A N.Y. Times article cited a 2020 study out of Stanford where 36 subjects with various fitness levels exercised on a treadmill for 9-10 min and using the latest techniques showed almost 10,000 molecular changes during and after exercise.
With these new techniques, called “omics”, the researchers have isolated various molecules in our bloodstream that alter our biology. Metabolomics looks at molecules like appetite hormones and enzymes produced by the microbes in the gut; genomics looks at changes in gene expression; immunomics looks at the changes in the immune system; and, proteomics and lipidomics look at changes in proteins and fats. The list goes on. The author of the study quotes there is an “ orchestrated choreography of biologic processes” demonstrated to occur.
Why is this research important?
Recently we find that we are spending more time at home. We find ourselves sitting in front of the computer more than ever. Sitting too much weakens our immune system, increases the risk of diabetes, heart disease, depression and decreases bone density. We need to learn to be more creative about how we move our bodies.
We are all concerned about how robust our immune system is against potential illnesses.
One of the best immune boosters is exercise and this recent study out of Stanford, published in the journal Cell, showed even less than 10 min of exercise produces changes in thousands of molecules which affect inflammation, DNA and tissue repair, insulin resistance, oxidative stress, metabolism, immunity, and appetite.
With less access to gyms, we need to be creative about making sure we incorporate exercise into our daily routine.
Hiking, biking, running, and many online classes including yoga are available. In addition, a total body workout is ideal to keep all of our muscles strong and stimulate bone density.
If time is short, one way is to do a 7-8 min workout using body weight and minimal props. Combining this with yoga improves bone density, strengthens our immune system, and stimulates proteins that reverse aging. So get out of your chair and move!
And there’s more to keep in mind…
Post-menopausal women have an increased risk of osteoporosis. Exercise is a key factor to improve bone density. Make sure you get a DEXA scan and review options for treating osteopenia and osteoporosis.
Evaluating gut health not only can boost your immune system but also can improve brain health. We have several tests to look at digestive health and a dietitian to help you navigate food choices.
Balancing your hormones (i.e. thyroid and sex hormones) can improve your metabolism. We have advanced testing to look at these hormones including cortisol to evaluate adrenal function.
NAD infusions can reduce DOMS (delayed onset muscle soreness), improve cognition and fatigue, reduce pain, and improve sleep.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
Yoga is a wonderful tool to alleviate stress, which in turn can improve both your mental and physical health. Taking just a few minutes each day to gently move and stretch your body can make a big difference. Here are some gentle yoga poses to try at home, demonstrated by Laura Dorsett, MTS, RYT500.
Seated Pigeon Pose
This gentle stretch opens up the hips, glutes, and lower back.
Eagle Arms Posture
Eagle Arms helps to release tension in the head, neck and shoulders.
Runners Lunge/Yogic Lunge
Yogic Lunge opens up the hips and releases the lower back.
Seated Spinal Twist
Seated Spinal Twist gently loosens strained muscles in the back to revitalize the spine and posture.
During stressful times I find the need for grounding, and through Yoga, I find its strength, stability, and ease to be most helpful.
Yoga (translated from Sanskrit as “to yoke”) is a moving meditation, utilizing breathing techniques called Pranayama, which we know will stimulate our parasympathetic nervous system, the opposite of fight and flight.
Here I am demonstrating 2 simple Sun Salutations, A & B, that take all your major joints through a range of motion, and warm up the musculature, with emphasis on the inhalation and the exhalation. These poses are the gateway to other standing poses.
Life’s demands before COVID-19, like keeping up with work, relationships, health, and finances, were already enough to negatively impact sleep for millions. Today, we are learning to deal with new stresses including how to live in isolation, along with the constant worry and uncertainty of the future. Despite our best efforts to remain focused on the mundane and simple pleasures of life – if for nothing else but to keep our sanity – our thoughts are diverted by fears. Getting to sleep and staying asleep seems impossible.
But preventing and recovering from the COVID-19 virus requires our immune system to be as strong as possible. Sleep is a crucial factor that cannot be overlooked.
If you are having trouble sleeping, here are some actionable steps that may help you wind down and get a good night’s rest.
1. Stick with a routine.
Although our lives turned upside down in just a matter of days, keeping a routine, particularly a nighttime routine, is important to regulate your body’s internal clock. Aim for a bedtime that will allow 7-9 hours of sleep each night.
2. Turn it off.
We all want to stay informed about the COVID-19 pandemic, but a continuous barrage of negative news can have a profound effect on sleep, mental health, and immune system. Avoid watching the news before turning in for the night.
3. Avoid caffeinated beverages after 3 pm.
4. Get regular physical exercise.
Regular exercise will help tire you out and reduce stress levels. If you can safely exercise outside while keeping within today’s social distancing guidelines set by the CDC, try to do so every day. If that’s not possible, look to the web for home workout appropriate to your fitness level.
We hope the tips above will make a difference in your sleep routine. We are all going through the hardest of times, but remember, you are not alone. Most importantly, please call your healthcare provider right away if you feel overwhelmed and are in need of help.
Dr. Lisa Lilienfield guides us through a wonderful breathing exercise called Three-Part Breath (Dirga Pranayama).
The “three parts” are the abdomen, diaphragm, and chest.
Do this anytime to ease feelings of fear, tension, and stress in the body.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
Stress is an inevitable part of life and will always be there, but the overwhelming amount of bad news is causing anxiety levels to skyrocket. How we respond to it is a key factor in maintaining good health.
In this article, I plan to explore healthy ways to live with stress, by focusing on breathing techniques called Pranayama that can help to change our negative response to stress.
What is Allostatic Load?
We have physiological responses to stress that are important for survival. It is only when these responses become chronic that we suffer what is termed allostatic load, leading to an increase in diseases such as heart disease, cancer, stroke, and diabetes. Consider the following process:
When crises or urgent situations occur, the amygdala, a structure in the brain with an influential role in fear and aggression at the sense of danger, fires to alert the brain to do something;
The sympathetic nervous system (SNS) is activated; breathing picks up, the heart beats faster, blood rushes away from organs like the digestive tract into the muscles, and we “fight or take flight;”
If the sense of danger persists then structures in the middle part of the brain (called the Limbic System) such as the hypothalamus & pituitary stimulate the adrenals to pour out cortisol and adrenaline (HPA Axis).
If this system is fired up repeatedly, over time this allostatic load will take a toll on the body.
Today’s stressors are far different than those of the past, even the very recent past. We are living in confusion about what we can and cannot do, the fear of losing our jobs, our health, and the health of a loved one – this on top of the more subtle stressors of everyday life. The result is a heightened and prolonged state of anxiety that needs to be addressed in some way other than constant worry and sleeplessness. We need to explore ways to mitigate the effects of the amygdala and HPA axis, which is involved in the neurobiology of mood disorders and functional illnesses.
The autonomic nervous system (ANS) consists of the sympathetic nervous system (sometimes referred to as the “fight or flight system”) and the parasympathetic nervous system (PNS), which returns us to a relaxed resting state. The PNS is under the control of the vagus nerve. Nerve fibers from the central nervous system go to the organs in the abdomen, thorax, throat area, and to the heart; and fibers from the organs go back into the central nervous system to convey what is going on internally. Nerve fibers send branches into the limbic system of the brain that stimulate or inhibit the stress response. All these structures control internal perceptions, threats, and affective states.
The most advanced part of the vagus nerve is the myelinated vagus, found only in mammals. The myelinated vagus enhances the calming PNS, which slows the heart rate, lowers blood pressure, and repairs, restores, and promotes feelings of safety. The variability of the heart rate is a reflection of PNS activity and can be measured as an indication that the vagus nerve is firing, leading to a calming, resting, restorative state.
Breathing & Respiration
Breathing involves the movement of air in and out of the lungs, and respiration involves a gas exchange between the lungs and the blood. As the diaphragm and the chest muscles contract on inspiration, the diaphragm moves down, the ribs expand and oxygen moves into the lungs. On expiration, the diaphragm and chest muscles relax and carbon dioxide moves out of the body, into the atmosphere.
For the most part, control of the breath is automatic and involuntary. The respiratory center in the brain stem is responsible for breath rate control, and there are receptors in the aorta that detect changes in the blood to regulate the respiratory rate. For example, with exercise, carbon dioxide levels go up, and the receptors in the aorta stimulate the respiratory center to increase the respiratory rate, decrease carbon dioxide and increase oxygenation. However, if breathing is shallow and fast, as is common in the stress response, hyperventilation occurs, which lowers carbon dioxide too much, leading to dizziness, unease, and anxiety.
There are aspects of breathing that we control in a voluntary and conscious manner via the cortex of the brain. Speaking, singing, and playing wind instruments are good examples. Also, stress and emotional stimuli may induce accommodation of breathing as mentioned previously.
Pranayama
Pranayama (yogic breathing) involves the voluntary control of the breath, and is practiced widely in yoga and meditation, but is something that anyone can do. Slow Pranayama appears to shift the autonomic nervous system from the fight or flight sympathetic to the calming parasympathetic state and has been shown to positively affect immune function, hypertension, asthma, and stress-induced psychological disorders. Examples of Pranayama include:
Ujayi breath – Used during yoga poses, inhaling and exhaling through the nose while creating a slight constriction in the throat;
3 part breath (Dirga) – Inhaling and expanding the belly, then the lower rib cage, then upper rib cage;
Alternate Nostril Breathing (Nadi Shodhana) – Exhaling then inhaling starting with the left side then exhaling and inhaling on the right;
Bellows Breath (Bhastrika) – Quick thrusts of the belly in on exhalation, which really works the diaphragm. The emphasis on the diaphragmatic breath is important because most people over-utilize chest muscles and don’t get adequate breath, thereby creating shallow breath and inadequate oxygenation.
Medical benefits of Pranayama
There are several studies that show the medical benefits of Pranayama. One study showed improvement in pulmonary function tests in patients with asthma and emphysema after practicing yoga and Pranayama for 45 min a day over the course of two months. Several studies have supported Bhastrika Pranayama in enhancing “parasympathetic tone.” Another study showed the benefits of Alternate Nostril Breathing in increasing parasympathetic tone by measuring heart rate variability and expiration-inhalation ratios. A pilot study with chemotherapy patients showed improvement in mood and sleep after Pranayama, and numerous other studies support the benefits of Pranayama in depression and anxiety.
In sum, Pranayama is accessible to all and can be used with meditation, or on its own, to stimulate the parasympathetic nervous system. This is something we all could use more of, leading us toward greater health and a sense of well-being.
References
C. Collins, “Yoga: Intuition, preventive medicine, and treatment,” Journal of Obstetric, Gynecologic, and Neonatal Nursing (1998): 27 (5) 563-568.
A. Dhruva, C. Miaskowski, D. Abrams, M. Acree, B. Cooper, S. Goodman, and F.M. Hecht, “Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial.” Journal of Alternative & Complementary Medicine (May 2012); 18(5):473-9. doi: 10.1089/acm.2011.0555. Epub 2012 Apr 23.
J. Gallego, E. Nsegbe, and E. Durand, “Learning in respiratory control,” Behavior Modification (2001): 25 (4) 495-512.T. Pramanik, H. Sharma, S. Mishra, A. Mishra, R. Prajapati, and S. Singh, “Immediate Effect of slow pace bastrika pranayama on blood pressure and heart rate.” Journal of Alternative & Complementary Medicine (March 2009).
A. Guz, “Brain, breathing and breathlessness,” Respiration Physiology (1997): 109, 197-204.P. Sangupta “Health Impacts Of Yoga & Pranayama; a State of the Art Review,” International Journal of Preventative Medicine (July 2012) Vol. 3 Issue 7, p444.
R. Jerath, J.W. Edry, V.A. Barnes, and V. Jerath, “Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system,” Medical Hypothesis (2006): 67, 566-571.
G.K. Pal, S. Velkumary, and Madanmohan, “Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers,” Indian Journal of Medical Research (2004): 120, 115-121.
T. Ritz and W.T. Roth, “Behavioral intervention in asthma,” Behavior Modification (2003): 27 (5), 710-730.
R. Soni, K. Munish, K. Singh, and S. Singh, “Study of the effect of yoga training on diffusion capacity in chronic obstructive pulmonary disease patients: A controlled trial,”International Journal of Yoga (July 2012): 5(2):123-7. doi: 10.4103/0973-6131.98230.
R. Sovik, “The science of breathing – The yogic view,” Progress in Brain Research (2000): 122 (Chapter 34), 491-505.
J. Willmore and D. Costill, Physiology of Sport and Exercise, 3rd ed. (Champaign: Human Kinetics, 2004)
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
Experts are predicting that many of us in our communities will contract the COVID-19 virus at some point in the next year. So what can you do to prevent getting sick? What do you do if you get sick? Here is some specific guidance:
Prevention:
Please click this link for a complete list of ideas, supplements and herbs for preventing colds and flu. Remember, we’re still in the middle of the flu season!
Here are some other things you can do to be prepared:
Make sure you have a working thermometer
Have a 30-day supply of all prescription medications
If you have a history of asthma, make sure you have an unexpired inhaler
Have Tylenol available to reduce fevers. Don’t use NSAIDS like Advil which have been linked to worsening symptoms
Nyquil, Dayquil, Mucinex are all helpful over the counter medications for symptom relief
Have a saline nasal spray like Ocean Spray to rinse out your nose
Consider a consultation with our acupuncturist/ Chinese herbalist Rebecca Berkson, L.Ac. to be prepared with herbal medicine for COVID-19
If you do get sick:
Remember, this is cold and flu season so every cough, sniffle, and sneeze is not COVID-19. We want to appropriately use emergency rooms so we do not overwhelm our medical system. In addition, we do not want you to be exposed to people with COVID-19.
The vast majority of people who will get sick with COVID-19 will have mild to moderate symptoms and will need to stay at home to recover. We are not sure how long after having the disease you are still contagious. The estimates from experts are between 10-37 days.
Over the years, our office has used a number of strategies to boost the immune system. The following are things that have been used for other viral infections and may be helpful for COVID-19.
These are strategies that might help to boost the immune system:
Wash your hands for at least 20 seconds, go to https://washyourlyrics.com/ to create a washing guide with your favorite song lyrics.
Stay hydrated, drink at least ½ of body weight (in ounces), for example, if you weigh 130 lbs, your daily water intake should be about 65 oz.
Get plenty of sleep (7-9 hours), put your electronic devices to sleep at least one hour before you go to bed
Take a multivitamin that contains zinc, selenium, and vitamin C.
Limit processed sugar consumption, as it weakens the immune system. Choose fresh fruits over desserts and ice cream.
Exercise, take a walk outside. Maximize your vitamin D exposure and absorption in the morning hours and take a vitamin D supplement if you’re deficient.
Cook with plenty of garlic, onion, fresh or dried herbs (especially oregano, thyme, and rosemary), and coconut oil, as well as foods rich in antioxidants.
Talk to your doctor, herbalist or nutritionist about supplements.
COVID-19 is a novel illness and we do not have any data showing evidence of protection or treatment with any supplement. There have been studies showing effectiveness on other coronaviruses, such as SARS. Some of these are listed below. Please make an appointment with your doctor, nutritionist, or acupuncturist/herbalist to personalize for your needs.
If you are having difficulty finding these supplements in stores, food as medicine is the best way to get them in their most natural and absorbable form.
We are working hard to stay updated on the most current information in order to provide you with the best care. The Kaplan Center family is here for you as we go through these challenging times together. Please contact our office if you have any questions (703)532-4892.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
“Provider Spotlight” is a series that highlights the wonderful team of healthcare providers and specialists here at the Kaplan Center for Integrative Medicine.
After experiencing the competitiveness of the ballet world for much of my life, Yoga gave me a way to experience my body in a room without mirrors. I was able to begin a new relationship with my body that was based on what my body felt like, rather than what it looked like to others in a performance environment. Little did I know that it was really a way of connecting more deeply to my inner life.
Around that time, I was also grieving the loss of my father, with whom I was very close, and who transitioned from this life when I was 23. I had no understanding of how to relate to grief and I lived in denial for several years, experiencing anxiety attacks, pain in my body at the same location as his tumor, and general emotional paralysis. It was Yoga that broke open the dam; in reconnecting to my body in a loving and conscious way, I was able to experience the feelings that had been locked up inside me. As I faced these feelings, the most astonishing thing happened: a tremendous peace would come over me right in the midst of the most emotional intensity. It was here that my spiritual life was born. For me, Yoga became the means of a profound spiritual awakening. And yet this awakening of spirit occurred within the context of the physical body, of listening to it, accepting it, and letting its intelligence guide me toward greater awareness and acceptance.
Just as Yoga changed my life, my dharma (Sanskrit for “calling” or “duty”) in this life is to awaken others to its profound possibilities.
What is the biggest challenge in your practice and how do you overcome it?
When self-judgment arises, I usually recognize it relatively quickly – “Ah, here we go… Hello, self-judgement.” I breathe into it, acknowledge it by placing a hand on my heart, and I reassure myself as if I am reassuring a small child. If I am really stuck in it, I sometimes do some gazing with my husband. We simply look in each other’s eyes and focus on our breathing for about a minute. It is an excellent way of bringing myself back home to presence and to feeling unconditionally accepted. I encourage people to try this with their partner, friend, or even – and perhaps more effectively – their pet! Having the unconditional presence of another being with you, especially while experiencing a harsh and unkind inner environment, is extraordinarily healing.
What’s the one piece of advice that you give to all of your patients?
You are exactly where you are supposed to be. Feel Life’s perfection working through you and as you, letting go of your ideas of how things are supposed to be and opening to how they are… a great surprise awaits you when you do this.
What are some of your interests and/or pastimes outside of work?
I love singing kirtan (devotional yoga music and mantras), spending time in nature with my family, curling up with a book, cranking up some music and having spontaneous dance parties around the house… lately we’ve been putting on the song “Afreen” from the “100 Foot Journey” soundtrack (highly recommended stress release!)
If you could choose another career, what would it be?
There is nothing else I would be doing other than what I am doing!
“Provider Spotlight” is a series that highlights the wonderful team of healthcare providers and specialists here at the Kaplan Center for Integrative Medicine.
Dr. Lisa Lilienfield has been with the Kaplan Center for over 16 years. She is board certified in Family Medicine and practices Acupuncture and Osteopathic Manipulative Medicine, with expertise in both Women’s Health and Sports Medicine.
Why did you choose your specialty?
When I was in medical school I really enjoyed all of the different aspects of medicine, including Pediatrics, OB/GYN, Adult Medicine, and Psychiatry. When I learned about family medicine, which incorporates all of these specialties, I knew it was the right choice for me. Family medicine allows me to see all different age groups and practice all of the different types of medicine I really enjoy.
What is the biggest challenge in your practice and how do you overcome it?
In our practice, we see patients with very challenging and difficult cases, many of whom have already been to multiple physicians. For me, the biggest challenge centers around the concern I feel about whether or not I am going to find my patients a solution. I want to help each one of them find the right answer and feel better.
One of the wonderful and unique things about the Kaplan Center is our weekly collaborative meetings, where all of our providers put our heads together to find the appropriate solution for each patient in our practice. Fortunately, we have a team of really smart providers and we are never alone in finding the right path for our patients.
What’s the one piece of advice that you give to all of your patients?
The one piece of advice that I give all my patients is to find balance in their lives. Life isn’t all about work. We have to find balance with play and creativity. We need to take care of ourselves by eating good food, getting enough sleep, exercising, and socializing. It’s easy to fall into a pattern where you are out of balance, so this is the one piece of advice I wish all of my patients would follow.
What are some of your interests and/or pastimes outside of work?
Outside of work I am presently completing advance yoga teacher training. I have really enjoyed learning about the philosophy and history of yoga because there’s a lot more to it than most people think. This training has taken up a good amount of my extra time. I also have a big family – kids, step-kids, and grand-kids – and fortunately we are able to spend a lot of time together.
If you could choose another career, what would it be?
This question really stumps me! I actually decided to go into medicine when I was in the 7th grade. My father was a physician, not a clinical physician, but a professor, so at an early age I decided that it was also the path for me. Quite frankly I can’t imagine doing anything else!
To read Dr. Lilienfield’s complete bio, click here.