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Friday, April 12, 2019

Sleep apnea may raise your risk

In the 1890s, a Shakespearean actor named Frederick Matthias Alexander set out to discover why he often lost his voice when he performed. (Imagine yourself as a Shakespearean actor, completely dependent on your voice to pay your bills, finding yourself without a voice just when you needed to perform!) Needless to say, Alexander had to figure out why this was happening.

He began by observing himself in multiple mirrors while he prepared to perform. Indeed, he did discover that something changed prior to his speaking: He was contracting the muscles in his upper body, especially his neck, so strongly that his entire posture changed. He theorized that his voice loss could be a result of his disrupted posture.

Fortunately, his guess turned out to be correct. When he was able to release the tension in his muscles with a variety of movements, not only did his voice loss resolve, but he was able to change the habit he had developed of contracting his neck. As he continued to refine and improve his methods, Alexander realized they could help others improve their health and well-being. His discoveries, which have since been codified into the Alexander Technique (AT), are still in use today.
How is the Alexander Technique used today?

Today, AT is considered a mental discipline that teaches individuals how to let go of tension in the body and how to enable the body to move with ease and minimal effort. AT is used to treat a variety of conditions, from musculoskeletal pain and repetitive strain injuries to breathing problems, voice loss, and sleep disorders. Many artists, musicians, dancers, singers, and actors use AT to help enhance their performance. The purpose of AT, ultimately, is to enable individuals to methodically unlearn maladaptive (negative) habits — which can show up in the way we stand, sit, eat, walk, or talk — and instead learn how to return the body to a relaxed, balanced state of alignment and poise.
Is AT for you?

But you don’t have to be a musician or dancer to benefit from AT. Here’s just one example: You, like most of us living in today’s world, spend much of your time on a computer or checking your smartphone for emails and texts. This means you spend much of your time looking down, rather than straight ahead, the way your vertebrae were designed to support your head. Keeping your head bent down for long periods puts continual strain on the large neck muscles, which are meant to normally be lax. In contrast, the small neck muscles (which are meant to hold up your neck vertebrae) are not being used and are therefore lax. The result is that your vertebrae lose their support, so that you end up not only with neck stiffness or pain, but possibly some degeneration in your cervical spine, too.

AT can address this habitual contraction of the neck and teach you how hold your phone, how to position your head, and ultimately, how to re-establish better posture and ease in your body.
Is there science to support AT?

A recent randomized controlled study published in the Annals of Internal Medicine found that Alexander Technique lessons led to significant reductions in neck pain over 12 months, compared with usual care. (Interestingly, the study also found that acupuncture reduced pain as well, compared with usual care.)

Another interesting study published in the medical journal BMJ in 2008 tested a variety of treatments for back pain. A total of 579 patients with chronic or recurrent low back pain were randomly divided into four groups. The first group were given “normal care” (that is, they were the control group). The second group received massages. The third took six Alexander Technique lessons. The fourth group took 24 Alexander Technique lessons. Half of each group also received a prescription for exercise (primarily walking) from a doctor, plus behavioral counseling from a nurse. The results showed that the patients who had AT lessons along with an exercise plan improved the most. In addition, this combined intervention was also the most cost-effective (in particular, taking six lessons combined with an exercise plan).
What does this mean for you?

Proponents of the Alexander Technique would tell you to start paying attention. Pay attention to your posture — the way you walk, talk, sit, stand, or generally do anything, even lifting a forkful of food to your mouth. If you are like most people, your body is likely stuck in tense muscle patterns that may be causing you myriad problems, from back pain to headaches to possibly even anxiety. It may behoove you to unlearn these stuck patterns so you can move through your life with more ease — and much, much less pain. Leftover Halloween candy. Marathon Thanksgiving meals. Up-for-grabs office chocolates. One holiday party followed by another…and another.

Whether you want to avoid overeating and gaining those extra pounds, you need to control your blood sugar (for example, if you have diabetes), or you simply wish to consume only what your body requires, the holiday season can make that goal challenging.

But mindful eating might help you reach it.

Mindfulness refers to the practice of being aware and in the moment. All too often, our thoughts wander somewhere other than where we are in the moment. Perhaps we are preoccupied with what happened an hour ago, worried about what might happen tomorrow, or stressed over what we need to do next week. Mindfulness encourages us to notice these preoccupations, and then to gently bring ourselves back to the now.

Mindfulness can help you fully enjoy a meal and the experience of eating — with moderation and restraint. Some studies suggest that mindfulness-based practices help improve eating habits. For those who binge-eat or eat for comfort or out of stress, mindful eating may even aid with weight loss.

Here are 10 tips for more mindful eating. Not all of these tips may feel right for you — try a few and see how they work.
1.  Reflect.

Before you begin eating, take a moment to reflect upon how you feel. Are you rushed? Stressed? Sad? Bored? Hungry? What are your wants, and what are your needs? Differentiate between the two. After you have taken this moment to reflect, then you can choose if you want to eat, what you want to eat, and how you want to eat.
2. Sit down.

Don’t eat on the go. Have a seat. You’re less likely to appreciate your food when you are multi-tasking. It’s also difficult to keep track of how much you are eating when you snack on the go.
3. Turn off the TV (and everything else with a screen).

Have you ever glanced down from your phone or tablet or computer, only to wonder where all the food went? These distractions make us less aware of what and how much we are eating.
4. Serve out your portions.

Resist eating straight from the bag or the box. Not only is it easier to overeat when you can’t see how much you’ve had, but it is also harder to fully appreciate your food when it is hidden from view.
5. Pick the smaller plate.

You might crave less if you see less. Smaller plates will help you with your portion control — an especially good strategy for those all-you-can-eat buffets.
6. Give gratitude.

Before you start to eat, pause and take a moment to acknowledge the labor that went into providing your meal — be it thanks to the farmers, the factory workers, the animals, mother Earth, the chefs, or even your companions at the table.
7. Chew 30 times.

Try to get 30 chews out of each bite. (30 is a rough guide, as it might be difficult to get even 10 chews out of a mouthful of oatmeal!) Take time to enjoy the flavors and textures in your mouth before you swallow. This may also help prevent overeating by giving your gut time to send messages to the brain to say you’re full.
8. Put down your utensil.

Often, we are already preparing the next morsel with our fork and knife while we are still on our previous bite. Try putting down your utensils after each bite, and don’t pick them back up until you have enjoyed and swallowed what you already have in your mouth.
9. Resign from the Clean Plate Club.

Many of us were brought up to finish everything on our plate and were not allowed to leave the table until we did. It’s okay to cancel your membership to the Clean Plate Club. Consider packing the leftovers to go, or just leaving the last few bites. Even though nobody likes to waste food, overstuffing yourself won’t help those in need. (This is also where Tip #5 comes in handy.)
10. Silence.

Try eating your meals in silence once in a while. When it’s quiet, it is natural for the mind to wander; acknowledge these thoughts, and then see if you can gently return to your experience of eating. Be conscious of the food’s consistency, flavor, tastes, and smells, and fully appreciate the moment. Of course, mealtime can be an important time for sharing the day when the whole household gathers, so having an entire meal in silence might be impractical or just feel awkward. But even spending the first five to 10 minutes in silence can be refreshing and set a grateful tone for the rest of the meal.

Mindfulness offers many benefits throughout the year, but can be especially helpful during the holidays, even beyond healthful eating. Purposefully focusing your attention on the present can help you embrace companionship, connectivity, and overall contentment and help make the season more meaningful for you. If you have arthritis, you may have noticed that the weather affects your symptoms. I hear it from my patients all the time.

If it’s true that the weather can worsen arthritis pain, how does that work? Is there any scientific evidence to explain it? People have been asking these questions for many years without finding good answers. But that’s not keeping researchers from trying to understand it better.
What we (think we) know

Past studies examining the effect of rain, humidity, and other weather-related factors on symptoms of arthritis have been inconclusive, and in some cases, contradictory. Some suggest that the key variable is rising barometric pressure. Other studies found just the opposite — that falling pressure could provoke joint pain or stiffness. There have even been attempts to artificially vary environmental conditions to mimic weather changes, such as placing arthritis sufferers in barometric chambers and varying the pressure up and down.

Despite this, we still don’t know whether it is one particular feature of the weather or a combination of features that matters. There are many potential factors — humidity, temperature, precipitation, and barometric pressure among them. Even if we could precisely identify what about weather affects arthritis pain and stiffness, we’re still not sure why — biologically speaking — weather should have any impact on joint symptoms.

Having reviewed the studies, I find myself not knowing how to answer my patients who ask me why their symptoms reliably worsen when the weather is damp or rain is coming, or when some other weather event happens. I usually tell them that, first, I believe there is a connection between weather and joint symptoms, and second, researchers have been unable to figure out just what matters most about the weather and arthritis symptoms or why there should be a connection.
The newest studies

In just the past year or so, two new studies have weighed in on the question of whether weather has an impact on arthritis symptoms. And both found that yes, indeed, weather matters!

In the first study, Dutch researchers enrolled 222 people with osteoarthritis of the hip — the most common, “wear-and-tear” type of arthritis — and compared their reported symptoms with a variety of weather variables. They found that over a two-year period, pain and stiffness were slightly worse with rising barometric pressure and humidity, although the overall average impact was small. The second study included more than 800 adults living in one of six European countries and who had osteoarthritis of the hip, knee, or hands. Although changes in weather did not seem to affect symptoms, higher humidity was linked with increasing pain and stiffness, especially in colder weather. So, while these studies varied in the specifics, we now have a bit more evidence linking weather to joint symptoms.
So what?

It’s a fair question. After all, even if we could prove a clear and powerful impact of weather on symptoms of arthritis, how is that helpful to know? It’s not as if doctors are likely to suggest that a patient move to a more arthritis-friendly climate. It’s even less likely that patients would follow such a recommendation. Until we can control the weather or our internal environments with precision, these new studies probably have little impact for the individual arthritis sufferer.

However, identifying a link between a particular type of weather and joint symptoms might help us understand the causes and mechanisms of arthritis symptoms. And that might lead to better treatments or even preventive strategies. In addition, figuring out why some people seem to feel worse in certain circumstances while others notice no change (or even feel better) in those same environments could help us understand subtle differences between types of arthritis or the ways individuals respond to them.
“Everyone keeps talking about the weather…

…but no one is doing anything about it.” That’s an old line but, of course, there’s truth to it. But even if weather does affect the symptoms of arthritis and there’s nothing that can be done about the weather, that doesn’t mean there’s nothing to be done about the arthritis! There are more treatment options than ever before, with and without the use of medications. If you have significant and persistent joint pain, stiffness, or swelling, see your doctor — rain or shine. If you’ve never heard of the Nordic diet, you might imagine a plate of those Swedish meatballs sold at Ikea. But in fact, this eating style focuses on healthier fare, including plenty of plant-based foods that nutritionists always encourage us to eat. And while the data are limited so far, several studies suggest following a Nordic eating pattern may foster weight loss and lower blood pressure.

As the name suggests, the Nordic diet features foods that are locally sourced or traditionally eaten in Denmark, Finland, Iceland, Norway, and Sweden. Developed in collaboration with the acclaimed Copenhagen gourmet restaurant NOMA, the diet emphasizes the use of seasonal, healthy, regional foods. (It doesn’t necessarily represent how most Scandinavians eat on a daily basis, however.)
What the diet delivers

Nordic diet staples include whole-grain cereals such as rye, barley, and oats; berries and other fruits; vegetables (especially cabbage and root vegetables like potatoes and carrots); fatty fish such as salmon, mackerel, and herring; and legumes (beans and peas).

“The Nordic diet is a healthy dietary pattern that shares many elements with the Mediterranean diet,” says Dr. Frank Hu, professor of nutrition at the Harvard T.H. Chan School of Public Health. The Mediterranean diet — widely considered the best eating pattern for preventing heart disease — also emphasizes plant-based foods. Both diets include moderate amounts of fish, eggs, and small amounts of dairy, but limit processed foods, sweets, and red meat.

While the Mediterranean diet includes olive oil, the Nordic diet favors rapeseed oil (also known as canola oil). Like olive oil, canola oil is high in healthy monounsatured fat. But it also contains some alpha-linolenic acid, a plant-based omega-3 fatty acid similar to the omega-3 fatty acids found in fish. Of course, fatty fish — the richest dietary source of omega-3s — play a role in both Nordic and Mediterranean diets (try for two to three servings a week).

The Nordic diet also emphasizes high-quality carbohydrates: cereals, crackers, and breads made with whole-grain barley, oats, and rye. Americans may be familiar with Swedish Wasa crispbreads, most of which are made with whole grains. In Denmark, a dense, dark sourdough bread called Rugbrød is popular. These whole-grain foods provide a wealth of heart-protecting nutrients, including fiber, vitamins, minerals, and antioxidants.

Eating lots of berries is another unique aspect of the Nordic diet that may account for some of its health benefits. Research by Harvard scientists has linked eating plentiful amounts of berries (such as blueberries and strawberries) to less weight gain and a lower risk of having a heart attack. Berries are excellent sources of plant chemicals known as anthocyanins, which seem to lower blood pressure and make blood vessels more flexible.
Bonus: It’s easy on the environment, too

The Nordic diet offers an added bonus: it’s environmentally friendly. For one thing, plant-based diets use fewer natural resources (such as water and fossil fuels) and create less pollution than meat-heavy diets. In addition, eating locally-produced foods also reduces energy consumption and food waste, says Dr. Hu. And while the Nordic diet makes sense for those living in Northern Europe, people everywhere can apply those same principles to their diet no matter where they live.

While the Nordic diet isn’t proven to prevent heart disease to the same extent as the Mediterranean diet, it’s clearly a step above the average American diet, which has too much processed food and meat to be considered good for the heart. “People who really like berries, rye bread, and canola oil should go ahead and enjoy a Nordic-style diet rather than waiting 10 years to get more evidence,” says Dr. Hu. Stress-related health problems are responsible for up to 80% of visits to the doctor and account for the third highest health care expenditures, behind only heart disease and cancer. But as few as 3% of doctors actually talk to patients about how to reduce stress.

Mind-body practices like yoga and meditation have been shown to reduce your body’s stress response by strengthening your relaxation response and lowering stress hormones like cortisol. Yoga has been shown to have many health benefits, including improving heart health and helping relieve depression and anxiety.

But the cost-effectiveness of these therapies has been less well demonstrated — until now.
The study

Dr. James E. Stahl and his team of Harvard researchers studied a mind-body relaxation program offered through the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital. The 8-week program taught participants several different mind-body approaches, including meditation, yoga, mindfulness, cognitive behavioral skills, and positive psychology. The study volunteers participated in weekly sessions and practiced at home as well.

The researchers found that people in the relaxation program used 43% fewer medical services than they did the previous year, saving on average $2,360 per person in emergency room visits alone. This means that such yoga and meditation programs could translate into health care savings of anywhere from $640 to as much as $25,500 per patient each year.

“There are many ways to get to the well state — many gates to wellness, but not every gate is open to every person. One of the strengths of the program is that it draws upon many different tools that reinforce each other and allow many gates to be opened to a wide array of people,” says principal investigator Dr. Stahl, who is now section chief of general internal medicine at Dartmouth-Hitchcock Medical Center.
Yoga and meditation are soaring in popularity — but will insurance pay?

Yoga and meditation programs are gaining wide appeal. Nearly one in 10 Americans practices yoga, and 45% of adults who don’t practice yoga say they are interested in trying it. Americans are also using other forms of complementary health therapies, such as meditation (8%) and deep breathing (11%).

Many health care plans do not cover yoga or meditation, although some provide discounts for fitness programs including yoga or tai chi. States like Washington require private health insurers to cover licensed complementary health care providers, but the majority of states do not. However, that may soon change.

A recent article in the Harvard Business Review recommends that health insurers cover wellness and prevention-oriented therapies that are both low-cost and evidence-based, as both yoga and meditation are. The article discusses a study of Aetna employees who participated in the company’s mindfulness program and enjoyed a 28% reduction in stress, 20% better sleep, and 19% less pain, as well as an increase in worker productivity worth an estimated $3,000 per employee per year. The company offers free yoga and meditation programs to its employees.

“There are a lot of great studies on the biologic side, just not enough on the economics,” notes Dr. Stahl, who is looking to change that with his ongoing research. As the evidence for the health benefits and cost-effectiveness of yoga and meditation programs continues to grow, we can expect to see more interest from health care insurers

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