What Really Causes GERD (Gastroesophageal Reflux Disease) and How Should It Be Treated?

by Ram

Damage by Melina Meza

GERD (gastroesophageal reflux disease) is a digestive disorder characterized by recurrent reflux of acid from the stomach into the esophagus triggering heartburn or acid indigestion. The esophagus is a muscular, tube-like structure that connects the throat to the stomach, which is lined by a moist, pink, gel-like tissue called mucosa. The food that you eat moves from your throat down to the esophagus. Two valve-like muscular structures exist in the esophagus to regulate the flow of the nutrients to the correct destination (from the esophagus to stomach to the small intestine). The upper esophageal sphincter (UES) at the top of the esophagus prevents food and other secretions from entering the windpipe by opening or closing at the appropriate time. The lower esophageal sphincter (LES) present at the esophagus-stomach junction prevents the stomach acids from traveling into the esophagus through its appropriate open-close function. 

Gastroesophageal refers to the stomach and esophagus. Reflux means return or flow back. Thus, gastroesophageal reflux is the reverse flow of stomach acids back up into the esophagus, either due to weakening of the lower esophageal sphincter muscles or due to inappropriate closure of the lower esophageal sphincter valve. Certain foods, fermented or fizz drinks, acidic fruits, cigarette smoke, and chronic stress can all cause the lower esophageal sphincter valve to relax, resulting in acid reflux into the esophagus. If this situation happens as a one-time event or acutely it is termed as a heartburn/acid reflux. If it is long lasting and a more serious form or a chronic issue, it is termed as gastroesophageal reflux disease (GERD).  

The most common symptom of gastroesophageal reflux disease (GERD) is heartburn. If the condition persists, additional symptoms may also appear, including a sour taste in mouth, chest pain, difficulty swallowing, dry cough, sore throat, and spewing of sour solids or liquids. Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. Over-the-counter treatments that may help control heartburn include:

1. Antacids that neutralize stomach acid
2. Acid production blockers, also called as H-2-receptor blockers, which provide longer relief and may decrease acid production from the stomach for up to 12 hours
3. Proton pump inhibitors, which are even stronger than H-2-receptor blockers of acid production

However, prolonged use of any of the above-mentioned medications can produce side effects, such as diarrhea, constipation, fatigue, confusion, or bone loss. If the heartburn and other symptoms don’t improve with lifestyle changes and medications, surgery may be the ultimate option. And while the symptoms of the heartburn may temporarily cease through the use of the above-mentioned medications, blocking the acid production is not a good remedy. There is a reason for the presence of acid in the stomach: it is necessary for proper digestion of food. The enzymes that digest the food completely work efficiently in the acidic environment. It is this combination of the acid and the enzymes in the stomach that facilitate efficient digestion of food to a form that can be easily delivered to the small intestine for further digestion and absorption. While the strength of the stomach acid is strong enough to burn a hole through a piece of wood, the stomach itself is well protected from its own acids. However, unlike the stomach, the esophagus does not possess any protective inner lining, resulting in its damage by the acids that shows up as a burning heartburn. This has been the premise so far. 

But now a new research study is changing this long-held paradigm (see Association of Acute Gastroesophageal Reflux Disease With Esophageal Histologic Changes). According to this new study, the stomach acid backing up into the esophagus does not cause chemical burns and damage to the lining of the esophagus as thought earlier. Instead, the researchers from UT Southwestern-Dallas VA hospital suggest that the damage in patients with GERD actually occurs owing to an inflammatory response prompted by the secretion of inflammatory proteins called cytokines. The research work done in mice demonstrates that it takes several weeks for the stomach acid to initiate any damage in the esophagus. So it is unlikely that acids are the cause of the chemical burn since burns develop immediately. In follow-up studies on humans, the researchers followed 12 patients who suffered from chronic GERD. The patients who were taking proton pump inhibitors to control the acid reflux were asked to stop taking the medication. The researchers thought that GERD might redevelop if the medication were to be stopped, providing an opportunity to observe the early changes of GERD. Nearly all of the patients showed damages to the esophagus after stopping the medications. More importantly, the damages that reoccurred were not consistent with acid-triggered burns. Rather, the changes revealed all the tell-tale signs of an inflammatory response, suggesting that the stomach acid in the esophagus actually triggered a pro-inflammatory response by stimulating the production of small molecules called cytokines that trigger’s the body’s own defense system to go awry (see Chronic Inflammation and Yoga: Combating the Fiery Killer).

So what’s in this for the doctors and pharmacists? Since the study challenges a long-held belief about the role of the acid in damaging the esophagus, it is important for medical personnel to have the correct understanding of the mechanisms underlying GERD in order to facilitate novel GERD in order to facilitate novel GERD treatments. 

And what does it mean for people who have the condition and are desperate to jump off the antacid/PPI bandwagon? Good eating habits and good lifestyle practices that include a regular yoga practice go a long way in strengthening the gut. A balanced yoga practice includes asanas, resting poses, pranayama and meditation, all of which support the best possible digestion via our conscious mind and the autonomic nervous system (see The Digestion System and Yoga). As I mentioned in the beginning, chronic stress—which can over-activate the sympathetic nervous system (your Fight or Flight response)—is the single most common trigger of GERD (Our Hyper-Competitive, Stressful World), so consider meditation and restorative yoga practices when you know you are under lots of stress (see How to Practice If You Have Digestive Problems). All of the above practices together with healthy food choices and timely meals will promote a healthy digestion that is required to maintain a long health-span (Why You Should Care About Your Digestive System). So one alternative to consider working your way to healthy aging is by closely listening to your gut!

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More

Chronic Inflammation and Yoga: An Update

by Ram

Yamamoto Takeru no Mikoto between Burning Grass 

by Utagawa Kuniyoshi

In my earlier posts on inflammation (see Chronic Inflammation and Yoga: Combating the Fiery Killer). I discussed inflammation and yoga’s role in dampening the inflammatory response. Briefly, inflammation is part of the body's defense response and involves clearance of toxic pathogens, damaged cells, or harmful irritants from the body. Inflammation has a high beneficial value. For example, if you develop a viral infection or if your back sustains a severe blow, inflammation sets in to care and protect the injured tissue and initiate a healing response. The classical signs of inflammation are pain, heat, redness, and fluid accumulation (swelling), and reflect the body’s defensive strategies that get activated to ward off the damage and heal the injured area. The defensive strategies are carried out by leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, interleukins, and TNF, among others. In a perfect setting, the inflammatory process occurs just as it should, releasing defense/pro-inflammatory molecules when needed and then turning them off when the threat has been sufficiently addressed.

Chronic inflammation, on the other hand, is characterized by an aberrant out-of-control defense response and is akin to a constant slow-burning fire. In chronic inflammation the defense/pro-inflammatory molecules continue to be present in the body even when they are not needed and the body operates as if it is constantly under attack. Thus, chronic inflammation continuously draws on your body’s energy and resources, which can result in bodily damage with time. Furthermore, as the system goes out of control, it self-perpetuates and triggers severe disease conditions, including, atherosclerosis (inflammation in blood vessels), diabetes (inflammation in pancreatic tissue), arthritis (inflammation in bones and joints), celiac disease (inflammation in digestive system), fibromyalgia, and neuralgia (inflammation in limbs, muscles and nerves) Ankylosing Spondylitis (inflammation in the spinal region), among others. 

In addition to the factors that influence inflammation that I outlined in my previous posts, today I’m updating that list to include:

Obesity. This is now considered a heightened state of chronic inflammation because of the elevated plasma levels of several pro-inflammatory markers. It is believed that fat cells (adipocytes) themselves trigger the release of a number of these markers in the blood stream.

Physical Activity. People who are physically very active have lower levels of inflammatory biomarkers than their sedentary counterparts, so physical fitness is inversely associated with inflammation.

Emotions. Emotional disorders, including anxiety and depression, can trigger inflammation and elevate the levels of pro-inflammatory molecules.

Stress. Chronic stress can directly provoke increases in proinflammatory cytokines.

Furthermore, inflammation is now regarded as a risk factor for most cancers as well because of the recent evidence that inflammation influences cancer cells to grow, survive, and proliferate. Scientists believe that cancer treatment procedures trigger the inflammatory process that fails to turn off. In addition to the weakness and pain from the cancer therapy procedures, cancer patients now suffer from inflammation that draws on their body’s resources resulting in chronic fatigue. It’s as though the body’s defense system fails to distinguish its own self thus making the body vulnerable to attacks from its own cellular system. 

Yoga can help with all these factors. On our blog we have highlighted yoga’s effects in controlling obesity by making correct choices of our eating habits (Yoga for Healthy Eating), and we discussed the benefits of yoga in controlling stress (Stress, Your Health and Yoga) and emotions (Yoga and Your Emotions). And in a landmark study that I highlighted earlier in Yoga's Healing Powers, researchers showed that cancer survivors who had a regular yoga practice: (a) reported less fatigue and higher levels of vitality, (b) showed reduced levels of several pro-inflammatory molecules in the body, (c) reported less pain and less inflamed joints, and (d) demonstrated significantly improved sleep (see 6 Ways to Foster Brain Health with Yoga). This study not only offered biological evidence of the benefits of yoga, in addition it substantiated people's own reports of their improvement. 

Yoga and yoga-related practices, including meditation, affect cellular processes at many levels that result in immense health benefits. While most of the health benefits may not appear immediately, all the benefits of yoga may become evident with a sustained and regular practice. So the next time you visit your doctor and are told that you have an inflammatory condition, think of yogic management practices.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More

Depression May Be Caused by Inflammation

by Nina

Burning House by Marc Chagall*

“Inflammation is our immune system’s natural response to injuries, infections, or foreign compounds. When triggered, the body pumps various cells and proteins to the site through the blood stream, including cytokines, a class of proteins that facilitate intercellular communication. It also happens that people suffering from depression are loaded with cytokines.” —Tim De Chant

The first thing I did after I read a short article Depression May Be Caused by Inflammation was write to Ram. After all, Ram has written more than once about the dangers of chronic inflammation (see Chronic Inflammation and Yoga: Combating the Fiery Killer and Yoga’s Healing Powers), but he never mentioned depression as a problem that could be caused by inflammation. Here is his reply:

"Yes, I saw this item this morning and it does not surprise me. Inflammation is now thought to be the underlying event for a number of health issues including Alzheimer's, diabetes, obesity, hypertension, thyroid issues, arthritis, etc. What was once thought of as a novel and protective mechanism for the hunter-gatherers has now gone haywire thanks to modern interventions/lifestyle that has extended the median life span.”

So with that nod of approval, I decided to look more into the matter. After all, if yoga can help with chronic inflammation and depression is caused by chronic inflammation, then practicing yoga for chronic inflammation could be helpful to people suffering from depression. So, what are scientists saying about how is depression connected to chronic inflammation? An article in the Guardian Is depression a kind of allergic reaction? put it this way:  

“Both cytokines and inflammation have been shown to rocket during depressive episodes, and – in people with bipolar – to drop off in periods of remission. Healthy people can also be temporarily put into a depressed, anxious state when given a vaccine that causes a spike in inflammation. Brain imaging studies of people injected with a typhoid vaccine found that this might be down to changes in the parts of the brain that process reward and punishment. Depression may be triggered by an immune response.” 

And because these scientists are now thinking that depression may be a side effect of inflammation, they are exploring new treatments that address the inflammatory symptoms of depression with positive results. For example, a study The cyclooxygenase-2 inhibitor celecoxib has therapeutic effects in major depression: results of a double-blind, randomized, placebo controlled, add-on pilot study to reboxetine in Molecular Psychiatry concluded that an anti-inflammatory medication had therapeutic effects for depression.

But as Ram wrote in Yoga’s Healing Powers, a regular yoga practice is also effective for reducing chronic inflammation. He said that yoga:

1. Brings down the levels of stress hormones that promote inflammation
2. Lowers the levels of a number of pro-inflammatory molecules in the body
3. Reduces a subset of pro-inflammatory molecules called cytokines

Yes! Yoga helps reduce those pesky cytokines, which are exactly what the scientists are thinking may be responsible for triggering depression, as well as reducing inflammation in general. And, stress, which promotes inflammation, has also been long thought to be a factor in depression, as Timothy McCall wrote in Stress, Your Health, and Yoga.

So I’m going to make the leap and say if you want to reduce chronic inflammation and lower your levels of cytokines to help depression: focus at least some of your practice on stress management (see The Relaxation Response and Yoga). In general, supported inversions (see All About Supported Inversions) are particularly good for people with depression because you can keep your eyes open while practicing and don’t need to focus internally, which can lead to brooding. 

But, as always, you should experiment to find out what works for you, and if you enjoy restorative yoga or guided relaxation or breath work, go for it. In general, the way you practice yoga should probably depend on the type of depression you have, rajasic or tamasic. See Tamasic and Rajasic Depression for further information.

I came to the conclusion that yoga for depression should include stress management practices a long time ago because I had two bouts of agitated depression that both followed periods of sustained stress. And since I’ve learned to manage my stress levels with yoga, I’ve managed to avoid any more episodes (going on 20 years now!). Of course, until recently, I only had what scientists call “anecdotal evidence” and the wisdom of my yoga teachers to back me up. Now it’s great to have a possible scientific explanation as well!

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More

Yoga's Healing Powers

by Ram

Morning Glory by Melina Meza

Undoubtedly, all of us who do yoga as part of our daily routine have experienced its benefits, either at the physical, mental, or emotional level or at all levels. We all agree that it is relaxing, it is calming, and above all it has helped us in our flexibility and strength. Additionally, for some of us, yoga has helped in the healing of the heart, brain, gut, colon, kidney, hips, spine, and so forth. And all the anecdotal reports of the benefits that people have raved about are now being proved by empirical findings. In one of the largest studies of health benefits of yoga, it appears that yoga can reduce inflammation, the body's attempt at self-protection. Before I describe the study, let me briefly discuss inflammation and its positive versus negative health effects.

Inflammation is part of your body's defense response; the objective is to remove damaged cells, harmful irritants, or toxic pathogens from the body and initiate a healing response. While inflammation is not infection, an infection itself caused by bacteria, virus, or fungus can trigger an inflammatory process. Inflammation has a high beneficial value. For example, if you develop a viral infection or if your back sustains a severe blow, inflammation sets in to care and protect the injured tissue. The classical signs of inflammation are pain, heat, redness, and fluid accumulation (swelling). Other signs include: fever, chills, fatigue/loss of energy, muscle aches, headaches, and loss of appetite. All these signs are the body’s defensive strategies were activated to ward off the damage and heal the injured area. These defensive strategies are carried out by an arsenal of molecules that fight the invaders. The molecules include but are not limited to: leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, interleukins, and TNF, among others. Thus, the inflammatory process is akin to a country’s defense system involving several units of entities of increasing specificity that culminate in the removal of invaders and promote healing of any damaged tissue. In a perfect setting, the inflammatory process occurs just as it should: releasing defense/pro-inflammatory molecules when needed and then turning them off when the threat has been sufficiently addressed.

Now imagine if this body’s strong defense system turns awry and the defending molecules take on their own body’s system (akin to a coup). That would be the negative aspects seen in chronic inflammation, which are characterized by a defense response that is aberrant, out of control, and not completely turned off. Just like a constant, slow-burning fire, in chronic inflammation the defense/pro-inflammatory molecules continue to be present in the body even when they are not needed and the body operates as if it is constantly under attack. Thus, chronic inflammation draws on your body’s energy and resources, which can with time result in bodily damage. Additionally, when this system goes out of control, it self-perpetuates and triggers disease conditions, such as, atherosclerosis (inflammation in blood vessels), diabetes (inflammation in pancreatic tissue), arthritis (inflammation in bones and joints), celiac disease (inflammation in digestive system), fibromyalgia, and neuralgia (inflammation in limbs, muscles and nerves), among others. It is as though the body’s defense system fails to distinguish its own self, making the body vulnerable to attacks from its own defense team. The causes of chronic inflammation are numerous and include age, genetic predisposition, smoking, environmental stressors, allergens, chronic stress (both physical and mental), poor foods (sugary, processed, or fast food), and hormonal imbalance, among others.

But there’s good news for those of us who have a regular yoga practice. Several studies now report that a regular yoga practice:

1. suppresses inflammation
2. lowers the level of several pro-inflammatory molecules in the body
3. reduces a subset of pro-inflammatory molecules called cytokines, thereby relieving severe pain associated with the inflamed tissue

More specifically, studies report that yoga reduces inflammation in patients with cardiovascular problems and also improves levels of glucose and insulin in diabetic patients. There are also reports demonstrating yoga’s role in curbing inflammation that may serve as a panacea for people recovering from cancer. It turns out that following several rounds of radiation and/or chemotherapy cancer survivors suffer from persistent and debilitating fatigue for months or even years. Scientists believe that the cancer treatment procedures trigger an inflammatory process that fails to turn off. In addition to the weakness and pain from the cancer therapy procedures, these patients now suffer from inflammation that draws on the body’s resources, resulting in chronic fatigue. It is estimated that about a third of breast cancer survivors suffer from inflammation and chronic fatigue for several years after they complete treatment.

In a recent paper published in the Journal of Clinical Oncology Yoga’s Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial, researchers looked at 200 breast cancer survivors who had completed all the breast cancer treatments. The randomized, controlled trial involved only yoga novices. The yoga group practiced yoga twice a week for 12 weeks with take-home DVDs to practice at home. The control group was wait-listed to receive the same yoga sessions after the completion of the trial. The group that had practiced yoga for three months reported less fatigue and higher levels of vitality three months after the treatment had ended. The yoga group also reported significantly improved sleep. Additionally, three cytokine proteins in the blood that are markers for inflammation were all lowered by 10 to 15 percent. The novelty of the study was that it offered biological evidence of the benefits of yoga in addition to people's own reports of how they felt.

Cancer treatment leaves patients with high levels of stress, fatigue, and insomnia, which may trigger inflammation that in turn triggers tissue damage, leaving the patients completely debilitated and in a downward spiral. As we are now well aware, yoga reduces stress and fatigue (see Stress, Your Health, and Yoga ) and helps people to sleep better (see Sleep: A Pillar of Life), all of which may ultimately block the inflammatory process thus providing immense benefits to the cancer survivors. I guess you would agree with me that you cannot find a better, cheaper, and effective therapy for combating inflammation!

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect  

Read More

Meditation: Effects on Gene Expression

by Ram

Yoga for Healthy Aging authors have written extensively on the power of meditation (dhyana) and its beneficial effects on so many aspects of life, including, but not limited to, disease and pain, sleep management, control of emotions, stress reduction, depression and weight-reduction goals. In all the above cases it seemed that meditation changed behavioral patterns and enhanced emotional stability. Articles by Baxter (How to Meditate, Thoughts On Dhyana ), Timothy (Starting a Meditation Practice), Brad (Stressed Mind, Stressed Cells), Nina (Meditation and Compassion)  and yours truly (Achieving Stillness in Turbulent Situations, Memory Loss: Meditation to the Rescue) have all provided lucid explanations of ways to meditate, the science of meditation and the effects of meditation on body and mind.

Vine and Wall by Melina Meza

In one of my recent posts, I also discussed meditation’s important role in slowing the progression of age-related cognitive disorders such as Alzheimer's disease. Researchers had demonstrated that meditation reduced hippocampal (the hippocampus is one of the areas of the brain involved in memory) degeneration and improved functional connectivity in those areas of the brain that are affected by Alzheimer's disease (see Memory Loss: Meditation to the Rescue). In response to the above-mentioned article, one of our readers recently sent us the following question:

“What exactly is meditation? At the end of our yoga class my teacher puts us all in a brief meditation session. Each day is different, one day she puts a audio tape and tells us to meditate on it, another day she reads some verses from a book and asks us to meditate on them, a third day she tells us to meditate on a color. I just cannot comprehend these different methods. To me all these are nothing but distractions. So how do I meditate?”

In chapter 3, verse 2 of the Yoga Sutras of Patanjali, we are introduced to the topic of meditation (dhayana) as follows: “Tatra Pratyaya Ekatanata Dhyanam.” Swami Jnaneshvara () translates this as: “The repeated continuation or uninterrupted stream of that one point of idea/notion is called meditation.” To put it simply, when the mind remains undistracted (still) for a length of time, it is called meditation.

Needless to say, humans inherently fear stillness, as it brings them closer to their true divine nature, which they are not prepared to face. Novices in a meditation practice have a tough time closing their eyes and keeping still in mind and body. It is a very natural response. Hence, in a beginner’s class the teacher usually begins by telling the class to focus on an object, color, flower, and so on. This type of meditation not only allows beginners to focus strongly on one point but it helps to bring their attention back to that focal point when the mind wanders. Another practice might include focusing on some soft music or recitation, engaging the auditory sense. The ultimate goal of the meditation exercise is to be at ease, relaxed and at peace with our surroundings. It is important not to resist any disturbing or distracting influences that come in the way of meditation practice. Everything is a part of meditation, including noise, thoughts, emotions, and resistance from the mind.

Now that I’ve answered our reader’s question about how to meditate, I’m excited to share some news with you about the benefits of the practice. In a new study by researchers in Wisconsin, Spain, and France, mediation seems to trigger very important genetic and physiological changes in the human body. The authors of the study report the first evidence of specific molecular changes in the body following a period of mindfulness meditation. Specifically, the study shows that meditation reduces the expression of several genes associated with inflammation. For more on inflammation, see my article Chronic Inflammation and Yoga.

In this latest study, the researchers investigated the impact of a day of intensive mindfulness practice on the expression of genes involved in several physiological functions. Blood samples from 19 experienced meditators and a control group of 21 subjects with no meditation experience who engaged in leisure activities were analyzed for gene changes. The changes in the gene expression were compared before and after the meditation session. Notably, the experienced meditators showed a marked reduction in the levels of pro-inflammatory genes, which in turn correlated with faster physical recovery from a stressful situation. There was no difference in the tested genes between the two groups of people at the start of the study, clearly suggesting that the pro-inflammatory gene changes were specifically associated with meditation. Interestingly, these same genes are the current targets of anti-inflammatory and analgesic drugs. According to the researchers, the research findings set the foundation for future studies to further assess meditation strategies for the treatment of chronic inflammatory conditions. I am very excited because if these studies prove successful, one can use stillness to curb almost all the present day inflammatory-associated maladies, such as, arthritis, thyroid disease, tendonitis, myositis, and neuropathies.

The health benefits from meditation are so strong that scientists are swearing by it and more doctors are recommending the practice to their patients. So it’s no wonder that meditation is going mainstream. I know if I had to choose between anti-inflammatory drugs or calmness of my mind to curb stress and inflammation, I would choose the latter. What about you? 

Subscribe to YOGA FOR HEALTHY AGING by Email ° Follow Yoga for Healthy Aging on Facebook

Read More

Chronic Inflammation and Yoga: Combating the Fiery Killer

by Ram

Red Leaves by Melina Meza

Ever experienced an unexplained excruciating pain in the joints, ankles, knees that lasted for some time and then subsided? Or, maybe when you bent your fingers to hold some object, you experienced a burning pain in your fingers so painful that you were unable to straighten them for some time. Or, for some of us who do yoga regularly, we may have experienced pain, burning, numbness, or tingling in the buttock, hip, low back, knees, etc. Notice how this pain subsides when you are advised by your physician to take non-steroidal anti-inflammatory drugs like ibuprofen, or for some of us who have been living with this chronic agonizing pain, relief comes from those powerful anti-inflammatory steroid medications.

So, what is inflammation, why does it occur, and what are the best safe and natural options to curb this disorder? Let’s start by defining the term: From the Latin term "inflammo" (meaning setting alight or igniting), inflammation is part of the body's immune/defense response, the body's attempt at self-protection. The objective of inflammation is to remove damaged cells, harmful irritants, or toxic pathogens and begin the healing process.

When something harmful or irritating affects a part of our body, there is a biological response to try to remove it. This response takes the form of inflammation for the body to heal itself. While inflammation is not infection, an infection itself caused by bacteria, virus or fungus can trigger an inflammation process. Thus, you may appreciate the fact that inflammation in a true sense is beneficial when, for example, you develop a viral infection or if your back sustains a blow and the injured tissues need care and protection. The classical signs of acute inflammation are pain, heat, redness and fluid accumulation (swelling). Inflammation may also be associated with symptoms including: fever, chills, fatigue/loss of energy, muscle aches, headaches and loss of appetite.

Chain of Events that Occur during the Inflammation Process. Just as every country maintains an army, air force and naval units to defend itself from enemy forces, our body too has an excellent defense system (aka immune system) characterized by an arsenal of molecules. Acute inflammation is the initial response of the body to harmful stimuli and is characterized by the release of (a) specialized chemicals that create a conducive atmosphere for the defense molecules (pro-inflammatory molecules) to act and (b) specialized defense molecules/cells that fight the invaders. You may have heard from your physician or other sources terms including but not limited to: leukocytes, macrophages, dendritic cells, mast cells, bradykinin, histamine, and TNF. All these constitute our defense/immune system that is akin to a country’s defense system, with several layers of defenses of increasing specificity that culminate in the removal of pathogens and promote healing of any damaged tissue. Thus, in a perfect world or perfect body, the inflammatory process occurs just as it should, releasing defense/pro-inflammatory molecules when needed and then turning them off when the threat has been sufficiently addressed.

Negative Aspect of the Inflammation Process. Imagine if the defense forces take on their own country and its citizens! Similarly, chronic inflammation is characterized by a defense response that is aberrant, out of control and is not completely turned off or extinguished. Just like a slow-burning fire that does not ebb, in chronic inflammation the defense/pro-inflammatory molecules continue to be present in the body even when they are not needed. With the inflammation switch refusing to turn off, the body operates as if it is always under attack. Inflammation draws on our body’s energy and resources and having a constant, low-grade flow of powerful pro-inflammatory molecules can result in bodily damage with time. Furthermore, once this system goes out of control, it self-perpetuates and quickly spirals into disease in areas such as blood vessels (atherosclerosis), pancreatic tissue (diabetes), bones and joints (arthritis), digestive system (lactose and gluten intolerance), limbs, muscles and nerves (fibromyalgia), fat tissue (obesity), throat (thyroid issues)—just for starters. Sounds like the body going haywire in its own defense, with the immune system failing to distinguish between what is foreign and what is our own self, and making the body vulnerable to attacks from its own defense team.

Causes of Chronic Inflammation. As an aging researcher, I have learned that aging is one of the biggest risk factors for chronic inflammation because as we age, our bodies are less able to disarm the inflammatory process. Couple the aging process with a genetic predisposition, hypertension, or even smoking and it fuels the flames. In addition, stress (both physical and mental), environment, poor foods (sugary, processed, or fast food), high blood-insulin levels (type-2 diabetes), hormonal imbalance (estrogen and menopause) and obesity (leptin, adiponectin and other dietary hormone imbalance) are just a few of the factors that promote chronic inflammation.

Treatment for Chronic Inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) that include drugs like aspirin, ibuprofen, and naproxen, reduce the level of certain chemicals called prostaglandins that are involved in inflammation. Treatment with NSAIDs can lead to less swelling and less pain. However, extended use of NSAIDS can cause intestinal bleeding and serious damage to the stomach, liver and kidneys. Commonly referred to as steroids, glucocorticoids work to calm an overactive immune system and to decrease the level of inflammation in the body. People with multiple sclerosis, rheumatoid arthritis, lupus and other chronic inflammatory diseases are frequently prescribed these steroids to calm the inflammatory response. The problem is that these come with their own baggage of side effects and extended use of steroids can trigger osteoporosis, glaucoma, weight gain, high blood pressure and a lowered resistance to infections. Finally, a nutritious diet is the basis for good health. Vitamins D, E and C and folic acid have powerful anti-inflammatory actions, and foods high in omega 3s&6s, fruits, vegetables, fermented foods and unrefined carbohydrates may help to reduce the body's inflammatory response.

Yoga as an Anti-Inflammatory Therapy. There’s also good news for those of us who have a regular yoga practice. Several studies now report that a regular yoga practice (a) brings down the levels of stress hormones that promote inflammation (b) lowers the levels of a number of pro-inflammatory molecules in the body and brings down inflammation that is beneficial in conditions like arthritis, (c) reduces a subset of pro-inflammatory molecules called cytokines thereby relieving severe pain seen in diseases like fibromyalgia, and (d) inhibits inflammation that in turn weakens and even kills cancerous cells in people with cancer. See Stress, Inflammation and Yoga Practice to read one of the original studies.

In a study that confirms nearly all of the above observations, researchers at Ohio State University in Columbus divided 50 women with an average age of 41 into two groups: new to yoga and experts. The researchers than subjected these women to a battery of stress-inducing tasks, including holding their feet in extremely cold water or solving difficult math problems without the aid of a paper and pencil. Blood samples were taken several times before, during and after the stressful activities and measured for the levels of several pro inflammatory molecules. The research team found that women who were new to yoga had higher levels of nearly all the pro-inflammatory molecules tested and a much greater inflammatory response to the stressful tasks than women who were experts - suggesting that yoga may help to tune down the stress responses. See Adiponectin, leptin, and yoga practice.

Yoga’s beneficial effects on inflammation are not confined just to people with inflammatory conditions. Remember, I wrote a previous post about caregivers and how yoga could help these Karma yogis. Turns out that caregivers who exhibit high levels of stress-associated inflammation and who often don't have the time or energy to bring on a little relief from the stress of taking care of a loved one will benefit from a yoga practice even if it is for a brief period daily as it lowers stress-associated inflammation. In a study published in the  journal Psychoneuroendocrinology, researchers found that caregivers who participated in a yoga practice experienced a change in the response of 68 anti-inflammatory genes, leading to a global decrease in inflammation.

After writing this article in one sitting I am experiencing an unexplained burning pain in my fingers. So, guess what? It’s time for me to roll out the mat and do a few yoga stretches. What a cheap and effective therapy for combating inflammation!

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More

Okay. Back to Aging.

by Brad

Manzanita by Brad Gibson

Okay. It’s been a while, as I’ve been busy with writing NIH grants and papers, as well as traveling. So it's time to get back to one of the central points of this blog: what is aging? It turns out this is no more clear than trying to define yoga. When I joined the Buck Institute for Research on Aging some 11 years ago, I was surprised and a little chagrined to discover how unsettled and wide open this central question of aging biology was.

This was not my original field of study, but as a chemist and structural biologist working at a major teaching university, I saw a prime opportunity to make a career shift by joining the Buck Institute and using my skill to elucidate molecular mechanisms of aging. But I had no idea how many competing theories existed on this subject, ranging from rather oblique terms like ”antagonistic pleotrophy” to more familiar ones—at least to a chemist—like “entropy” and “free radical damage.” So the other day when there was some news coverage in the New York Times of a breakthrough in aging research (see NY Times article here), I saw this as a chance to tackle this subject. The article, titled “In Body’s Shield Against Cancer, a Culprit in Aging May Lurk,” came out of the Mayo Clinic and looked at the role of senescent cells in aging (see original research here).

When cells reach a point of pathological state, either through telomere shortening or some other aberration or damage, a sequence of events are put into place that either sends these cells into a cell death pathway, or into a state of senescence, a kind of limbo non-dividing state. One reason this occurs is to avoid the formation of a cancerous cell, which the organism obviously wants to avoid. Cells that become senescent were usually thought of as sequestered cells that no longer posed a problem to the organism, but were also no longer productive. However, what this new study showed is that these senescent cells appear to have more damaging effects on neighboring cells and tissues, possibly through a secreted inflammatory signal.

By constructing a mutant mouse strain where the researchers could target and kill these senescent cells without harming the healthy cells, researchers found that it had a significant beneficial effect on the health of the mice, and that they lived longer. There is a lot of follow-up work to be done to confirm these studies in “normal mice” as well as in humans. In any case, the data are highly intriguing. It is also worth pointing out that when asked whether this would cure aging, the scientists were much more cautious, as they clearly understood that this is probably only one of many mechanisms that are contributing to aging. Nonetheless, it is interesting to see how inflammation comes up repeatedly as a cause or at least a driver of many age-related disease, from Alzheimer’s disease to diabetes.

One question that I would like to get back to is: what can we do as individuals to influence this process? What are the conditions that lead to cellular senescence versus cell death, for example, and what are the physiological and environmental determinants that cause as a cell to enter this critical state in the first place? If we knew the answers to these questions and as well other questions of this type, we might be able to critically examine how we can influence are own rate of aging. This question is related but separate from how we can reduce and/or cope with various age-related losses and pathologies as they emerge. Both questions will be critical to answer to reach an understanding on the practice of healthy aging.  How yoga might be a part of that practice is what we are trying to address here….

Subscribe to YOGA FOR HEALTHY AGING by Email ° Follow Yoga for Healthy Aging on Facebook

Read More

What is a Yoga Practice?

by Brad

From The Poetry of the Body by Yee and Zolotow

A year or so ago I was talking with a colleague about a genomics study he was planning that was going to look at exercise and aging. Previously, he and his colleagues had shown that resistance exercise training had a significant effect on the genes that were transcribed in muscle tissue, and that the older people undergoing this training had gene transcription profiles that resembled much younger people. This time around they were planning a more nuanced study and would look at several exercise regimens, including yoga. I remembered asking him what type of yoga practice they planned to use, and was met with a slightly confused look. He wasn’t sure, but thought it was a “standard practice” involving some stretching and aerobic components. When I inquired further about whether it was Iyengar style or one of those high-energy aerobic practices (like Ashtanga Vinyasa), I realized that our discussion had reached a dead end. He had no idea what I was talking about.

So when I ran across another article today on Yoga for Back Pain that was mentioned in the Science Times section of this weeks NY Times (see here), I decided to take a little closer look at what the actual practice was. I also looked back at the Ornish and Blackburn study I discussed a couple weeks ago (see here), as well as a few other studies I had run across. I was interested in seeing how well the practice was described and whether it made in sense.

I was surprised to find that the most high profile of these studies, the 2008 Ornish and Blackburn study (see here), had the least detail. What they described as yoga for stress management consisted of “gentle yoga-based stretching, breathing, meditation, imagery, and progressive relaxation techniques 60 min/day, 6 days/week”. In contrast, a study published this summer by Dr. Fishman on osteoporosis and yoga (see here ) was considerably more comprehensive, listing all 10 yoga poses by both Anglicized and Indian names, e.g., “Upward and Downward Dog poses (Adho Mukha Svanasana and Urdhva Mukha Svanasana),” as well providing an appendix of 13 figures illustrating each poses. It should be pointed out that the lead author of this study was extremely familiar with yoga, having practiced it in India for three before attending medical school.

Another group that was fairly thorough in their description was Sherman et al. which just appeared on-line a couple days ago (see here) in their study of chronic low back pain, where they describe a viniyoga practice consisting of 5-11 poses (with pictorial diagrams referenced from earlier 2005 paper by this same group (see here). Interestingly, these authors also provided the credential for the teachers as “instructors with at least 500 hours of viniyoga training, 5 years of teaching experience, and familiarity with the selected postures and who were briefed by our yoga consultant.” This paper also gave a defense of their yoga style (viniyoga), as “a therapeutically oriented style of yoga that emphasizes safety and is relatively easy to learn.”

Iyengar-style yoga was used in another study examining stress and inflammation by Kiecolt-Glaser, et al (see here) because it ”emphasizes the use of props to help students achieve precise postures safely and comfortably according to their particular body types and need”. In this latter study, the 12 poses and timing of each were well described and was constant, and apparently selected “based on their purported relationship to immune function and/or restorative effects.”

Obviously not everyone is going to agree with what is a good or best yoga practice for stress, back pain, osteoporosis or whatever. But what is clear is that these studies need to provide a through description of the regimen (time, poses, teacher qualifications) and their overall rationale, so that if someone wanted to reproduce this study or compare it with another, they shouldn’t be in the dark as to what the yoga practice was. In the end, it’s you who is going to have to decide on what to believe, as the standards for comparing these practices, pose sequences, and yoga styles are confusing at best. Maybe Nina and Baxter can comment on this, as I’m not an expert.

Subscribe to YOGA FOR HEALTHY AGING by Email ° Follow Yoga for Healthy Aging on Facebook

Read More

Friday Q&A: Stretching, Science and Autoimmune Diseases

Q: I'm wondering to what extent, and at what rate, we should expect to be able to increase our flexibility as we continue to age. I've made significant progress over the years, and have generally learned how to be mindful enough not to overdo. However, every so often I overstretch without realizing it - whether it's my back trying to get a fuller forward bend, or my Achilles tendon while pushing the envelope. I'm in my 50s and have been doing regular yoga for about 5 years. It's made an immense difference in my core strength and balance and flexibility and I'm much less injury prone now. And yet, every so often, it's my yoga practice that puts me out of commission. 

A: Baxter and I discussed your question, and he agrees with me that there is no fixed extent or rate for increasing flexibility as we age, as this will differ from person to person. His advice is to maximize the effectiveness of your stretches while minimizing potential injury by holding your stretches longer rather than pushing harder. He mentioned that it takes at least 45 seconds to get your muscle to fully release. And my kinesiology teacher taught me that in order to change the resting length of the muscle (the length the muscle returns to after stretching), you need to stretch it for 90 seconds. So I use a timing of 90 seconds for many of my stretches. —Nina 

Q: Does yoga have any good stretches for a 60 year old stiff person?

A: Yoga has a very large number of poses that allow you to stretch a very wide variety of muscles, no matter how stiff you are. So the first question to ask yourself is: where exactly am I stiff? Some of us are stiff all over and some of us are flexible all over, but it turns out that many of us are flexible in some areas and stiff in others. Identifying which areas you need to stretch will help you chose the poses that will be most helpful to you. That being said, there are a couple of poses that we highly recommend for their versatility. Downward-Facing Dog pose is especially wonderful because it stretches your legs, hips, shoulders and arms, all at the same time.

If this pose is too demanding, you can do an easy variation, Half Dog pose (also called Right Angle pose). With your hands at shoulder-height on the wall or resting on the surface of a table, walk back so your hips are directly over your feet and your arms are parallel to the floor.

Baxter recommend that you warm up for these poses with some dynamic movement, such as swinging your arms above your head or moving your legs around in your hip joints. —Nina

Q: How would one go about investigating the effects of yoga on aging scientifically?

A: This question is intriguing and so important that Brad will devote an entire post to the subject sometime soon.

Q: Just curious about how autoimmune diseases are related to aging? Some seem to be inflammatory conditions I think, and that makes me wonder about allergies, yoga and aging. 

A: This is a very big and complicated question! And there’s no quick, simple answer, as the mechanisms behind many of these diseases (not to mention aging itself) are not fully understood. But Baxter says, “Not all autoimmune diseases are created equal.” Different autoimmune diseases arise at different stages in life, so not all are related to aging. Also, not all are related to inflammatory conditions. So that’s why we’ve decided that on this blog we’ll discuss the autoimmune diseases associated with aging individually, over time. Is there any particular disease that concerns you? 

We are going to try to do a Q&A every Friday, so keep the questions coming. You can leave a question in a comment or you can email us at nina@wanderingmind.com.

Subscribe to Yoga for Healthy Aging by Email ° Follow Yoga for Healthy Aging on Facebook ° Join this site with Google Friend Connect

Read More