.
BMJ 2004;329:1447-1450 (18 December), doi:10.1136/bmj.329.7480.1447
The limits of medicine
The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%
Oscar H Franco, scientific researcher1, Luc Bonneux, senior researcher2, Chris de Laet, senior researcher1, Anna Peeters, senior researcher3, Ewout W Steyerberg, associate professor1, Johan P Mackenbach, professor1
1 Department of Public Health, Erasmus MC University Medical Centre Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands, 2 Belgian Health Care Knowledge Centre (KCE), Wetstraat 155, B-1040, Brussels, Belgium, 3 Department of Epidemiology and Preventive Medicine, Monash University Central and Eastern Clinical School, Melbourne, Australia
Correspondence to: O H Franco o.francoduran@erasmusmc.nl
Abstract
Objective Although the Polypill concept (proposed in 2003) is promising in terms of benefits for cardiovascular risk management, the potential costs and adverse effects are its main pitfalls. The objective of this study was to identify a tastier and safer alternative to the Polypill: the Polymeal.
Methods Data on the ingredients of the Polymeal were taken from the literature. The evidence based recipe included wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds. Data from the Framingham heart study and the Framingham offspring study were used to build life tables to model the benefits of the Polymeal in the general population from age 50, assuming multiplicative correlations.
Results Combining the ingredients of the Polymeal would reduce cardiovascular disease events by 76%. For men, taking the Polymeal daily represented an increase in total life expectancy of 6.6 years, an increase in life expectancy free from cardiovascular disease of 9.0 years, and a decrease in life expectancy with cardiovascular disease of 2.4 years. The corresponding differences for women were 4.8, 8.1, and 3.3 years.
Conclusion The Polymeal promises to be an effective, non-pharmacological, safe, cheap, and tasty alternative to reduce cardiovascular morbidity and increase life expectancy in the general population.
Introduction
Cardiovascular disease continues to be the leading cause of mortality and morbidity in Western populations.1 Although several risk factors for cardiovascular disease have been identified, its prevention is still suboptimal owing to high costs, low compliance, and side effects of treatment. In 2003 Wald and Law introduced the concept of the Polypill.2 The advocates of the Polypill selected six pharmacological components that by modifying different risk factors of cardiovascular disease multiplicatively might reduce the levels of cardiovascular disease in the population by more than 80%.2 In general, the medical community has welcomed the concept but questioned the potential adverse effects and costs of such an intervention.
Our objective was to define a safer, nonpharmacological, and tastier alternative to the Polypill in the general population: the Polymeal. We also wanted to calculate the potential effects of the Polymeal in terms of total life expectancy and life expectancy with and without cardiovascular disease.
Methods
The recipe
To optimise the Polymeal ingredients we used an evidence based diet conceptual framework, which follows similar principles to evidence based medicine.4 The constituting elements of a meal or recipe are selected on the basis of the best available evidence; the evidence available for each ingredient is graded according to the level of evidence. We searched PubMed, informed by expert advice, for nonpharmacological ingredients with evidence levels 1 or 2: randomised controlled trials, meta-analyses of randomised controlled trials, and meta-analyses of observational studies.5 To be included in the Polymeal, the ingredient had to have individually reported effects (not as an element of a diet) on reduction in cardiovascular disease events or modification of risk factors for cardiovascular disease. We checked papers retrieved for further possible ingredients. The following dietary elements met the inclusion criteria to be ingredients of the Polymeal: wine, fish, dark chocolate, fruits and vegetables, almonds, and garlic (Allium sativum).
Efficacy of the Polymeal
We obtained information from the literature on the benefits of the interventions (table 1). Daily consumption of 150 ml of wine reduces cardiovascular disease by 32% (95% confidence interval 33% to 41%).6 Fish (114 g) consumed four times a week reduces cardiovascular disease by 14% (8% to 19%).7 For chocolate, fruits and vegetables, almonds, and garlic, we found data on modification of risk factors for cardiovascular disease. One hundred grams of dark chocolate consumed daily reduces systolic blood pressure by 5.1 mm Hg and diastolic blood pressure by 1.8 mm Hg8; similar reductions in blood pressure correspond to a reduction in cardiovascular disease events of 21% (14% to 27%).9 A total of 400 g of fruit and vegetables consumed daily produced a reduction in blood pressure similar to that observed with chocolate (4.0 mm Hg systolic blood pressure and 1.5 mm Hg diastolic blood pressure), so we decided to assume the same reduction in cardiovascular disease effect as assigned for chocolate (21%).10
View this table:
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[in a new window]
Table 1 Effect of ingredients of Polymeal in reducing risk of cardiovascular disease
Daily consumption of garlic reduced total cholesterol concentrations by 0.44 mmol/l (17.1 mg/dl),11 12 corresponding to 66% of the reduction (0.66 mmol/l) that was found to be associated with a 38% reduction in cardiovascular disease at age 50.13 Therefore, we considered 66% of the effect previously reported and assumed a reduction of 25% (21.7% to 27.7%) in cardiovascular disease events for garlic. Most of the randomised controlled trials included in the meta-analysis used 600-900 mg/day of dried garlic powder preparations, equivalent to 1.8-2.7 g/day of fresh garlic.14 We selected 2.7 g/day of fresh garlic for the Polymeal. Consuming 68 g/day of almonds produced half the reduction in total cholesterol (10 mg/dl) observed with garlic,15 16 so we assumed a reduction in cardiovascular disease half the one assigned to garlic.
We calculated the combined effect of the ingredients of the evidence based diet Polymeal by multiplying their correspondent relative risk estimates. This is the same method that was used for the Polypill.
Saturday, March 27, 2010
Friday, March 26, 2010
FOTEO- reading list (Dr J Moch)
FOTEO Reading list. (*** Essential for the FOTEO program)
1. ***Dan Buettner – The Blue Zones
2. ***Wayne W. Dyer DVD: Explores the spiritual journey from ambition to meaning.
3. *** Jonny Bowden – The 150 healthiest foods on earth.
4. Andrew Weil – Healthy Aging (a lifelong guide to your physical and spiritual well-being.
5. Andrew Newberg - How God changes your brain.
6. Daniel Goleman – Emotional intelligence.
7. Joseph Le Doux – The emotional brain.
8. Eric Kandel – In search of memory.
9. Norman Doidge – The brain that changes itself.
10. Michael Gazzazinga – The ethical brain.
11. Don Campbell – The Mozart Effect
12. Howard Gardner – Multiple intelligences.
13. Daniel Siegel - The mindful brain.
14. Daniel Levitin – This is your brain on music.
1. ***Dan Buettner – The Blue Zones
2. ***Wayne W. Dyer DVD: Explores the spiritual journey from ambition to meaning.
3. *** Jonny Bowden – The 150 healthiest foods on earth.
4. Andrew Weil – Healthy Aging (a lifelong guide to your physical and spiritual well-being.
5. Andrew Newberg - How God changes your brain.
6. Daniel Goleman – Emotional intelligence.
7. Joseph Le Doux – The emotional brain.
8. Eric Kandel – In search of memory.
9. Norman Doidge – The brain that changes itself.
10. Michael Gazzazinga – The ethical brain.
11. Don Campbell – The Mozart Effect
12. Howard Gardner – Multiple intelligences.
13. Daniel Siegel - The mindful brain.
14. Daniel Levitin – This is your brain on music.
FOTEO: Nine brain circuits - muliple intelligences (H Gardner)
FOTEO Part three:
The Nine Types of Intelligence
By Howard Gardner
1. Logical-Mathematical Intelligence (“Number/Reasoning” Smart)
Logical-mathematical intelligence is the ability to calculate, quantify, consider propositions and hypotheses, and carry out complete mathematical operations. It enables us to perceive relationships and connections and to use abstract, symbolic thought; sequential reasoning skills; and inductive and deductive thinking patterns. Logical intelligence is usually well developed in mathematicians, scientists, and detectives. Young adults with lots of logical intelligence are interested in patterns, categories, and relationships. They are drawn to arithmetic problems, strategy games and experiments.
2. Linguistic Intelligence (“Word Smart”)
Linguistic intelligence is the ability to think in words and to use language to express and appreciate complex meanings. Linguistic intelligence allows us to understand the order and meaning of words and to apply meta-linguistic skills to reflect on our use of language. Linguistic intelligence is the most widely shared human competence and is evident in poets, novelists, journalists, and effective public speakers. Young adults with this kind of intelligence enjoy writing, reading, telling stories or doing crossword puzzles.
3. Musical Intelligence (“Musical Smart”)
Musical intelligence is the capacity to discern pitch, rhythm, timbre, and tone. This intelligence enables us to recognize, create, reproduce, and reflect on music, as demonstrated by composers, conductors, musicians, vocalist, and sensitive listeners. Interestingly, there is often an affective connection between music and the emotions; and mathematical and musical intelligences may share common thinking processes. Young adults with this kind of intelligence are usually singing or drumming to themselves. They are usually quite aware of sounds others may miss.
4. Spatial Intelligence (“Picture Smart”)
Spatial intelligence is the ability to think in three dimensions. Core capacities include mental imagery, spatial reasoning, image manipulation, graphic and artistic skills, and an active imagination. Sailors, pilots, sculptors, painters, and architects all exhibit spatial intelligence. Young adults with this kind of intelligence may be fascinated with mazes or jigsaw puzzles, or spend free time drawing or daydreaming.
5. Bodily-Kinesthetic Intelligence (“Body Smart”)
Bodily kinesthetic intelligence is the capacity to manipulate objects and use a variety of physical skills. This intelligence also involves a sense of timing and the perfection of skills through mind–body union. Athletes, dancers, surgeons, and craftspeople exhibit well-developed bodily kinesthetic intelligence.
6. Naturalist Intelligence (“Nature Smart”)
Designates the human ability to discriminate among living things (plants, animals) as well as sensitivity to other features of the natural world (clouds, rock configurations). This ability was clearly of value in our evolutionary past as hunters, gatherers, and farmers; it continues to be central in such roles as botanist or chef. It is also speculated that much of our consumer society exploits the naturalist intelligences, which can be mobilized in the discrimination among cars, sneakers, kinds of makeup, and the like.
7. Interpersonal Intelligence (“People Smart”)
Interpersonal intelligence is the ability to understand and interact effectively with others. It involves effective verbal and nonverbal communication, the ability to note distinctions among others, sensitivity to the moods and temperaments of others, and the ability to entertain multiple perspectives. Teachers, social workers, actors, and politicians all exhibit interpersonal intelligence. Young adults with this kind of intelligence are leaders among their peers, are good at communicating, and seem to understand others’ feelings and motives.
8. Intra-personal Intelligence (“Self Smart”)
Intra-personal intelligence is the capacity to understand oneself and one’s thoughts and feelings, and to use such knowledge in planning and directing one’s life. Intra-personal intelligence involves not only an appreciation of the self, but also of the human condition. It is evident in psychologists, spiritual leaders, and philosophers. These young adults may be shy. They are very aware of their own feelings and are self-motivated.
9. Spiritual/Existential Intelligence
Sensitivity and capacity to tackle deep questions about human existence, such as the meaning of life, why do we die, and how did we get here.
{From: Overview of the Multiple Intelligences Theory. Association for Supervision and Curriculum Development and Thomas Armstrong.com}
The Nine Types of Intelligence
By Howard Gardner
1. Logical-Mathematical Intelligence (“Number/Reasoning” Smart)
Logical-mathematical intelligence is the ability to calculate, quantify, consider propositions and hypotheses, and carry out complete mathematical operations. It enables us to perceive relationships and connections and to use abstract, symbolic thought; sequential reasoning skills; and inductive and deductive thinking patterns. Logical intelligence is usually well developed in mathematicians, scientists, and detectives. Young adults with lots of logical intelligence are interested in patterns, categories, and relationships. They are drawn to arithmetic problems, strategy games and experiments.
2. Linguistic Intelligence (“Word Smart”)
Linguistic intelligence is the ability to think in words and to use language to express and appreciate complex meanings. Linguistic intelligence allows us to understand the order and meaning of words and to apply meta-linguistic skills to reflect on our use of language. Linguistic intelligence is the most widely shared human competence and is evident in poets, novelists, journalists, and effective public speakers. Young adults with this kind of intelligence enjoy writing, reading, telling stories or doing crossword puzzles.
3. Musical Intelligence (“Musical Smart”)
Musical intelligence is the capacity to discern pitch, rhythm, timbre, and tone. This intelligence enables us to recognize, create, reproduce, and reflect on music, as demonstrated by composers, conductors, musicians, vocalist, and sensitive listeners. Interestingly, there is often an affective connection between music and the emotions; and mathematical and musical intelligences may share common thinking processes. Young adults with this kind of intelligence are usually singing or drumming to themselves. They are usually quite aware of sounds others may miss.
4. Spatial Intelligence (“Picture Smart”)
Spatial intelligence is the ability to think in three dimensions. Core capacities include mental imagery, spatial reasoning, image manipulation, graphic and artistic skills, and an active imagination. Sailors, pilots, sculptors, painters, and architects all exhibit spatial intelligence. Young adults with this kind of intelligence may be fascinated with mazes or jigsaw puzzles, or spend free time drawing or daydreaming.
5. Bodily-Kinesthetic Intelligence (“Body Smart”)
Bodily kinesthetic intelligence is the capacity to manipulate objects and use a variety of physical skills. This intelligence also involves a sense of timing and the perfection of skills through mind–body union. Athletes, dancers, surgeons, and craftspeople exhibit well-developed bodily kinesthetic intelligence.
6. Naturalist Intelligence (“Nature Smart”)
Designates the human ability to discriminate among living things (plants, animals) as well as sensitivity to other features of the natural world (clouds, rock configurations). This ability was clearly of value in our evolutionary past as hunters, gatherers, and farmers; it continues to be central in such roles as botanist or chef. It is also speculated that much of our consumer society exploits the naturalist intelligences, which can be mobilized in the discrimination among cars, sneakers, kinds of makeup, and the like.
7. Interpersonal Intelligence (“People Smart”)
Interpersonal intelligence is the ability to understand and interact effectively with others. It involves effective verbal and nonverbal communication, the ability to note distinctions among others, sensitivity to the moods and temperaments of others, and the ability to entertain multiple perspectives. Teachers, social workers, actors, and politicians all exhibit interpersonal intelligence. Young adults with this kind of intelligence are leaders among their peers, are good at communicating, and seem to understand others’ feelings and motives.
8. Intra-personal Intelligence (“Self Smart”)
Intra-personal intelligence is the capacity to understand oneself and one’s thoughts and feelings, and to use such knowledge in planning and directing one’s life. Intra-personal intelligence involves not only an appreciation of the self, but also of the human condition. It is evident in psychologists, spiritual leaders, and philosophers. These young adults may be shy. They are very aware of their own feelings and are self-motivated.
9. Spiritual/Existential Intelligence
Sensitivity and capacity to tackle deep questions about human existence, such as the meaning of life, why do we die, and how did we get here.
{From: Overview of the Multiple Intelligences Theory. Association for Supervision and Curriculum Development and Thomas Armstrong.com}
Monday, March 22, 2010
Laughter is the best medicine (1)
The winning joke
After much careful scrutiny, we finally found the joke that received higher ratings than any other gag. Here it is:
Two hunters are out in the woods when one of them collapses. He doesn't seem to be breathing and his eyes are glazed. The other guy whips out his phone and calls the emergency services. He gasps, "My friend is dead! What can I do?". The operator says "Calm down. I can help. First, let's make sure he's dead." There is a silence, then a shot is heard. Back on the phone, the guy says "OK, now what?"
After much careful scrutiny, we finally found the joke that received higher ratings than any other gag. Here it is:
Two hunters are out in the woods when one of them collapses. He doesn't seem to be breathing and his eyes are glazed. The other guy whips out his phone and calls the emergency services. He gasps, "My friend is dead! What can I do?". The operator says "Calm down. I can help. First, let's make sure he's dead." There is a silence, then a shot is heard. Back on the phone, the guy says "OK, now what?"
Laughter is the best medicine (2)
In second place
The joke that came second was submitted by Geoff Anandappa, from Blackpool in Britain:
Sherlock Holmes and Dr Watson were going camping. They pitched their tent under the stars and went to sleep. Sometime in the middle of the night Holmes woke Watson up and said: “Watson, look up at the stars, and tell me what you see.”
Watson replied: “I see millions and millions of stars.”
Holmes said: “and what do you deduce from that?”
Watson replied: “Well, if there are millions of stars, and if even a few of those have planets, it’s quite likely there are some planets like earth out there. And if there are a few planets like earth out there, there might also be life.”
And Holmes said: “Watson, you idiot, it means that somebody stole our tent.”
The joke that came second was submitted by Geoff Anandappa, from Blackpool in Britain:
Sherlock Holmes and Dr Watson were going camping. They pitched their tent under the stars and went to sleep. Sometime in the middle of the night Holmes woke Watson up and said: “Watson, look up at the stars, and tell me what you see.”
Watson replied: “I see millions and millions of stars.”
Holmes said: “and what do you deduce from that?”
Watson replied: “Well, if there are millions of stars, and if even a few of those have planets, it’s quite likely there are some planets like earth out there. And if there are a few planets like earth out there, there might also be life.”
And Holmes said: “Watson, you idiot, it means that somebody stole our tent.”
Saturday, March 20, 2010
The World in Search of A Sabbath!
Bay Area - 9 Counties, 8 Bridges, 7 Million People
March 19, 2010, 1:14 pm
A New Take on the Old Sabbath Ritual of Unplugging
By MICHELLE QUINN
I am typing fast because at sundown (7:20 p.m.), I plan to join in the first National Day of Unplugging and turn my electronic devices off until sundown Saturday. The effort, reported in The New York Times and elsewhere, is the brainchild of Reboot, a nonprofit organization of Jewish professionals who want to adapt the concept of Sabbath traditions to the digital age.
I thought at first, yadda yadda yadda. Go ahead and unplug, everyone. But then I saw “Yelp,” the YouTube video above by Ken Goldberg and Tiffany Shlain. It uses Allen Ginsberg’s “Howl” as the muse for a short video promoting the day of unplugging. Having just reread “Howl” for a post on the movie about Mr. Ginsberg’s life, I felt “Yelp” kept somehow true to the poem, even if the creators mixed Mr. Ginsberg’s visceral words with the less-visceral brand names of the soon-to-be-disconnected digisphere: Google, iPhone, Facebook.
Mr. Goldberg is a professor of robotics at the University of California, Berkeley, and Ms. Shlain is best known for putting on the Webby Awards, celebrating the best of the Internet. This Mill Valley couple, with their two children, left Friday morning for Hawaii, where they will try to stay unplugged for six days. Not that they are doctrinaire about their unplugged-ness. I interviewed them via cellphone as they sat on the tarmac ready to leave. But more on that in a second.
Reboot is not the first or the last group to address the jittery need among many to clean out e-mail in-boxes and glance at RSS feeds. Starting in February at the Actual Cafe in Oakland, laptop use has been forbidden on weekends — an attempt by the owner to get patrons to talk to one another, as The San Francisco Chronicle described. In “The Keep,” by Jennifer Egan, the main character loses his bearings and sense of self, like a character in an Edgar Allan Poe (or Franz Kafka) story, when he is cut off electronically from the outside world.
At home, my husband and I have talked about the messages we’re sending to our children by the constant checking of our cellphones and laptops. As we stood looking out to the Pacific Ocean at Point Lobos, a state park on the craggy coast, my son, 7, asked me, “Why do people go to beautiful places and look at their cellphones?”
But back to Mr. Goldberg and Ms. Shlain, who managed to post her thoughts about unplugging this morning on The Huffington Post as the two carted a 6-year-old and 10-month-old baby to the airport.
Ms. Shlain said they were approached by Reboot to do something for the day. Three weeks ago, they knocked out the poem “Yelp” during a four-hour drive back from Tahoe, then decided to create a short video, using imagery from a feature-length documentary film Ms. Shlain is working on called “Connected: A Declaration of Interdependence.”
Have a great trip, I said, adding that I would send an e-mail message with the link to this post, since they wouldn’t see it for six days.
Oh, Mr. Goldberg said, we’ll sneak a peek at the Internet. “I’m sure I won’t make it a week,” he said.
* Copyright 2010 The New York Times Company
* Privacy Policy
* NYTimes.com 620 Eighth Avenue New York, NY 10018
March 19, 2010, 1:14 pm
A New Take on the Old Sabbath Ritual of Unplugging
By MICHELLE QUINN
I am typing fast because at sundown (7:20 p.m.), I plan to join in the first National Day of Unplugging and turn my electronic devices off until sundown Saturday. The effort, reported in The New York Times and elsewhere, is the brainchild of Reboot, a nonprofit organization of Jewish professionals who want to adapt the concept of Sabbath traditions to the digital age.
I thought at first, yadda yadda yadda. Go ahead and unplug, everyone. But then I saw “Yelp,” the YouTube video above by Ken Goldberg and Tiffany Shlain. It uses Allen Ginsberg’s “Howl” as the muse for a short video promoting the day of unplugging. Having just reread “Howl” for a post on the movie about Mr. Ginsberg’s life, I felt “Yelp” kept somehow true to the poem, even if the creators mixed Mr. Ginsberg’s visceral words with the less-visceral brand names of the soon-to-be-disconnected digisphere: Google, iPhone, Facebook.
Mr. Goldberg is a professor of robotics at the University of California, Berkeley, and Ms. Shlain is best known for putting on the Webby Awards, celebrating the best of the Internet. This Mill Valley couple, with their two children, left Friday morning for Hawaii, where they will try to stay unplugged for six days. Not that they are doctrinaire about their unplugged-ness. I interviewed them via cellphone as they sat on the tarmac ready to leave. But more on that in a second.
Reboot is not the first or the last group to address the jittery need among many to clean out e-mail in-boxes and glance at RSS feeds. Starting in February at the Actual Cafe in Oakland, laptop use has been forbidden on weekends — an attempt by the owner to get patrons to talk to one another, as The San Francisco Chronicle described. In “The Keep,” by Jennifer Egan, the main character loses his bearings and sense of self, like a character in an Edgar Allan Poe (or Franz Kafka) story, when he is cut off electronically from the outside world.
At home, my husband and I have talked about the messages we’re sending to our children by the constant checking of our cellphones and laptops. As we stood looking out to the Pacific Ocean at Point Lobos, a state park on the craggy coast, my son, 7, asked me, “Why do people go to beautiful places and look at their cellphones?”
But back to Mr. Goldberg and Ms. Shlain, who managed to post her thoughts about unplugging this morning on The Huffington Post as the two carted a 6-year-old and 10-month-old baby to the airport.
Ms. Shlain said they were approached by Reboot to do something for the day. Three weeks ago, they knocked out the poem “Yelp” during a four-hour drive back from Tahoe, then decided to create a short video, using imagery from a feature-length documentary film Ms. Shlain is working on called “Connected: A Declaration of Interdependence.”
Have a great trip, I said, adding that I would send an e-mail message with the link to this post, since they wouldn’t see it for six days.
Oh, Mr. Goldberg said, we’ll sneak a peek at the Internet. “I’m sure I won’t make it a week,” he said.
* Copyright 2010 The New York Times Company
* Privacy Policy
* NYTimes.com 620 Eighth Avenue New York, NY 10018
Friday, March 19, 2010
Rest Well!
Opinionator - A Gathering of Opinion From Around the Web
March 18, 2010, 9:30 pm
At Midnight, All the Doctors…
By LISA SHIVES
All-Nighters is an exploration of insomnia, sleep and the nocturnal life.
Tags:
medical training, residency, sleep deprivation, sleep doctors
“I’m a sleep doctor.” Silence. There is a pause in the conversation, which is common.
Sleep medicine, as a field, is new enough that people are often taken off guard: “You do what?” The disheveled older man, who seems to have Ritz crackers woven into the fabric of his tie, leans closer. He appears to have misheard or misunderstood. (I often wonder what goes through peoples’ minds in that split second; what do they think they heard me say: “I’m a peep doctor”?) I repeat and explain that I do sleep medicine, “you know, insomnia, sleep apnea, that sort of thing.” “Oh, yes. I see.” His eyes widen with interest; now he steps really close, and a trembling hand lightly lays itself on my forearm.
Doctors preach the importance of sleep, yet medical students and residents are trained to be sleep-deprived.
I know that if I am not extremely creative and diplomatic, I will be stuck in the corner all night doing what I do all day — listening to some sad soul pour out his story of tortured, restless sleep. At a party, I am right up there in popularity with the dermatologist and plastic surgeon. Everyone needs our help and no one is embarrassed to say so.
Don’t get me wrong; I feel for this sleep-deprived, soiled and seemingly desperate man, but not much can be solved in a few minutes over canapés and gin. I am happy to help out and give useful advice where I can; it’s just that most people want to talk to me about their insomnia, and insomnia is the “dreaded disease” of sleep medicine. Every medical specialty has the one patient complaint that makes the doctors groan. For neurologists, it is headache; for rheumatologists, chronic fatigue; and for gastrointestinal docs, it is irritable bowel. What these all have in common is that we doctors don’t know how to treat them very well. One reason is that they are disorders, which means they are sets of symptoms, rather than one clear-cut, pathologically definable disease, and in their complexities, they are often not well understood and consequently not well treated using Western medical paradigms.
If there were a medical solution to sleeplessness, there would not be this need for sharing stories of nocturnal misery and outlining strategies for persevering. There have, however, been advances in our understanding of the disorder. The latest biomedical explanation for insomnia is much like the one for depression: There is an imbalance in the neurotransmitters in the brain, in this case, the ones that control the sleep/wake cycle. However, mapping out exactly what the problem is in which part of the brain remains the challenge for medical scientists.
One piece of advice I have to give to all insomnia suffers is to beware of the word “insomnia.” The problem is that the word is used by patients and doctors to describe the symptom of not being able to initiate sleep or maintain sleep or having persistent early morning awakenings. But it is also the word used for the final diagnosis. Patients walk into their primary care doctor and say: “Hey doc, I can’t sleep. I have insomnia.” And they are getting into their car before the ink has dried on the prescription for Ambien. People don’t walk into their internist’s office and say, “I’m having appendicitis.” They tell the doctor about the horrible pain in their “stomach,” and it is the doctor’s job to think of all the problems this might represent and to narrow the possibilities by asking further questions, doing a physical exam and running tests. Insomnia is not that easy to work up, and it takes the one thing that doctors have so little of: time for questions and discussion with the patient.
So be a proactive patient and do not easily accept chronic insomnia as your final diagnosis. There are, after all, so many medical problems that can masquerade as insomnia. Sleep disorders like sleep apnea and delayed sleep phase disorder can mislead patients and non-sleep doctors. Psychiatric disorders, cardiovascular disease, lung disease and rheumatologic and endocrine disorders (as well as the medications used to treat them) can all disrupt sleep and lead people to think that they suffer from insomnia.
The gentleman with the crumb problem (which is likely secondary to being sleep deprived and living without a wife as most phenomena are multifactorial) wanted to know what got me interested in the area of sleep medicine. I answered: “Because it is an oxymoron — sleep and medicine do not go together at all.” Doctors preach to patients how important sleep is to lower their risk of all sorts of diseases: high blood pressure, heart disease, stroke, diabetes, weight gain and obesity, depression and dementia. Yet the institution of medical training in this country practices systematized sleep deprivation of medical students and residents. By the way, we use the term “resident” because junior doctors used to live in the hospitals.
Driving while sleep deprived can be just as dangerous as driving drunk.
For the majority of the three years I trained in internal medicine (and during the two years before that when I did clinical rotations as a medical student), I would work 30 to 36 hour shifts every fourth night with no guarantee of sleep. Why, you might wonder, are students and residents pushed so hard, for so long? One reason is that medicine is a very tradition-bound profession and this is just the way “things have always been done.” But there are myriad other reasons: a culture of hard work that tests the mental stability and physical stamina of these brave young men and women; a belief held by many doctors that residency training is simply too short to teach doctors all they need to know unless they are pretty much working non-stop during that period seeing all the “interesting cases” that come through; and the simple economic fact that residents are a cheap way to man the hospital around the clock.
After 24 hours on duty, I would crave sleep like other people desire food or sex. And like an addict, I would plot and plan and structure my activity around getting the balm I so desperately needed. I would try to squeeze some sleep in, no matter how short the time allotted, no matter the location. I have slept in wheel chairs and on a patient gurney; I have dozed in stairwells and while riding on elevators. I, like almost every resident physician I know, would routinely fall asleep during the morning and noontime lectures that were meant to teach me how to be a decent doctor. Every woman doctor I know, and quite a few men, have wept from sheer exhaustion. The question is not only how did I live through this, but how did my patients?
More in This Series
* “Night Lights, Blankets and Lullabies” By Siri Hustvedt
* “In the Night Kitchen” by Leanne Shapton
* “Seeing in the Dark” by Lisa Russ Spaar
* “The A-to-Z Cure” by Roz Chast
* The entire series »
I have a friend who wrecked her car three times in the first two months of her surgery internship. The same surgeon fell asleep with a needle-driver in her hand. Luckily, a senior attending caught her before she fell into the open wound. I was so tired driving home one afternoon after a call, that I had to roll down the window in the middle of Chicago winter, blast the radio and light a cigarette. I was shifting in my seat and flailing my arms so erratically that I thought other drivers on the road would think that I was having an epileptic fit. I didn’t worry about being mistaken for a drunk driver because even a drunk wouldn’t have acted as crazy as that. (Years later, in my training as a sleep medicine doctor, I learned that driving while sleep deprived can be just as dangerous as driving drunk.) It may assuage the reader’s fears to know that there are new regulations prohibiting resident physicians from working more than 80 hours per week, not to relieve the residents so much as to protect the patients because there was mounting evidence that many medical errors are attributable to physician fatigue.
Now I get my 7 to 8 hours without fail. Although I have not suffered much from insomnia, that inner, unwanted drive to wakefulness, I do know sleeplessness driven by external exigencies. I have a lot of sympathy and not a small amount of empathy for those sleepless souls who bleary-eyed and sallow-skinned must go forth into “the desolation of reality,” in Yeats’s memorable phrase. Day after day, they drag themselves into my office. Their minds are muddled; their hearts are heavy; and many are just plain angry. So I tell them: “I have no quick fix, no miracle pill, but I will listen long and hard to your story of chasing the elusive elixir of sleep. Although I might not cure you, I’ll go through this with you, as your witness, your night watchman, as someone who knows how long one night can seem.”
Lisa Shives, a doctor and the medical director of Northshore Sleep Medicine in Evanston, Ill., is an official spokesperson for the American Academy of Sleep Medicine. She is working on her first book which will focus on pediatric sleep disorders.
* Copyright 2010 The New York Times Company
* Privacy Policy
* NYTimes.com 620 Eighth Avenue New York, NY 10018
March 18, 2010, 9:30 pm
At Midnight, All the Doctors…
By LISA SHIVES
All-Nighters is an exploration of insomnia, sleep and the nocturnal life.
Tags:
medical training, residency, sleep deprivation, sleep doctors
“I’m a sleep doctor.” Silence. There is a pause in the conversation, which is common.
Sleep medicine, as a field, is new enough that people are often taken off guard: “You do what?” The disheveled older man, who seems to have Ritz crackers woven into the fabric of his tie, leans closer. He appears to have misheard or misunderstood. (I often wonder what goes through peoples’ minds in that split second; what do they think they heard me say: “I’m a peep doctor”?) I repeat and explain that I do sleep medicine, “you know, insomnia, sleep apnea, that sort of thing.” “Oh, yes. I see.” His eyes widen with interest; now he steps really close, and a trembling hand lightly lays itself on my forearm.
Doctors preach the importance of sleep, yet medical students and residents are trained to be sleep-deprived.
I know that if I am not extremely creative and diplomatic, I will be stuck in the corner all night doing what I do all day — listening to some sad soul pour out his story of tortured, restless sleep. At a party, I am right up there in popularity with the dermatologist and plastic surgeon. Everyone needs our help and no one is embarrassed to say so.
Don’t get me wrong; I feel for this sleep-deprived, soiled and seemingly desperate man, but not much can be solved in a few minutes over canapés and gin. I am happy to help out and give useful advice where I can; it’s just that most people want to talk to me about their insomnia, and insomnia is the “dreaded disease” of sleep medicine. Every medical specialty has the one patient complaint that makes the doctors groan. For neurologists, it is headache; for rheumatologists, chronic fatigue; and for gastrointestinal docs, it is irritable bowel. What these all have in common is that we doctors don’t know how to treat them very well. One reason is that they are disorders, which means they are sets of symptoms, rather than one clear-cut, pathologically definable disease, and in their complexities, they are often not well understood and consequently not well treated using Western medical paradigms.
If there were a medical solution to sleeplessness, there would not be this need for sharing stories of nocturnal misery and outlining strategies for persevering. There have, however, been advances in our understanding of the disorder. The latest biomedical explanation for insomnia is much like the one for depression: There is an imbalance in the neurotransmitters in the brain, in this case, the ones that control the sleep/wake cycle. However, mapping out exactly what the problem is in which part of the brain remains the challenge for medical scientists.
One piece of advice I have to give to all insomnia suffers is to beware of the word “insomnia.” The problem is that the word is used by patients and doctors to describe the symptom of not being able to initiate sleep or maintain sleep or having persistent early morning awakenings. But it is also the word used for the final diagnosis. Patients walk into their primary care doctor and say: “Hey doc, I can’t sleep. I have insomnia.” And they are getting into their car before the ink has dried on the prescription for Ambien. People don’t walk into their internist’s office and say, “I’m having appendicitis.” They tell the doctor about the horrible pain in their “stomach,” and it is the doctor’s job to think of all the problems this might represent and to narrow the possibilities by asking further questions, doing a physical exam and running tests. Insomnia is not that easy to work up, and it takes the one thing that doctors have so little of: time for questions and discussion with the patient.
So be a proactive patient and do not easily accept chronic insomnia as your final diagnosis. There are, after all, so many medical problems that can masquerade as insomnia. Sleep disorders like sleep apnea and delayed sleep phase disorder can mislead patients and non-sleep doctors. Psychiatric disorders, cardiovascular disease, lung disease and rheumatologic and endocrine disorders (as well as the medications used to treat them) can all disrupt sleep and lead people to think that they suffer from insomnia.
The gentleman with the crumb problem (which is likely secondary to being sleep deprived and living without a wife as most phenomena are multifactorial) wanted to know what got me interested in the area of sleep medicine. I answered: “Because it is an oxymoron — sleep and medicine do not go together at all.” Doctors preach to patients how important sleep is to lower their risk of all sorts of diseases: high blood pressure, heart disease, stroke, diabetes, weight gain and obesity, depression and dementia. Yet the institution of medical training in this country practices systematized sleep deprivation of medical students and residents. By the way, we use the term “resident” because junior doctors used to live in the hospitals.
Driving while sleep deprived can be just as dangerous as driving drunk.
For the majority of the three years I trained in internal medicine (and during the two years before that when I did clinical rotations as a medical student), I would work 30 to 36 hour shifts every fourth night with no guarantee of sleep. Why, you might wonder, are students and residents pushed so hard, for so long? One reason is that medicine is a very tradition-bound profession and this is just the way “things have always been done.” But there are myriad other reasons: a culture of hard work that tests the mental stability and physical stamina of these brave young men and women; a belief held by many doctors that residency training is simply too short to teach doctors all they need to know unless they are pretty much working non-stop during that period seeing all the “interesting cases” that come through; and the simple economic fact that residents are a cheap way to man the hospital around the clock.
After 24 hours on duty, I would crave sleep like other people desire food or sex. And like an addict, I would plot and plan and structure my activity around getting the balm I so desperately needed. I would try to squeeze some sleep in, no matter how short the time allotted, no matter the location. I have slept in wheel chairs and on a patient gurney; I have dozed in stairwells and while riding on elevators. I, like almost every resident physician I know, would routinely fall asleep during the morning and noontime lectures that were meant to teach me how to be a decent doctor. Every woman doctor I know, and quite a few men, have wept from sheer exhaustion. The question is not only how did I live through this, but how did my patients?
More in This Series
* “Night Lights, Blankets and Lullabies” By Siri Hustvedt
* “In the Night Kitchen” by Leanne Shapton
* “Seeing in the Dark” by Lisa Russ Spaar
* “The A-to-Z Cure” by Roz Chast
* The entire series »
I have a friend who wrecked her car three times in the first two months of her surgery internship. The same surgeon fell asleep with a needle-driver in her hand. Luckily, a senior attending caught her before she fell into the open wound. I was so tired driving home one afternoon after a call, that I had to roll down the window in the middle of Chicago winter, blast the radio and light a cigarette. I was shifting in my seat and flailing my arms so erratically that I thought other drivers on the road would think that I was having an epileptic fit. I didn’t worry about being mistaken for a drunk driver because even a drunk wouldn’t have acted as crazy as that. (Years later, in my training as a sleep medicine doctor, I learned that driving while sleep deprived can be just as dangerous as driving drunk.) It may assuage the reader’s fears to know that there are new regulations prohibiting resident physicians from working more than 80 hours per week, not to relieve the residents so much as to protect the patients because there was mounting evidence that many medical errors are attributable to physician fatigue.
Now I get my 7 to 8 hours without fail. Although I have not suffered much from insomnia, that inner, unwanted drive to wakefulness, I do know sleeplessness driven by external exigencies. I have a lot of sympathy and not a small amount of empathy for those sleepless souls who bleary-eyed and sallow-skinned must go forth into “the desolation of reality,” in Yeats’s memorable phrase. Day after day, they drag themselves into my office. Their minds are muddled; their hearts are heavy; and many are just plain angry. So I tell them: “I have no quick fix, no miracle pill, but I will listen long and hard to your story of chasing the elusive elixir of sleep. Although I might not cure you, I’ll go through this with you, as your witness, your night watchman, as someone who knows how long one night can seem.”
Lisa Shives, a doctor and the medical director of Northshore Sleep Medicine in Evanston, Ill., is an official spokesperson for the American Academy of Sleep Medicine. She is working on her first book which will focus on pediatric sleep disorders.
* Copyright 2010 The New York Times Company
* Privacy Policy
* NYTimes.com 620 Eighth Avenue New York, NY 10018
DeepMeaningful Conversations
March 17, 2010, 2:34 pm
Talk Deeply, Be Happy?
By RONI CARYN RABIN
ZenShui/Getty Images Deep conversations made people happier than small talk, one study found.
Would you be happier if you spent more time discussing the state of the world and the meaning of life — and less time talking about the weather?
It may sound counterintuitive, but people who spend more of their day having deep discussions and less time engaging in small talk seem to be happier, said Matthias Mehl, a psychologist at the University of Arizona who published a study on the subject.
“We found this so interesting, because it could have gone the other way — it could have been, ‘Don’t worry, be happy’ — as long as you surf on the shallow level of life you’re happy, and if you go into the existential depths you’ll be unhappy,” Dr. Mehl said.
But, he proposed, substantive conversation seemed to hold the key to happiness for two main reasons: both because human beings are driven to find and create meaning in their lives, and because we are social animals who want and need to connect with other people.
“By engaging in meaningful conversations, we manage to impose meaning on an otherwise pretty chaotic world,” Dr. Mehl said. “And interpersonally, as you find this meaning, you bond with your interactive partner, and we know that interpersonal connection and integration is a core fundamental foundation of happiness.”
Dr. Mehl’s study was small and doesn’t prove a cause-and-effect relationship between the kind of conversations one has and one’s happiness. But that’s the planned next step, when he will ask people to increase the number of substantive conversations they have each day and cut back on small talk, and vice versa.
The study, published in the journal Psychological Science, involved 79 college students — 32 men and 47 women — who agreed to wear an electronically activated recorder with a microphone on their lapel that recorded 30-second snippets of conversation every 12.5 minutes for four days, creating what Dr. Mehl called “an acoustic diary of their day.”
Researchers then went through the tapes and classified the conversation snippets as either small talk about the weather or having watched a TV show, and more substantive talk about current affairs, philosophy, the difference between Baptists and Catholics or the role of education. A conversation about a TV show wasn’t always considered small talk; it could be categorized as substantive if the speakers analyzed the characters and their motivations, for example.
Many conversations were more practical and did not fit in either category, including questions about homework or who was taking out the trash, for example, Dr. Mehl said. Over all, about a third of all conversation was ranked as substantive, and about a fifth consisted of small talk.
But the happiest person in the study, based on self-reports about satisfaction with life and other happiness measures as well as reports from people who knew the subject, had twice as many substantive conversations, and only one-third of the amount of small talk as the unhappiest, Dr. Mehl said. Almost every other conversation the happiest person had — 45.9 percent of the day’s conversations — were substantive, while only 21.8 percent of the unhappiest person’s conversations were substantive.
Small talk made up only 10 percent of the happiest person’s conversations, while it made up almost three times as much –- or 28.3 percent –- of the unhappiest person’s conversations.
Next, Dr. Mehl wants to see if people can actually make themselves happier by having more substantive conversations.
“It’s not that easy, like taking a pill once a day,” Dr. Mehl said. “But this has always intrigued me. Can we make people happier by asking them, for the next five days, to have one extra substantive conversation every day?”
Talk Deeply, Be Happy?
By RONI CARYN RABIN
ZenShui/Getty Images Deep conversations made people happier than small talk, one study found.
Would you be happier if you spent more time discussing the state of the world and the meaning of life — and less time talking about the weather?
It may sound counterintuitive, but people who spend more of their day having deep discussions and less time engaging in small talk seem to be happier, said Matthias Mehl, a psychologist at the University of Arizona who published a study on the subject.
“We found this so interesting, because it could have gone the other way — it could have been, ‘Don’t worry, be happy’ — as long as you surf on the shallow level of life you’re happy, and if you go into the existential depths you’ll be unhappy,” Dr. Mehl said.
But, he proposed, substantive conversation seemed to hold the key to happiness for two main reasons: both because human beings are driven to find and create meaning in their lives, and because we are social animals who want and need to connect with other people.
“By engaging in meaningful conversations, we manage to impose meaning on an otherwise pretty chaotic world,” Dr. Mehl said. “And interpersonally, as you find this meaning, you bond with your interactive partner, and we know that interpersonal connection and integration is a core fundamental foundation of happiness.”
Dr. Mehl’s study was small and doesn’t prove a cause-and-effect relationship between the kind of conversations one has and one’s happiness. But that’s the planned next step, when he will ask people to increase the number of substantive conversations they have each day and cut back on small talk, and vice versa.
The study, published in the journal Psychological Science, involved 79 college students — 32 men and 47 women — who agreed to wear an electronically activated recorder with a microphone on their lapel that recorded 30-second snippets of conversation every 12.5 minutes for four days, creating what Dr. Mehl called “an acoustic diary of their day.”
Researchers then went through the tapes and classified the conversation snippets as either small talk about the weather or having watched a TV show, and more substantive talk about current affairs, philosophy, the difference between Baptists and Catholics or the role of education. A conversation about a TV show wasn’t always considered small talk; it could be categorized as substantive if the speakers analyzed the characters and their motivations, for example.
Many conversations were more practical and did not fit in either category, including questions about homework or who was taking out the trash, for example, Dr. Mehl said. Over all, about a third of all conversation was ranked as substantive, and about a fifth consisted of small talk.
But the happiest person in the study, based on self-reports about satisfaction with life and other happiness measures as well as reports from people who knew the subject, had twice as many substantive conversations, and only one-third of the amount of small talk as the unhappiest, Dr. Mehl said. Almost every other conversation the happiest person had — 45.9 percent of the day’s conversations — were substantive, while only 21.8 percent of the unhappiest person’s conversations were substantive.
Small talk made up only 10 percent of the happiest person’s conversations, while it made up almost three times as much –- or 28.3 percent –- of the unhappiest person’s conversations.
Next, Dr. Mehl wants to see if people can actually make themselves happier by having more substantive conversations.
“It’s not that easy, like taking a pill once a day,” Dr. Mehl said. “But this has always intrigued me. Can we make people happier by asking them, for the next five days, to have one extra substantive conversation every day?”
Tuesday, March 9, 2010
Interesting overview of leadership criteria
.
Most of the following can be adapted for personal leadership. Mapping your own path to success, and walking the talk (vision) are the essential ingredients. Enjoy.
Articles
The Top 10 Traits of an Outstanding Leader
Aspire to achieve 10 key leadership qualities and watch your business success skyrocket.
By David Javitch
Many writers have penned essays on the characteristics, behaviors, values and attitudes that spell success for the entrepreneurial leader. My top 10 list goes further, blending the theoretical, practical and the common sense based on 25 years I've spent in the field assessing, coaching and consulting leaders.
1. The successful leader has a vision
Think things through and know where you want to go and how you want to get there. Work with others to ensure a vision is followed through. Direct the actions and resources toward making it a reality.
2. The successful leader communicates well
Articulate a vision clearly to others. Encourage two-way communication between managers and non-managers and always be available to others. Strive to be succinct and specific about directions and instructions. Above all, a good leader avoids generalisations and ambiguities that can lead to misunderstanding, conflict and poor performance.
3. The successful leader supports and guides the employees
Start by helping others clarify and achieve goals by identifying and removing any obstacles. Provide the resources (time, money, people, information and equipment) needed to complete the task. Don't reprimand others who make mistakes when taking a well-calculated risk. Instead, critique and analyse what went wrong and what went right. Next, work with the employee to correct the error. Decide whether another attempt at a previous goal is necessary, and offer encouragement if it is. During the entire process, provide appropriate feedback to ensure positive attitudes and actions. Serve as a model of good attitude and use approaches that others can emulate.
4. The successful leader believes in themselves
A good leader possesses a strong sense of confidence, built upon years of learning, experimenting and at times failing – but always growing. Be aware of personal strengths and limitations, and demonstrate those skills and talents without boasting. Assume responsibility for faults and personal errors without hiding them or blaming others, and know that if a mistake occurs, it does not equate inadequacy. A successful leader believes that he or she can turn around a negative situation by re-examining the variables and other circumstances – with input from others, when necessary.
5. The successful leader creates the atmosphere that encourages others to grow and thrive
Know that no one individual possesses all of the answers. By appreciating the role that motivational techniques can play in improving employee performance, you can work with others to increase organisational productivity and improve individual job satisfaction. Here are some tips on how to create a motivational atmosphere:
Most of the following can be adapted for personal leadership. Mapping your own path to success, and walking the talk (vision) are the essential ingredients. Enjoy.
Articles
The Top 10 Traits of an Outstanding Leader
Aspire to achieve 10 key leadership qualities and watch your business success skyrocket.
By David Javitch
Many writers have penned essays on the characteristics, behaviors, values and attitudes that spell success for the entrepreneurial leader. My top 10 list goes further, blending the theoretical, practical and the common sense based on 25 years I've spent in the field assessing, coaching and consulting leaders.
1. The successful leader has a vision
Think things through and know where you want to go and how you want to get there. Work with others to ensure a vision is followed through. Direct the actions and resources toward making it a reality.
2. The successful leader communicates well
Articulate a vision clearly to others. Encourage two-way communication between managers and non-managers and always be available to others. Strive to be succinct and specific about directions and instructions. Above all, a good leader avoids generalisations and ambiguities that can lead to misunderstanding, conflict and poor performance.
3. The successful leader supports and guides the employees
Start by helping others clarify and achieve goals by identifying and removing any obstacles. Provide the resources (time, money, people, information and equipment) needed to complete the task. Don't reprimand others who make mistakes when taking a well-calculated risk. Instead, critique and analyse what went wrong and what went right. Next, work with the employee to correct the error. Decide whether another attempt at a previous goal is necessary, and offer encouragement if it is. During the entire process, provide appropriate feedback to ensure positive attitudes and actions. Serve as a model of good attitude and use approaches that others can emulate.
4. The successful leader believes in themselves
A good leader possesses a strong sense of confidence, built upon years of learning, experimenting and at times failing – but always growing. Be aware of personal strengths and limitations, and demonstrate those skills and talents without boasting. Assume responsibility for faults and personal errors without hiding them or blaming others, and know that if a mistake occurs, it does not equate inadequacy. A successful leader believes that he or she can turn around a negative situation by re-examining the variables and other circumstances – with input from others, when necessary.
5. The successful leader creates the atmosphere that encourages others to grow and thrive
Know that no one individual possesses all of the answers. By appreciating the role that motivational techniques can play in improving employee performance, you can work with others to increase organisational productivity and improve individual job satisfaction. Here are some tips on how to create a motivational atmosphere:
Thursday, March 4, 2010
Mini Essays on the Ten Commandments of Stress Management
The following content informs my master classes in FOTEO (From Ordinary To Extra-Ordinary). Each concept/commandment has its own unique principles and practices and can stand alone as seperate presentations.
The Master Classes can be presented across a spectrum of variable time options ranging from 30 minutes to half day to five day getaways.
Further information:
1. Scroll through previous blogs or
2. email = jacben@telkomsa.net or
3. sms = 078 439 8889
Looking forward to meeting you.
Dr. Jonathan Moch (BSc MBBCH, FFPsych (SA)
1. Time.
As a result of advances in medical technology, the human inhabitants of the planet now have an increasing lifespan. The human being can probably live for many decades post retirement and after all the children have left home. The progressive aging world will result in massive demographic changes for such societies, but does open up the possibility of great opportunities.
Poor personal architecture of the unfolding future results, at the very least, in a life of quiet desperation. Time divided into its classical three components – past, present and future – can ensnare the mind by living in the dismal facts of the past (What could have been? What should have been?) or conversely frozen by the wild imaginations of infinite possibilities of the future (What might be? What ought to be?), without ever being fully present in the current moment. Living persistently in the past leads to depression; living in the future leads to anxiety.
The aim is to anchor oneself in the present moment even it requires deep painful reflection of past deeds or stretching far into the future to strategize and prioritize. Aim your future trajectory into building banks of positive memories by creating environments that positive experiences are the most likely consequences.
One moment at a time, for it is only the present moment we can control!
2. Attitude.
The brain/mind filters constant rivers of information from both outside (via the senses such as sight, sound and touch) and internal streams of consciousness of thoughts and emotions. How our internal software programs handles such information determines to a very large extent our behavioral responses. Deeply held beliefs are like their biological cousins - genes. Some authors call these incorrigible creatures; memes, which are the initial building blocks of dozens of rules and assumptions made about ourselves, others and the future. These in turn are the bedrock of automatic thinking – knee jerk responses to everyday stimuli.
Memes are very stubborn to change as many are developed from childhood. Examples are: I am helpless; or I am unlovable.
Your attitudinal stance certainly determines your altitude. In other words - the amount of personal potential that is actualized. Deep psychological mining to the source within the mind/brain is one way to change negative thinking and emotions. Sometimes it is much easier to create new memes by constant rehearsal of positive attributes and placing oneself in a range of positive environments that support and nurture such new beliefs.
3. Relationships.
A famous scientific study performed by Dean Ornish and his team on heart diseased patients, indicated that the vast majority were isolated in at least one of three relationship directions. Towards others; towards oneself; and/or towards a Higher Power. A significant number of the healthy control group i.e. people matched for gender, age, race, educational standard, had much better refined and robust relationships.
So social relationships exist really in three dimensions: With the self (inwards), with others (outwards) and with a transcendental being (upwards). Such relationships are seldom static, but rather fluctuate with variable intensity, and can be devastating when lost, abandoned, or revised. Of course, the nature of the relationship with the Higher Power generates the most social heat, as scientific methods cannot, by definition, measure such existence. However, it is almost universal that the existence of a Higher Power is part of the truth and mental reality of most people at any socioeconomic level. Maybe that there is a God gene that manifests itself in the mind/brain as a recurrent need to be filled. But so too the deeply embedded social drive to be recognized and accepted by the family or nearby group.
All these forms of relationships can be healthy and provide a wonderful stable foundation for personal growth and success, joy and feeling alive. Conversely, low self-esteem, rapidly changing/superficial friendships, and in-your-face arrogance/narcissism often lead to chaotic lives and relationships. Very difficult to relate/love/embrace such pain and suffering.
4. Diet.
Ultimately, stress management concerns itself with the optimal use of energy. Diet is considered the critical resource to meet moment-to-moment energy needs. But diet is not only what is eaten, but includes the oxygen inhaled, the water drunk, and the effect of sunshine on skin. Careful analysis of dietary input by individuals will show, in general, a pyramidal structure of the types of food eaten. The bottom layers will be packed with common foods and the peak the least eaten.
The problem is the ratios between these layers and group types such as carbohydrates, protein and fats. Most diets prescribed by professionals are an adjustment of the ratios and constituents of the pyramid. Often the best way to lose weight is to just eat less (and exercise more). In other words, reduce the surface area of the pyramid. Of course, there are good foods and bad foods, and ongoing adjustments to the ideal pyramid are the goal. But experts still argue what the ideal pyramid (size, shape, and building blocks) might be!
Diet also includes information entering other orifices such as the ears and eyes, and can ultimately cause brain change for the better or the worse. So be careful what sights and sounds you can control at entry points. And there is of course food for the soul.
5. Detoxification.
Toxins are regarded generally as chemicals that cause harm to organisms. Chemicals come in many forms: tobacco, alcohol, fumes, excessive sunshine, or refined sugars. Emotions are also neuro-chemicals divided broadly into positive (love, joy, contentment) and negative (hate, anger, fear, guilt, shame). So many minds are filled with toxic negative emotions linked to past incidents, and carry heavy grudges and revenge. Toxic emotions drain scarce energy resources, and can convert the wide range of physiological body systems into a host of illnesses. An intense anger outburst can switch off the immune system for hours.
At another level: There is no human being I know who does not experience at least one toxic relationship: an ex spouse, a wayward child, an absent parent, an abusive relative, a value disadvantaged colleague, a dishonest business partner, the litigious next door neighbor. Many souls carry such unfinished business to their graves.
Toxins – in all their forms – crowd out space for healthier emotions and relationships. What a wonderful feeling to let go of anger or fear or shame, or build assertive boundaries around toxic others. Bottom line: Detoxification is not just a three week carrot juice diet!
6. Exercise.
Interesting results coming out of long term observations of centenarians – those folk who seem to live forever, past one hundred years and more. Grey, wrinkled, rickety, but healthy and wholesome. Live meaningful lives, doing God’s work, so to speak. Extensive interpersonal networks, but all move physically everyday. Gardening, farming, walking to the local village, gentle hiking, cycling, playing with grandchildren, climbing trees to pick olives are a sprinkling of examples. The movement/exercise is at a steady low intensity level whenever possible.
More extensive scientific results suggest a combination of four types of exercise: stamina building(aerobic, notice the slight shortness of breadth); stretch (hold a body position and feel the stretch for count of twenty, then shift into another position, repeat: standing, sitting, lying for fifteen minutes everyday; strengthening muscles (resistance training, carrying, lifting, throwing); and balance exercises. Once again, a pyramid structure of four layers, the base being low intensity everyday movement.
The brain can also be understood as a muscle. And if you do not use it, you will lose it. There are many “muscles” of the brain to be kept in tip-top shape. Reading, puzzles, new sights, and thousands of other possibilities are examples of exercising the brain. The best seems to be learning a new language.
7. Rest.
Rest is more than just sleeping well at night. Indeed, many people around the world do suffer from insomnia, and thus do not receive their full dose of rejuvenation every night. Rest the brain and body takes place also during the day - taking a cat nap, or a short break away from the intensity of everyday chores. Sleep debt is a problem that is escalating in our tech savvy cyberspace world of information overload.
The world is rapidly becoming a 24/7 time zone, where information crosses oceans and continents in milliseconds. The world is in search of a Sabbath, and each person in their own way requires a day off, once a week to chill and read and reflect and spend good quality time with oneself, and others who one cares deeply about.
Sabbaticals are also needed sporadically spread through the life cycle – significant real time out of the everyday routines - to again reflect deeply about career choices; to heal fundamentally from major losses; and make, if required, a radical break from self-defeating behavior.
Neuroscience is discovering multiple brain circuits that underpin a wide range of intelligences. Musical, linguistic, interpersonal, spiritual, naturalistic, mathematical….. Perhaps the most sustainable way to rest, everyday, is to shift regularly from a one circuit to another. Resting one, activating the next, returning to the first. Music, then reading or chatting or loving or solving mathematical challenges or dancing or stretching then back to music etc.
Try it. Notice the difference. Feel rejuvenated.
8. Health monitoring
There are hundreds and thousands of internal physiological processes, exquisitely integrated to produce optimal health. Sometimes one or two can wobble because of genes, aging, or lifestyle choices. High blood pressure, diabetes, depression, inflammation of joints, closing down of arteries and blood supply.
One system that is central to health is the vast vascular network that serves almost every cell of the body, providing essential nutrients and removing waste. Think of water, electrical or gas supply, telecommunications, coming into your home; and water borne sewerage and waste removal away from the home. Remember the last blackout, gas leak, burst water pipe, or rubbish collectors strike.
Therefore the vascular system that keeps your blood pressure stable, which prevents strokes, that supplies glucose and oxygen to cells needs focused attention. Regularly measure your blood pressure and act on the results, measure your blood sugars, the fatty lipids, weight, and take necessary preventative precautions always under the advice of competent medical professionals.
Secondly, it is vital to keep a monitor on other health indicators depending on your age, gender, genetic risk, previous medical events, and environmental factors causing chronic stress. Make a point of keeping up with latest public health advisories.
Look after your health as no-one else will, until it is irreversible and chronic.
9. Lotions and potions.
Ethno-pharmacology is the scientific study of lotions and potions used by cultures throughout the world to heal a host of patient complaints and illnesses. Their use is universal based on local natural products, often refined and packaged and prescribed in acceptable form, for a charge. In the vast majority of cases the cure is effective.
More recently, evidence that many of the compounds actually contain an active chemical ingredient is negative, and the idea of the placebo effect is the response to the findings. Placebos are inert substances prescribed, not only in the classic encounter between health professional and patient, but are a cornerstone of the Western scientific method of investigating the effectiveness of a new drug. It is not uncommon that a significant minority of patients in these controlled double blind studies (i.e. neither the investigator nor the patient know which drug has been prescribed) respond to the placebo - probably a combination of belief, expectation, and hope as well as the power of the doctor – patient relationship. It does raise the intriguing idea of the power of the mind – the placebo response – on physical symptoms.
Without any doubt there are many potions that have significant effect on health: anti-hypertensives, analgesics, antibiotics, steroids, antidepressants, mood stabilizers, and hundreds more – when used appropriately. The effectiveness is witnessed in the upward tick in increasing lifespan wherever populations have access to such sustainable medical services.
Lotions are important especially for the biggest organ of the body – the skin - and regular massage, oiling of the skin, hair and nail treatment is important to self-care and optimal health.
10. Financial.
Money makes the world go round? Repeated surveys confirm that financial concerns form the majority of arguments in marriage. Many sleepless nights are money-related. Most of an adult’s life is spent pursuing a paycheck. Unemployment is a major stressor; being made redundant is even worse; and early retirement without a meaningful life-plan is fatal for most men.
Finance is, in essence, the fuel that fires the material parts of our lives. Without money we would be homeless, starving, ill, and exposed to the violent elements of the environment. But there does come a point where income meets basic needs and any further increase in income does not necessary increase happiness. Sometimes the exact opposite occurs: Frustration, strife, and depression.
There will always be greed and fear that drive financial markets; cause turmoil in the macroeconomic arena. However, for everyone who can influence their micro-economic area, the goal should be that expenses are never more than income; and the disposable amount is used to reduce unavoidable debt or liabilities, and increase the value of assets. Assets come in many forms, not only material. Think about it?
The Master Classes can be presented across a spectrum of variable time options ranging from 30 minutes to half day to five day getaways.
Further information:
1. Scroll through previous blogs or
2. email = jacben@telkomsa.net or
3. sms = 078 439 8889
Looking forward to meeting you.
Dr. Jonathan Moch (BSc MBBCH, FFPsych (SA)
1. Time.
As a result of advances in medical technology, the human inhabitants of the planet now have an increasing lifespan. The human being can probably live for many decades post retirement and after all the children have left home. The progressive aging world will result in massive demographic changes for such societies, but does open up the possibility of great opportunities.
Poor personal architecture of the unfolding future results, at the very least, in a life of quiet desperation. Time divided into its classical three components – past, present and future – can ensnare the mind by living in the dismal facts of the past (What could have been? What should have been?) or conversely frozen by the wild imaginations of infinite possibilities of the future (What might be? What ought to be?), without ever being fully present in the current moment. Living persistently in the past leads to depression; living in the future leads to anxiety.
The aim is to anchor oneself in the present moment even it requires deep painful reflection of past deeds or stretching far into the future to strategize and prioritize. Aim your future trajectory into building banks of positive memories by creating environments that positive experiences are the most likely consequences.
One moment at a time, for it is only the present moment we can control!
2. Attitude.
The brain/mind filters constant rivers of information from both outside (via the senses such as sight, sound and touch) and internal streams of consciousness of thoughts and emotions. How our internal software programs handles such information determines to a very large extent our behavioral responses. Deeply held beliefs are like their biological cousins - genes. Some authors call these incorrigible creatures; memes, which are the initial building blocks of dozens of rules and assumptions made about ourselves, others and the future. These in turn are the bedrock of automatic thinking – knee jerk responses to everyday stimuli.
Memes are very stubborn to change as many are developed from childhood. Examples are: I am helpless; or I am unlovable.
Your attitudinal stance certainly determines your altitude. In other words - the amount of personal potential that is actualized. Deep psychological mining to the source within the mind/brain is one way to change negative thinking and emotions. Sometimes it is much easier to create new memes by constant rehearsal of positive attributes and placing oneself in a range of positive environments that support and nurture such new beliefs.
3. Relationships.
A famous scientific study performed by Dean Ornish and his team on heart diseased patients, indicated that the vast majority were isolated in at least one of three relationship directions. Towards others; towards oneself; and/or towards a Higher Power. A significant number of the healthy control group i.e. people matched for gender, age, race, educational standard, had much better refined and robust relationships.
So social relationships exist really in three dimensions: With the self (inwards), with others (outwards) and with a transcendental being (upwards). Such relationships are seldom static, but rather fluctuate with variable intensity, and can be devastating when lost, abandoned, or revised. Of course, the nature of the relationship with the Higher Power generates the most social heat, as scientific methods cannot, by definition, measure such existence. However, it is almost universal that the existence of a Higher Power is part of the truth and mental reality of most people at any socioeconomic level. Maybe that there is a God gene that manifests itself in the mind/brain as a recurrent need to be filled. But so too the deeply embedded social drive to be recognized and accepted by the family or nearby group.
All these forms of relationships can be healthy and provide a wonderful stable foundation for personal growth and success, joy and feeling alive. Conversely, low self-esteem, rapidly changing/superficial friendships, and in-your-face arrogance/narcissism often lead to chaotic lives and relationships. Very difficult to relate/love/embrace such pain and suffering.
4. Diet.
Ultimately, stress management concerns itself with the optimal use of energy. Diet is considered the critical resource to meet moment-to-moment energy needs. But diet is not only what is eaten, but includes the oxygen inhaled, the water drunk, and the effect of sunshine on skin. Careful analysis of dietary input by individuals will show, in general, a pyramidal structure of the types of food eaten. The bottom layers will be packed with common foods and the peak the least eaten.
The problem is the ratios between these layers and group types such as carbohydrates, protein and fats. Most diets prescribed by professionals are an adjustment of the ratios and constituents of the pyramid. Often the best way to lose weight is to just eat less (and exercise more). In other words, reduce the surface area of the pyramid. Of course, there are good foods and bad foods, and ongoing adjustments to the ideal pyramid are the goal. But experts still argue what the ideal pyramid (size, shape, and building blocks) might be!
Diet also includes information entering other orifices such as the ears and eyes, and can ultimately cause brain change for the better or the worse. So be careful what sights and sounds you can control at entry points. And there is of course food for the soul.
5. Detoxification.
Toxins are regarded generally as chemicals that cause harm to organisms. Chemicals come in many forms: tobacco, alcohol, fumes, excessive sunshine, or refined sugars. Emotions are also neuro-chemicals divided broadly into positive (love, joy, contentment) and negative (hate, anger, fear, guilt, shame). So many minds are filled with toxic negative emotions linked to past incidents, and carry heavy grudges and revenge. Toxic emotions drain scarce energy resources, and can convert the wide range of physiological body systems into a host of illnesses. An intense anger outburst can switch off the immune system for hours.
At another level: There is no human being I know who does not experience at least one toxic relationship: an ex spouse, a wayward child, an absent parent, an abusive relative, a value disadvantaged colleague, a dishonest business partner, the litigious next door neighbor. Many souls carry such unfinished business to their graves.
Toxins – in all their forms – crowd out space for healthier emotions and relationships. What a wonderful feeling to let go of anger or fear or shame, or build assertive boundaries around toxic others. Bottom line: Detoxification is not just a three week carrot juice diet!
6. Exercise.
Interesting results coming out of long term observations of centenarians – those folk who seem to live forever, past one hundred years and more. Grey, wrinkled, rickety, but healthy and wholesome. Live meaningful lives, doing God’s work, so to speak. Extensive interpersonal networks, but all move physically everyday. Gardening, farming, walking to the local village, gentle hiking, cycling, playing with grandchildren, climbing trees to pick olives are a sprinkling of examples. The movement/exercise is at a steady low intensity level whenever possible.
More extensive scientific results suggest a combination of four types of exercise: stamina building(aerobic, notice the slight shortness of breadth); stretch (hold a body position and feel the stretch for count of twenty, then shift into another position, repeat: standing, sitting, lying for fifteen minutes everyday; strengthening muscles (resistance training, carrying, lifting, throwing); and balance exercises. Once again, a pyramid structure of four layers, the base being low intensity everyday movement.
The brain can also be understood as a muscle. And if you do not use it, you will lose it. There are many “muscles” of the brain to be kept in tip-top shape. Reading, puzzles, new sights, and thousands of other possibilities are examples of exercising the brain. The best seems to be learning a new language.
7. Rest.
Rest is more than just sleeping well at night. Indeed, many people around the world do suffer from insomnia, and thus do not receive their full dose of rejuvenation every night. Rest the brain and body takes place also during the day - taking a cat nap, or a short break away from the intensity of everyday chores. Sleep debt is a problem that is escalating in our tech savvy cyberspace world of information overload.
The world is rapidly becoming a 24/7 time zone, where information crosses oceans and continents in milliseconds. The world is in search of a Sabbath, and each person in their own way requires a day off, once a week to chill and read and reflect and spend good quality time with oneself, and others who one cares deeply about.
Sabbaticals are also needed sporadically spread through the life cycle – significant real time out of the everyday routines - to again reflect deeply about career choices; to heal fundamentally from major losses; and make, if required, a radical break from self-defeating behavior.
Neuroscience is discovering multiple brain circuits that underpin a wide range of intelligences. Musical, linguistic, interpersonal, spiritual, naturalistic, mathematical….. Perhaps the most sustainable way to rest, everyday, is to shift regularly from a one circuit to another. Resting one, activating the next, returning to the first. Music, then reading or chatting or loving or solving mathematical challenges or dancing or stretching then back to music etc.
Try it. Notice the difference. Feel rejuvenated.
8. Health monitoring
There are hundreds and thousands of internal physiological processes, exquisitely integrated to produce optimal health. Sometimes one or two can wobble because of genes, aging, or lifestyle choices. High blood pressure, diabetes, depression, inflammation of joints, closing down of arteries and blood supply.
One system that is central to health is the vast vascular network that serves almost every cell of the body, providing essential nutrients and removing waste. Think of water, electrical or gas supply, telecommunications, coming into your home; and water borne sewerage and waste removal away from the home. Remember the last blackout, gas leak, burst water pipe, or rubbish collectors strike.
Therefore the vascular system that keeps your blood pressure stable, which prevents strokes, that supplies glucose and oxygen to cells needs focused attention. Regularly measure your blood pressure and act on the results, measure your blood sugars, the fatty lipids, weight, and take necessary preventative precautions always under the advice of competent medical professionals.
Secondly, it is vital to keep a monitor on other health indicators depending on your age, gender, genetic risk, previous medical events, and environmental factors causing chronic stress. Make a point of keeping up with latest public health advisories.
Look after your health as no-one else will, until it is irreversible and chronic.
9. Lotions and potions.
Ethno-pharmacology is the scientific study of lotions and potions used by cultures throughout the world to heal a host of patient complaints and illnesses. Their use is universal based on local natural products, often refined and packaged and prescribed in acceptable form, for a charge. In the vast majority of cases the cure is effective.
More recently, evidence that many of the compounds actually contain an active chemical ingredient is negative, and the idea of the placebo effect is the response to the findings. Placebos are inert substances prescribed, not only in the classic encounter between health professional and patient, but are a cornerstone of the Western scientific method of investigating the effectiveness of a new drug. It is not uncommon that a significant minority of patients in these controlled double blind studies (i.e. neither the investigator nor the patient know which drug has been prescribed) respond to the placebo - probably a combination of belief, expectation, and hope as well as the power of the doctor – patient relationship. It does raise the intriguing idea of the power of the mind – the placebo response – on physical symptoms.
Without any doubt there are many potions that have significant effect on health: anti-hypertensives, analgesics, antibiotics, steroids, antidepressants, mood stabilizers, and hundreds more – when used appropriately. The effectiveness is witnessed in the upward tick in increasing lifespan wherever populations have access to such sustainable medical services.
Lotions are important especially for the biggest organ of the body – the skin - and regular massage, oiling of the skin, hair and nail treatment is important to self-care and optimal health.
10. Financial.
Money makes the world go round? Repeated surveys confirm that financial concerns form the majority of arguments in marriage. Many sleepless nights are money-related. Most of an adult’s life is spent pursuing a paycheck. Unemployment is a major stressor; being made redundant is even worse; and early retirement without a meaningful life-plan is fatal for most men.
Finance is, in essence, the fuel that fires the material parts of our lives. Without money we would be homeless, starving, ill, and exposed to the violent elements of the environment. But there does come a point where income meets basic needs and any further increase in income does not necessary increase happiness. Sometimes the exact opposite occurs: Frustration, strife, and depression.
There will always be greed and fear that drive financial markets; cause turmoil in the macroeconomic arena. However, for everyone who can influence their micro-economic area, the goal should be that expenses are never more than income; and the disposable amount is used to reduce unavoidable debt or liabilities, and increase the value of assets. Assets come in many forms, not only material. Think about it?
Physical Activity and Aging well
FYI- is there not an entrepeneurial opportunity in the following?
Enjoy! Comments?? (to jacben@telkomsa.net)
All the best Jonathan Moch.
March 2, 2010
Personal Health
Even More Reasons to Get a Move On
By JANE E. BRODY
“I’m 86 and have walked every day of my life. The public needs to wake up and move.”
“I’m 83 going on 84 years! I find that daily aerobics and walking are fine. But these regimens neglect the rest of the body, and I find the older you get the more attention they need.”
These are two of many comments from readers of my Jan. 12 column on the secrets of successful aging. At the risk of sounding like a broken record, a new series of studies prompts me to again review the myriad benefits to body, mind and longevity of regular physical activity for people of all ages.
Regular exercise is the only well-established fountain of youth, and it’s free. What, I’d like to know, will persuade the majority of Americans who remain sedentary to get off their duffs and give their bodies the workout they deserve? My hope is that every new testimonial to the value of exercise will win a few more converts until everyone is doing it.
In a commentary on the new studies, published Jan. 25 in The Archives of Internal Medicine, two geriatricians, Dr. Marco Pahor of the University of Florida and Dr. Jeff Williamson of Winston-Salem, N.C., pointed to “the power of higher levels of physical activity to aid in the prevention of late-life disability owing to either cognitive impairment or physical impairment, separately or together.”
“Physical inactivity,” they wrote, “is one of the strongest predictors of unsuccessful aging for older adults and is perhaps the root cause of many unnecessary and premature admissions to long-term care.”
They noted that it had long been “well established that higher quantities of physical activity have beneficial effects on numerous age-related conditions such as osteoarthritis, falls and hip fracture, cardiovascular disease, respiratory diseases, cancer, diabetes mellitus, osteoporosis, low fitness and obesity, and decreased functional capacity.”
One of the new studies adds mental deterioration, with exercise producing “a significantly reduced risk of cognitive impairment after two years for participants with moderate or high physical activity” who were older than 55 when the study began.
Most early studies demonstrating the benefits of exercise were done with men. Now a raft of recent studies has shown that active women reap comparable rewards.
Research-Based Evidence
Sedentary skeptics are fond of saying that of course exercise is associated with good health as one ages; the people who exercise are healthy to begin with. But studies in which some participants are randomly assigned to a physical activity program and others to a placebo (like simply being advised to exercise) call their bluff. Even less exacting observational studies, like the Nurses’ Health Study, take into account the well-being of participants at enrollment.
Thus, in one of the new studies, Dr. Qi Sun of Harvard School of Public Health and co-authors reported that among the 13,535 nurses who were healthy when they joined the study in 1986, those who reported higher levels of activity in midlife were far more likely to still be healthy a decade or more later at age 70. The study found that physical activity increased the nurses’ chances of remaining healthy regardless of body weight, although those who were both lean and active had “the highest odds of successful survival.”
Taking the benefits of exercise one system at a time, here is what recent studies have shown, including several published in The Archives of Internal Medicine in December.
Cancer. In a review last year of 52 studies of exercise and colon cancer, researchers at Washington University School of Medicine in St. Louis concluded that people who were most active were 21 percent less likely to develop the disease than those who were least active, possibly because activity helps to move waste more quickly through the bowel.
The risk of breast cancer, too, is about 16 percent lower among physically active women, perhaps because exercise reduces tissue exposure to insulin-like growth factor, a known cancer promoter.
Indirectly, exercise may protect postmenopausal women against cancers of the endometrium, pancreas, colon and esophagus, as well as breast cancer, by helping them keep their weight down.
Osteoporosis and fragility. Weak bones and muscles increase the risk of falls and fractures and an inability to perform the tasks of daily life. Weight- bearing aerobic activities like brisk walking and weight training to increase muscle strength can reduce or even reverse bone loss. In one of the new studies, German researchers who randomly assigned women 65 and older to either an 18-month exercise regimen or a wellness program demonstrated that exercise significantly increased bone density and reduced the risk of falls. And at any age, even in people over 100, weight training improves the size and quality of muscles, thus increasing the ability to function independently.
Cardiovascular disease. Aerobic exercise has long been established as an invaluable protector of the heart and blood vessels. It increases the heart’s ability to work hard, lowers blood pressure and raises blood levels of HDL- cholesterol, which acts as a cleansing agent in arteries. As a result, active individuals of all ages have lower rates of heart attacks and strokes.
Though early studies were conducted only among men, in a 2002 study published in The New England Journal of Medicine, Dr. JoAnn E. Manson and colleagues found that among 73,743 initially healthy women ages 50 to 79, walking briskly for 30 minutes a day five days a week, as well as more vigorous exercise, substantially reduced the risk of heart attacks and other cardiovascular events.
In another study, women who walked at least one hour a day were 40 percent less likely to suffer a stroke than women who walked less than an hour a week.
Diabetes. Moderate activity has been shown to lower the risk of developing diabetes even in women of normal weight. A 16-year study of 68,907 initially healthy female nurses found that those who were sedentary had twice the risk of developing diabetes, and those who were both sedentary and obese had 16 times the risk when compared with normal-weight women who were active.
Another study that randomly assigned 3,234 prediabetic men and women to modest physical activity (at least 150 minutes a week) found exercise to be more effective than the drug metformin at preventing full-blown diabetes.
Dementia. As the population continues to age, perhaps the greatest health benefit of regular physical activity will turn out to be its ability to prevent or delay the loss of cognitive functions. The new study of 3,485 healthy men and women older than 55 found that those who were physically active three or more times a week were least likely to become cognitively impaired.
One study conducted in Australia and published in September 2008 in The Journal of the American Medical Association randomly assigned 170 volunteers who reported memory problems to a six-month program of physical activity or health education. A year and a half later, the exercise group showed “a modest improvement in cognition.” Various other studies have confirmed the value of exercise in helping older people maintain useful short-term memory, enabling them to plan, schedule and multitask, as well as store information and use it effectively.
Enjoy! Comments?? (to jacben@telkomsa.net)
All the best Jonathan Moch.
March 2, 2010
Personal Health
Even More Reasons to Get a Move On
By JANE E. BRODY
“I’m 86 and have walked every day of my life. The public needs to wake up and move.”
“I’m 83 going on 84 years! I find that daily aerobics and walking are fine. But these regimens neglect the rest of the body, and I find the older you get the more attention they need.”
These are two of many comments from readers of my Jan. 12 column on the secrets of successful aging. At the risk of sounding like a broken record, a new series of studies prompts me to again review the myriad benefits to body, mind and longevity of regular physical activity for people of all ages.
Regular exercise is the only well-established fountain of youth, and it’s free. What, I’d like to know, will persuade the majority of Americans who remain sedentary to get off their duffs and give their bodies the workout they deserve? My hope is that every new testimonial to the value of exercise will win a few more converts until everyone is doing it.
In a commentary on the new studies, published Jan. 25 in The Archives of Internal Medicine, two geriatricians, Dr. Marco Pahor of the University of Florida and Dr. Jeff Williamson of Winston-Salem, N.C., pointed to “the power of higher levels of physical activity to aid in the prevention of late-life disability owing to either cognitive impairment or physical impairment, separately or together.”
“Physical inactivity,” they wrote, “is one of the strongest predictors of unsuccessful aging for older adults and is perhaps the root cause of many unnecessary and premature admissions to long-term care.”
They noted that it had long been “well established that higher quantities of physical activity have beneficial effects on numerous age-related conditions such as osteoarthritis, falls and hip fracture, cardiovascular disease, respiratory diseases, cancer, diabetes mellitus, osteoporosis, low fitness and obesity, and decreased functional capacity.”
One of the new studies adds mental deterioration, with exercise producing “a significantly reduced risk of cognitive impairment after two years for participants with moderate or high physical activity” who were older than 55 when the study began.
Most early studies demonstrating the benefits of exercise were done with men. Now a raft of recent studies has shown that active women reap comparable rewards.
Research-Based Evidence
Sedentary skeptics are fond of saying that of course exercise is associated with good health as one ages; the people who exercise are healthy to begin with. But studies in which some participants are randomly assigned to a physical activity program and others to a placebo (like simply being advised to exercise) call their bluff. Even less exacting observational studies, like the Nurses’ Health Study, take into account the well-being of participants at enrollment.
Thus, in one of the new studies, Dr. Qi Sun of Harvard School of Public Health and co-authors reported that among the 13,535 nurses who were healthy when they joined the study in 1986, those who reported higher levels of activity in midlife were far more likely to still be healthy a decade or more later at age 70. The study found that physical activity increased the nurses’ chances of remaining healthy regardless of body weight, although those who were both lean and active had “the highest odds of successful survival.”
Taking the benefits of exercise one system at a time, here is what recent studies have shown, including several published in The Archives of Internal Medicine in December.
Cancer. In a review last year of 52 studies of exercise and colon cancer, researchers at Washington University School of Medicine in St. Louis concluded that people who were most active were 21 percent less likely to develop the disease than those who were least active, possibly because activity helps to move waste more quickly through the bowel.
The risk of breast cancer, too, is about 16 percent lower among physically active women, perhaps because exercise reduces tissue exposure to insulin-like growth factor, a known cancer promoter.
Indirectly, exercise may protect postmenopausal women against cancers of the endometrium, pancreas, colon and esophagus, as well as breast cancer, by helping them keep their weight down.
Osteoporosis and fragility. Weak bones and muscles increase the risk of falls and fractures and an inability to perform the tasks of daily life. Weight- bearing aerobic activities like brisk walking and weight training to increase muscle strength can reduce or even reverse bone loss. In one of the new studies, German researchers who randomly assigned women 65 and older to either an 18-month exercise regimen or a wellness program demonstrated that exercise significantly increased bone density and reduced the risk of falls. And at any age, even in people over 100, weight training improves the size and quality of muscles, thus increasing the ability to function independently.
Cardiovascular disease. Aerobic exercise has long been established as an invaluable protector of the heart and blood vessels. It increases the heart’s ability to work hard, lowers blood pressure and raises blood levels of HDL- cholesterol, which acts as a cleansing agent in arteries. As a result, active individuals of all ages have lower rates of heart attacks and strokes.
Though early studies were conducted only among men, in a 2002 study published in The New England Journal of Medicine, Dr. JoAnn E. Manson and colleagues found that among 73,743 initially healthy women ages 50 to 79, walking briskly for 30 minutes a day five days a week, as well as more vigorous exercise, substantially reduced the risk of heart attacks and other cardiovascular events.
In another study, women who walked at least one hour a day were 40 percent less likely to suffer a stroke than women who walked less than an hour a week.
Diabetes. Moderate activity has been shown to lower the risk of developing diabetes even in women of normal weight. A 16-year study of 68,907 initially healthy female nurses found that those who were sedentary had twice the risk of developing diabetes, and those who were both sedentary and obese had 16 times the risk when compared with normal-weight women who were active.
Another study that randomly assigned 3,234 prediabetic men and women to modest physical activity (at least 150 minutes a week) found exercise to be more effective than the drug metformin at preventing full-blown diabetes.
Dementia. As the population continues to age, perhaps the greatest health benefit of regular physical activity will turn out to be its ability to prevent or delay the loss of cognitive functions. The new study of 3,485 healthy men and women older than 55 found that those who were physically active three or more times a week were least likely to become cognitively impaired.
One study conducted in Australia and published in September 2008 in The Journal of the American Medical Association randomly assigned 170 volunteers who reported memory problems to a six-month program of physical activity or health education. A year and a half later, the exercise group showed “a modest improvement in cognition.” Various other studies have confirmed the value of exercise in helping older people maintain useful short-term memory, enabling them to plan, schedule and multitask, as well as store information and use it effectively.
Attitude determines Altitude? You bet!! Article from NYT
.
Attitude determines altitude? You bet!! Enjoy. all the best Jonathan
The New York Times
March 2, 2010
Cases
Old Age, From Youth's Narrow Prism
By MARC E. AGRONIN, M.D.
The old woman had drawn down the shade in her room - hoping, I imagined, to
stop the midday Miami sun from penetrating her grief. But the sun still hit
the window full force and illuminated the shade like a Chinese lantern.
She sat silently in a wheelchair, her 93-year-old silhouette stooped in the
bathing light. I entered, held her hand for a moment and introduced myself.
"Sit down, doctor," she said politely.
I asked her why she had come to the nursing home, and she described the
recent passing of her husband after 73 years of marriage. I was overwhelmed
by the thought of her loss, and wanted to offer some words of comfort. I
leaned in close and spoke.
"I'm so sorry," I told her. "What has it been like for you losing your
husband after so many years of marriage?"
She paused for a moment and then replied: "Heaven."
Seeing my bewilderment, she smiled and went on to describe how she had
endured decades in an unhappy marriage with a gruff, verbally abusive man.
As she spoke, I realized why my instincts were so completely off. In my
misguided empathy I had committed what William James called the
psychologist's fallacy, assuming incorrectly that one knows what someone
else is experiencing. With this newly widowed patient I imagined that only a
life of sadness and decrepitude remained, and I felt bad about it.
But I was wrong. She had not fallen into the abyss. She was glad to have
finally won a measure of freedom and was determined to make the best of it.
As her life unfolded at the nursing home over the next year, she threw
herself into new activities and relationships in a way that was quite
unexpected.
All of us lapse into such mistaken impressions of old age from time to time.
It stems in part from an age-centered perspective, in which we view our own
age as the most normal of times, the way all life should be. At 18 the
50-year-olds may seem ancient, but at 50 we are apt to say the same about
the 80-year-olds.
"So what's it really like to be old?" I often ask my patients, who are
mostly in their late 80s and 90s, and the responses are unexpected.
"I forgot I was so old," a 100-year-old patient recently told me, and then
excused herself to make it to bingo on time.
This age-centrism is particularly pervasive in people's attitudes toward
nursing homes. All too often we imagine that life seems to end at the
nursing home door - that it is loveless and lonely, with death hovering
close by.
We make this mistake when we refuse to see the needs for intimacy even in
the most debilitated elderly. Our youth-centered culture equates love with
sex; in contrast, I have seen with my older patients that love can be an
endlessly blossoming flower, felt and expressed in hundreds of ways. A
friend's mother who suffers from Alzheimer's disease has fallen in love with
another resident on her floor, and they walk around holding hands and
snuggling with a newfound innocence that perhaps only their memory loss
restored.
We also project our terror of death onto the aged, assuming that fear and
depression must stalk the final years of life. And yet in my 15 years of
working in nursing homes, I have never heard a patient say that he or she
was afraid of death. Sometimes there is acceptance, other times
anticipation, but most often it is not a great concern. Life goes on in its
shadows.
In the end, there is a cost to our myopic view of aging. We imagine the
pains of late-life ailments but not the joys of new pursuits; we recoil at
the losses and loneliness and fail to embrace the wisdom and meaning that
only age can bring. Henry Wadsworth Longfellow captured the sentiment well:
For age is opportunity no less
Than youth itself, though in another dress,
And as the evening twilight fades away
The sky is filled with stars, invisible by day.
Dr. Marc E. Agronin is a geriatric psychiatrist at Miami Jewish Health
Systems.
Attitude determines altitude? You bet!! Enjoy. all the best Jonathan
The New York Times
March 2, 2010
Cases
Old Age, From Youth's Narrow Prism
By MARC E. AGRONIN, M.D.
The old woman had drawn down the shade in her room - hoping, I imagined, to
stop the midday Miami sun from penetrating her grief. But the sun still hit
the window full force and illuminated the shade like a Chinese lantern.
She sat silently in a wheelchair, her 93-year-old silhouette stooped in the
bathing light. I entered, held her hand for a moment and introduced myself.
"Sit down, doctor," she said politely.
I asked her why she had come to the nursing home, and she described the
recent passing of her husband after 73 years of marriage. I was overwhelmed
by the thought of her loss, and wanted to offer some words of comfort. I
leaned in close and spoke.
"I'm so sorry," I told her. "What has it been like for you losing your
husband after so many years of marriage?"
She paused for a moment and then replied: "Heaven."
Seeing my bewilderment, she smiled and went on to describe how she had
endured decades in an unhappy marriage with a gruff, verbally abusive man.
As she spoke, I realized why my instincts were so completely off. In my
misguided empathy I had committed what William James called the
psychologist's fallacy, assuming incorrectly that one knows what someone
else is experiencing. With this newly widowed patient I imagined that only a
life of sadness and decrepitude remained, and I felt bad about it.
But I was wrong. She had not fallen into the abyss. She was glad to have
finally won a measure of freedom and was determined to make the best of it.
As her life unfolded at the nursing home over the next year, she threw
herself into new activities and relationships in a way that was quite
unexpected.
All of us lapse into such mistaken impressions of old age from time to time.
It stems in part from an age-centered perspective, in which we view our own
age as the most normal of times, the way all life should be. At 18 the
50-year-olds may seem ancient, but at 50 we are apt to say the same about
the 80-year-olds.
"So what's it really like to be old?" I often ask my patients, who are
mostly in their late 80s and 90s, and the responses are unexpected.
"I forgot I was so old," a 100-year-old patient recently told me, and then
excused herself to make it to bingo on time.
This age-centrism is particularly pervasive in people's attitudes toward
nursing homes. All too often we imagine that life seems to end at the
nursing home door - that it is loveless and lonely, with death hovering
close by.
We make this mistake when we refuse to see the needs for intimacy even in
the most debilitated elderly. Our youth-centered culture equates love with
sex; in contrast, I have seen with my older patients that love can be an
endlessly blossoming flower, felt and expressed in hundreds of ways. A
friend's mother who suffers from Alzheimer's disease has fallen in love with
another resident on her floor, and they walk around holding hands and
snuggling with a newfound innocence that perhaps only their memory loss
restored.
We also project our terror of death onto the aged, assuming that fear and
depression must stalk the final years of life. And yet in my 15 years of
working in nursing homes, I have never heard a patient say that he or she
was afraid of death. Sometimes there is acceptance, other times
anticipation, but most often it is not a great concern. Life goes on in its
shadows.
In the end, there is a cost to our myopic view of aging. We imagine the
pains of late-life ailments but not the joys of new pursuits; we recoil at
the losses and loneliness and fail to embrace the wisdom and meaning that
only age can bring. Henry Wadsworth Longfellow captured the sentiment well:
For age is opportunity no less
Than youth itself, though in another dress,
And as the evening twilight fades away
The sky is filled with stars, invisible by day.
Dr. Marc E. Agronin is a geriatric psychiatrist at Miami Jewish Health
Systems.
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