Resolving stress

We all have to deal with some level of stress.  Stress can be beneficial and sometimes saves your life, especially if you have to run from a tiger (or other similar situation).  As your amazing body shunts the blood to vital areas so you can flee, or fight or get everything done that you have to do that day, you have extra power to move and act.  However, when we are using our reserves because we have created a pattern of unnecessary stress due to our reactions to daily life, we are literally burning up our life force faster than we can build it back up, just like burning our candle at both ends, or even throwing the candle in the fire.  These patterns can be hard to break once we have become accustom to them, it is hard to see how we could exist any other way.  The problem is that when you are using your blood in your muscles and not to digest and assimilate your food and nutrients, or running instead of restoring your muscles and tendons, your body will literally break down leading to increased injury, illness and a shorter life.

So how do we change these patterns and find balance?  Starting with simple routine can be quite profound.  There are cycles of hormones, like cortisol, going on in your body signaled by light, food, and time.  If you work with these patterns transitions into balance can seem effortless.  

The following recommendations are based on extensive research on biomollecular physiology and have been shown to have measurable effects on health:

•  Keep patterns of waking, sleeping and eating that are in line with the light of day.
  
•  Eat 3 healthy meals a day that include 7-9 servings of a variety of fruit and vegetables in a variety of colors.

•  Have breakfast between 7-9, within 2 hours of waking.  

•  Include protein and fat, and avoid all processed carbohydrates (flour, sugar, processed oatmeal, or any bread or pastries) especially in the morning.  

•  Have a snack (not refined carbs) around 11 am, and 2 pm.

•  Have dinner before 7 pm and 2 hours before bedtime.

• Practice finding peace in your heart and mind through meditation, prayer, breathing exercises or anything that works for you on a daily basis.  Coherence is a term used to describe the heart and brain connection that can be measured by proven tools such as an EmWave2® so you can evaluate whatever method you choose for effectiveness on your own or in a class.

•  Adaptogens like ginseng, rhodiola and others can help put a cap on the stress response and nutrients like L-Tyrosine, theanine and others can help support the neurotransmitters and hormones that maintain stability in the body and brain.  Always consult your practitioner to get a personalized recommendation plan prior to purchasing these types of supplements as type and timing should be individualized for optimum benefit and safety.

Dietary considerations are important, so here is some more information about the basics in relation to stress:

Every bite of food affects our entire body, it's chemistry and neurons.  Sugar, including processed carbohydrates like bread, quickly raise your glucose level.  Your body has to process that glucose to maintain balance so it quickly absorbs the energy, uses what it can and stores what it can't use now as fat, often flooding the body with insulin to help with the process.  If we eat a diet that often raises our blood sugar quickly (high glycemic index) this system can be overwhelmed leading to insulin resistance, inflammation and a vast array of diseases, not just diabetes.

Fats have gotten a bad name because most of the fats we eat have been destroyed with processing, and chemicals.  The science that originally showed fat was causing disease did not take sugar into account as a variable.  We have just begun to explore the incredible importance and complexity of this vital category of nutrition.  Good fats digest slowly helping us maintain our stable blood sugar preventing inflammation and keeping our mind, body and spirit nourished and stable.  Fats make our cell walls, our brain (which is 60% fat), and our hormones and can be slowly broken down or easily excreted if the energy is not needed, helping us to loose weight.  The idea that calories are calories is antiquated as we clearly understand now that not all food acts the same in the body and different forms of calories (even from the same food, like fruit juice vs. fruit) act completely differently in our body.  Fats like coconut oil are even being used successfully for weight loss, and being prescribed by all sorts of practitioners, allopathic and alternative to prevent and treat disease.  Omega 3's have been shown to help with heart problems, inflammation, ear infections, allergies, and more (references will be added at a later date, please contact me if you have any questions about the research to support any part of this post).

Protein is another crucial building block of our bodies, muscles, immunity and more.  It also stabilizes blood sugar and can be used to help maintain and rebuild our bodies.  Too much protein fat or carbs can cause imbalance.

Not having essential nutrients that we get from eating a wide variety of vegetables can create unnecessary stress on the body.  I recommend a basic nutrient supplement along with a healthy diet for everyone because to ensure adequate nutrient and co-factor intake.  Co factors such as zinc or magnesium are crucial for many processes in the body that have to do with maintaining balance and preventing and recovering from stress.  Different people will benefit from different 


The Need for Relevant Acupuncture Research

A paper written for Graceland University 
by Sarah Piestrup EAMP, Dipl OM, RN

Some promising research is being conducted that sheds light on a few of the mechanisms behind the effects of acupuncture. These include adenosine, endomorphin-1, beta endorphin, encephalin, and serotonin release and fMRI changes (Cabyoglu, Ergene, & Tan, 2006; Fang, et al., 2004; Goldman, et al., 2010; Hui, et al., 2005). There is even theory that shows a plausible explanation for the physical existence of acupuncture channels just under the skin and between muscles (Silberstein, 2009). However, most research looking at acupuncture for allopathic diagnoses in humans is simply irrelevant.

Because acupuncture is based on an ancient Asian conceptual framework it is difficult to transfer meaning into modern allopathic scientific understanding. Studies that look at “Traditional Chinese Medicine for treatment of fibromyalgia” are as irrelevant as a study looking at “Allopathic medicine for heart fire.” With detailed study design it can be done, and scientific studies have shown some benefits of acupuncture as compared to placebo (Cao, Liu & Lewith, 2010). However, because fibromyalgia does not have one equivalent diagnosis in Traditional East Asian Medicine (TEAM), the meaning of this word is irrelevant to what points or modalities are chosen to treat an individual patient. In other words, the individual patient would normally be diagnosed with a TEAM diagnosis that would be different for different patients with the allopathic diagnosis of fibromyalgia, and different treatments would be rendered based on that individual TEAM diagnosis. There are many ways to treat this one allopathic diagnosis based on the person’s underlying constitution, their specific symptoms and how they all relate to their specific lifestyle. Indeed, there are many different styles in the TEAM system that could be used, making conducting a controlled study very difficult.

Some levels of control, like consistency of treatment details, such as specific point use, would render the study irrelevant because they would remove the theoretical basis and diagnosis of acupuncture when used with placebo needling which is sure to stimulate a nearby point. In this type of case we are left with a study that is comparing bad acupuncture to bad acupuncture. It would be just as irrelevant as an allopathic study on an acupuncture diagnosis that has no relevance to modern terminology and no allopathic diagnostic equivalent.

Volker Scheid helped shed some light on some of the deeper aspects of this problem (such as a lack of consistency within the acupuncture community in regards to terminology and diagnoses) with his papers and research that scientifically examines the system of Chinese medicine. He illustrates how the terms used to describe patterns such as menopause are westernized in modern acupuncture schools and textbooks. These oversimplify the medicine and ignore the meaning of the time-tested system (Scheid, 2008). He also had a hand in research looking critically at this problem with a review of the literature on the treatment of menopause with TEAM (Scheid, et al., 2010). This type of refinement is crucial for TEAM to be critically analyzed with any relevance. It is useless to study it without a clear understanding of the basic diagnosis and terminology that define a medicine.

TEAM is the longest continually practiced literate medicine used consistently worldwide with the first known evidence of acupuncture on Otzi the Iceman; a 5,300 year old mummy found in Austria who had tattoos of acupuncture points used today for lumbar lordosis of which his spine showed evidence. This long history must not be lost to modern confusion because TEAM is a far too important and valuable system of medicine to loose.



References

Cabyoglu, M. T., Ergene, N. & Tan, U. (2006). The mechanism of acupuncture and clinical applications. International Journal of Neuroscience, 116, 115-125.

Cao, H., Liu J., & Lewith, G. T. (2010). Traditional Chinese Medicine for treatment of fibromyalgia: A systematic review of randomized controlled trials. Journal of Alternative and Complimentary Medicine, 16(4), 397-409.

Fang, J. L., Krings, T., Weidemann, J., Meister, I. G. & Thron, A. (2004). Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints. Neuroradiology, 46(5), 359-62.

Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., ... Nedergaard, M. (2010). Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience, 13, 883-888. Retrieved from http://www.nature.com/neuro/journal/v13/n7/full/nn.2562.html

Hui, K. K., Liu, J., Marina, O., Napadow, V., Haselgrove, C., Kwong, K. K., Kennedy, D. N., & Makris, N. (2005). The integrated response of the human cerbro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage, 27(3), 479-96.

Otzi the iceman. (2011). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/%C3%96tzi_the_Iceman

Scheid, V., Ward, T., Cha, W., Watanabe, K. & Liao, X. (2010). The treatment of menopausal symptoms by traditional East Asian medicines: Review and perspectives. Maturitas. doi: 10.1016/j.maturitas.2009.11.020

Silberstein, M. (2009). The cutaneous intrinsic visceral afferent nervous system: A new model for acupuncture analgesia. Journal of Theoretical Biology, 262(4), 637-642.

The Clinically Relevant Value of Meditation


A paper written for Graceland University
by Sarah Piestrup, RN, EAMP

Meditation is a cost effective and clinically proven tool that can benefit a myriad of health disorders. Aftanas and Golosheykin (2005) looked at electroencephalograms (EEGs) in a controlled environment to empirically show that meditators have more control over their reactions to stressful situations or “intensity of emotional arousal” (p. 894). According to the studies reviewed by Koopsen and Young (2009), meditation can provide physiological benefits such as a decrease in: oxygen consumption, blood lactate levels, cortisol levels, heart and respiratory rates, blood pressures, muscle tension, and pain and an increase in: skin resistance, alpha waves, and psychological benefits. These emotional and physiological effects have far reaching benefits to the health of a patient as well as the effectiveness of a health care provider if they too engage in conscious awareness.

Astin, Shapiro, Eisenberg, & Forys (2003) review a collection of cumulative clinical evidence that “lends strong support to the notion that medicine should indeed adopt a biopsychosocial rather than exclusively biologic-genetic model of health” (p. 141). They identify meta-analyses and randomized controlled trials that have shown mind-body medicine has effective benefits with: chronic low back pain, coronary artery disease, headache, insomnia, surgical procedure preparation, symptoms of cancer and its treatment, arthritis and urinary incontinence (Astin, et al., 2003). Grossman, Niemann, Schmidt, & Walach (2004) find that improvements in health are consistently seen in a variety of standardized mental health measures and measures of disability with mindfulness-based stress reduction. Other health parameters such as medical symptoms, sensory pain, physical impairment and functional quality of life estimates were also found to have benefits from mindfulness-based stress reduction (Grossman, et al., 2004).

Jung, et al. (2010) give us some clues about the background physiology of these positive effects. They looked at 67 subjects who regularly engaged in mind-body training vs. a control group of 57 healthy subjects and compared their plasma catecholamine (norepinephrine, epinephrine, and dopamine) levels as well as their positive and negative affect scores, and showed: lower stress, higher positive affect, and higher plasma dopamine levels in the meditation group.

A state of heart centered consciousness that can be achieved through meditation or even quick redirection of attention is contagious. A high state of “coherence” affects others in the room to also a achieve a high state of coherence (McCraty, Atkinson, Tomasino & Bradley, 2006). Coherence has been measured with reliable instruments and has shown health benefits in numerous studies over the past 20 years (McCraty, et al., 2006). Practitioners can have positive effects on their patients during a therapeutic encounter if they practice coherence (McCraty, et al., 2006). Nursing literature has examined similar phenomena under the term “presence” and researchers like Zyblock (2010) identify presence as having a sustained therapeutic effect. The Annals of Internal Medicine even has articles on healing skills for physicians that outline themes such as being open, listening, removing barriers and sharing authority (Churchill & Schenck, 2008).

Simple meditations can be easily taught by trained physicians and ancillary staff in a short amount of time and patients can be referred to a growing number of highly trained individuals who specialize in a variety of forms of mindful practices. With so many options and variations, all patients and providers should be able to find some form of mediation that works for them and implement them into daily practice.



References

Aftanas, L., Golosheykin, S. (2005). Impact of regular mediation practice on EEG activity at rest and during evoked negative emotions. International Journal of Neuroscience, 115: 893-909. doi: 10.1080/00207450590897969

Astin, J. A., Shapiro, S. L., Eisenberg, D. M. & Forys, K. L. (2003). Mind-body medicine: State of the science, implications for practice. Journal of the American Board of Family Practice, 16(2), 131-147.

Churchill, L. R. & Schenck, D. (2008). Healing skills for medical practice. Annals of Internal Medicine, 149, 720-724.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindful-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomic Research, 57, 35-43.

Jung, Y. H., Kang, D. H., Jang, J. H., Park, H. Y., Byun, M. S., Kwon, S. J., ... Kwon, J. S. (2010). The effects of mind-body training on stress reduction, positive affect, and plasma catecholamines. Neuroscience Letters, 479(2), 138-42.

Koopsen, C. & Young, C. (2009). Integrative health: A holistic approach for health professionals. Boston, MA: Jones and Bartlett Publishers.

McCraty, R., Atkinson, M., Tomasino, M. & Bradley, R. T. (2006). The coherent heart. Boulder Creek, CA: The Institute for HeartMath

Zyblock, D. M. (2010). Nursing presence in contemporary nursing practice. Nursing Forum, 45(2), 120-124.

A new view of statins fats and cholesterol

A quick look at some new compelling research on statins, fat and cholesterol : 
Cholesterol is not just pathogenic, in fact it is what our brains, and artery walls are made of.  In a review of 136,905 hospitalizations for CAD almost half had LDL levels less than 100, and more than half had HDL levels less than 40 with less than 10% greater or equal to 60. While the authors of this drug company funded study conclude this may mean that the goals may need to be lower for LDL, this could mean that LDL is less associated with CAD than was previously thought (Sachdeva, et. al., 2009).  A recent Cochrane review on statins for primary prevention notes: “evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease” (Taylor, et al., 2010).

It is also concluded that raising HDL is an important priority. In a critical reappraisal of the JUPITER trial which claimed benefit for statin drugs in primary prevention Lorgeril, et. al. (2011) present evidence that the results do not in fact support this conclusion and conclude that “troubling questions” were raised about the role of commercial sponsors. Side effects such as: mytosis and myalgia (from muscle pain fatigue and weakness to rhabdomyolysis) as well as mitochondrial effects have been identified which may affect the brain, heart and other organs that have similar mitochondrial mechanisms. Mitochondial defects predispose to adverse reactions on statins, and statins predispose to mitochondrial defects in all users and to a greater degree in vulnerable individuals (Golomb, et al., 2008).

Astrup, et al. (2010) found no clear benefit of replacing saturated fats with carbohydrates.  There was a benefit in replacing saturated fats with polyunsaturated fats.  The authors concluded that the effects of particular foods on cardiovascular disease can not be predicted only based on their saturated fat content because of the individual saturated fatty acids and other constituents in the food may have effects on cardiovascular disease.  A recent meta-analysis of prospective studies with 5-23 year follow up including a total of 347,747subjects that showed no significant evidence to conclude that dietary saturated fat was associated with coronary artery disease or cardiovascular disease (Siri-Tarino, Sun, Hu & Krauss, 2010). However, trans-fatty acids have specific atherogenic, inflammatory, and pro-thrombic effects (Stachoska, 2004; Mozaffarian, et al., 2004).

Many studies have shown higher lipid levels with an increased risk of coronary artery disease with diets high in added sugars and high refined carbohydrate intake (especially greater than 10% of calories) (Astrup, et al., 2010; Jakobsen, et al., 2010; Sieri, et al., 2010; Wesh, et al., 2010).

These are critical details to consider for individual people.  Educated, logical decisions about statin use and fat intake should include thought about what is right for the whole body and relate to actual health outcomes and not just biomarkers that are loosely related to disease in some people. 


Translation : There is clearly no reason to recommend a statin for primary care prevention.  The evidence that shows some benefit with statin use is on white men, but not women, under age 65 who have hyperlipidemia and could be related to statins anti-inflammatory effect rather than their lipid lowering capability (more to come on this aspect).  Your HDL cholesterol cleans up the extra cholesterol from your artery walls and is more consistently related to cardiovascular disease.  


It's not saturated fat that is the issue, it's destroyed fats and carbohydrates, so anything processed at high heat (including refined oils, or over heating an oil with a low flash point like olive, or old or even slightly heated highly unstable oils like flax, unrefined canola or walnut).  There is a short list on my website, and a link to a book on the subject if you would like even more details on fats.  Sugar and carbohydrates are stored as energy in your body as fat, while fat is used as energy.  So while fat has more calories per gram, it is absorbed more slowly so it helps keep your blood sugar stable and your stress response in check.  Refined carbohydrates lower your HDL or good cholesterol and increase your triglycerides and should be limited or avoided in general.  Even saturated animal fat has beneficial and necessary nutrients for you body.  That being said this means animals that ate their native diets such as grass, NOT GRAINS (even if they are "finished" on grain for the last 3 months of their life) like most of the meat you find at the store and even some called "grass fed" that are "finished."  Here are some resources to find healthy sources of animal protein and organic vegetables.  Never limit nutrient filled vegetables and fruits and eat for variety, of colors, of fats and of all fresh unprocessed foods ! 

References:

Astrup A., Dyerberg J., Elwood P., Hermansen K., Hu F. B., Jakobsen M. U., … Willett, W.  (2010). The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: Where does the evidence stand in 2010? The American Journal of Clinical Nutrition. Advance online publication. doi: 10.3945/ajcn.110.004622

Golomb, B. A., Evans, M. A. (2008). Statin adverse effects: A review of the literature and evidence for a mitochondrial mechanism. American Journal of Cardiovascular Drugs, 8(6), 373-418.

Jakobsen, M. U., Dethelfsen, C., Joensen, A. M., Stegger, J., Tjonneland, A., Schmidt, E. B., Overvad, K. (2010).  Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: Importance of the glycemic index.  American Journal of Clinical Nutrition, 91(6), 1764-1768.  doi 10.3945/​ajcn.2009.29099

Lorgeril, M., Salen, P., Abramson, J., Dodin, S., Hamazaki, T., Kostucki, W., ... Rabaeus, M. (2011).  Cholesterol lowering, cardiovascular diseases, and the rouvastatin-JUPITER controversy: A critical reappraisal.  Archives of Internal Medicine, 170(12), 1032-1036.

Mozaffarian, D., Pischon, T., Hankinson, S. E., Rifai, N., Joshipura, K., Willett, W., & Rimm, E. B. (2004). Dietary intake of trans fatty acids and systemic inflammation in women. The American Journal of Clinical Nutrion,79(4), 606-12

Sieri, S. Krogh, V., Berrino, F., Evangelista, A., Agnoli, C., Brighenti, F., … Panico, S. (2010).  Dietary glycemic load and index and risk of coronary heart disease in a large Italian cohort: The EPICOR study. Archives of Internal Medicine 170(7), 640-7.



Sachdeva, A., Cannon, C. P. , Deedwania, P. C., Labresh, K. A., Smith, S. C., Dai, D. ... Fonarow, G. C. (2009).  Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitilizations in Get with The Guidelines.  American Heart Journal, 157(1), 111-117.  

Stachowska, E., Dolegowaska, B., Chlubek, D., Wesolowska, T., Ciechanowski, K., Gutowski, P., … Turowski, R. (2004). Dietary trans fatty acids and composition of human atheromatous plaques. European Journal of Nutrition, 43, 313-318. doi: 10.1007/s00394-004-0479-x

Taylor, F., Ward, K., Moore, H. M. T., Burke, M., Davey Smith, G., Casas, J., & Shah, E.
(2011). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systemic Reviews, 1. (accession No. 00075320-100000000-03785).

Welsh, J. A., Sharma, A., Abramson, J. L., Vaccarino, V., Gilespie, C., Vos, M. B. (2010).  Caloric sweetener consumption and dyslipidemia among US adults.  Journal of the American Medial Association, 303(15), 1490-1497.