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Sunday, December 20, 2015

Stress: Is there a positive side to all this caring?

            Key Points

1. Stress is your mind’s interpretation of either an internal or external stimuli
2. Stress does not function as a simple external force causing harm
3. You have the ability to modulate your perceptions and approach to adversity, ultimately deciding if “stress” will cause DISTRESS or EMPOWERMENT
4. By learning to control your internal thoughts and your reactions to external stimuli, you can create an effective and downright feel good physiologic “stress response.”
5. Stress is simply CARING, A LOT
6. Stress can be way to create meaning in our lives, to connect with others and to reach higher states of functioning rather than succumbing to anxiety and fear.

            If you haven’t been living under a rock for the past few years, you are probably more than aware that stress management is often a pivotal part of any functional approach to improving health and avoiding disease. Along with this message, you may have also heard of the idea that chronic stress in the form a perpetually hyperactive  sympathetic nervous system, or ‘fight or flight” response, can create a relative imbalance in our overall autonomic nervous system, leading to significant dysfunction, morbidity and just plain poor health. Taking this into consideration, nothing seems more worrisome to me than an “automatic” machine that evolved to perform functions such as regulating blood pressure, orchestrating proper digestion and maintaining metabolic energy balance working in a less than optimal manner.  I cannot stress this enough (no pun intended)- automatic DOES NOT mean optimally functioning- it simply means autonomously and continuously performing a given task that may or may not actually be helpful to the system in question. Lastly and perhaps most intriguingly, automatic DOES NOT mean out of OUR control. While we are blessed with an autonomic nervous system that can function independently of any conscious thought, the beauty of this system lies in the fact that we CAN control the inputs to this system such that we can alter our physiology simply by our thoughts!  Ever heard of psyching yourself up for the big game? Well guess what, you may have just willfully increased blood flood to your skeletal muscles, mobilized glycogen stores to provide precious glucose for your mitochondria to make ATP- and increased your cardiac output in order to supply your cells with the oxygen required to maximize this energy production- did someone just say Electronic Transport Chain?

            In order to help answer the main questions at hand: what exactly is stress and how does it affect our overall health, I have turned to the wisdom of Kelly McGonigal, a prominent health psychologist, who has become the leading researcher wiithn this field of stress psychology. If you have not seen her TED Talk, I would like to say you are not alone, but the truth is, she has over 9 million views! Just perhaps she has something interesting to say.

TED Talk Link

 Additionally she recently did two wonderful podcasts with Brian Johnson, one of the most practical and productive mental health geniuses I know, which provide further fuel to this discussion.

Podcast Link:

One of Brian’s most important “Big Ideas” from his discussions with McGonigal is that “stress” can actually be a motivating and helpful component of our daily lives. As he point outs, rather than seeing stress as the all or nothing “fight or flight” response or stress as chronic, runaway anxiety with actually minimal amounts of “fighting or flighting,” we should simply see stress as the acknowledgment that we CARE, A LOT. Taking our positive approach to stress and applying it to a real world situation, let’s examine the scenario of an impending thunderstorm barreling down overtop some hikers completely exposed to the elements. If you feel like this would be a good time to begin some quiet mindful reflection, trying to avoid overt sympathetic arousal, maybe you should apply our new positive stress paradigm and think instead, "I do not have to necessarily fight or flee, but maybe I should start CARING, A LOT.”

            While we commonly associate enthusiasm and passion as “positive” traits and stress and anxiety as “negative”, McGonigal argues and I agree, why can’t stress be positive? Why can’t we channel this physiologic energy into passionate work? Ever been buzzing as you churned through a book, or hummed along writing a deadline paper- you may have been in what some people call a “Flow State.” With creativity seeming to ooze from your eyeballs, in this perceived “Flow State” there often times is very little thinking, just doing, feeling, and moving with the moment. Just as you can’t tickle or scare yourself by jumping around a corner, you cannot seek to obtain or reach a “Flow State” through purposeful action; it just simply happens. Now if I were to ask you how you were feeling during one of these moments of clear action, of precise expression, of being “in the zone” I can almost guarantee you would not describe it as the sympathetic response- running away from a saber tooth tiger, but you surely would also not describe it as a calm, collected and peaceful parasympathetic state; so what exactly then is this “Flow State?” To answer this last question, I turn to the work of Andrew Bernstein.

            Bernstein’s most recent book: “The Myth of Stress” seeks to completely shatter the idea that stress is some external force leading to the systematic activation of our sympathetic nervous system. Rather, Bernstein postulates that stress is pretty much all a mental construct, an interpretation, internally created through our thoughts regarding our present environmental circumstances. Bernstein discusses this idea and others further in a thought-provoking podcast with Robb Wolf.

Podcast Link

        Taking even what seems to be the most obvious rebuttal to his theory regarding stress: a massive grizzly bear standing 20 yards ahead of your path, he argues that  while we all just assume the presence of the bear will initiate our "fight or flight" response, we actually have to mentally decide “hmmm, interacting with this bear might not be the best idea, maybe I should start caring about staying alive.” So we see that the ensuing physiologic response involving fleeing or possibly fighting, depending on the person in question, stems not from some switch the bear triggered, but from our internal ruminations, a conscious decision that this situation requires a different level of attention. Going back to our previously described “Flow State,” I suggest to you that perhaps, the reason we do not perceive these moments of action as stressors or stressful or conversely, describe them as soothing or calming- operating at our normal homeostatic baseline, is because, just maybe, we aren’t thinking much at all. Thus we return to the question: Without thinking, without an internal dialogue, without conscious awareness of our thoughts, is stress even possible? Whether operating in a “Flow State” or choosing to mindfully direct our energy during situations of perceived stress, it seems that we truly have the power to control stress, and more importantly, use stress to live more productive, happy and fulfilled lives.

              The possibilities of a positive approach to stress are endless, but I want to end this discussion with one last key question and idea: what if we saw stress as a positive way to create meaning? McGonigal sites an amazing study that looked people personal interpretations of stress and meaning in there lives and sure enough, the people who said they were the most stressed also identified more meaningful pursuits and relationships in their lives. So if we approach stress as the opportunity to acknowledge our values and subsequently create meaning in our lives, instead of just another moment to let anxiety, worry and disappointment reign supreme, would we see stress differently? And lastly, I ask you curiously, do we really need stress management, when we can have stress empowerment instead? Just an idea or maybe some misdirected stressful thinking, who knows, it’s all just in our heads anyway.

Sunday, October 18, 2015

Sunday Morning Photography and Poetry, October 18th, 2015

Courtesy of my wonderful father, here is a photograph taken in Utah with none other than irreplaceable i-Phone. 



After seeing this amazing picture, I knew just the poem for this post. Written a few months back after a rather intense thunderstorm, the poem was meant to be a simple reminder that even when our lives  seem to revolve around computer screens and fluorescent lights, the true beauty of the world comes from looking out just a little bit farther with a friend right by your side!

Rainbow
7-19-2015

Bounding over the horizon
The rainbow stretches
An archway, an entrance
Into a fantasy world beyond
Some search for the glistening gold
At the end of the rainbow
I for one, seek something more
Passing underneath Newton’s wonder
The sun appears a little brighter
The birds sing a little louder
The flowers smell a little sweeter
And I begin to feel a little happier
Breathing in, I take a solemn pause
And let my hand reach out
Effortlessly finding its peaceful partner
We are ready to start this journey together

Under the rainbow

Monday, September 28, 2015

Do you have the genes to be an Olympian?


Ever thought what it would be like to train or perform  like an Olympic athlete?  Having read The Sports Gene:  http://thesportsgene.com/ by David Epstein and listened to recent podcasts by Mark Sission of Mark’s Daily Apple with the entrepreneurs at DNA Fit: http://www.dnafit.com/us/ , a new research group providing genetic testing/analysis for athletes hoping to optimize their training. From energy/nutrient utilization and susceptibility to connective tissue injuries to one’s predilection for strength based training versus long-duration endurance exercise, DNA Fit hopes to give athletes a wide variety of data so that they can get the most out of their pursuits. While I am very open-minded when it comes to epigenetic research and studying the interplay between our genes and the environment, we must always take pause when new genomic research hits the scene- touting to have found numerous genes showing strong associations with specific physiologic and metabolic functions related to athletic performance.

Of course, being an active person myself, it would be quite fun and interesting to do a DNA Fit test just to see and maybe rationalize in my mind what I already believe to be true with regards to my overall athletic performance, optimal nutrition requirements and potential tendencies to injury. The reality is, however, I have no money for such testing and waiting a few years for the research to evolve and my pockets to fill with at least a little cash may be the better option.

While people like David Epstein and the geneticists at DNA Fit have been studying the role of specific genes in creating the champion Olympian, I had perhaps a more relevant question for the population as a whole that arose from a happenstance encounter with a patient during my recent ambulatory internal medicine rotation. The patient was a 46 year old male, who was by BMI standards, morbidly obese and without significant weight loss in recent months. His diet was improving but still consisted of primarily highly processed and refined foods including a fair share of Hardee’s. In addition, he worked a relatively sedentary job, did not exercise and seemed to be sleeping only 5-6 hours a night at best. Sound like recipe for poor health to you? Other than being obese, however, his metabolic parameters were remarkably within normal limits. From fasting and post prandial glucose to lipids and inflammatory marker such as CRP, he seemed to be free from disease. With no evidence of coronary artery disease, diabetes, dyslipidemia or even hypertension, this guy was managing to defy the odds of his poor lifestyle choices. While there appeared to be almost nothing about his environment conducive to optimal genetic expression, he was still functioning at a relatively high level. How was this man eating donuts and drinking Big Gulps without any evidence of metabolic derangements and better glucose control than his health care providers? Could the blessing of amazing genetics be the answer?

So my questions for the smarter people of the world is this: When it comes to identifying the genes that seem to be associated with optimal health, should we be studying the gold medal Olympians or should we switch our attention to a different population? Was my patient the individual that the geneticists at 23 and Me and DNA Fit should actually be studying? Are individuals like my patient, who appear on the outside to be the antithesis of health, the ones who have the genetic secrets to avoid chronic disease even in the face of a very poor lifestyle? I do not have many answers to these questions, only more speculation into the complicated nature of gene-environment interaction. One thing is for certain, however, there are likely hundreds or thousands of individuals working and living who will never compete for a place on the podium, yet the metabolic and genetic heroics at play within their cells and tissues is probably worth a gold medal.

What We Need Most?



So it has been a while since my last post and despite having relatively more free time over the last month, I haven’t been able to get around to posting a new piece- until now! But, before I delve into the main subject of the post, I wanted to share two simple rules that inspire me to keep writing and blogging and maybe will inspire you to do the same. 1) Keep your posts short and to the point and 2) only write about things worth writing about. Take note, the prerequisites for successful writing are not 1) talented and elegant word choice or 2) an Ivy league education. Anyone with the right motivation can write about topics that bring meaning to a wider audience. While some people choose to write for personal exploration and shy away from public exposure, I feel there is something beautiful about sharing with others, especially when the intention is simple: to bring knowledge, happiness and joy with your words.

With this wonderful construct in mind, I have been thinking more and more lately about a wonderful question posed by my uncle during a recent week long family vacation. During this vacation, I was surrounded by my aunts, uncles, cousins, grandparents and parents in the most complete family reunion in recent memory. Seeing some of my cousins embarking on the adventure that is college, and talking to my grandparents about their world travels brought me back to the reality that there was, indeed, a life outside of the hospital. More importantly, however, I was able to reconnect with my closest of kin, the ones who I called family, the ones who I loved the most. In this age of fabricated relationships and social media, we often substitute real human connection to live in the seemingly satisfying world of “likes,” Instagram photos and an insatiable Facebook news feed. If we could only see that technology is not the solution to all ills, would we finally find happiness from the simple hug? If we could step back from the “irrationalizations” that the pleasures gained through social media actually fulfill our true desires/needs as loving human beings, we would see that all we actually want is to connect with other humans?


Living once more in this world of nourishing interaction, it was no surprise that my uncle would provide the greatest food for thought during our last evening meal.  With the most earnest yet humorous tone, my uncle asked, “Being the most medically educated among us, if there was one thing you would recommend to keep healthy/improve one’s health, what would it be?” It took less than 2 seconds for me to respond. Instinctually and without fail, I replied, “Do this at least once a year.” It took slightly more than 2 seconds for the reality of my answer  to sink in, but the sentiment was immediately crystal clear. Being surrounded by your “tribe,” enjoying good food in a stress-free environment, sleeping more than 6 hours night and engaging in multiple forms of movement was exactly what all of us needed to restore and renew our strong passions for work. I will be the first to tell you that my family is full of enthusiastic “smartypants” and just having a few days together, sharing our collective knowledge brings about a mini-enlightenment without the feeling of a medical school lecture. And while it would be amazing if we could always live and work in this supportive and nourishing environment, it is vacations/times like these that remind us all that even as modern humans relying on technology for the simplest of tasks, maybe there is something to be gained from choosing to keep it simple all in the company of the ones you love.

Saturday, August 22, 2015

Saturday Photography and Poetry: August 22nd, 2015

It is taken a little longer than I would have liked to start this series, by without regrets and further adieu, here is a little something from my recent trip to Maryland to hike a portion of the Appalachian Trail with one of the best friends anyone could ask for: Max "Bear Bag" Mishkin. If only we all could  see the nature through eyes like his! Enjoy



Mountaintop

Climbing
Switchbacks never-ending
Within the green tunnel
Searching for the horizon
We told ourselves we did this for fun
In ninety-five degree heat
And packs strapped to our backs
We began to rethink
Where is the mountaintop?
Calling out the leaves rustled a reply
Just keep climbing, you are almost there
Trudge mode we called it
When all hope seemed lost
A flash of blue peaked through
The sky was beckoning
As we inched ever closer
Invigorated
Our new-found energy
Appearing to come from deep within
But instead, surging forth from the pair of legs
Churning right alongside
Companions
Having reached another mountaintop
There was no such thing as failure
Just another opportunity

To redefine resilience