Wednesday, January 17, 2018

The Truth About Postpartum Hormones and Healing: A Q&A With Aviva Romm, MD

 As a new mom, I found postpartum to be a shocking series of events with my hormones, body, and emotions. Navigating this period of life on sparse sleep — and unrealistic expectations — I not only floundered but felt like I drowned within a few days.

Unable to hide my emotions and experience, I started being intensely honest with those around me. What I found was a chorus of other women voicing similar experiences — isolation and intense overwhelm.

I celebrated when celebrities like Chrissy Teigen and Tammin Sursok shared their raw and honest stories because it felt like the secret veil of postpartum was being torn down.

I often ask myself why postpartum depression and anxiety aren’t discussed more widely. Is it shame? Fear of freaking out other women? Something else?

I think it’s high time to shed light on this life-altering time in women’s lives. I recently had the honor of chatting with Aviva Romm, MD, about some of my most pressing questions, like how hormones are altered in postpartum, how long it takes your system to reregulate, how to handle postpartum depression and anxiety, and ways to support yourself during this period.

I hope that some of her answers can bring ancient women’s wisdom to the forefront by arming moms with basic, essential information about what is happening in their bodies. And that maybe, as a culture, we can try to understand the necessity of honoring that.

EL | How are women’s hormones altered during postpartum?

AR | The postpartum hormone drop is considered the single largest sudden hormone change in the shortest amount of time for any human being, at any point of their life cycle.

During pregnancy, our estrogen and progesterone increase to [the] level of something like taking a hundred birth-control pills a day. By about three days postpartum you’re essentially back to a baseline that is close to non-pregnant. So if you can imagine, it’s sort of like PMS on steroids, or something like that. It’s just so sudden. Estrogen and progesterone are going from so escalated to normal that it can cause huge emotional changes.

EL | How long does it take for things to reregulate, especially if you’re breastfeeding?

AR | Your estrogen and progesterone by about the end of that first week should be kind of closer to your baseline of what you are when you’re non-pregnant. But then your oxytocin goes up. That should ideally make us feel pretty well and happy, but it has to be enough to counterbalance that huge drop.

If you’re breastfeeding your cycle could be very inconsistent and irregular — for a year or more having cycles where you don’t ovulate and your hormones don’t reach peaks and dips that they usually would, and that others would.

There’s also a lot going on that impacts hormone balance, with varying levels of intensity for different women depending on the support they have in their lives, stress about going back to work, etc. Even in the best of circumstances, most of us are losing sleep, experiencing new anxiety and concerns over our baby, and making a whole lot of internal emotional adjustments.

EL | Are there other things a woman can do to support her body to heal during postpartum besides having the physical support of people around?

AR | Definitely. Probably one of the most important things I think we can do is actually make sure that we’re doing something called “sleep banking,” which is a really weird concept but proven to be effective. It works like this: If you lose sleep it’s very hard to catch up on the loss of sleep and bring your body back to rested. Sleep banking is the idea that if you pre-sleep, you can store reserves of energy. How can you do this? When baby naps during the day, that’s when we get our time to do everything else that we couldn’t do while we were holding the baby. So we tend to not catch up on sleep, and we tend to not sleep bank. But if you can make it a committed habit, even if it’s just a few times a week — to nap when the baby naps, even if you’re getting about 40 minutes of sleep — you can actually, not completely, but you can preempt some of the impact of the lost sleep by sleeping ahead. Sleep when baby sleeps even though it’s so tempting to do other stuff during that time. That 40 minutes of sleep can make a huge difference in your healing and your life!

EL | What if you’re pumping when the baby’s sleeping?

AR | You don’t have to pump when the baby’s asleep. You could pump while the baby’s awake, between or after feedings, for example.

EL | Besides sleep banking, are there other things?

AR | Making sure that your diet is really spot-on, never letting yourself skip meals or let your blood sugar drop. Each meal should contain good protein and good-quality fats. Keeping that blood sugar steady can keep your moods steady, help you sleep better, keep your energy up, and also help you keep your metabolism healthy so you can lose that baby weight, too.

EL | Why do some women continue to gain weight postbirth and while breastfeeding, or have trouble losing baby weight?

AR | I look for a couple of underlying causes. Number one is fatigue, which does two things: It raises our cortisol, which can make us hold weight, and both fatigue and elevated cortisol in turn make us crave – and eat – more sugar and more carbs, which can actually make us more tired in the long run and not lose weight. Next, and super important, is hypothyroidism. If I’m working with a new mom who’s having pretty significant trouble losing weight, I do a full thyroid assessment to make sure there is not a thyroid problem.

EL | All labor is intense, but does the length or strenuousness of labor have an impact on your hormones and healing?

AR | Not necessarily. I would say if you have a complication in labor, that could make it harder. Certainly a C-section [takes longer] — you have to heal from major abdominal surgery, you’ve had antibiotics, IV fluids, and perhaps an emotionally painful road if you were strongly hoping for a natural birth.

A woman’s experience of labor and birth can have a tremendous impact on hormones and healing. If a woman had a sense that her labor was really traumatic and that she doesn’t have the support and outlet for addressing that afterwards, that might have more of an impact on her healing.

EL | What’s the range of time it takes women to heal from pregnancy to childbirth?

AR | Physically, your uterus goes back to its pre-pregnant size and your hormones generally return to a baseline of more normal in about eight weeks. But I think we conflate physical healing with “back to normal,” and those are two different things.

The way postpartum is defined medically is that it ends at eight weeks. Historically what’s happened is, the rest of the world says, “Oh, well, eight weeks, you’re not postpartum anymore, so hey honey, you are back to work, you are back to normal. The support is gone. You should be back on your feet by now, you’re fine.” That’s sort of the MO, and yet the emotional adjustment is continuing to happen, you’re continuing to lose sleep. You may start to lose more sleep around eight weeks when the baby starts to get colicky, or around six months or eight months when the baby starts teething. So we need to really give ourselves that full year for complete adjustment.

If the baby’s breastfeeding, that means that there’s a lot going on psychologically and emotionally that we’re still adjusting to. If a woman had perineal trauma, or an episiotomy, or a C-section, it can take months and months and months for her to feel like she’s regained her strength and her tone.

And if she has a significant diastasis recti, she might feel limited in what exercises she can do, or she might be afraid. I’ve had women who have come to me and say, “I was afraid my organs were going to pop out, so I didn’t exercise as much.” So if she’s not sort of getting her life back, normal everything can still feel totally topsy-turvy for a long time.

EL | Do you think that there’s been an increase in postpartum anxiety and depression, or just an increase in awareness?

AR | Both. We know that rates of depression in the general society have tripled in the past decade or so, and one in 10 Americans is now on an antidepressant. Somewhere between one in four to six women is on an antidepressant, so those rates are much higher for women. Across the board, anxiety has gone up in our culture. In fact, we know now that there are almost 200,000 kids under the age of 2 years old on medications for anxiety, depression, or mood.

So overall there’s definitely been just this huge escalation of anxiety and depression, and women who have anxiety and depression before pregnancy are much more likely to have it during and after pregnancy. It’s one of the warning signs that we look for, to be aware of women who are at risk for postpartum depression.

And at the same time, fabulously, some celebrities are coming out about postpartum depression. More people have become more forthcoming about talking about it, and the medical community has become more aware of the need to pay attention to and screen for it. It’s not always being done as well or as often as it should with as much awareness as it should be, but overall I think, yes, we have way more of it, and also that it’s being identified more, and it’s being treated more. So it’s kind of a double-edged sword in a way.

EL | Do you have any tips on how women can get through that anxiety?

AR | Getting support postpartum is critically important — finding someone to talk to so that you’re not keeping it all in. One of the things we know is that talking with someone about our stress actually increases our oxytocin and decreases anxiety and depression, so just talking with anyone about it is really helpful. Realizing that you’re not alone and that this is — even though it’s not comfortable — somewhat normal. It’s a big deal to be a new mom.

For women who have a history of postpartum anxiety and postpartum depression, I start way ahead of time making sure they’re getting essential fatty acids and B complex. I check their MTHFR status. I make sure that they have really, really good support on tap.

And then there are some things particularly for depression that can be done — light therapy using the light box and some herbs that have been used, like St. John’s Wort and motherwort, that can help a woman get through it as well. Staying well-fed and well-rested. Low blood sugar causes anxiety, and lack of sleep causes anxiety and depression.

EL | Do you have any tips for a partner or family member who wants to help?

AR | I would check in on how you can help with the older kids, how you can help with housework. Getting a special little gift for the mom just for herself. Maybe mom would want a gift certificate to have someone to come to her house and give her a massage, a (sexy and comfortable) new bathrobe or nightgown, or something lovely just for mom can really make a difference in feeling supported.

Ask mom what she needs, or if she would like the gift of some postpartum care. Friends could all chip in and get that for her if the cost is too much. Ask her if she would like some time alone where somebody can come and watch baby for an hour and a half so that she can get a shower without worrying about the baby. Having 45 minutes to read a book or [even] brush your teeth might just be enough.

[Giving the gift of a] housekeeper for that first three months coming in for two hours once a week just to do some of the nitty-gritty stuff. Anything like that that can take the edge off for the mom can be huge.

EL | Do you find that bodywork, including abdominal massage, acupuncture, and a chiropractor, help support during postpartum?

AR | Absolutely. First of all, if you’re getting any of these, it means that you’re getting an hour to yourself! That in itself can do wonders.

It’s so easy to start [to get] the nursing-mom shoulder, holding-the-baby shoulder, sleeping in funny positions if you co-sleep — all of that stuff affects your posture, and that can start to make you hold more tension in your body. So it can be tremendously helpful. But then also, for chiropractic, for example, if you had any kind of sciatica, or if your hips aren’t feeling quite right, or your back is uncomfortable, all of that can be really helpful.

EL | What would you recommend for exercise specifically?

AR | I think getting out and walking with the baby is great, because that’s a great way to calm and relax baby and you. Postpartum yoga can be fabulous. You can do a yoga class on your own, or you can do a new mom yoga class.

A new mom yoga class can be a great source of support because women are going to start to talk about what’s going on for themselves. Pretty much everyone is still going to have a little bit of a new mom belly and it starts to be a little bit normative.

If you did exercise before, pick that up when you’re ready and give yourself a break to ease into it more gently. Usually I recommend not picking it up until you’re back to your full level of activity and until your bleeding has been completely stopped for two weeks, because it can pick up your postpartum bleeding if you start over-exercising. So that’s a good indication. If your bleeding stops, and then you start exercising and your bleeding comes back, then you might be overdoing it a little bit, so back down to where you were before.

EL | What are your top tips for somebody who’s entering postpartum or during postpartum?

AR| Have support set up ahead of time. Set yourself up for the reality that being a new mom, as natural as it might be, is not usually ‘easy peasy’ no matter what your friends or neighbors might say. Keep taking your prenatal multi and fish oil because they will give you a little boost of nutrients and eat well. Rest. Rinse and repeat.  Using postpartum herbal baths (if you’ve had a cesarean, talk with your midwife or doctor first) can be nice also. Most importantly, be gentle with yourself, and be very open about asking for help.  It’s a steep learning curve that so many women do in isolation. It’s never been that way historically throughout most of the world, and it should not be for you now, either.

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Monday, January 8, 2018

PUMPING IRONY: Sleeping and Forgetting

Memories are elusive here in Geezerville, an irony that is not lost upon folks like me for whom the past often seems to offer more inspiration than the present. I can’t tell you how many times My Lovely Wife and I have had our spirits lifted by shifting from discussing everyday matters to recalling episodes from our life as young parents or struggling entrepreneurs or clueless newlyweds. And how those recollections gradually become clouded as the years go by.

How old is the cat our daughter rescued from the horse barn up in Forest Lake? Did she have her driver’s permit then? When did she get her license? What car were we driving then? And who was the kid who glommed onto our son in first grade? He was related in some way to that community activist our friend Tim always stays with when he’s in town. You know, that guy who showed up out of the blue at that soccer game.

Give me a minute. It’s on the tip of my tongue.

Scientists have long sought to uncover the mysteries of memory and why it begins to fail us as we pass through the foggy corridors of middle age. Recent investigations have focused on the way sleep affects the brain.

Last month, University of California, Berkeley, researchers released a study suggesting that geezers struggle to remember because our slow brain waves aren’t synchronizing with their faster counterparts during non-REM sleep. This lack of harmony disrupts the transfer of short-term memories to the part of the brain that stores recollections for the long haul.

“It’s like a drummer that’s perhaps just one beat off the rhythm,” study coauthor Matt Walker, PhD, author of Why We Sleep, tells National Public Radio. “The aging brain just doesn’t seem to be able to synchronize its brain waves effectively.”

That’s probably because the brain’s medial frontal cortex tends to atrophy as we grow old and can disrupt the wave harmony — even if dementia hasn’t yet set in. Walker and his team suggest they may be able overcome that by zapping forgetful geezer brains with acoustic, electrical, or magnetic pulses. “What we’re going to try and do is act like a metronome and in doing so see if we can actually salvage aspects of learning and memory in older adults and those with dementia,” he explains.

This approach may not be as far-fetched as skeptics like me might assume. Northwestern University researchers last year reported that gentle acoustic sounds, when synchronized to the rhythm of brain waves, boosted deep sleep among older study participants and improved their ability to recall information.

The sound of a rushing waterfall, for instance, seems to have accelerated participants’ slow brain waves, possibly bringing them into closer alignment with their fast waves. “This is a potential tool for enhancing memory in older populations and attenuating normal age-related memory decline,” lead study author Phyllis Zee, PhD, said in a statement released by the university.

I mentioned this research to My Lovely Wife the other day, when we weren’t reliving the good old days. She pondered it for a moment before suggesting that the whole idea of constantly updating our memory banks might not be a priority if and when we hit our 90s. “Thirty years from now,” she ventured, “storing new memories for the long term is not going to be that useful.”

She has a point, one that University of Wisconsin, Madison, scientists explored way back in 2003. Biologists Giuliani Tononi and Chiara Corelli argued that the whole reason why we snooze is to forget. We take in so much neural stimuli each day, they explained, that the brain voluntarily deletes some of it when we sleep in order to quiet things down.

This makes a lot of sense to me. I mean, there’s only so much worth remembering. Like the name of that guy who showed up out of the blue at the soccer game in South Minneapolis. Or was it in Blaine?

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How to Eat More Veggies

It’s a perennial question: How can I improve my eating habits? Food activist and journalist Michael Pollan famously counsels, “Eat food. Not too much. Mostly plants.” While clever and catchy, the lack of specificity can be vexing. What foods are acceptable? What’s too much? And when it comes to all those plants, how does “mostly” translate to the plate?

The 2015–2020 Dietary Guidelines for Americans (DGA) recommends 2 1/2 cups of vegetables per day. But many health experts believe the U.S. government sets the standards way too low.

“If you look around the world, [you realize] government agencies that have no relationships with food companies come up with very different recommendations,” observes Terry Wahls, MD, clinical professor of medicine at the University of Iowa Carver College of Medicine and author of The Wahls Protocol. “They advise much higher vegetable and fruit consumption.”

The Japanese government, for example, recommends 13 portions of vegetables and four portions of fruit daily. In France, it’s 10 servings of veggies and fruits.

In the United States, however, the Departments of Agriculture and Health and Human Services develop nutrition guidelines with input from groups such as the National Cattlemen’s Beef Association and the International Dairy Foods Association. Although the dietary-guidelines committee notes that these industry lobbyists offer only advice — not mandates — Wahls and others argue that the DGA guidelines are overly influenced by the special interests of these groups. (For more on the role the food industry plays in official health advice, see “Decoding Health Media.”)

Many health and nutrition experts want to raise the bar on eating veggies, challenging us to eat much more than the DGA advises. Wahls, for instance, advises her patients to eat 9 cups of vegetables — measured raw — per day (less for smaller-framed people and more for those addressing specific health issues).

Other experts advise levels that are higher than the current DGA recommendations, and most of them emphasize vegetables over fruits. For all of fruits’ nutritional virtues, including antioxidants, phytonutrients, and fiber, they can cause blood-sugar problems, such as elevated triglycerides, if regularly eaten in excess.

Americans currently consume an average of only 11/2 cups of veggies daily — half of which are potatoes and tomatoes, including fries and pizza sauce. Nine cups of vegetables may seem like an exceptionally tall order, but experts emphasize the nutritional and health benefits that only plants can provide. Plus, by focusing on eating more veggies, you’ll have less room for unhealthy foods.

Wahls can attest to the myriad health benefits her patients see when they shift to a plant-heavy diet. But her strongest testimonial is her own.

In 2007, after several years of decline from progressive multiple sclerosis (MS), she was using a tilt/recline wheelchair and facing a dismal prognosis. As conventional treatments failed, Wahls researched alternative protocols, ultimately discovering a functional-medicine approach to treating complex chronic diseases that employs specific nutrients to support her health. Along with other therapeutic interventions, she eventually adopted an eating plan based on paleo principles, with an emphasis on large quantities of nutrient-rich vegetables.

It had a profound effect. In 2008 Wahls competed in an 18-mile bicycle race and started marathon training. Since 2010 she has been conducting clinical trials on her nutrition protocol — a cornerstone of which is consuming 9 cups of produce daily. (For more about Wahls’s protocol for managing auto-immune conditions including MS, see “One Day at a Time: A Conversation With Terry Wahls, MD (Audio.”)

“If you change how you eat, you can change everything — physically, but also mentally and emotionally,” Wahls says. “This way of eating gave me my life back.”

If you’re intent on getting more plant-powered foods in your diet, read on.

Your Body on Vegetables

Wahls’s recovery powerfully illustrates the influence of food on health — and it’s a good reminder that nutrition does its most important work at the cellular level.

Cells issue the signals that affect how you think, feel, sleep, age, breathe, and operate. Their main power source, the mitochondria, helps them rejuvenate and function effectively. Proper nutrition is one of the keys to boosting mitochondrial health, with nutrient-dense, plant-based foods — particularly veggies — playing an important role.

While it might be tempting to pop supplements to get these nutrients, you’d miss out on the numerous compounds in vegetables that work together to support cell function. By eating plenty of vegetables, you can get all the vitamins, minerals, and phytochemicals you need — in their most bioavailable form. (For more on how whole foods outperform supplements, see “The Whole-Food Advantage.”)

These are a few of the ways veggies support your health.

Reduce Inflammation 

Several factors can damage your cells, including poor diet, too much sunlight, viruses, and chronic stress. While damaged cells have the capacity to repair themselves, they are vulnerable to further harm by free radicals created through normal bodily processes — such as the release of digestive enzymes and other metabolic functions — as well as from environmental toxins and other external sources.

Unchecked oxidative stress and sustained cellular damage can trigger bodywide inflammation, which can cause the immune system to attack healthy cells. Scientists link rogue immune systems to MS, rheumatoid arthritis, atherosclerosis, and a host of other conditions. They’ve also found a connection between inflammation and obesity, and some researchers suggest it increases the risk of type 2 diabetes.

“Antioxidants stop the cascade of reactions that occur with unchecked oxidative stress and inflammation,” explains Maggie Ward, MS, RDN, LDN, nutrition director of The UltraWellness Center in Lenox, Mass. Found in various vitamins, minerals, and phytonutrients, antioxidants are the primary anti-inflammation compounds in veggies, and they’ve been shown to restore cellular health.

Clear Your Head

Inflammation also inhibits frontal-lobe function, Wahls says, which can hamper insights and clarity, and even prompt anger and stress. Research at the National Institutes of Health has tied inflammation to cognitive health, Alzheimer’s disease, and other forms of dementia. People of any age can suffer brain fog — as well as feelings of frustration, high stress levels, and mood shifts — if they don’t get enough nutrients, says Wahls.

Not only do vegetables (minus the deep-fried, sugar-drenched, preservative-laced kind) lower inflammation, but they also deliver vital vitamins and nutrients to the brain. They have a powerful effect on cognition, including emotional responses, memory, learning, and executive function.

In several studies, researchers have found that the antioxidants and folate compounds in specific vegetables — such as leafy greens and crucifers — are particularly important for improved brain health. From the B vitamins that produce mitochondrial energy to vitamin K, which supports healthy blood vessels, the breadth of specific plant nutrients that support brain health is unmatched.

Boost Gut Health

Fiber is the workhorse of a healthy microbiome, helping good gut bacteria thrive, explains nutritionist and educator John Bagnulo, MPH, PhD. And despite the marketing efforts of bran-cereal makers to convince you otherwise, vegetables are among your best sources of fiber. He recommends at least 2 cups of vegetables per meal for optimal digestive health.

Some studies have found that when digestive microbes are starved of fiber, they may start to feed on the mucous lining of the gut, leading to intestinal permeability, which allows undigested food molecules to leak into the bloodstream. Known as leaky gut syndrome, this can trigger an autoimmune response as the body deals with the perceived invaders, producing symptoms such as food allergies, migraines, and digestive distress.

“Many people are suffering from gut disorders and may not even realize it,” Bagnulo says. Digestive issues can also manifest as skin conditions and even moodiness and depression. (For more on gut disorders, including irritable bowel syndrome, see “An Integrative Approach for IBS Relief.”)

This originally appeared as “Eat More Veggies” in the January/February 2018 issue of Experience Life.

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Wednesday, January 3, 2018

PUMPING IRONY: To Live Long, Be Happy

My old friend The Captain tends to lean a bit toward the morose side of life. He’s midway through his eighth decade and generally worries too much about things he can’t control. His wife is ailing, his children and grandchildren are far-flung, and his Mad Men days in the New York magazine scene have receded into the far corners of his memory. Antsy by nature, he’s constantly immersing himself in one project or another in a mostly fruitless effort to recover a measure of the relevance he once enjoyed.

When life gets too dark, TC will sometimes drop me a line and suggest we get together to hash things out. So we rendezvoused for lunch the other day, TC lugging a satchel full of books and notebooks (he likes to take notes) and displaying all the enigmatic gregariousness that made him such a great sales guy. We quickly dispensed with the pre-holiday cheer, though, and as is our custom, got down to business. His youngest brother had recently died. His wife’s illness had forced them to sell their winter retreat in Arizona. He had decided to quit a part-time ad-sales job. Trump was still president.

We compared notes on grieving (he’s better at it than I am) and wrestled awhile with the many ways we become attached to people and things and how tough it is to stay focused on what’s happening right now rather than lamenting the past or worrying about the future. Life is full of ups and downs, we agreed. The key is to remember that everything — good and bad — is temporary.

“This is how it is now,” I explained. He reached for his notebook and scrawled the words on a patch of open space.

We parted as amiably as usual, but as he turned to walk away, I grabbed his arm. “Be happy!” I said.

He chuckled and moved along.

I was thinking about The Captain last week after I stumbled upon a piece in the New York Times suggesting that the key to happiness is to “think like an old person.” The latest in a series of articles profiling a group of New York–area nonagenarians, John Leland’s story offers some real-life evidence to back research showing that we geezers are more content than younger folks.

“If they were not always gleeful, they were resilient and not paralyzed by the challenges that came their way,” Leland writes of the six people he’s been following for the past three years. “All had known loss and survived. None went to a job he did not like, coveted stuff she could not afford, brooded over a slight on the subway, or lost sleep over events in the distant future. They set realistic goals. Only one said he was afraid to die.”

Despite their narrowed horizons, Leland’s subjects display levels of resilience “that would shame most 25-year-olds.” And he suggests that we would all become more resilient, more focused, more joyful if we followed their lead.

That may certainly be true, but there’s plenty of research pointing to a slightly different conclusion: If you want to live to a ripe old age, be happy. Leland’s nonagenarians aren’t upbeat because they’ve grown really old, in other words. They’ve grown really old because they’re upbeat.

A 2016 study at Harvard’s T.H. Chan School of Public Health found “strong and statistically significant associations of increasing levels of optimism with decreasing risks of mortality” from major causes of death such as cancer, heart disease, and stroke. This is probably due to the optimist’s tendency to have a healthier lipid profile, lower inflammation levels, higher antioxidant levels, and better immune function, notes lead study author Eric Kim, PhD.

“Our finding that optimism is associated with a wide range of causes of mortality adds to a growing evidence base that optimism plays an important role in health and longevity, further supporting the possibility that optimism could be a novel target for future research on prevention and intervention strategies aimed at improving public health,” Kim concludes.

In their book, The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer, Elizabeth Blackburn and Elissa Epel take the positivity argument to the cellular level, arguing that your mindset can actually affect the length of your telomeres, hastening — or slowing — the rate at which your cells age. They describe specific negative traits, including cynical hostility, pessimism, rumination, thought suppression, and mind-wandering, as harmful to telomeres. In one study they cite, participants who reported the most mind-wandering tendencies had telomeres that were 200 base pairs shorter than their more focused peers. The average 65-year-old has about 4,800 base pairs, so that lack of focus can make a sizable difference.

“To an extent, it has surprised us and the rest of the scientific community that telomeres do not simply carry out the commands issued by your genetic code,” they write. “Your telomeres are listening to you.”

I often wonder whether The Captain listens to my often incoherent and arcane bits of advice, so I was heartened to receive a text from him after our recent lunch. The photo he attached showed his notebook page where he had scribbled “This is how it is now.”

That made my day.

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An Integrative Approach for IBS Relief

For most of his life, Rich Geldreich suffered gut distress. The 42-year-old San Diego–based software engineer had experienced recurring bloating, gas, and constipation since he was 13. His symptoms grew more severe as he aged and were exacerbated by his stressful job.

“Every time I had a big deadline at work, I’d hit a wall with my gut,” he says. The pain and gas felt “like a volcano erupting.”

After one especially bad bout in 2013 triggered by severe food poisoning, Geldreich saw five doctors, including a gastroenterologist. They all offered the same diagnosis: irritable bowel syndrome (IBS).

This didn’t bring relief.

IBS affects one in five Americans, yet its causes are a mystery to most health professionals, even those who specialize in gastrointestinal (GI) disorders. Unlike a disease, which has identifiable biomarkers, a syndrome is a collection of common symptoms — and can be devilishly difficult to treat.

“IBS is the most common diagnosis made by gastroenterologists, yet it’s the one we know the least about,” says Robynne Chutkan, MD, an integrative gastroenterologist at Georgetown University Hospital. Part of the problem, she says, is that root causes can be as varied as the individuals suffering from them, and doctors often don’t take time to search them out.

“Stopping with a diagnosis of IBS is too vague,” Chutkan explains. “If you take a good look, you find lots of potential explanations — gluten sensitivity, parasites, bacterial overgrowth, lactose intolerance, and leaky gut. But none of those can really be addressed in your typical 15-minute appointment.”

Most physicians are taught to view gut ailments as a problem with anatomy, but IBS is usually about biology and function, says Greg Plotnikoff, MD, coauthor of Trust Your Gut. “IBS doesn’t lend itself to quantification; it won’t show up on a CT scan, an ultrasound, or a biopsy. So people with IBS get passed from doctor to doctor like a hot potato.”

Geldreich was one such hot potato. When he visited his doctors in 2015, each one put him through a variety of tests. They all ruled out ulcers, Crohn’s disease, and cancer. After no one found an explanation for his chronic pain, Geldreich went home with a prescription for heartburn medication and the suggestion that he start supplementing with probiotics.

Doctors write nearly 6 million prescriptions a year for drugs to ease IBS symptoms. Yet GI specialists agree that these medications — usually laxatives, antidiarrheals, and antispasmodics for cramping —  often provide little relief.

“The drugs we use to treat IBS only have a 10 to 40 percent efficacy rate compared with placebo,” says University of Michigan gastroenterologist Shanti Eswaran, MD. And they often produce side effects that can compound IBS symptoms. The antacids Geldreich’s doctors prescribed, for example, can lead to reduced stomach acid and poorer digestion. (For more on problems with antacids, go to “Natural Ways to Fight Heartburn.”)

Leaving the underlying causes of IBS untreated takes a toll. By 2015 Geldreich developed gastritis, a painful inflammation of the gut lining, as well as small intestinal bacterial overgrowth (SIBO), which can cause bloating and nutrient malabsorption. He couldn’t sleep. He struggled to find foods he could eat, and his weight dropped from 150 to 115 pounds.

It was at this point, after meeting a stressful deadline at work, that Geldreich made up his mind. He took his bonus, quit his high-pressure job, and devoted himself full-time to getting to the root of his gut problems.

“I had no choice,” he says. “This was a battle for my life.”

The Path to Healing

While every case of IBS is different, most functional-treatment strategies cover the same basic protocol. These are the steps Geldreich followed in his recovery.

1. Know Your Gut’s History

IBS can seem like a lifetime diagnosis, but it doesn’t have to be — especially if you work with a health practitioner who helps you address the root causes.

“It’s absolutely essential to figure out why you have IBS, rather than just accept the -diagnosis and resign yourself to a life of pharmaceutical intervention,” says Chutkan. “You have to be a medical detective.”

Geldreich enlisted the help of two Seattle healthcare providers: functional naturopath Dan Lukaczer, ND, and acupuncturist Avigail Cohen, LAc. Over the next 18 months, each would help him identify and treat the underlying causes of his IBS.

When he first met with Geldreich, Lukaczer asked for a detailed health history. “As a physician, I get a lot of clues from a patient’s story,” Lukaczer says. “Getting to the root cause of a condition like IBS isn’t like one of those medical TV shows, where you find out it’s one unusual thing, like the mercury from fish or lead from the pipes, that’s making a person sick. Usually it’s a combination of factors, and Rich is a good example of that complexity.”

Their discussion revealed several potential causes for Geldreich’s distress. He told Lukaczer about his pressure-cooker job and how he often worked 12- to 14-hour days. He also recalled getting sick after drinking water contaminated with raw sewage when he was 13. (Hostile microbes are a common trigger for chronic gut ailments, and they can persist in the gut for years.) By the end of the 90-minute appointment, Geldreich felt hopeful.

“Lukaczer was the first doctor who I felt was actually paying attention,” he recalls.

Most IBS patients feel unheard and disempowered, says Plotnikoff. “Asking a patient to ‘tell me your story’ often shines a light on the most important information.”

Geldreich’s health history also revealed a family connection: Both his mother and his brother experienced gut distress. Studies show that people who have a parent or sibling with IBS are three times as likely to suffer from the condition, though it’s unclear precisely why or how.

“We know genes play a role in IBS,” says Gerard Mullin, MD, associate professor of medicine at The Johns Hopkins Hospital in Baltimore. But we don’t know exactly how or how much.

Both genetics and mic-robes have an influence. The microbiome is a pillar of gut health, so any inherent weakness ups the odds of a gut-related condition.

Meanwhile, the bulk of the 100 trillion microbiota that compose our gut microbiomes are inherited from our mothers, including some 1,000 species of bacteria and untold archaea, fungi, and viruses. This inher-it-ance is transferred from mother to baby in the birth canal. If a mother’s intestinal microbiota are imbalanced at the time of delivery, her child’s often are, too.

Studies have found that people with diarrhea-predominant IBS have lower-than-normal levels of Bifidobacterium and Lactobacillus; those with constipation-predominant IBS show flagging levels of Veillonella species.

While genes can’t be altered, the microbiome can be revitalized with nutritional and lifestyle interventions. A genetic predisposition is not a life sentence.

2. Balance the Microbiome

Like many people, Geldreich inherited a less-than-robust microbiome. And then life piled on.

For years he worked too much, rarely exercised, and ate a less-than-stellar diet: He often wolfed down energy bars for lunch and chain-restaurant fare for dinner. He’d taken multiple courses of antibiotics over the years, and Chutkan notes that a single course of a broad-spectrum antibiotic, such as ciprofloxacin (commonly prescribed for urinary- and respiratory-tract infections), can destroy up to a third of the gut’s good bacteria. “The process of repopulation may take months or even years,” she explains.

“Identifying and remedi-ating the cause of bacterial imbalance is essential to repairing and healing the gut,” Chutkan adds. “Your microbiome wasn’t built in a day, so rebuilding it will be a gradual process. But tangible improvements can be made.” (For more on this, see “Build Your Microbiome.”)

For her IBS patients, Chutkan often advises a 90-day course of high-quality probiotics to repopulate the gut with good bacteria. She recommends a formula with strains of Bifidobacterium, Lactobacillus, and Strepto-coccus, which “help crowd out pathogenic species.

“Probiotics aren’t a panacea,” she admits, “but for those suffering from microbial discord, they represent a glimmer of real hope for improved health.”

To get a glimpse of what was going on in his patient’s microbiome, Lukaczer reviewed the results of Geldreich’s comprehensive digestive stool analysis.

The results showed Geldreich was free of many of the parasites and yeasts common in people with IBS, though they did show he had difficulty digesting fats, which can lead to bloating, pain, and indigestion. Lukaczer put him on supplements containing fiber and bile salts to aid with fat absorption.

This allowed him to move forward to the next step of healing his gut’s lining.

3. Address Leaky Gut

In a healthy gut, the lining serves as a sophisticated filter. It’s composed of permeable cells that allow fully digested nutrients to pass through while deflecting larger food particles, chemicals, and toxins.

When those cells are -irritated — by food allergens, stress, toxins, and other sources — the cell junctures loosen and microscopic bits of undigested food leak into the bloodstream. The immune system attacks these invaders, leading to chronic inflammation that can perpetuate low-grade digestive discomfort for years. (For more, see “How to Heal a Leaky Gut.”)

Chronic inflammation is the long road to a leaky gut and IBS; the shortcut is intestinal infection. One in three cases of IBS begins with a severe bout of food poisoning or traveler’s diarrhea. The infection causes the immune system to target the gut directly. The resulting inflammation weakens the microbiome and, for some, unleashes IBS symptoms.

Geldreich took the long road and the short road. He had a family history of gut ills and a microbiome weakened by a childhood illness; then the bad bout of food poisoning in 2013 triggered his chronic gut distress. “After that, I was in near-constant stomach pain,” he says.

To heal a leaky gut, Chutkan follows the three Rs: remove, replace, and repair.

Remove the major dietary sources of inflammation, including dairy, gluten, refined sugars, alcohol, and artificial sweeteners.

Replace them with nutrient-rich vegetables and fermented foods, like sauerkraut and kefir.

Repair by eating anti-inflammatory foods, such as gut-healing bone broth, cold-water fish, flaxseeds, and walnuts.

Lukaczer put Geldreich on a comprehensive elimination diet for three to four weeks that cut out gluten, dairy, soy, corn, beef, pork, sugar, and processed foods. (See “Nutrition Protocols to Relieve IBS,” opposite page.) This offered Geldreich substantial relief, as it does for many IBS sufferers whose guts have become leaky and, by extension, hypersensitive to inflammatory fare.

Lukaczer also started him on gut-healing supplements, including probiotics and digestive enzymes.


Geldreich left his job to escape the stressful work environment, though he knew unemployment was not a long-term solution. He worked with his healthcare providers to develop a supportive plan: In addition to maintaining good nutrition and stress management, he committed to exercising at least 30 minutes a day, retiring between 9 and 10 p.m. to optimize restorative sleep, and scheduling a weekly massage and chiropractic adjustment. He also started walking up to three miles daily.

Geldreich moved to San Diego for its sunny, laid-back atmosphere. He is once again employed as a tech consultant but now works from home. This allows him to eat well and take breaks to exercise. He walks every day, and as his health has improved, he’s started jogging and weightlifting. After following an elimination diet for several months and using a rigorous, food-and-supplement-based approach to rebuilding his gut lining, he now eats most foods comfortably. His IBS symptoms have been absent for a year.

“The human body has quite a bit of resiliency if we unleash it,” Lukaczer says. Though the symptoms of IBS once nearly ruled his life, Geldreich is now living proof that the gut, when given the tools and support it needs, is built to heal.

This originally appeared as “Gut Feelings” in the January/February 2018 issue of Experience Life.

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Wednesday, December 13, 2017

Rejuvenating Retreats

I’ve visited Breitenbush Hot Springs during every season: the excitement of spring, when the river is at its highest; the conviviality of summer, when towels damp from soakers hang from the lodge’s banisters like prayer flags; the vibrancy of fall, as the first frost arrives and the air carries a pungent spicy aroma. But it’s quiet winter I love most, when snow covers the ground and snug cabins await deep in the woods.

Any time in winter is worth a visit, but Breitenbush is especially popular during the end of the year. That’s when the center hosts a 12-day celebration observing the winter solstice and holidays, culminating with an adults-only retreat on New Year’s Eve.

Some guests opt to stay for the entire stretch, but most choose one event and come for a multiday escape featuring daily well-being programs — including yoga, crystal divination, and meditation — as well as hearty vegetarian meals, massage, and refreshing soaks in the site’s seven hot springs.

Bethany McCraw, 51, has been visiting the nondenominational retreat center since the ’80s and has attended both events at one time or another. “Winter Solstice was pretty special because it was all about bringing in the light, and there was a nice guided meditation before dinner,” she says.

New Year’s Eve is a more lively affair, but there are no champagne corks popping at this alcohol-free destination. Instead, guests enjoy a feast of international dishes followed by live music and dancing. A midnight peace vigil offers an opportunity for introspection. “New Year’s was my favorite,” recalls McCraw. “The closing of the old and looking forward to the new. I love the sense of hope it brings.”

Margaret Duperly, who has lived and worked at Breitenbush for more than 20 years, explains that, while the event is fun, it’s more than an amusing soiree. “There’s a thoughtful part to exploring our humanity together,” she says.

The Winter Holidays celebration is filled with seasonal workshops and memorable meals, but Santa never stops by and there is no special emphasis on the 24th or 25th. It’s also a popular event for parents with young children. “Christmas at Breitenbush is a chance for people to come away from the materialism of the mainstream and return to simplicity, nature, and relationships, and sharing together,” says Duperly. (For more on Breitenbush, read “Retreat to Simplicity: Restorative Spas“.)

Solstice and holiday retreats
Where: Breitenbush Hot Springs Retreat and Conference Center, Detroit, Ore.
Individuals and families looking to celebrate the holiday season in a less materialistic fashion
Cost: $162–$256/person

Inner Awakenings

In 2009, Carmen Nadler, 36, was searching online for a place to recover from a health issue and decompress from the stress of new motherhood.

YouTube led her to videos featuring the soft-spoken, kind-eyed guru Acharya Shree Yogeesh. A longtime spiritual leader and activist, Acharya Shree has founded spiritual retreat centers in the United States, Europe, and India. He also opened a secondary school in Haryana, India.

After watching all of Acharya Shree’s videos, Nadler packed up her family and drove from Saskatchewan, Canada, to Siddhayatan — a ranch in Windom, Texas, that Acharya Shree converted into a spiritual retreat center.

Siddhayatan offers no massages or other spa-type wellness services. The digs — located on 260 Internet-free acres of stunning rolling hills, grass fields, and pockets of forest — aren’t fancy, but the private and shared rooms are clean and affordable.

The center has no religious affiliation and welcomes people of all faiths; it also adheres to principles of nonviolence, transformation, compassion, and healthy living.

Retreats focus on a range of topics: meditation, juice fasting, or posttraumatic stress disorder. But Siddhayatan’s monthly Stress Relief Retreat is one of its most popular options.

Acharya Shree leads the three-day escape, which features a blend of guided mantra chanting, small-group workshops (three to 10 participants), homemade vegetarian meals, and tea times.

During classes, students share their stories, develop concentration techniques, and do Purnam yoga, a detoxifying practice that involves 84 breathing combinations.

“During workshops, you get a lot of time with Acharya Shree,” Nadler explains. “He really listens to you — he validates; he shares good wisdom. I’ve felt empowered and inspired by him.”

For many visitors, Siddhayatan becomes like a second home. Since her first visit, Nadler has visited more than 10 times. “It’s not about stress now. I go because I enjoy it and think people need to take time out in their lives and retreat from society and the busyness of work,” she says.

“After a retreat, I feel like a bunch of weight has been lifted off my shoulders. In fact, I feel it the minute I get there.”

What: Stress-relief retreat
Siddhayatan Spiritual Retreat Center, Windom, Texas
Those seeking a no-frills place to unwind and engage with their inner wisdom
Cost: $450–$590/person

Deepening Connections

Here’s the thing about the Playa Viva couples’ yoga retreat: Your partner must be willing to go with you. When I asked my husband if he’d consider it, he raised his eyebrows. “I’m as flexible as a dry stick,” he said. Not a decisive no, but a far cry from an enthusiastic yes.

I should have started by telling him about the retreat’s beautiful location, tucked into the western Mexican coastline, surrounded by the music of a lush tropical forest. Every private casita has a view of the shoreline — front-row seats to sunsets over the Pacific. And then there’s the food: A farm-to-table kitchen turns out dark, leafy greens from the onsite garden, grilled fish from the ocean, heaps of jewel-toned fruit, and myriad salsas to go with the ubiquitous rice, beans, and hot-off-the-griddle corn tortillas. Eco-friendly Playa Viva is secluded, intimate, and deliciously romantic — the ideal setting to relax and reconnect with your partner.

Bay Area yogis Anjuli Mahendra and Alok Rocheleau have been leading yoga escapes at Playa Viva for five years, including this one designed exclusively for couples. During the six-day workshop, they lead participants in partner poses aimed at creating meaningful connection. In butterfly pose (baddha konasana), for example, couples sit back to back feeling each others’ breath rhythms, attempting to inhale and exhale as one.

Rocheleau also teaches massage techniques. “Learning to give and receive with your partner can be very empowering,” he says. “A lot of couples reach out to us because they are missing that intimate connection of touch.”

“Couples sometimes conflate intercourse and touch, an understandable conclusion, but one that is limiting,” explains Mahendra. “Couples really appreciate the oppor-tunity to share touch that is not sexual. This has been a theme and an overarching part of our work — teaching people how to be in contact as a spiritual experience that can support all levels of communication.”

Rocheleau and Mahendra also allocate time for group meditation as well as dyadic conversations in which one partner speaks while the other simply listens.

Nicole Shea, 35, attended last year’s retreat with her partner, Michael Shea, 48, and says the dyadic aspect was a challenge at first, but then it became a rich healing experience. “We quickly saw how speaking to one another about our personal experiences, needs, and desires within our relationship was enlightening,” Nicole recalls. “This served as a platform for us to have deeper conversations on our own later.”

Much of the workshop focuses on spending quality time together. This was a big takeaway for Nicole. “There were many unscheduled times during the retreat when we just got to hang out as a couple instead of always doing something,” she says. “This was invaluable because we don’t often get a lot of time together during the day to just be with one another.”

Playa Viva provides the opportunity to hear and touch each other as well as chill together with a good book and a fresh-basil margarita. There is plenty of free time to beachcomb, rock in a hammock, splash in the waves, or take part in organized activities such as permaculture hikes and a cacao ceremony. Nightly beach bonfires bring guests together for singing and storytelling under countless stars.

What: Couples yoga retreat
Where: Playa Viva, Mexico
For: Yogis of all levels looking for a place to get in touch with their partner
Cost: $1,650–$1,900/person includes lodging and three meals a day

This originally appeared as “Rest and Reflect” in the December 2017 print issue of Experience Life.

Excerpt from

Tuesday, December 12, 2017

Eczema treatment before and after: Woman CURED her skin with THIS £1 bathing trick

ECZEMA is a common condition that causes red, dry skin. Symptoms are often eased with cream, but one sufferer treated hers with some unlikely bath salts.

Reporting from