Healthy Eating, Stress and Self Control

by Nina

One of the most important things you can do to support healthy eating is to practice stress management. Thought the reasons for this weren’t immediately obvious to me, the more I’ve looked into this topic, the more compelling those reasons become. Recently I wrote a post Yoga, Stress and Weight Management about how chronic stress causes weight gain by stimulating your appetite. As if increased hunger isn’t bad enough, it turns out that being stressed out can pose an even bigger challenge to your commitment to eating right: it weakens your willpower and causes you to be more impulsive. Say you had a long, traffic-jammed commute on the way to the office, there’s a critical meeting with a client that you make with a minute to spare, and someone’s left a big, pink box of fresh donuts glistening there on the table. Then, even though you planned a day of healthy eating, with a homemade lunch and a healthy snack, before you have time to stop yourself, you somehow you find yourself with a half-eaten donut in your hand.... Does this sound familiar to anyone? According to The Willpower Instinct by Dr. Kelly McGonigal, you’re more likely to cave in to temptation when you’re experiencing the stress response than you are when you are in a state of relaxation.

“While your body was getting ready to defend your life, the alarm system in your brain was busy trying to make sure you didn’t get in the body’s way. It focused your attention on the saber-toothed tiger and your surroundings, making sure no stray thoughts distracted you from the threat at hand. That’s right, the fight-or-flight response wants to make you more impulsive.”

As is often the case, a response that makes sense when your life is actually in danger (a time when over-thinking is probably not a good idea) can backfire on you in modern times. The traffic jams and the meeting with the client that were stressing you out weren’t exactly life threatening, so not being “distracted” by your plans for healthy eating won’t improve the situation (and might even make you feel worse after you come down from your sugar high).

Line of Moss by Brad Gibson

Fortunately, yoga has a few solutions to offer, both for the short term and the long term, to help you reduce the impulsive behavior that can accompany chronic stress. For the short term, Dr. McGonigal recommends slowing down your breathing to four to six breaths per minute, which she says helps shift your body from a state of stress to “self-control mode.” This is obviously something you could do discretely at your desk or even in that conference room where the donuts lay glistening at you. (Your meeting might even go better if you stopped for a minute to “center” yourself this way before it begins.) And since lengthening your exhalation is also a good way to turn down the stress response, I’d add that you could practice any form of pranayama that emphasizes the exhalation over the inhalation.

For the longer term, Dr. McGonigal recommends that you spend some time practicing conscious relaxation to “restore your willpower reserve.” She suggests lying down and breathing deeply, which sounds like Savasana (Relaxation pose) to me! Besides this, of course, yoga has a huge repertoire of ways you can de-stress, including meditation, yoga nidra, restorative yoga, supported inverted poses, and active asana poses practiced with mindfulness (see The Relaxation Response and Yoga for further information).

So if you’re having trouble sticking to your healthy eating plans for the new year, why not experiment by trying one or more of these relaxation techniques and see if they strengthen your willpower. I’d love to hear back about any results. (Besides, if worse comes to worst, you’ll at least be less stressed out!)

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Music for Savasana: A Gift from Baxter

by Baxter

One of my New Year’s Intentions the past two New Year’s Eves, 2010 and 2011, was to play as much music in the coming year as I possibly could. I had discovered how much joy creating and participating in music is for me on a more conscious level in the past several years, perhaps influenced by the quieting and reflective effects of my ongoing yoga practice. And I decided I wanted more!

And the last two years have definitely exploded with music for me! Playing with friends, performing at art openings, and even sitting in with touring kirtan bands. And even prior to the last two years, if you have ever attended one of my weekend workshops or week long retreats, you know how I love to play my violin for you at the end of class during Savasana. From the feedback I routinely get at these events, I’ve learned that yoga practitioners are moved by the presence of music during this time of rest, reflection and integration.

The asana and pranayama practice releases so much held physical and mental/emotional tension that yoga practitioners seem keenly receptive to the power of sound. I’ve heard back from listeners that it liberated long forgotten memories, touched and released emotions and deepened the experience of Savasana, which for many of us was an early reason we kept coming back to the yoga practice.

So, my intention this year is to record 50 minutes of music, broken up into Savasana-like morsels, all original works, for your enjoyment. As a kick-off, I have recorded a six-minute track for you to listen to here during your next home practice Savasana.

You can listen for free on this blog or from our Band Camp page. I made it six minutes so you can take three to four minutes after the music ends to drop even deeper into your Savasana, or you can make your rest a short six-minute one. I prefer a ten- minute Savasana personally, as it gives time for the Relaxation Response to take full effect. But however you chose to use it, I hope this music adds to the deepening of your practice in 2013.

And for those who would like to own a copy of the first of my recordings, there is a $2 dollar minimum donation to purchase from Band Camp. The proceeds go to Band Camp and to help us defray the costs of producing our blog five days a week. And if you are so moved, you can of course donate more than that!  Finally, a favorite poem of mine by Sufi poet Hafiz:

When the Violin

When the violin can forgive the past it
starts singing.

When the violin can stop worrying about
the future

you will become such a drunk laughing
nuisance

the Sun will then lean down and start
Combing you into its hair.

When the violin can forgive every wound
caused by others

your soul, your soul will start singing.

Translation by Daniel Ladisnky

Namaste,

Baxter

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Yoga and Shoulder Joint Replacements

by Shari

Nina and Baxter asked me to finish up the total joint replacement series with a discussion about shoulder joint replacements. Like the other joint replacements previously discussed, people will consider shoulder joint replacement when all other conservative approaches have failed. The difference in shoulder joint replacement compared to hip or knee replacements is that this procedure is far less common. So if you are thinking about a shoulder replacement, it is considered a good idea to find a physician who has already done a significant number of these surgeries (one place to look is the American Shoulder and Elbow Surgeon’s Society).

Now let’s review why you might consider this treatment. Pain is often the most significant problem that an individual is suffering from. Other symptoms might include stiffness, loss of functional motion, inability to sleep on that shoulder, decreased range of motion and symptoms that are worsening with conservative treatment approaches (whether western or alternative methodologies).

Healthy Shoulder Joint

Regardless, your first step should be thorough diagnostic and physical evaluation from a qualified surgeon that includes X-rays and whatever other tests the physician orders. There has to be a differential diagnosis that separates out the cause of the pain. Rotator cuff tears or avulsions, frozen shoulder, cervical and thoracic spinal pain, shoulder bursitis and other forms of soft tissue inflammation, avascular necrosis (in which the blood supply to the joint is affected), and infections will all cause shoulder pain that can be unrelenting. Metastatic disease or other tumors can also be the cause of shoulder pain so the differential examination is critical in trying to pinpoint the problem. So only once it has been determined that your shoulder pain is due to arthritis (where the cartilage covering the joint surfaces is affected) should you explore your options for shoulder replacement. After you have determined that you’re a good candidate for the surgical joint replacement, you will probably wonder how is surgery this going to affect your yoga practice, including how longer after the surgery will you be able to do yoga again and, when you do resume practice, which poses should you avoid and for how long?

Shoulder With Joint Replacement

According to my research as well as my personal experience as a physical therapist, yoga practitioner and yoga teacher, this procedure has significant post-operative protocols. This means that there is a very specific healing algorithm that your surgeon will adhere to. It does not help if you are a “fast healer” because if you push too much and too fast, for this surgery in particular, you will be setting yourself up for significant problems in the future. This surgery is very complicated because the subscapularis is detached to expose the glenohumeral joint and then reattached after surgery. The rotator cuff may also need to be repaired because often in severe shoulder arthritis, the soft tissue ligaments and muscles are severely affected and may also need repair due to compromised biomechanics and impingement in the shoulder joint.

The literature I reviewed states conservatively a three-month recovery but more common is six to twelve months post-operative recovery with very strict dos and don’ts. And unfortunately I cannot go into what you can and can’t do here on this blog because that is totally dependent on your surgeon and which type of procedure he or she deems is appropriate for you (there are four different types of shoulder replacements).

But from a yogic perspective, here is what I can recommend. Start by being in the best possible health you can be before surgery. Understand that you will have a lot of work to do in your post-operative recovery, but believe 100% in your ability to recover and in your surgeon.

Have stress management techniques that you do regularly as part of your healing repertoire. Pain medication is not something to be shunned but used responsibly and respectfully as part of your healing process. But, because pain is a very subjective experience, yoga and stress management techniques, though not substitutions for pain medication, can be an adjunct in allowing you to “relax into the pain.” Deep breathing in particular does a world of good for your body post operatively and into your healing process. It allows your lungs to be used to prevent post-operative complications, and is also calming and a good focus for your mind when you might be counting the minutes until you can take your next pain medication dosage. Simple deep breathing also assists in decreasing muscle tension from unconscious holding and splinting because you are in pain. You may also want to work with lengthening your exhalation to assist in stimulating your parasympathetic system (triggering your relaxation response). Other stress management techniques you could explore include: meditation, Savasana (Relaxation pose), and Yoga Nidra.

Be familiar with restorative poses, such as Reclined Cobbler’s pose (Supta Baddha Konasana), Legs Up the Wall pose (Viparita Karani), and Supported Relaxation pose (Savasana) that you can do while adhering to the post-operative protocol. Shoulder positioning and propping is very important for your post-operative pain management, and your physical therapist or surgeon (or their support staff) should be able to assist you in ways to position for improved comfort. Once you understand how to position your arm in these poses (for example, using support under your arms and shoulders or having your arms in a neutral position) then you should be able to figure out how to set yourself up for restorative poses without putting your shoulder into a compromised position. Remember, how you go into and out of poses, including restorative poses is important. You may find that your bed is a perfect place to practice restorative poses because it is easier for you to position yourself.

Once you are allowed to start exercises with your physical therapist, be very clear in asking when you can do which poses, bringing pictures to demonstrate. Taking your arms out to your sides in standing poses may or may not be possible because just the weight of your arm being statically held may be contraindicated. Then, before you return to your yoga class, please contact your yoga teacher and explain your limitations and restrictions. It is your responsibility to educate your yoga teacher on your particular needs and then he or she can help you keep your practice safe within the guidelines you understand from your physician.

Finally, please be gentle with yourself and don’t overuse your arm even just a little bit. When you are allowed to stop wearing your sling, you might find that you can practice with your sling on more successfully then with your arm out of it. Stay away from weight-bearing poses like Downward-Facing Dog pose until you have medical clearance (even Half Dog pose at the Wall). Night-time positioning and pain management are often the most challenging. Make sure you understand your pain medication recommendations and do what ever your surgeon tells you. After all, you only want to do this surgery once. So be patient and creative. And good luck!

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Friday Q&A: Weight and Longevity

Q: I've been following this discussion Being Slightly Heavy Aids Longevity  for a while & would like to hear your perspective (phew! Managed to NOT ask you to "weigh in"). I've read that the numbers are skewed because people who are very sick tend to be under weight, and then there is that group of people that become intentionally underweight because they believe it encourages longevity. Thoughts?

A: No causal relationship exists between body weights (BMI) and death. One cannot predict health and the risk of death from BMI alone as there are several confounding factors that need to be taken into consideration. No doubt, longevity (in terms of mortality rates) is lower among people with BMIs of less than 18 (underweight) or greater than 30 (overweight). Being overweight or underweight puts an individual at risk from several associated diseases. Both Western medicine and Ayurveda agree that too little fat (underweight) or excess fat (overweight) can trigger an entire gamut of health issues that in turn affects the quality of life. I do not see any purpose in having a long lifespan while suffering from diabetes, arthritis, infections, osteoporosis or other health issues. It is for this very reason that I advocate quality of life rather than life span extension. All of us are equally aware about ways to improve our quality of life. In addition, anything in moderation is good and that applies to weight issues as well.

—Ram (Professor Rammohan Rao, Buck Institute for Research on Aging)

A: I am a bit reluctant to “weigh in” (as you well put it), as this is truly a messy issue. First, not all fats are the same. As mentioned in the article, the fat that accumulates in your belly can be quite different than that distributed in other tissues or areas of the body. Fat droplets have been observed to increase in aging bones, for example, although it’s not clear what the significance of this is. There has also been a lot of discussion recently on “brown fat” and its role in health and disease. However, none of these distinctions were considered. Second, I don’t like these types of epidemiological studies. They are typically only correlative, and rarely get to the molecular or physiological underpinnings (if they exist at all). Third, only small differences were observed among the main weight groups (excluding the highly obese). Fourth, BMI is a very crude index. That said, the results of this study are still surprising and suggest that our notions of a healthy weight may need to be reconsidered. Most of us intuitively know this, as we have seen plenty of thin people who look unhealthy while many who fit the category of "somewhat overweight" look real healthy, robust and fit. I remember several years hearing from a seminar speaker that early Alzheimer’s’ patients weighed less than their age-matched non-AD controls. The speaker suggested there might be some type of abnormal metabolic disorder associated with AD that had not yet been identified as such.

With so many possible confounders and variables to consider, it’s pretty hard to make any serious conclusions. Eat healthy, be physically active and put away the scale? Sounds good to me.

— Brad (Professor Bradford Gibson, Buck Institute for Research on Aging)

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Is Yoga Really Dangerous for Men? Dr. Timothy McCall's Response to William Broad

by Timothy

Science reporter William Broad, who a year ago woke the proverbial sleeping (downward facing) dog of the yoga world with his NY Times Magazine article How Yoga Can Wreck Your Body, is back at it. This time he's claiming—based on a review of injury statistics—that men are at much greater risk of serious injury from yoga (see Wounded Warrior Pose). The claim may or may not be true, but I don’t think you can really tell from the data he presents. I plan on writing more about this topic in my next email newsletter, but wanted to respond to Nina's query for the blog today.

Man in Unwounded Warrior 3 Pose by Nina Zolotow

As Broad makes clear in his book, The Science of Yoga (from which the first Times yoga article was excerpted), the subject of his inquiry is the physical practice of yoga as found in most classes. He’s not talking about meditation, chanting, selfless service or spiritual development. Even so, styles of asana practice, different teachers and classes vary enormously. It’s my feeling that Broad's failure to account for these differences could entirely explain his findings.

Back when I was taking a lot of classes of different styles (which I'm not doing anymore, so if things have changed I’d love to get feedback from readers), I found that in the more meditative and restorative classes, I was often one of the only males in the room. But in some of the more vigorous and acrobatic classes, the gender split was closer to even. Thus, men having a higher incidence of yoga injuries could simply be a reflection of their favoring the kinds of classes where injuries seem more common, and not actually reflect any greater vulnerability to injury.

It is also my experience (and that of most yoga teachers I’ve spoken with) that people who are more flexible are generally at greater risk of injury, particularly for injuries like hamstring muscle tears, and overstretching of the ligaments. It varies from person to person obviously, but on average men are much stiffer than women, and seemingly less prone to these types of injuries.

Many yoga injuries—again based on my experience, since we lack data—happen when people are trying too hard to achieve a particular result. Your foot won’t go into Lotus pose, for example, so you pull a little harder to get it into position, and in the process tear ligaments in your knee. But before that happens, the body almost always gives warning signs, such as pain or strained breathing. If you decide to ignore them and power your way through, problems may result. Both men and women can do this, but if I had to guess I’d say men are more likely to, so in this way may be at higher risk.

William Broad loves to create controversy. Beyond claiming that yoga can wreck your body, he has also written that yoga can make you fat, and that the entire practice started out as a sex cult (neither of which is true). Statistically speaking, if Broad’s analysis is correct (and given the methodological problems in how he did his analysis—see Is Yoga Really Dangerous for Men? Dr. Ram Rao Weighs In—I don't think we can know), men may indeed be at higher risk of injuries when practicing asana, but this may miss a larger truth. My guess is that if a man practices less demanding forms of yoga, or any style of yoga in a less aggressive and more mindful way, that his risk probably isn’t any greater than that of a woman, and may even be less. Uh oh, there’s a potential future headline for Mr. Broad: Women at Greater Risk of Yoga Injuries! You heard it here first….

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Is Yoga Really Dangerous for Men? Dr. Ram Rao Weighs In

by Ram

Recently William Broad, author of The Science of Yoga, wrote an article in the New York Times Wounded Warrior Pose, which claimed that yoga is “remarkably dangerous” for men. While this article is a must read for folks who practice yoga asanas (practitioners, teachers in training or students), there are several important issues mentioned in the article that needs to be properly understood and clarified.

Happy, Healthy Warrior Pose

Let’s start by clarifying for the benefit of practitioners and non-practitioners: the main reference throughout the article is to yoga asanas and not yoga per se. While this seem trivial, it is very important because one can resort to other yoga activities like dharana (focus), dhyana (meditation), pranayama (regulated breathing) and sustain very minimal if no injuries. Also, yoga is not a competitive sport; for more on this kindly refer to BKS Iyengar’s book Light on Yoga.

While it may seem that the practice of yoga asana is largely a feminine pursuit, such gender inequalities exist in several other sports and training programs. We do not see a mainstream ladies equivalent of American football, the zumba and pilates classes in the gym that I go to is dominated by females and it is mostly men that are busy working out their “ceps and packs” in the weight lift arena. Uncoordinated or improper movements can put an individual at risk and subsequent injury in any sport or training program. The same is true for yoga asanas, which require coordinated movements of several areas/parts of the body.

William Broad acquired medical data, performed a non-scientific partial analysis and concluded that gender differences in yoga injuries exist and men are at most risk for these types of injuries. To me it seems that the differences could be explained at least in part by differences in the amount of training and asana practice.

Retrospective training/sport injury studies have to be normalized (a suitable denominator has to be factored in). Typically, total exposure time in hours or months or years have to be factored in to draw a reasonable conclusion. In a retrospective 12-month scientific study reported by a group in Finland and published in the 2009 issue of Journal of Sports Science and Medicine, the authors concluded that after combining all reported acute injuries sustained by cross-country skiers, swimmers, long-distance runners and soccer players, no significant difference was observed in such injuries when calculated per 1000 exposure hours.

Similarly, another study comparing sports injuries in men and women that was reported by a group of family practitioners from Kaiser Permanente found no statistically significant gender difference for injuries per 100 participant-years (Sallis et al; Int J Sports Med. 2001 Aug;22(6):420-3. Comparing sports injuries in men and women).

If proper scientific standards were applied to Broad’s yoga analysis, it would mean factoring in the mean exposure hours of yoga asanas performed. Based on the above studies my gut feeling is that no gender differences would similarly be found in injuries sustained from yoga asanas.

So do not be put off by Broad’s article! Remember yoga philosophy, which includes asana practice as well, does not discriminate between estrogen and testosterone. The major component of the practice is about “letting go” of the ego, including your body image, and finding your true self. So focus on yourself and your personal practice. And focus less on a “macho” body and more on achieving stability, mobility and encouraging integration—gently coaxing all the muscles that are tight from sports and weight training to move and work together. Pay close attention to connections—between one part of the body and another, between thought and action and between breath and movement. Moving with this awareness helps in reducing risks from any serious injuries.

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New Year, New Contributor: Welcome Dr. Ram Rao to Yoga for Healthy Aging!

by Nina and Ram Rao

Nina: I’m excited to announce that we’ve added someone new to our staff at Yoga for Healthy Aging: Dr. Rammohan Rao. Ram is a colleague of Brad’s from the Buck Institute for Research on Aging. He’s also a certified Ayurveda specialist as well as a yoga teacher. Obviously he'll be able to tackle a wide range of subjects, and, like the rest of us, he'll welcome your questions. But, to start, he'll tell you about himself in his own words....

Ram: I come from a family of Ayurvedic practitioners and Vedic teachers in India tracing back to the illustrious Vedic-acharya Rishi Kaundinya (although I admit I cannot do the Eka Pada or Dwi Pada Kaundinyasana).

I hold a doctorate degree in Biochemistry and Neurosciences, and presently work as a Research Associate Professor at the Buck Institute for Research on Aging, Novato, CA, on various aspects of age-associated neurodegenerative diseases.

In addition, I also completed the academic training at the California College of Ayurveda (CCA) and received the certification as Clinical Ayurvedic Specialist. I serve as a faculty member at the California College of Ayurveda and teach the Year 1 program in their Nevada city location. I am also a dedicated hatha yoga practitioner and a registered yoga teacher (RYT) from Yoga Alliance USA. 

In my spare time I offer consultations in YAMP techniques (Yoga, Ayurveda, Meditation & Pranayama), and conduct YAMP workshops, seminars and cooking classes. I have published several articles in major Yoga/Ayurveda journals and have been a featured speaker in several meetings and symposia. I am a member of the National Ayurvedic Medical Association (NAMA) and also serve on the Research Board of the Association of Ayurvedic Professionals of North America (AAPNA). I was awarded the Vagbhata Award for Excellence in Ayurvedic Teaching by the Association of Ayurvedic Professionals of North America in October 2010.

I bring with me a wealth of information that I’d love to share and exchange with you all. I will discuss aging and age-associated diseases and ways to alleviate these problems through what I term as “green therapies,” including but not limited to yoga, ayurveda, meditation and pranayama. In addition, I will keep you all abreast with the latest scientific discoveries pertaining to the above therapies.

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