelines in 2018. Both guidelines recommend using opioids as a last resort and then only in people with no history of drug abuse or mental health problems. The Canadian guideline strongly recommends that not more than the equivalent of 90mg of morphine be given daily and that current patients taking more than this for chronic non-cancer pain should be gradually reduced to 90mg daily for safety reasons.

A new study this year, the SPACE study, found that the ability to function and relief from chronic pain was not significantly different in patients who took only anti-inflammatories compared to those who took opioids for their pain. And those who took the narcotics had more side effects.

So, even if you had success taking Tylenol #3 or Dilaudid the last time your back “went out”, don’t be surprised if your doctor gives you Naproxen 500mg instead if it happens again. He’ll be following pain management guidelines that have your best interests in mind!

Next week I’ll talk about non-drug strategies for back and neck pain…

Further reading:

Crooked by Cathryn Jakobson Ramin

Back pain: How to live with one of the world’s biggest health problems – The Guardian

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Health

Eating dessert first…

Churros and Chocolate for breakfast in Marbella, Spain.

Does life seem too short? When you look back, will you be happy with what you’ve accomplished? Are there things you’ve always wanted to do but just can’t find the time to get started? Do you sometimes feel like you should eat dessert first in case your mealtime is cut short?

Where does the time go?

It seems that, despite our current hurried lifestyles with its many distractions and demands on our time, this isn’t a new problem. Almost 2000 years ago, Roman philosopher, Lucius Annaeus Seneca, wrote an essay entitled “On the Shortness of Life” that I just stumbled across. Even back then, people complained that life was too short. Though the average lifespan is years longer now, most of us still feel the same.

In his essay, Seneca wrote “our lifetime offers ample scope to the person who maps it out well… It’s not that we have a short time to live, but that we waste much of it. Men are thrifty in guarding their private property, but as soon as it comes to wasting time, they are most extravagant with the one commodity for which it’s respectable to be greedy. No one values time: all use it more than lavishly, as if it cost nothing.” Once time is gone you can’t get it back…

So, how do you “map it out well”?

You may have heard of the 80/20 rule: 80% of benefit often comes from 20% of your effort. Keeping this in mind, if we became purposeful and productive with just 20% of our time we might still be able to reap 80% of the benefit we achieve in a normal unstructured day. It’s difficult to change your whole life, but what about just 20% of it? Or even 10%?

Here’s one way to do it…

First: Take some time to decide what you really want from life. What are your most important goals that you’ve not yet achieved? What have you always wanted to do that you haven’t yet tried? This is where you want to focus; this is what you want create time to start doing now. Keep in mind that your goals will likely change over time, and you will want to reassess and refocus some time down the road…

Second: Ask yourself: Are you working on these goals that are important to you or just keeping “busy” with life? Remember the 80/20 rule and carve some time away for yourself from activities that really don’t matter in the overall picture, to focus on what is really important to you.

Third: Don’t multitask. Turn off distractions so you can increase your efficiency, to accomplish more in this limited amount of special time you’ve created for yourself. Multitasking lowers the quality of your attention, makes you tire faster, increases your stress and unhappiness, and lessens the effectiveness of your activity or learning.

Start now…

I’ve always been a procrastinator… in fact, my parents once gave me a little round medallion with the letters “TUIT” engraved on it – “I’ll do it when I get around to it” (a round TUIT)… a little family joke. My dad also used to call me “the late Jeannie Collins” because I was late so often, having been oblivious to time and put off preparing to go somewhere!

When we first spent an entire winter in Florida, I had several retirement activities that I wanted to do… things I’d been wanting to try, like improving my drawing, trying some painting and learning a new language. As the winter passed and March rolled around, I realized that I’d put off starting these activities, day after day, thinking that I had lots of time to get around to it. I’d “wasted” 4 months of what I thought would be a long “empty” winter! It was so easy to just fill in the time with other interesting activities.

Knowing I only had 2 more months left there, helped me to focus on what was important to me at the time, the things I really wanted to do. I started setting some time aside every day for what was important to me. At least I was able to make good use of my last 2 months to achieve a few things I’d always wanted to do.

The ancient Roman philosopher, Seneca, also said “The greatest waste of life lies in postponement: it robs us of each day in turn and snatches away the present by promising the future.” At some point, like me, you need to decide to get started and do the things you really want to do. The alternative is really just giving up on your dreams.

I read somewhere that the most common regrets expressed at the end of life are not about what the person did, but about what they wanted to do but never found (or made) the time for. So, what can you do to make sure this isn’t one of your regrets? Just like choosing to be happy, discussed in last week’s blog, choose now to accomplish (or at least work on) your life’s greatest desires. Consciously making choices now can help you to experience satisfaction and happiness as you go through life and when you look back on your past.

“Eating dessert first”, of course, isn’t really talking about food… Many of us think of dessert as the tastiest, most desirable part of a meal. The “life” version of dessert refers to the best, most desired, and most rewarding parts of your life. The expression encourages us to put the best parts of life first. The decisions you make about what you’ll do today can change your future.

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One of the reasons I write this blog each week is to investigate new ideas and learn more about being healthy myself, both mentally and physically, while I find ideas to share and answer questions from readers. Please let me know what you’d like to read about or share interesting articles you’ve read elsewhere that might provide ideas to share here. You can email me directly at Jeannie.beaudin@gmail.com or just hit the “Comments” button below or on the right!

References:

Why you don’t need to read those productivity guides

Seneca, on the greatest obstacle to living a more fulfilling life

On the Shortness of Life, Seneca. Full text (translated)

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Start a Happiness Project

Think of happiness as something you can decide on, something you can practice and get better at… Does that sound strange? Scientists say, the more you choose to focus on being happy and having positive thoughts, the happier you can become.

Your brain is “plastic”. It constantly changes, making new connections as you learn something new or create a new memory, and it strengthens the connections that are used most often. Think of a new skill or hobby you’re learning – the more you practice, the easier it becomes to do it.

It’s the same, experts say, with your thoughts. The more attention you give to the happy, pleasant things in your life, the better you will remember them looking back at the end of the day, week, or year. Your whole life will just feel happier, because that’s what sticks with you.

Survival of the busiest…

Darwin’s theory, “survival of the fittest”, explains how species gradually evolve over time. Psychologists use the term “Neural Darwinism”, or survival of the busiest connections, to refer to our brain’s ability to change over time according to what we focus on and learn. Just like muscle, the brain builds up the parts that are used most. They have actually measured thickening in certain parts of the brain that are used more. For example, taxi drivers who memorize streets in large cities have thickened layers in the hippocampus area of their brains, the area where visual-spatial memory is stored.

And brain pathways that aren’t used become weakened and wither over time. Limiting the time spent dwelling on sad events from the past, for example, means that over time our ability to pop these thoughts into our mind will lessen. Of course, we all have negative, unpleasant things that happen to us, but dealing with them as best you can then setting them aside in your thoughts can mean they will have less impact on your life and you will be a happier person.

You can also try to find something positive in an unpleasant situation – did you learn something from what happened? Can you find a way to do it better next time? Did it bring you closer to those you love? Take any positivity you can and move on. You can’t change the past. But you can limit how much effect it has on your future.

For some people, writing a journal of positive thoughts at the end of the day can prompt them to focus on the positive in their lives. For others, simply taking a few seconds to appreciate what is pleasant as it happens is all they need to do to reinforce these memories and feelings.

So, train your brain to be happy. What you focus on and practice regularly will eventually become a habit. Make it a project to consciously decide every day to dwell on the best things in your life, and very likely you will soon find you are a happier person.

Further reading:

The Happiness Habit

Hardwiring Happiness, by Rick Hanson, PhD

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Health Public Health

Could antibiotics increase risk of disease?

New research suggests that antibiotic use during pregnancy and in early childhood may affect a child’s chances of developing asthma, obesity, Crohn’s and other inflammatory bowel diseases later in life, and increase risk of severe infection in the first 6 years of life.

A baby’s first contact with bacteria is during birth. The organisms in the mother’s birth canal will be the first to become established in the baby’s digestive system and on the skin. If a baby is born by Caesarean section, she will acquire organisms from the mother’s skin and from whatever she contacts in the hospital.

In my June 15th blog, The world inside…, I talked about how the types of bacteria, viruses, fungi and other organisms we have in our digestive systems (collectively known as the “microbiome”) can change the way the immune system works, especially in early life when the immune system is “learning” how to function. Studies I found this week suggest that this effect can extend to later in life and perhaps even to the next generation.

Obesity

In agriculture, animals are given antibiotics to promote their growth and weight gain, increasing production. The effect is believed to occur by changing their gut microbiome. It has been proposed by scientists that a similar effect could be expected in humans. Depending on the antibiotic, growth could be promoted or stunted, the same as what is seen in animals.

An article published in the National Review of Endocrinology suggests an altered microbiome in early life could have long-lasting effects on weight, possibly contributing to 10-15% increases in rates of obesity. This article also describes how researchers have demonstrated in animals that antibiotic exposure early in life has a longer-lasting effect than when given later. This supports the premise that antibiotics have a greater disrupting effect if given while the microbiome is becoming established in the early years. In humans this happens in the first 3 years of life.

Infections

One study published in the International Journal of Epidemiology showed that antibiotics taken by an expectant mother before or during pregnancy, especially in larger amounts and close to the birth, were associated with an increased chance that the child would later be hospitalized for an infection. This is believed to be caused by an antibiotic-induced change in the microbiome, passed from the mother on to the baby, that changes the way the immune system develops in the newborn.

Inflammatory diseases

Another study reported that 7 or more courses of antibiotics in childhood increased risk of developing Crohn’s disease 7-fold. Celiac disease was also associated with early antibiotic use and these effects were greatest when the medications were given during the first year of life.

Asthma

Increased antibiotic use has also been found in many studies to be associated with asthma, but it is yet to be proven that antibiotics or resulting changes in gut microbiome are the cause. Some researchers have suggested that infections severe enough to require an antibiotic or some other factors could be contributing to the increased risk of developing asthma. So, lots of controversy…

The hygiene hypothesis

The “hygiene hypothesis” originally suggested too little exposure to infections as a child could disrupt development of our immune systems and cause increases in allergic and inflammatory diseases. Researchers now also suggest that overuse of antimicrobial soaps and strict avoidance of exposure to non-infectious bacteria in early life in an effort to avoid contact with disease-causing bacteria may contribute to both a poorer quality microbiome and a malfunctioning immune system. It seems that it’s a matter of balance: too little exposure to microorganisms may create immune problems, and too much exposure may increase risk of infectious disease. The big question is, what is the best level? That hasn’t been determined yet but, for now, experts recommend spending lots of time outdoors in nature where we will be exposed to plenty of healthy natural organisms, especially children with developing immune systems.

We need more research…

More research is needed to determine whether antibiotic is increasing risk of allergic and autoimmune diseases. Fortunately, in the past 10 years there has been increased interested in investigating links with antibiotic use, changes in microbiome and how this could affect us. This research is especially important as there have been substantial increases in asthma, allergies, and autoimmune diseases, such as Multiple Sclerosis, Lupus and inflammatory bowel diseases like Crone’s and Celiac disease in the past generation as antibiotics have become more widely used. We need to learn whether it’s just a coincidence or a cause…

There is no question that we benefit from proper use of antibiotics. They can save lives. But too often they are used when unnecessary or for viral infections like colds and flu when they have no effect. Increasingly, healthcare professionals are recommending probiotics to help our microbiome recover after a needed course of antibiotic treatment, as they become aware of the negative consequences of damage to our gut organisms.

So, if you’re sick with an infection, don’t just go to your doctor and demand an antibiotic. Ask if you truly need this medication, take the lowest level antibiotic that will work if you do need one (ideally one that has been identified by a culture to work on the infection you have), and ask what you can do afterward to repair any damage to your gut microbiome. This could include probiotics and a change in your diet to help stimulate growth of your good organisms.

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Health

4 Things you should do to avoid becoming a frail little old lady (or man)…

Becoming frail when you get old isn’t inevitable… Researchers have found 4 things you can change to increase your chances of being able to move easily and do all the things you want well into old age.

4 things you should do to to prevent becoming frail:

  1. Watch your weight. Keep your weight in the normal to overweight class. Those who are very overweight, classed as “obese” have a 7.9% chance of having difficulty getting around when they’re old compared to 2.9% of those who are a healthy weight.

    1. Not sure what’s normal? Here’s a link to a chart that can help you figure it out, or a calculator that will give you a Body Mass Index (BMI) number.

    2. Aim to have a BMI between 18.5 and 29.9, although some recent studies suggest people with a BMI between 25 and 29.9 live the longest. Being underweight is considered as risky to your health (statistically) as being obese.

  2. Be active, ideally every day, but at least for 30 minutes 3 times a week. This recommendation just makes sense – muscles that aren’t used wither and become weak over time. As some will say, “use it or lose it”!

    1. Note that it doesn’t have to be strenuous exercise, just walking will do. And it doesn’t have to be 30 minutes straight of exercise. Ten minutes 3 times during the day works just as well.

    2. If you carry a phone around with you, an easy way to measure your activity is to install a free pedometer on it. I tried out a few and the one I like best is called Pedometer Step Counter. It tracks steps, distance, calories burned and time, and allows you to set goals if you want. You can look back by day, week or month to see how you’ve been doing. It’s really fun to see how far you’ve walked when on vacation… I walked over 150 km a month when we were in Spain last fall!

    3. By the way… the photo above is of a 90-year old who teaches yoga! Here’s her story as told on ABC News in 2013…

  3. Don’t smoke. This one probably has something to do with losing lung function… 5.4% of smokers became frail in old age, compared to 3.5% of non-smokers. But smoking also causes inflammation (see #4) so could be causing frailty and contributing to the aging process in several ways. There are so many reasons to quit… Smoking makes your skin age more quickly too, by the way, so quitting will help keep you looking your best!

  4. Reduce chronic inflammation. Two proteins are found in your blood that tell doctors how much inflammation might be hiding in your body.

    1. The first is called interleukin-6, and it is an indication of inflammation levels in the body. Higher interleukin-6 means you have more inflammation, and that’s an important factor in aging and disease. More about that later…

    2. The other is C-Reactive Protein (CRP), another marker of inflammation. Some doctors have started checking CRP levels to determine their patients’ risk of heart disease.

      1. Production of both interleukin-6 and CRP proteins can be decreased by cutting down on sugar intake and reducing stress.

Chronic inflammation

A Harvard Health article refers to inflammation as a “unifying theory of disease”. Often thought of as a result of disease, inflammation has been shown in newer studies and observations to be part of the cause of many diseases. Mounting evidence suggests that coronary artery disease (that leads to heart attacks), diabetes, cancer and Alzheimer’s Disease all include inflammation as part of their causes.

We recognize acute inflammation by the heat, pain, redness and swelling it causes. This is part of the body’s response to injuries, like cuts, scrapes, and sprains, to foreign substances, and disease-causing organisms like bacteria and viruses. Acute inflammation is part of our immune system’s protective action. The problem occurs when the helpful inflammation is not turned off afterward. This leads to chronic inflammation that can cause aging and disease.

We all have a certain amount of chronic inflammation and for many it stays under the radar, only to be noticed by a blood test. Anti-inflammatory drugs like aspirin and ibuprofen reduce inflammation and this is likely part of the reason that low-dose aspirin helps to prevent heart attacks along with its ability to prevent blood clots.

But many chronic diseases have been observed to occur less often in people who are taking anti-inflammatory drugs for other reasons, such as for pain or arthritis. Over a hundred years ago, it was observed that sugar levels in the urine of people with diabetes were reduced when they took high doses of sodium salicylate, a form of aspirin. It was even documented that sugar in the urine could be eliminated in some people with milder cases of diabetes. Of course, that doesn’t say that their blood sugar, the more important reading, was completely reversed, but it was a very interesting observation.

Cancers of the liver, cervix and stomach which make up about 15% of cancers, are closely tied to levels of chronic infectious diseases, generators of chronic inflammation. Cigarette smoke, a known cause of lung cancer, and asbestos, associated with a type of cancer of the lining of the chest, both contain ingredients that cause inflammation.

Inflammatory reactions produce reactive forms of oxygen that can damage cell DNA, and this damage can lead to the initiation of a cancer. Fruits and vegetables contain many anti-oxidants that can neutralize these free oxygen radicals, and this is likely one way that these foods help to prevent heart disease and cancer. They probably help to prevent diabetes and Alzheimer’s, too, through the same mechanism… reducing inflammation in the body.

Here’s what you can do…

The good news is that there is lots you can do to reduce inflammation in your body and keep your cells from aging more quickly. Eat a healthy diet with lots of fruits and vegetables, and avoid high amounts of added sugar, refined carbohydrates (like white flour), and processed foods, especially those containing trans fats. Reduce stress as much as you can and exercise regularly, as it reduces the negative effects of stress on your health as well as keeping you fit.

Make sure you seek treatment for any infection, complete the treatment and go back if it’s not completely cleared. And talk to your doctor about whether you would benefit from a low dose of the anti-inflammatory, aspirin.

Other research

In an earlier blog “On family dinners and living longer” I described research on Blue Zones, areas where significant numbers live beyond the age of 100 years… click here if you missed it.

References:

Old before your time? Daily Mail, UK

Inflammation and Insulin Resistance, Journal of Clinical Investigation

BMI Calculator

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The world inside…

We humans, each of us, have trillions of microbes that live inside and on the surface of our bodies – most experts say about 4 pounds worth. These include over 10,000 different types of microbes (including bacteria, viruses, and fungi), collectively known as our “microbiome”. And having a larger variety of microbes in our system may actually be a protector against future illness, as new research suggests they give us resilience against disease.

For many years we only heard about bad bacteria, viruses and fungi that cause disease. But the truth is, most organisms are beneficial, and, in fact, we can’t live without them. We need to think of these good microscopic inhabitants of our bodies, as a part of us that we need to keep healthy. We have a “symbiotic” relationship: we evolved together and rely on each other for survival.

The pharmacy school at the University of Toronto recently hosted an online Town Hall Medicine summit on the microbiome, where 21 researchers spoke about results of research they have been conducting in this area. I listened to most of the lectures and want to share some of what I learned. The series is still available (for a fee) if you are interested in learning more.

What do microbes do for us?

These microorganisms perform many bodily functions for us: from helping to digest our food and absorb nutrients, to protecting us from disease, to controlling how our immune system functions, and more. Although they’ve been researching our microbiome for over 10 years, scientists are still learning new ways they interact with our human cells with significant increases in understanding in the last 5 years. They now believe there is a connection between the make-up and health of the microbiome and obesity, autism, allergies, intestinal health, responses to drugs, rheumatoid arthritis, Type 1 diabetes and many other conditions.

Inflammatory diseases, like Multiple Sclerosis (MS), asthma and Crohn’s disease, have been on the rise over the past 50 years. Researchers have proposed the “hygiene theory” which suggests that decreased exposure to microbes, through overuse of antibacterial agents and just being too clean, has lead to decreased diversity of our bodies’ beneficial microbes. Some evidence suggests that exposure to good bacteria in the early years of life is crucial to avoid inflammatory diseases, such as asthma and inflammatory bowel disease, later in life. Think of it as giving your immune system “exercise” to help it strengthen and learn to function properly.

The gut and the brain “talk” to each other…

Recently they have even identified communication between gut bacteria and the brain, through hormones, nerves, and chemicals known as neurotransmitters. They believe that this communication affects our mental health. What we eat influences the composition and activity of the microbiome and this has lead to research on how our diet could influence mental health. For example, newer studies suggest eating a western diet of highly processed food may increase risk of depression and anxiety. But choosing a Mediterranean diet, with higher amounts of vegetables and good fats like olive oil, may reduce risk of these mood disorders. This field of study is called nutritional psychiatry.

We also have a major nerve, called the vagus, that directly connects the brain and the gut. Years ago, surgeons would sometimes cut this nerve in patients who had ulcers caused by stress. The ulcers healed, but many patients developed psychiatric problems afterward. It turns out that this nerve is a two-way street, carrying messages from the gut to the brain as well as in the other direction, and it’s another important way our gut and our brain communicate.

I’ve read about an abdominal breathing technique that is suggested help with relaxation: the belly is pushed out during inhalation and pulled in while exhaling. I’d always thought this was just a distraction technique, a type of meditation to take a person’s mind off their troubles. But I’ve learned that this abdominal movement can stimulate the vagal nerve when done correctly, actually creating a relaxation response in the brain. However, experts stress that it requires practice to be able create a full parasympathetic relaxation response that is useful during an episode of stress. Seems like a worthwhile skill to develop!

Exposure early in life is important

Studies of asthma and allergies are very telling. Children who receive an antibiotic in the first year of life have higher rates of asthma. Studies also suggest growing up on a farm, with a dog, or being born by natural birth versus by sterile caesarean section can result in lower risk for asthma and allergies. All of these affect the types of bacteria a child is exposed to early in life and therefore will incorporate into their digestive and other systems. It seems that exposure to organisms in the first 3 years of life – while the immune system is developing – is more important with longer-lasting effects than later in life when our systems are well-established. Trying to repair and maintain a microbiome that is damaged as an adult is more difficult than establishing a healthy one in the first place and requires ongoing effort. Researchers describe extinction of entire species of microbes in the inside world, the gut, of some populations. And they can be very difficult to reintroduce, just as it’s almost impossible to reintroduce animal species that have become extinct in the outer world. Keep in mind that a typical probiotic capsule contains less than 10 species of organisms, compared to around 10,000 species in a healthy adult. Although probiotics can help some, we need to do more.

How can we help out our gut microbes?

Factors that affect the composition of our microbiome include the types of food we eat and where we spend our time. With modern urban living, many can spend as much as 90% of their time indoors. Simply spending time in nature can change the types of organisms we take into our bodies. Bringing fresh fruits, vegetables and plants into the home can help recreate “the farm effect” with benefits to our microbiome.

Eating fermented foods can also help, as the fermentation process creates many beneficial bacteria. One expert recommends five servings per week of at least three different types of fermented foods. These foods also provide fibre, which feeds good bacteria. Although raw foods contain more live bacteria than those that have been cooked, even organisms killed in the cooking process benefit the immune system.

Just like a garden…

One expert, Anne Bikle, who is also an avid gardener, describes our large bowel as a “garden” and a “medicine chest”, producing substances that protect us from abnormal, potentially cancerous, cells as well as infections. She tells us that 40% of the compounds in our blood are made by our microbiome, and that we are as much microbial as we are human. She suggests we need to treat our digestive system as we would a garden: feed it plenty of fiber and nutrient rich plants, just as you would add nutrients and compost to soil to have a healthy garden that produces tasty vegetables or beautiful flowers. Her advice in a nutshell? “Mulch your garden soil, inside and out”. Keep your inside world and your outside world healthy…

Reference:

Town Hall Medicine, University of Toronto, Leslie Dan Faculty of Pharmacy

Are we more microbe than human?

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Could pizza prevent cancer?

Italian scientists at the National Cancer Institute in Naples claim they have designed a cancer-preventing pizza. Their Pizza Pascalina is being called “the pizza that extends life” and an “anti-tumour” pizza.

North American pizza is generally thought of as an unhealthy treat… so what’s the difference with this new style of pizza?

First, there is no cheese or meat on it. The ingredients, chosen for their ability to decrease risk of heart disease, stroke and some types of cancer, are common in the Mediterranean diet.

It has fresh tomatoes which contain vitamins and minerals, and some research suggests tomatoes may slow the growth of some cancers.

It also has olives and olive oil – basic ingredients of the healthy Mediterranean diet that contain healthy fats our bodies need. Broccoli is another vegetable in the recipe that provides vitamins and minerals and has been shown to reduce risk of various cancers, according to some research.

Here’s my version of this recipe:

  • Whole wheat crust

    • 4 cups whole wheat flour (bread flour is best)

    • 2 tsp (1 envelope) instant rise yeast

    • 1 tsp salt

      • Mix together then add:

    • 1 1/2 cups warm water

    • 2 tbsp olive oil

    • 1 tbsp honey (optional – helps “feed” the yeast)

      • Mix, then knead until smooth and elastic, 5 – 10 mins

        • To knead, fold dough in half towards you, push away with heels of hands, turn dough 1/4 turn, and repeat. Add flour underneath and on top as needed to prevent sticking.

      • Let rest for 10 mins, then spread in pizza pans (makes 2 pizzas)

      • Meanwhile, prepare desired amount of toppings:

  • Cherry tomatoes (halved)

  • Rapini (a type of broccoli) – finely chopped (I used regular broccoli)

  • Ripe olives (Kalamata) – pitted and sliced

  • Extra virgin olive oil

  • Garlic

  • Onions

  • Chilli or other spices/herbs as desired (I used tarragon, oregano and basil)

    • Fry onions and garlic in olive oil until softened

    • Add tomatoes – fry until excess liquid is mostly evaporated

    • Add finely chopped broccoli

    • Spread 1 to 2 tbsp olive oil on uncooked pizza crusts

    • Add toppings from pan

    • Sprinkle on sliced olives, herbs and/or spices

    • Bake at 500F 10-15 mins, or until browned on bottom and edges

I didn’t miss the salami or pepperoni at all, but I did add some cooked seafood (small scallops, shrimp) to mine to make it tasty! And I cheated just a little and added a small amount of Asiago – a strong cheese that you don’t need much of to add flavour. A small amount of Parmesan or Feta would work too, and these provide some calcium that our bodies require. It’s all about the amount you add… everything in moderation!

I love making pizza and have been making it for many years, but I think this was the best one I’ve ever made… tasty as well as healthy! Researchers say this one is healthy enough to have it twice a week.

Let me know how yours turns out if you decide to try it!

Reference article:

The Cancer-Preventing Pizza

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Health

Doing what successful people do…

Many of the most successful people, like Bill Gates and Elon Musk, have an interesting habit. They spend time every day learning something new.

Are you trying to keep your brain sharp? Or do you want to get ahead in your career? Lifelong learning – setting time aside to learn something new every day – can help, especially if you choose to learn specific skills that contrast with what you already know or do for a living.

Learning opposing skills and integrating them with what you already know has a fancy name –”Integrative Complexity”. Think of it as becoming a more complex person by integrating new knowledge. Many of us avoid learning skills in areas that are outside our comfort zone. But these are the skills that can challenge you to expand your mind and capabilities, both in your personal life and at work, more than just learning more about something you already know. Continually learning new ideas and skills throughout your life keeps your brain sharp too! Your brain actually forms new connections between its neurons (nerve cells) as you learn.

Some examples…

As a pharmacist I had to study a large amount of scientific information. For over twenty years, I have done formal reviews of pharmacy education programs. This was much more professional education than was required, but I enjoyed and appreciated the opportunity for exposure to the newest ideas and information. After I sold my business, I had a chance to improve my second language, French, by working in an area where French was spoken. I’d always wanted to speak the language better! Although it was very different from learning about my scientific profession, I enjoyed my new skill so much I decided to work on a third language, Spanish. I found a free app called Duolingo, that sends me reminders every day. Now I just need to find someone in my area of Canada to help me practice speaking Spanish!

At the same time, I decided to write down “everything I’d learned about hormones” into a book. I wanted to record the information I’d learned about how hormones work, what happens when they get out of balance, and what can be done to rebalance them again in a format where others might find useful. I quickly realized that writing a book is a lot different than writing articles, as I’d been doing for pharmacy journals for over ten years. So, I decided to study writing techniques and skills…all about words, grammar, and how to get ideas across effectively in written form. This blog is one way I’ve been practicing my new skills. I’ve learned a great deal about the craft of writing in the past two years, and will continue to learn for years to come, I expect!

What if you don’t have the time?

Integrative Complexity, learning and integrating skills of diverse types and reading/learning daily, is a common trait of highly successful people like Barak Obama. We might think these busy people would have difficulty finding the time to read an hour a day. However, they regard learning as an activity important enough to justify the necessary time.

How can you create time for learning? One way is by reducing time spent on TV and social media. Another is to “multi-task” by listening to learn as you do another activity like driving or household chores. Most books are available in audio form now, and audio lectures, courses and educational podcasts abound on the internet, many at no or low cost.

Where to start?

A simple internet search can find information sources that interest you. Udemy is a website I came across with courses on many topics, and I found some excellent writing courses there. Digital Photography School’s website is where I indulge my passion for photography, reading tips and short articles each week. This educational blog format is particularly useful for those who just want a new ideas on their chosen topic on a regular basis. I also signed up for a wonderful free online photography course, A Year With My Camera, in January that’s taught me many new skills. They send a weekly email with information, techniques and exercises to practice what was discussed.

Choose a learning goal…

But, learning is most effective when we have a goal that we work toward, rather than just learning random facts and ideas. Putting what you’ve learned to use right away (as I’ve been doing with my writing skills in this blog) helps you to remember and integrate information, too. Experimenting with activities that use your new knowledge can also help you to learn quickly what else you need to learn to improve your new skills further.

So, take a minute to think about what you’d like to learn, or what you’ve always avoided doing because you feel uncomfortable about trying it. Research sources of information (YouTube.com is great for this) and wade in! Your brain and your career will more interesting and no doubt you’ll gain a sense of satisfaction and pride from your new skills…

Happy learning… and let me know if I can help (especially if one of your goals is to learn to be healthier!).

Sources and further reading:

Integrative complexity

5-Hour Rule (spending at least 5 hours a week learning)