Mindful Grocery Store Shopping

After being diagnosed with any medical condition, or being told to lose weight, many patients feel overwhelmed. The first question  is what do I eat?

In my previous post, I invite readers to consider a mindful approach with eating.  In this post, I invite you to now approach your trips to the grocery store in the same way, with non-judgmental observation.

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I have found over the years when advising patients on dietary habits, I can hand out printouts on eating more greens, reducing intake of sugary foods, or stopping soda.  This can be helpful, but once the patient is at the store, juggling a family and watching a budget, this advise can become difficult to follow.

In the last few years, I’ve been taking a “boots on the ground” approach.  Although a patient’s visit with me may be an important episode in their healing journey, the real healing process happens outside of the office.  

If like most of us, you shop for groceries on the weekends.  I invite you to observe your trip to the grocery store. Do you have a certain aisle you go to first?  Do you take a with a list? Do you look for sales?

Finally, at the conclusion of your trip, make observations of what is in your cart  This may be difficult, but please try not to judge what’s in your cart. Simply observe if there is a dominant food type, or if there are any foods you don’t have in your cart.

While doing this, it is so important to not judge your cart, or yourself.  If you find yourself doing this, simply take a breath and let the judgement thought go.

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Mindful Approach to Nutrition

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In a few of my previous post, I’ve discussed the topic of Nutrition. Over the next several post, I’d like to discuss a mindful, self compassionate approach to nutrition and making better choices.

In the practice of Yoga, one very simple and power practice we use is observation. Sometimes during a Yoga session, students are asked to observe the breath entering the nostrils. A very nice way to start a Yoga class is simple observation of the body, or a Body Scan. This is done by mentally scanning over the body and how every part of the body feels. When this is done, we seek to observe, but not to judge (for example, call “good”, “bad”, “short”, “tall”, etc.).

After practicing Yoga for nearly 20 years, I remain fascinated that the practice of simple observation (without judgement) can be soothing and relaxing.

The practice of Mindfulness is becoming very popular. Mindfulness can start to sound fancy and complicated, but its simply making observation without judgement.

This week, I invite you, as I will myself to make non-judgmental observation of your diet. Throughout this week, maybe make a mental note, or even a real note of what you are eating or will be eating. Over the next week, don’t judge the food at all. Try not to consider any consequences of what you eat. Maybe even 30 seconds before eating, simply observe the meal.

Thank you so much for stopping by. I always have so much gratitude for you taking time to spend with me here on this blog.

Dealing with the Root of Insomnia

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Insomnia is one of my favorite topics because it is multifaceted. When you experience insomnia, its simply “I can’t sleep”, then the awareness of the affects this will have over the next several hours.

Please see the above illustration of the Chakra system. This pictures shows the location of each one of these energy centers. The Root Chakra, or Muladhara, is located very low in the pelvis, somewhere near the rectum and anus. The Root Chakra is associated with a deep red color. The emotional energy of the Muldhara is usually associated with survival, being on a tribe/family and feeling safe.

In this post, I would like to explore issues that may arise from the Root Chakra, and how this can lead to disrupted sleep.

Diseases at the Root

My list by all means is not exhaustive. Disease that may arise from disrupted energy flow in the root. I include:

  • Restless Leg Syndrome
  • Anemia
  • Lower back pain from lumbar disc degeneration
  • Vitamin B12 Deficiency
  • Peripheral Neuropathy

This list will seem eclectic. My understanding of the Chakra center, blood is affected most by the Root Chakra. Interestingly, some of the common causes of insomnia come from blood disorders.

Anemia, B12 Deficiency, and peripheral neuropathy can all come from blood disorders. Anemia most commonly comes from iron deficiency. B12 deficiency is can cause anemia, but may exist without anemia. Peripheral neuropathy (sometimes called Nerve Pain) may arise as a symptom of anemia, B12 deficiency, or other nutritional deficiency.

The end result of these disorders is overactive nerve endings that tend to hurt, ache and burn at night. Many patients describe sensations such as “marching ants” or “lightening shocks”.

It is easier to relate structural disease like Low Back Pain to the Root Chakra. Low back pain frequently is cause be disruptions in the lumbar disc of vertebra that put pressure on a peripheral nerve.

Mind/Body Connection

Long before I studied Yoga, I patients often presented with “1st Chakra Insomnia”. They typically were experiencing big life changes (marriage, divorce, job change, a move). They may also be experiencing financial stress. These stresses would occur around the same time insomnia would occur. The complaint may present as follows:

“I’m so exhausted at night. As soon as I lay down, I drift off to sleep, then bam, a terrible, lightening pain shoots through my legs and wakes me up”

Assessment and Treatment

For “1st Chakra” insomnia, although the main complaint is I can’t sleep, the ultimate reason must be determined. This requires an extensive workup to determine if an anemia exist, and why. Neurological assessment may be required as well.

What’s Next?

I am working on some very exciting things. Please keep checking back.

As always, much gratitude for your time. Please feel free to leave comments or replies.

Intermittent Fasting for Breast Cancer Recurrence Prevention

I’m very excited to start discussing real topics that come up during my practice. Please check back under the Q and A section frequently for more real world topics.

A patient asked me about a topic I was completely unaware. She asked if anyone who has had a personal history of breast cancer should start doing a 16 hour fast.

Until researching this topic, I actually had not heard of fasting in dealing with cancer.

I discovered that there could be some benefits from Intermittent Fasting in terms of Breast Cancer Survivor-ship. There is a potential benefit from fasting while being treated for breast cancer.

Before delving too deeply into this topic, I have a few of my own caveats. I typically don’t recommend intermittent fasting in patients who don’t have a PRISTINE diet. If I have patients that are following a nutritionally sound diet, that are not diabetic, and not being treated with medications that lower their blood sugar, I think Intermittent Fasting can be beneficial.

Patients that are Diabetic likely can’t perform intermittent fasting. Several diabetic medications cause the body to release insulin in an uncontrolled manner. If you aren’t eating and take these medications, blood sugars may drop unexpectedly.

If you don’t regularly consume a healthy quantity of fruits and vegetables daily, fasting means you will become further deprived in necessary nutrients.

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I was able to find the article, Prolonged Nightly Fasting and Breast Cancer Prognosis. This link will take you the article which can be accessed by the public. Breast cancer survivors were asked to keep track of their diets for up to 4 years. The researchers collected data on how long these women fasted overnight. The researchers discovered that women that fasted less than 13 hours per night had an increased risk of breast cancer recurrence.

“…prolonging the length of the nightly fasting interval could be a simple and feasible strategy to reduce breast cancer risk recurrence”

Marinac CR, Nelson SH, Breen CI, et al. Prolonged Nightly Fasting and Breast Cancer Prognosis. JAMA Oncol. 2016;2(8):1049–1055. doi:10.1001/jamaoncol.2016.0164

This study excluded diabetic patients. Prolonged overnight fasting (ie, not eating late at night) was not associated with weight loss, but there was a drop in inflammatory markers in the blood.

I stumbled across a related article concerning short-term fasting while being treated with chemotherapy. The researchers here examined the role of short-term fasting while receiving chemotherapy. The theory here is that cancer has a higher metabolism than normal tissues, and will take up more of the chemotherapy than regular cells. Human cells tend to go into a quiet state during fasting. The researchers found that short term fast while receiving chemotherapy in certain cancer types (HER2-Negative) had less markers of DNA damage during chemotherapy treatment.

Summary and Recommendations

  • If you are a breast cancer survivor, consultation with a nutritionist can play an important role in your future care
  • If you are a breast cancer survivor, you may want to consider avoiding late night eating.
  • If you are a Breast Cancer Survivor with Diabetes, discuss with your doctor dietary changes that may prevent recurrence.
  • If you are undergoing treatment for Breast Cancer now, discuss with your Oncologist, General Surgeon, and Nutritionist if you should consider short term fasting. Keep in mind, you nutritional status affects healing, and your doctors may not wish for you to to this.

References:

Marinac CR, Nelson SH, Breen CI, et al. Prolonged Nightly Fasting and Breast Cancer Prognosis. JAMA Oncol. 2016;2(8):1049–1055. doi:10.1001/jamaoncol.2016.0164

de Groot, S., Vreeswijk, M. P., Welters, M. J., Gravesteijn, G., Boei, J. J., Jochems, A., … Kroep, J. R. (2015). The effects of short-term fasting on tolerance to (neo) adjuvant chemotherapy in HER2-negative breast cancer patients: a randomized pilot study. BMC Cancer, 15(1). https://doi.org/10.1186/s12885-015-1663-5

DIY Home Yoga Studio

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I first practiced Yoga in my apartment while in Medical School. While studying at a Starbucks within a Barnes and Nobles, I picked up a book about Yoga and bought it.

18 years later, Yoga is now part of my vocabulary and has been one of the most important self care tools I use.

I frequently advise patients on doing poses at home, or even starting Yoga at home. You can start with no equipment at all. Just the floor can work, but having a few simple pieces of equipment can set you up for a fulfilling, healing self care regimen at home.

I encourage beginning Yoga Students to consider starting at a studio with a well trained instructor. This may not be available for many reasons (time constraints, money, location), so equipping yourself at home is a great alternative.

Additionally, your Yoga practice is an individual experience. It is a journey of self discovery, with the ultimate goal of bringing you back to yourself. There are luxuries of being in a Yoga Studio, but being able to access your practice on a regular basis is the most important.

Yoga Supplies for a Home Practice

If you don’t own any of these, and your planning to start practicing at home, the initial investment will pay off for years to come. The above picture are examples from my home practice.

Yoga Blocks

Yoga block have multiple uses during a practice. The term I’ve heard frequently during a class is the blocks can be used to “bring the floor closer” to you hands. They are best used during a pose such as Forward Bending, but help with lunges. There are several types of blocks available, but I recommend foam that are softer and more versatile. You can use Yoga blocks at work for a foot support, or an impromptu lumbar support.

Yoga Blankets

Yoga Blankets have nearly limitless uses in your home practice. They can be a mat alone (although they don’t provide the sticky surface your after). folding 1-2 Yoga Blankets make a great cushion for seated postures. The blankets can be placed under the knees for cushion. They are excellent after for outdoor activities, especially as beach blankets or cover ups in the cold.

Yoga Mats

This is where it gets fun when your shopping. Other than you cute tights, you can go wild with you mat. Some recommendations I have, if your home space is carpeted, you may enjoy a thinner mat. Consider a thicker mat on hard floors. Try to get a sticky mat for extra support. I like colors and patterns. The mat has a special place in your practice. You’ll likely take it with you to classes if you choose to attend one. You’ll find the more you practice Yoga that every time you unroll your mat, a deep sense of calm and centering will enter you. Buy a mat in a color you may have dreamed of decorating your home with.

Yoga Bolster

The Yoga Bolster is optional. 4 Yoga blankets equal one bolster, so consider starting with blankets if you don’t want to spend the money. I purchased round bolsters, but I think the rectangular shapes would be nice. The Yoga Bolster Make a great seat for meditation, knee support during Savasana (or Corpse Pose). The bolster can be used for support in various Yoga poses as well. If you are limited on storage room, consider using Yoga Blankets which can double for other uses.

Blue Tooth Speaker or Headphones

An overlooked aid in a home yoga practice is your sound system. I usually use a Bluetooth speaker since I don’t like to have anything in my ears during my practice. Likely, you’ll either have music, or a class your taking on your phone or tablet. Of course, if your using your television, you won’t need this.

Optional Equipment

I also recommend Yoga Straps, which can assist with any forward bend or leg extension. These aren’t recommended, but they really aid in your home practice.

Most of all, if you’ve committed to starting Yoga, have fun shopping! I had so much fun searching for my equipment. I now have my own little oasis at home.

Thanks again for stopping by!

Essential Oils-Eucalyptus

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Happy Saturday All!!

I have been creating my own essential oil blends for awhile. One of the road blocks to buying essential oils is what to buy and why.

One of my favorites is Eucalyptus Essential Oil. It’s a great investment, very versatile, and blends well with many oils. Here’s a new favorite of mine:

  • Eucalyptus oil (high quality oil)
  • Lemon Essential Oil
  • Carrier oil (preferably a light oil such as grapeseed oil)
  • 10 ml Roller bottle

I add 4 drops of Eucalyptus oil, 1 drop of lemon oil with the remainder being the carrier oil. This makes a nice chest rub to use at night.

Things combination makes a great spray as well. I like to used distilled water with the same amount of essential oil.

Eucalyptus is a favorite first aid for colds. I am probably partial to this now as I’m fighting a bit of a cold. I like to put a few drops on tissue and inhale throughout the day to fight congestion.

Eucalyptus is an excellent starter oil if your thinking of trying Essential Oils on your own.

Breast Size and Physical Activity

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The above recording is mostly an a brief educational opportunity for physicians and nurses, but it brings up an important topic. Breast size is a real barrier for many women who want to engage in a physical activity, in particulary a team sport, but feel support is so low in typical bras that they are embarrased to move around.

The Bra Queendom falls under the realm of fashion. This is nice for ladies as far as colors, or wanting a certain contour such as more cleavage or minimizing.

I’ve noticed an increase in women asking for consideration for plastic surgery to reduce their breast size. When I examine them, I usually see the problem is a poorly fitted bra.

Signs of a poorly fitting bra include:

  • Pain in the neck an upper back
  • Bra Straps that cut into the shoulders leaving creases
  • Rashes underneath the breast
  • Inability to run (or jump) in a bra meant for being active due to breast pain
  • Needing frequent adjustment throughout the day

Ideally, its best to be fit by a seamstress or professional who is experienced in bra fittings.

It is possible to fit yourself. Here is a nice video that can walk you through the process:

Once you have corrected your size, consider haivng different bras depending on activities. I personally wear a T-back or Razor back for high impact activities. In a sports bra, you want wide straps that distribute the weight of your breast better.

Thanks for reading!

Essential Oils and Pregnancy

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Disclaimer:  I am board certified Internal Medicine.  Please follow the recommendations of your obstetrician if you are considering using essential oils or aromatherapy during your pregnancy.

I was recently asked what essential oils to use during pregnancy.  I thought I could answer the question easily, since I’ve used essential oils for a few years now, and I’ve often recommended essential oils without much thought.  I recently read Bottle of Lies, a chilling reminder not to take drug safety for granted. I decided that before I would answer her, I should check some references.  There is always a concern about safety of a chosen drug or treatment. Even more so, pregnancy is a unique time. Fetal development can be affected by many factors, and there many historical reminders of assuming at treatment is safe during pregnancy when it really isn’t.  

I was surprised to find that most of my trusted references concerning aromatherapy, essential oils and use in pregnancy are sparse, with very little information.  I decided to search the database Pubmed for answers. .

I approach this subject with caution because throughout the history of medicine, treatments deemed to be safe initially are later to be found unsafe.  There are many blogs and post that will give a list of essential oils to use during pregnancy, but I caution readers not start any therapy while pregnant without speaking to your physician. Essential oils are natural, but like any treatment, they are highly active within the human body.  

Pregnancy is typically a time of many symptoms.  Women are often seeking relief from nausea, vomiting, fatigue, insomnia, and postpartum depression.   I did a general search term of essential oils/aromatherapy and pregnancy. I initially reviewed 39 medical journal articles seeking some guidance.  I was able to narrow my search to a few relevant articles, any my search list can be found here

   

Nausea and Vomiting Relief

This is the most common symptom pregnant women must cope with.  Pregnancy related nausea and vomiting is unfortunately not very well understood.  Prior to actually researching the topic, I assumed, like many people, that peppermint, ginger, and lavender are the best essential oil to relieve nausea. 

When peppermint oil was tested in a small study consisting of 56 pregnant women suffering from nausea and vomiting in the first and second trimester, it was found to have the same effect as placebo for relieving nausea and vomiting(1).

1.Joulaeerad N, Ozgoli G, Hajimehdipoor H, Ghasemi E, Salehimoghaddam F. Effect of Aromatherapy with Peppermint Oil on the Severity of Nausea and Vomiting in Pregnancy: A Single-blind, Randomized, Placebo-controlled trial. J Reprod Infertil. 2018 Jan-Mar;19(1):32-38. PubMed PMID: 29850445; PubMed Central PMCID: PMC5960050.

I found another study here also showing that peppermint is not likely to reduce pregnancy related nausea and vomiting. A systematic  review of the effects of complementary medicine conducted by researchers also confirmed that peppermint was not effective at relieving nausea (2).

 

2. Ozgoli G, Saei Ghare Naz M. Effects of Complementary Medicine on Nausea and Vomiting in Pregnancy: A Systematic Review. Int J Prev Med. 2018;9:75. doi: 10.4103/ijpvm.IJPVM_430_16. eCollection 2018. Review. PubMed PMID: 30319738; PubMed Central PMCID: PMC6177529.

Lemon essential oil was found to be effective in relieving nausea and vomiting related to pregnancy in two of the articles I found (2, 3).

My recommendations with the information I have available is that Lemon Essential Oil is a good idea to relieve nausea.  I would recommend to use the aromatherapy by inhalation only, breathing the oil in on a tissue or cotton ball a few times a day to relieve pregnancy related nausea. 

Aromatherapy for Easing Labor Pain

Treating labor pain is likely going to be of the utmost concern. Many women these days are opting to forgo traditional anesthesia techniques and use holistic care to assist during labor. Women choosing to forgo regional anesthesia such as epidural injections may opt to use aromatherapy during the labor process.

A study consisting of 104 young women in labor with uncomplicated pregnancies showed that overall pain levels throughout early labor were reduced in those  that received aromatherapy. (4).

Tanvisut R, Traisrisilp K, Tongsong T. Efficacy of aromatherapy for reducing pain during labor: a randomized controlled trial. Arch Gynecol Obstet. 2018 May;297(5):1145-1150. doi: 10.1007/s00404-018-4700-1. Epub 2018 Feb 3. PubMed PMID: 29397442.

Women in labor in an Iranian hospital showed reduced pain an anxiety during labor when they received Rose aromatherapy (5).  

Hamdamian S, Nazarpour S, Simbar M, Hajian S, Mojab F, Talebi A. Effects of aromatherapy with Rosa damascena on nulliparous women’s pain and anxiety of labor during first stage of labor. J Integr Med. 2018 Mar;16(2):120-125. doi: 10.1016/j.joim.2018.02.005. Epub 2018 Feb 9. PubMed PMID: 29526235.

Aromatherapy for Postpartum Depression

A small, double blinded study of pregnant women, many who were at risk of postpartum depression tested the efficacy of using Rose and Lavender essential oils to reduce the incidence of postpartum depression.  This particular study I found interesting because the subjects were chosen that had risk of depression, which made gathering a large sample size difficult. Most studies tend to select subjects with no history to simplify gathering date.  The researchers tested a combination of rose and lavender essential oil again sesame seed oil and sweet musk oil, and no oil at all. According to the results of the present study, it seems using aromatherapy has a significant effect on reducing depression after delivery (6).

6. Kianpour M, Moshirenia F, Kheirabadi G, Asghari G, Dehghani A, Dehghani-Tafti A. The Effects of Inhalation Aromatherapy with Rose and Lavender at Week 38 and Postpartum Period on Postpartum Depression in High-risk Women Referred to Selected Health Centers of Yazd, Iran in 2015. Iran J Nurs Midwifery Res. 2018 Sep-Oct;23(5):395-401. doi: 10.4103/ijnmr.IJNMR_116_16. PubMed PMID: 30186346; PubMed Central PMCID: PMC6111664

My Recommendations

  • Nausea Relief:
    • Consider trying Lemon Essential Oil used by inhalation.  I would not recommend it topically since it may cause photosensitivity (sun sensitivity).  I recommend inhaling Lemon essential oils using a diffuser of choice or applying a drop to a cotton ball.
    • Peppermint essential oil is not shown by my evidenced based search to be effective at relieving nausea or vomiting in pregnancy, however, if you find using it helps, consider using only inhaled forms.
  • Mood Improvement:
    • Consider using Rose Essential Oil or Lavender Essential Oil for improving your mood.  Lavender essential oil tends tobe reasonably priced. Rose essential oils is expensive, and I would recommend investing in the purchase form a company with a good track records such as Doterra.  Doterra makes a ready made Rose Essential Oil.

During my research, I discovered the National Association for Holistic Aromatherapy.  I bookmarked this wonderful online resource.  This organization is primarily for professional aromatherapists but has some wonderful resources.  This link will take you to the websites recommendations on aromatherapy use in pregnancy. 


Please see the citation list below. Please post any additional questions in the comments. Thank you for reading!

Citations

1.Joulaeerad N, Ozgoli G, Hajimehdipoor H, Ghasemi E, Salehimoghaddam F. Effect of Aromatherapy with Peppermint Oil on the Severity of Nausea and Vomiting in Pregnancy: A Single-blind, Randomized, Placebo-controlled trial. J Reprod Infertil. 2018 Jan-Mar;19(1):32-38. PubMed PMID: 29850445; PubMed Central PMCID: PMC5960050.

2. Ozgoli G, Saei Ghare Naz M. Effects of Complementary Medicine on Nausea and Vomiting in Pregnancy: A Systematic Review. Int J Prev Med. 2018;9:75. doi: 10.4103/ijpvm.IJPVM_430_16. eCollection 2018. Review. PubMed PMID: 30319738; PubMed Central PMCID: PMC6177529.

3.  Yavari Kia P, Safajou F, Shahnazi M, Nazemiyeh H. The effect of lemon inhalation aromatherapy on nausea and vomiting of pregnancy: a double-blinded, randomized, controlled clinical trial. Iran Red Crescent Med J. 2014 Mar;16(3):e14360. doi: 10.5812/ircmj.14360. Epub 2014 Mar 5. PubMed PMID: 24829772; PubMed Central PMCID: PMC4005434.

4.  Tanvisut R, Traisrisilp K, Tongsong T. Efficacy of aromatherapy for reducing pain during labor: a randomized controlled trial. Arch Gynecol Obstet. 2018 May;297(5):1145-1150. doi: 10.1007/s00404-018-4700-1. Epub 2018 Feb 3. PubMed PMID: 29397442.

5.  Hamdamian S, Nazarpour S, Simbar M, Hajian S, Mojab F, Talebi A. Effects of aromatherapy with Rosa damascena on nulliparous women’s pain and anxiety of labor during first stage of labor. J Integr Med. 2018 Mar;16(2):120-125. doi: 10.1016/j.joim.2018.02.005. Epub 2018 Feb 9. PubMed PMID: 29526235.


6. Kianpour M, Moshirenia F, Kheirabadi G, Asghari G, Dehghani A, Dehghani-Tafti A. The Effects of Inhalation Aromatherapy with Rose and Lavender at Week 38 and Postpartum Period on Postpartum Depression in High-risk Women Referred to Selected Health Centers of Yazd, Iran in 2015. Iran J Nurs Midwifery Res. 2018 Sep-Oct;23(5):395-401. doi: 10.4103/ijnmr.IJNMR_116_16. PubMed PMID: 30186346; PubMed Central PMCID: PMC6111664

Please welcome Brandi!

I have the honor of introducing a dear friend and colleague who will be posting, Brandi Gibson.

Brandi and I met as students at the same Yoga studio. We have come to know each other very well, and are working toward an exciting collaboration (Stay Tuned!). Brandi specializes in marria and Family counseling, as well as addiction treatment.

Brandi’s first post can be found here. Please keep stopping by to read how Brandi combines her expertise as a Master’s level Counselor, Yoga Instructor as well as Reiki practioner. I’m so looking foward to her insight on these topics. Having personally been a Yoga Student of hers, I am honored for her presence here.