Monthly Archives: September 2013

Bridge, The Perfect Game for the Aging Brain

Bridge, the Game for Aging Brains

Reference: NYT on Kids and Bridge,  A Place for Mom Blog on Bridge

Bridge anyone?  We tell you to use your brain in puzzles and intellectually challenging projects as you age.  We suggest you stay socially invested.  We want you to be active and get out of your home and see people on a regular basis.  And we want you thinking on something that always challenges you to get better.

Well, Bridge it is.  Did you know that the average age of bridge players in America is somewhere in the later 60s? Did you know that there are many people in their 90s who are still playing bridge, and consider their investment in bridge as the best thing they have done for their personal health?  Now, schools are beginning to use bridge as a means by which kids can be challenged to be social and add up all their skills into a common cause.

What does this card game do for you?  Here are a few ideas.  You have to play as a team.  But you have to communicate in code and be subtle and clever in your communication as you bid to take the lead.  Then you have to count every card as it’s being played so that you can remember what needs to be played on the last trick, the trick that allows you to make your contract that you bid for. And because you can’t do all those things all the time, each round only takes 3-5 minutes and you get to laugh a lot at your failings and foibles.  After two hours of laughing, you leave the bridge table with the delicious glow of having done something worthwhile, being with friends.  You forget that you were set three times and went down 200 points.

Is it hard to learn bridge?  That’s what makes it such an ideal game.  It’s very easy to start and the rules can be read from a simple guide sheet.  You can look them up on line.   If it weren’t so easy, I would never have learned it.   What is compelling is the level to which it can become complex, if you play with the same partner and learn to communicate with all sorts of codes and “conventions” in the bidding.   The odds of getting a good enough hand to start bidding and winning are about 50:50, so every other hand, you or your partner have something to say, and then your opponents have the same odds.

And then you have purpose.  You have to get together and play.  You have the chance to go to someone else’s home and discover the sheer pleasure of friends.  You get 10 or 15 little challenges each week, and the rest of the time you can talk about your dog, your garden, your vacation, the grandkids, or the recent symphony.

WWW.  What Will Work For Me?   I’ve played bridge since high school when I remember rushing during recess to play a couple of hands on the library steps.  Now I have some very dear friends who put up with my rather sloppy approach, because we all end of saying, “The purpose was to laugh”.   And that it is.  Now, if you could just figure out for me when I keep getting in trouble every time my opponents have the 6 of spades.  No logical reason, but it’s only weird if it works.

Estrogen Balance, Metabolism and Stress

Estrogen Balance, Metabolism and Stress

Reference:  A4M Advanced Endocrine Module with Eldred Taylor

Just about the most common complaint women tell me when they get to be 55 and post menopausal is, “Why can’t I sleep and why is all this stuff showing up around my middle?  My waist is expanding and I’m gaining weight.  What’s going on?”

The simple answer is never simple and never accurate. But the more nuanced answer might be all about stress.  Mid life adults have lived through a lot, and like 57 Chevys, have accumulate their share of nicks, dents and life traumas. The accumulated effects of those traumas remain in our pysches and play out in our stress response.  Last week we talked about how mindfulness meditation can lower your cortisol level.  Well, the reason to do that is that just about all of us, men and women have elevated cortisol and stress response as we age.  Lowering it is important.  The relationship of cortisol to estrogen metabolism is one of the key reasons to lower it.   Here is the short list why.

Elevated cortisol has a profound effect on the way your body handles estrogen.  It effectively upsets the whole pathway.  First, it decreases sex hormone binding globulin, the protein that binds estrogen which means you increase the estrogen pool. It also makes you insulin resistant to that you have higher insulin, stimulate your “thecal cells” and make more testosterone.  Then, cortisol makes you have “leaky gut”  and increases your “enterohepatic circulation” of estrogen – so the estrogen your liver handled once and excreted gets reabsorbed and back into circulation in your body.  (If you have had gall bladder surgery or have stones, your enterohepatic system is on overdrive and signals you have poor detoxing going one.)  It also causes dysbiosis in your gut which means your gut isn’t working.   You don’t absorb the nutrients you need to detox Phase I and Phase II.  You also have more oxidation.   That increases the pathway that metabolizes estrogen to dangerous estrogens.  AND, because you have increased SHBG and insulin, you have increased aromatase in your fat tissue and that increases estrogen.  Because you are going down the cortisol pathway instead of the mineralocorticoid pathway, you waste magnesium which is a critical co-factor for COMT, the enzyme that excretes estrogen.   Ouch, ouch, ouch and ouch.  Five coordinated means by which cortisol conflicts with estrogen.  You simply aren’t in balance.

Did you get all that?  The problem is the cortisol and stress level, and the coordinated, global, synergistic effect by which virtually every arm of estrogen metabolism and excretion is messed up.  To clear up your estrogen metabolism, you have to start with cleaning up your cortisol. To clean up your cortisol, you have to deal with your stress.  To deal with your stress, you have at address your “story”. What is the stressful event that triggered it all?   Modern medicine says that stress is all in your head and there is no connection between stress and dysfunction?!!!  We are now beginning to understand the link, and be able to measure the nuance.  It’s not black and white, it’s gray added upon gray added upon stress.  You have to see the pattern and start with the simple premise that excessive stress is dangerous.

WWW. What will work for me.   Dealing with stress might be the first thing we have to think about when we want to be well.  Wellness isn’t just medical.  The good news is that with measurement, we can now assure ourselves that we are making progress.  What is so fascinating is watching seemingly remote things, like estrogen metabolism and waist size respond.   How can you reduce your stress?

Taste Receptors in your Gut Are Dysfunctional in Diabetes

Taste Receptors in your Gut Are Dysfunctional in Diabetes

Reference:  Diabetes, Sept 2013

I bet you didn’t know that you had taste receptors in your intestine!  I didn’t.  But it makes sense when you think about how things go awry in diabetes.  And that’s just what this very interesting and seminal research figured out.  To do this study, 27 people had to be endoscoped twice, at low and high blood glucose levels.  Biopsies were taken of their intestinal lining to understand the actions of the taste receptors in response to different glucose levels.

What they found was just what you would intuitively expect.  In adult onset diabetes, there is a problem with the taste receptors.  In the normal subjects, there was a reciprocal relationship with higher glucose and the expression of the taste receptors.  That way, glucose is handled properly.  In the folks with diabetes, that didn’t happen and glucose was absorbed too quickly and went up too high.

As the authors state: “This defect may enhance glucose absorption in type 2 patients and exacerbate postprandial hyperglycemia”.

In Type two diabetes, that disorder that most of us get when we put on weight in a gradual and gradated fashion, we have now found a disorder of how that glucose is absorbed.  Too fast and too high.  When you get rapid absorption, you stimulate your pancreas to put out a burst of insulin.  Insulin is your storage hormone and tucks that glucose way as fat.  But insulin also keeps your fat cells locked shut and tight.   The net effect is that we store those calories we wanted to use as fuel, so we feel fatigued and tired because that glucose isn’t available for energy use.  It’s locked up in fat cells (after transitioning through our blood as LDLs that are inflamed and glycated setting off the beginning of coronary artery disease.)  So our blood sugar goes swooping up, our insulin follows, our blood sugar comes crashing down, and we feel awful, and start doing “brownie seeking behavior”.  At 10 am we are all off to the donut shop to get some quick carbs.  And our fat cells get a bit bigger and our pancreas has to put out a bit more insulin.  Our pancreas only has a certain life-time supply of insulin it can put out, so eventually it gets burned out.  The fatter we get, the faster we burn it out.

That all sounds like a treadmill we ought to get off of.  The solution here is looking us right in the face.  Sugar is a problem.  When you eat it, your tongue registers it as sweet, as does your intestine.  And both send messages to your pancreas to make insulin.  But too high, too fast, and then we end up with too low, too often.  And the net effect is that we get a bit fatter, and reproduce the whole cycle all over again.

WWW. What will work for me.  Dr. Lustig, on YouTube has a brilliant lecture on the evils of sugar.  He points to the sacred cow of American breakfast, orange juice, as the archtype source of sugar to avoid.  Watch him. Then stop eating sugar if you want to lose weight, have energy to live with, and want to avoid diabetes, heart disease, Alzheimer’s and cancer.   Goodness. That’s a heavy load to lay on your sweet receptors in your gut. But that’s what this research supports.

Mindfulness Meditation Reduces Cortisol

Mindfulness Meditation Reduces Cortisol

Reference:  J Med Assoc Thai

Cortisol is a curious hormone.  We make a burst of it first thing in the morning.  Its job is to make your feel alert and awake, full of “vim and vigor”.  Your blood level zooms from 2-4 up to 16-20 between 4 am and 7 am when you are fully awake.  You can get things done in the morning, because cortisol helps your mobilize energy.  You are creative and energetic.  Your brain has more cortisol receptors than anywhere else, to help you feel that alert and awake.  That role of cortisol is its bright side, the good side, what you want if for.

Cortisol also has a dark side.  You experience too much stress and cortisol correlates with that stress.  We call cortisol our “stress” hormone and there is abundant evidence that it also seems to be part of wearing you down and burning you out.    As we age, we accumulate life stresses and many of us have the inability to mobilize cortisol in the same fashion we once did.  When you have destructive, persistent stress, from any of hundreds of reasons, we find our cortisol to be too low and the experience is that of being fatigued and being unable to function optimally.  In the functional medicine world, we measure that and call it adrenal fatigue.   Of all the hormones, cortisol rises as we age.  All the other hormones fall.  The net effect is that our sum “catabolic hormones” (cortisol and all its breakdown products) rise with persistent stress and aging.  Stress is clearly one of the causes of many of our illnesses and is considered one of the “four horsemen” of cardiovascular disease.  With too much stress, your brain can’t learn, remember, adapt.  As we get older, our stress accumulates and our bodies burn out and wear down.

Hence, it’s useful to know how to manage your stress.  That’s what this study is about.   Thirty second year medical students (age 20 or so) were given brief four day instruction on “mindfulness meditation”.  Their cortisol levels were measured before and after.  Their cortisol levels dropped from 381 to 306 nmol/L.  That’s a 20% drop.  That’s huge.  With just four days of practice and training.  That means this idea is available to all of us.  And that’s huge.

What is mindfulness meditation? How do you do Mindfulness Meditation.?  My pardon to those who have strong feelings about their technique, but there may be more in the habit, the pattern, the consistency of daily practice.  It’s not taking a nap.  It’s really training your brain to be aware, but be relaxed and at peace with itself.  A curious thought it is that our brain needs to be tamed, calmed, cared for, but that’s the point.  Effortless, repetitive, calming, non-shaming or emotionally blaming, the goal is to use breathing, gentle thinking, and training to generate inner peace.

WWW.  What will work for me.  I learned Transcendental Meditation in medical school and practiced it for about 10 years with some rigor.  I use the same technique still, though I use other tools.   I believe it’s foundational to my own creativity and source of ideas.  It’s my belief that each and every one of us yearns for that peace and calmness.  If you don’t feel confident in how to do it, find a coach who will teach you.  Practice prayer if you have a strong religious tradition.  I know some excellent mindfulness coaches if you want a referral.  But reducing stress may be just about your most important health and wellness building behavior.  And it’s not so hard.  And in your days, you can lower your cortisol 20%.   Wow!