Saturday, April 23, 2011

The Disease of Helplessness

Spring has finally graced us with some warmth. So after finishing a light 1/2 day of work, I jumped on my bike to take full advantage. Cycling out east at warp speed provided the illusion of considerably respectable fitness: surprising after a winter of creating a significant indentation on my favourite couch. Heading back west offered me the true reality of my current state: recovering sloth. In Ontario, we may not have mountains like the ones that abused me in France, but we do have wind .. and lots of it! Regardless of the challenge today, the experience left me with a feeling of gratification that I only really get from cycling.

On a kind of related note, I read a study the other day out of the University of Pennsylvania. Rats were grafted with the exact quantity of cancer cells known to induce a fatal tumour in 50 percent of them (it is related .. you'll see). The rats were divided into three groups: the control group were grafted and were left to live their lives as normal in the laboratory cage. The second grafted group received small, random electrical shocks which they had no control over receiving. The third grafted group also received random electrical shocks but were provided with a button that they could press to avoid getting extra shocks. One month after the graft, of the rats in the control group, 54% had rejected their tumour. The second group, the rats which received random shocks and had no control over them, demonstrated despondence: they lost their appetite for food and sex and did not respond to intrusions into their cage. 27% of these rats rejected the tumour. In the third group, the rats that received the shocks but had control over avoiding extra shocks, did not become despondent: they became agitated when their cage was intruded, they ate well, copulated as frequently as rats do in a normal environment and, most interestingly, 63% of these rats successfully rejected their tumours! Recall that this is a higher percentage than the rats who were left alone. The study suggests that the feeling of helplessness associated with receiving shocks and having no control was capable of hastening the tumour's spread.

The theories of a "cancer" personality have changed over the years. Initially, the type "C" personality was popular: the person who has never felt welcome in their childhood, the "really nice" people who avoid conflict and sacrifice themselves for others, the "saints" of our society. This theory has been rejected though, due to lack of scientific evidence supporting it.

Whatever the personality type, what does ring true from a science perspective is that there is an indisputable association between cancer and a feeling of helplessness. David Spiegel MD coupled with Yale psychotherapist Irvin Yalom MD and conducted a study involving women with metastatic breast cancer (this is the kind that has already spread beyond the breast tissue. It is much more serious). The expectant survival rate of the participants was between a few months to a few years. Groups of 8-10 women met weekly to develop relationships that facilitate attaining "powerful authenticity"through openness to others. In comparing the psychological states of the women in the meetings to those that had recieved the same diagnosis and were not participating, Spiegel noticed that the women who had participated in the group meetings experienced less depression, anxiety and physical pain. In addition, ten years after the diagnosis of their disease, when Spiegel evaluated the lifespan of the women participating in the group sessions compared to the ones who had not, three out of the original women from the group sessions were still alive (which is amazing in and of itself) verses none of the women from the group that had not participated. In addition, he discovered that the women who participated in the groups sessions lived an average of twice as long as the ones who had not participated. Spiegel concluded that the authentic relationships, the support, the empowerment that was achieved by those participating in the group sessions contributed to their better prognosis.

In addition, an alternative scientific study has demonstrated that women with breast cancer who were better able to face the disease psychologically had more active NK cells (immune cells that fight cancer) than those who sank into depression and helplessness.

I could go on and on citing studies but I think you all get the point. By bringing this to light I am, in no way, suggesting that cancer happens solely on the basis of psychology alone. Cancer is a complex disease with many contributing factors. I am suggesting however, that our state of mind plays a significant role in immune function and does influence our ability to fight cancer.

When it comes to helplessness, having strategies in place that allow you to access your power allows an avenue for cultivating a more positive mental outlook and, potentially, a healthier immune system. My strategy is cycling - I like to think that Lance Armstrong and I are alike in this (although I don't look quite as good naked and I'm not in the usual habit of comparing myself to Lance Armstrong in any realm of cycling)! In reading his book however, cycling as his coping strategy is clearly illustrated. He writes, "so long as I was on the bike, I knew that I was still alive". Riding gave Lance Armstrong the strength that he needed to persevere through cancer and treatment. In the depths of disease, finding hope, finding power, finding your ability to step out of helplessness can mean the difference between resilience and despondence. So, on days like today, when I'm fighting wind, riding about 2km/hr and wondering how I possibly rode the French Alps a few months ago when I can hardly get across Whitevale road, I take comfort in the fact that I may be weak but at least I'm not helpless.

Monday, April 11, 2011

The Skinny on Skinny ...

As a kid, I was skinny: a genetic predisposition that occasionally led to name calling: parachute pants were in style at the time resulting in the unfortunate and politically incorrect "gail" reference of "Ethiopian in a bag"! My parents tried to fatten me up by changing "FRI"days to "FRY"days and force-fed me french fries at least once weekly!

As a teen, skinny began to mean something entirely different. With fashion magazines reinforcing skinny as beautiful, maintaining my skeletal genetics became of utmost importance! Walking four kilometres a day, to school and back, coupled with two aerobics classes on less than a few cookies and an apple became my norm. When I think back on my years from ages 14-18, I cannot fully comprehend how exactly I survived.

Anorexia (long-term calorie restriction to the point of starvation) is an interesting pathological disorder: from a mental-emotional perspective, anorexia gives the sufferer a sense of control when everything else in their lives seems completely out of control - it is a coping mechanism of sorts. From a patho-physiological perspective, the body attempts to maintain homeostasis in the event of starvation which results in an inability to determine hunger (due to a slower metabolic rate) and an inability to determine when the appetite has been satiated (an inability to determine fullness). This mechanism is implemented as a protective measure: if the anorexic begins to eat, the body does not initiate the feeling of fullness because it doesn't really want the person to stop eating! Chemically, low levels of BDNF (brain-derived neurotrophic factor) is found in anorexics. This neurotransmitter plays a key role in learning and memory: it's really no surprise that I was failing high school organic chemistry and couldn't add to save my life!

Anorexia and body dysmorphia are not conditions that an individual recovers from with ease: many physiological mechanisms are still in place long after an individual has achieved a healthier lifestyle. For instance, even now, I have a difficult time determining hunger and fullness - these mechanisms have never re-regulated themselves completely.

In athletics, anorexia and body dysmorphia are glaringly present. In a 2002 study of 425 female, university level athletes, 43% said they were terrified of being or becoming too heavy, 55% reported pressure to maintain a certain weight. I can appreciate this! Even years after my difficult eating challenges, while training to compete nationally (age 27, height 5ft 6.5", 106lbs), I was told by a coach that I would run faster if I lost a "good 5lbs". I never went back to that coach: better to run and not feel like collapsing and dying!

Anorexia is a complicated condition with a multitude of influencing factors. Recovery is a bit of a winding road with quite a few setbacks. Sometimes it is difficult to let go of behaviour patterns that don't serve us simply because they become our comfort zone. My disordered eating was an unhealthy behaviour pattern that I used to cope. Letting go of that pattern meant letting the illusion of control and the outside appearance of having it all together. This still feels vulnerable and chaotic sometimes, but at least now I have the chaos AND some curves!

**For additional information and statistics, please go to NEDIC: the National Eating Disorder Information Centre**

Friday, April 8, 2011

An Exciting Week in the World of Gail Sauer

There have been many times in my life when I have felt completely overwhelmed: like a ball of string with about a thousand loose ends, of which, none are true beginnings. This week, however, was a rare week in which those thousands of loose ends seemed to come together to form a beautiful and scripted pattern: a pattern of possibility and potential, a pattern of budding flowers timidly playing with their new found splendor, a pattern of birth and growth. Let me explain ...

Early in the week, I decided to take a trip to Dundas, Ontario to "shadow" one of the true pioneers in our naturopathic field. As a rule, it is unusual for an individual who is already practicing to indulge in a "preceptorship": we are all forced to do this as students to satisfy a certain number of required hours. As practicing doctors, we usually have too much ego and too little time to indulge in learning from the masters. I, however, after the IV weekend, decided that I need to continue being inspired by the roots of my profession: the true healers that have found the art in practice. So off I went to a 14 hour day of some of the most stimulating moments of learning in my career so far. I cannot say enough about how moved I was by the passion I witnessed, coupled with efficiency and true patient care. As humbling as it was, it was equally inspiring.

Midweek came and I checked the mail .. some of you know that, a few weeks back, I wrote a really "important" exam ("important" may not be entirely accurate, when we have nuclear reactor leaks on the other side of the world)! Needless to say, it was important in my little microcosm. Suspending my anxiety attack, I opened the envelope containing the results and to my shock and surprise, I passed every element of the exam (and it really was a shock: during the practical component of the exam, my examiners mistook me for a deer caught in headlights .. it was bad)!

Next my website, that has sat dormant for almost a year, was finally launched. My brother kindly bought me this domain for my birthday last year. Knowing nothing about website design, my dear and generous friend, Audrey, came to my rescue. It amazes me that I have such precious and generous friends in my life that are so willing to share their talents and lend a hand. I am so lucky and so blessed! Check out the site, if you get a chance. It's a work in progress, but it looks wonderful so far:

And now, Friday, the end of the week , my brother's birthday: I picked up the card brochures for the Women's Cycling Tour of the Alps (this is on my website). The tour is scheduled for Aug 20th-27th and is designed to give women who are intimidated by mountain cycling, a safe space in which to achieve their riding goals .. in a supportive and encouraging environment. It's exciting to think about the opportunity we all have to help each other to achieve our potential.

So, there you are: a week that makes me feel that maybe things have started to fall into place, a week that feels like the vision is slowly coming into fruition, a week that's inspiring and fun and that has made me feel so fortunate for the freedom that I have to create.

I will leave you with this .. in the Native Indian tradition, spring is said to be a time of creation; a time where ideas are put into action and a time where there is an abundance of energy to facilitate the growth of ideas. In the summer the ideas that are meant to move forward will flourish and in the fall (harvest time), we harvest the ideas that have produced fruit and discard the one's that have not served us. We are coming into spring: embrace your ideas and cultivate the forward energy of growth. It is time ....

Friday, April 1, 2011

Off Coffee, Trying to Avoid Homocide!

I have been drinking coffee since I was 8 years old. Call it child abuse or call the influence of my European roots, either way the beautiful caramel-roasted flavour and aroma has become a full blown addiction for me. It's an addiction that I have come to peace with really and have accepted as one of my few vices when it comes to healthy eating. Regardless of my peace, however, every year around this time I kick the habit in honour of a 4-6 week cleanse.

It always seems like a good idea .. a good idea that I almost get excited about. Then, around day 3, reality hits, cravings are through the roof, the coffee headache is at its most intense and I am ready to kill someone!

Now, coffee is an interesting little substance. 81% of Canadians drink coffee, 63% of Canadians over the age of 18 drink coffee on a daily basis, versus Americans where only 49% of people in the US drink coffee on a daily basis. The highest provincial consumption is in Quebec at 70% (oh, the French)!

So what's the deal with coffee then? Is it good or bad? Like anything, moderate consumption (2-3 cups of brewed coffee per day) is not going to put you at risk for any really awful pathology and may assist in optimizing short term memory. Dr. Koppelstatter MD, PhD (Medical University Innsbruck, Austria, 2005) conducted a study using fMRI scans after subjects consumed 100mg of caffeine through coffee (2 cups). When asked to perform exercises that required short term memory skills, subjects on coffee performed better and had noticeably improved short term memory.

Another study conducted in France by Karen Richie PhD (French Institute for Health and Medical Research, Montpellier, 2007), found that women over the age of 65 who consumed moderate amounts of coffee (3 cups of coffee/day) had less decline over time on tests of memory than women who drank one cup of coffee or less.

I find it especially interesting that many studies in support of coffee consumption are actually based out of Europe!

On the less beneficial side, coffee can increase your blood pressure, increase your heart rate, can cause sleep disturbance, can aggravate gastric acid reflux conditions (GERD) and can predispose susceptible individuals to migraine headaches. Caffeine also causes a cortisol surge, however, with regular consumption (or in my case, addiction), the surge is lessened (please see this study). Increased cortisol, due to stress as well as coffee consumption, is part of the reason for the increased blood pressure and increased pulse rate associated with a cup of java (anyone that does not drink coffee regularly and has a shot of expresso can tell you about this)! Cortisol in excess has been also associated with increased abdominal fat retention. This, of course, leads to increased pressure on the heart and visceral organs .. that isn't too good and in the long term, can be a contributing factor to heart disease. However, since the cortisol surge is lessened with regular consumption, if you are going to consume coffee, you might as well do it daily! :)

So here I am, writing this blog, drinking some matcha green tea (and trying to be happy about it) and wondering why I have a headache that resembles someone taking an axe to my cranium! A little digging revealed that caffeine/coffee increases cerebral blood flow velocity (that is, the rate at which blood travels through the brain). Yet another study found that people experiencing caffeine withdrawal had a decreased cerebral blood flow velocity .. which, we can extrapolate, less O2 (oxygen) getting to the brain. No wonder I'm having difficulty putting sentences together!

So what can I do about it - and what can all the people out there on a spring cleanse do about their caffeine withdrawal symptoms? First, find a replacement: green tea and matcha green tea are good options: they are high in antioxidants and have just enough caffeine to curb the headache a little. Second, incorporate activities that will increase the cerebral blood flow velocity. These means move! Exercise will increase blood flow - just don't jump around too much as this will likely aggravate your headache!! Third, be patient!! The withdrawal doesn't usually last more than a few days. Forth, if you are absolutely dying, have 1/4 cup of black tea or coffee just to take the edge of your discomfort and last, but definitely not least, warn everyone around you that they are at risk in your presence and really, really try not to kill anyone!