Mood disorders are among the most common complaints I see in my anti-aging practice. The most common symptoms are anxiety and depression. However common associated symptoms are fatigue, insomnia, difficulty concentrating and memory problems. One of the challenges I always face in treating a new patient is tackling numerous symptoms in just one hour. Sometimes [...]
“The Anti-Inflammation Diet” The anti-inflammation diet may have an imposing name, but it goes down easy. Mediterranean and traditional Japanese foods lead the pack in inflammation-lowering eating plans. They provide plenty of tasty options for the culinary minded, the casual cook and the restaurant eater, too. Inflammation is a normal immune-system response to infections or [...]
Mood disorders are among the most common complaints I see in my anti-aging practice. The most common symptoms are anxiety and depression. However common associated symptoms are fatigue, insomnia, difficulty concentrating and memory problems.
One of the challenges I always face in treating a new patient is tackling numerous symptoms in just one hour. Sometimes the history alone can take half that time.
For that reason I advise my patients when I first meet them that the first visit will focus largely on hormone balancing. If mood problems are among their chief complaints I advise them that hormone balancing may result in dramatic improvements in their mood symptoms. I let my patients know which hormones are associated with nervousness and anxiety and which ones associated with sadness and depression so they can anticipate what they might experience with the initial course of treatment.
The following is a simple guide for patients to help them understand common associations between hormones and mood.
Nervousness and anxiety:
In women these symptoms are typically associated with low progesterone levels and/or excess estrogen (specifically estradiol). The best marker is the progesterone to estradiol ratio (Pg/E2). Optimal ratios are between 100-500 to one. I target 300:1as my goal.
Men, especially those who are obese, may have elevated estradiol as well because of excess conversion of testosterone to estradiol. This can contribute to anxiety(and further weight gain).
Low testosterone in both men and women can contribute greatly to anxiety. Many patients with low testosterone feel buffeted by stressors in their lives. They tend to be “reactive” rather than “proactive.”. Testosterone deficiency, when corrected, helps them feel more “in control” of their lives and better able to handle what challenges life throws at them.
Thyroid deficiency can cause not only anxiety but also panic attacks, trouble concentrating, decreased memory and slow speech. Thyroid excess can also cause anxiety and a racing heart and insomnia. Hence the reason for tight monitoring of thyroid levels to keep them in the mid to high normal range but not outside the range.
Overactive adrenals caused by chronic stressors generally will not cause anxiety per se, but they can cause irritability, cravings, confusion, fatigue, and insomnia. Adrenal fatigue can cause general emotional imbalances, fatigue, trouble concentrating, and insomnia.
DHEA deficiency can be associated with e inability to handle stress, trouble concentrating and insomnia.
Estrogen excess can be associated with depression. The annoying additional symptoms of weight gain, water retention, mood swings irritability, insomnia, swollen and/or tender breasts and headaches commonly associated with excess estrogen all serve to aggravate depression.
Progesterone deficiency (see earlier discussion of a low P/E2 ratio) can also cause depression as well as irritability.
Testosterone deficiency can also be associated with mild depression in men and women. However it can also do this if it is too high (as what might occur with too vigorous replacement, although this is a far less common cause of depression than too low.
Thyroid deficiency is a common cause of depression. Associated symptoms of constipation, headaches, water retention, memory and concentration problems, insomnia, fatigue, and reduced libido all tend to aggravate these symptoms of depression.
Cortisol deficiency, as what occurs in adrenal fatigue, generally won’t cause depression symptoms specifically but can certainly cause emotional disturbances, aggravated by associated blood sugar swings.
Finally, symptoms of deficiency of DHEA, one of the master adrenal hormones, can include depression, along with trouble concentrating and insomnia.
While deficiency of vitamin D, a hormone not a vitamin, is not typically associated with depression, I have seen patients who reported better mood when their levels were normalized.
So an initial anti-aging plan usually starts with hormonal balancing: first adrenals, then the sex hormones, and finally thyroid. I advise my patients to start with this approach for tackling their mood related symptoms, adjust dosages based on labs and clinical response and see how they do.
Many patients can stop at this point. They feel more on an even keel, able to cope with their daily stressors, and feel more optimistic about their current life and their future than before normalizing their hormones.
Hormones are not a panacea for mood problems. If symptoms persist we next pay attention to optimizing neurotransmitter levels. We have one option of a scientific approach, which can include direct measurement of urinary neurotransmitter levels, testing for cofactors deficiency, identifying markers of toxicity in the GI tract (including dietary stressors, intestinal and liver status), followed by corrective treatments. Or we can choose the other option of empirical (try it and see what happens) intervention with herbals, amino acids, cofactors like NAC to enhance nerve transmission, and other natural therapies to target symptoms by promoting boosting or calming of neurotransmitters based on our clinical experience. This is what is done by psychiatrists. In our specialty we look for corrective natural approaches first, or if the patient is already on psychotropic drugs, seek to eventually replace them if possible and the patient is willing. We never stop psychotropic drugs that are working until we feel the time is right, and then only with gentle tapering and the cooperation of the patients’ doctor(s).
It is critical to have knowledge of one’s hormone status if mood problems are present. This requires salivary or capillary blood testing for the adrenals and sex hormones and venous blood (regular blood draw)for the thyroid. Your fellowship trained ant-aging specialist is equipped to start you on the pathway to correction of hormone imbalances. This could be you solution to mood problems and the response can be rapid If the response is suboptimal then the neurotransmitters themselves can be nudged into normal balance with a creative,individualized plan. This process can be more lengthy, involving dietary changes, detoxification and correction of nutrient deficiencies. It requires close monitoring and good communication between doctor and patient.
The many successes I have had in my career with helping patients feel better with hormones and adjunctive treatements continue to enhance my enthusiasm for this approach to managing anxiety and depression. If these problems plague you I encourage you to seek our a doctor with the proper training and experience to help you feel your best.
“The Anti-Inflammation Diet”
The anti-inflammation diet may have an imposing name, but it goes down easy. Mediterranean and traditional Japanese foods lead the pack in inflammation-lowering eating plans. They provide plenty of tasty options for the culinary minded, the casual cook and the restaurant eater, too.
Inflammation is a normal immune-system response to infections or injuries. When you cut your finger, for example, the immune system kicks in to help heal the wound (causing redness and swelling). But problems arise when your immune system becomes overactive – rushing around inflaming things when there is no threat, causing harm instead of healing.
Chronic inflammation has been associated with conditions such as rheumatoid arthritis and degenerative joint disease. Inflammation is also not good for general circulation, increasing the likelihood of heart attacks and strokes, and can affect affect sexual performance and erectile function.
An anti-inflammation diet has the potential to benefit anyone because the Western diet is out of balance, but the eating plan is thought to be especially beneficial for those with inflammatory diseases, such as arthritis and allergies.
Food should not be thought of as the only saving grace. Other lifestyle issues affect inflammation – for example, smoking and the lack of exercise.
But food choices play an important role because what you eat can trigger or temper inflammatory responses in your body.
Dr. Andrew Weil is among those who believe diet influences inflammation. As he states in his book “Healthy Aging,” an imbalance of fats, elevated blood sugar, refined foods and lack of micronutrients pave the road to inflammation.
In short, eat your fruits and vegetables, avoid processed foods and add fish to your diet regularly, and you could stave off the many problems caused by inflammation. Two fats play pivotal roles in the immune system game: omega-3 and omega-6 essential fatty acids. Omega-6s are pro inflammatory; it is their job to trigger inflammation. Omega-3s are anti-inflammatory.
“Your body needs omega-3 and omega-6 fats. It’s not about demonizing one fat over another; it’s about a proper ratio. We have way too many omega-6s (in the American diet).”
That excess comes from our over-reliance on processed and fast foods that often have plant-based oils (corn, safflower), animal fats and trans fats – all pro inflammatory.
Instead, choose olive oil, butter in moderation or butter substitutes that are mechanically emulsified rather than chemically processed.
Another easy change is switching from corn oil (high in omega-6) to canola oil (high in omega-3). Other foods rich in omega-3 include grass-fed meats, flax seeds, omega-3 enriched eggs and cold-water fish.
No conversation about the anti-inflammatory diet would be complete without mentioning fish. Yes, much has been publicized about the problems with mercury and PCB levels in large fish such as tuna and shark. Smaller fish such as sardines and herring, however, are less vulnerable to those pollutants because the bigger the fish, the higher the potential pollutant level.
Cold-water fish are among the best sources for omega-3 fatty acids. In his book, Weil says he eats wild Alaskan salmon, Alaskan black cod and sardines.
I wish you all an inflammation free 2012!
Here it is again. That time of year when thoughts turn to the changes we want to make for the next year. We may tell ourselves: “this year things are going to be different!”
You know what happens. Some changes are made which are gradually discontinued and we return to our old habits, using stress and lack of time as an excuse, feeling like a bit of a failure. Then we tell ourselves: “no more resolutions…I will just try to do better.”
As an anti-aging physician my focus is on health and wellness. So here are 3 DOABLE lifestyle changes that you can easily add for 2012 to improve your day-to-day quality of life, along with your long term health.
1. Go to bed 15 minutes earlier then you usually do and get out of bed in the morning 15 minutes earlier. After washing up, do a 15 minute stretching routine (see my blog on stretching). Stretching your flexors in the morning will help you feel more upright when standing, lets you take a deeper breath and helps shake off morning stiffness, if that is a problem. It will help your mental attitude and energy. Over time try shifting to an earlier wake-up time and add more stretches or a 20 minute interval training (1 min intense exercise routine (as hard as you can pedal, walk, jog, etc.)followed by 4 minutes of less intense, lower heart rate activity. Repeat this 3 times. If you are not a morning person do the interval training in the late aft’n before dinner. Shoot for stretching daily and aerobic at least 5 days a week. If you are in pretty good shape already, get a trainer for a few sessions to target problem areas or general fitness goals.
2. If you have weight concerns like most people, decide to limit your starches to one meal a day. If you have a sandwich for lunch, then have a starch free breakfast like a egg white omelet with vegetables sautéed in extra virgin coconut oil. If you have oatmeal for breakfast choose a salad with protein for lunch. Try to create dinners containing protein and vegetables and omit the starches.They are not necessary. Discover a new type of fruit (this year for me it was blood oranges) and add it to the list of your fruit options. Eat some fruit 2-3 times a day or more. My favorite is Fuji apples.
3. Work on creating a more spiritually satisfying life. One way is to nurture a relationship by giving a bit more of yourself and asking for a bit less. Making someone you care about happy will make you happier as well. Stress is so much easier to cope with when two people support each other.
These are not Herculean tasks. They are self sustaining, as things that make you feel better are often continued. What they will do is improve your structure, your chemistry and your spirit. These are the 3 key elements needed to achieve a healthy long life.
Happy holidays and may your new year be a healthy one!
Progesterone is a critical ovarian produced steroid hormone that plays specific roles throughout a woman’s life. For women who are premenopausal, progesterone production begins around mid-cycle, rises to a peak @ day 21 of the typical cycle, and then plummets in the absence of pregnancy, triggering a period @ 2-5 days later. Low progesterone during this “luteal” or “moon phase” of one’s cycle is referred to commonly as PMS. During this PMS time of the month low progesterone and normal or high estrogen levels create the typical pattern of “estrogen dominance,” with weight gain, water retention, breast tenderness, mood swings and general crabbiness. For these women, when testing confirms low luteal progesterone, anti-aging physicians prescribe bioidentical progesterone. This includes either (or both) topical progesterone or oral progesterone. With proper dosing and timing adjustments PMS symptoms will usually decrease or disappear altogether.
Most gynecologists and family doctors only think about the uterine protective effects of progesterone, so that when women have hysterectomies they don’t recommend it. That is a very bad decision, as post hysterectomy patients generally gain a lot of weight and experience major mood problems when they are given nothing or unopposed estrogen. What they need, as virtually all postmenopausal women need, is progesterone (and usually estrogen as well in the form of Biest). .
What are the roles of Progesterone in one’s body?
Balances the effects of estrogen
Has a calming effect and enhances mood
Has beneficial cardiovascular effects
Balances blood sugar and thyroid function
Helps rebuild bone 9up to 10% increase in bone density on clinical studies).
Among the many symptoms of low progesterone are::
Mood swings insomnia
Pain and inflammation
I have seen many women gradually reduce and later discontinue (under medical supervision) their anti-anxiety and anti-depressive drugs as well as sleeping pills after they achieved the optimal progesterone levels and proper progesterone to estradiol ratio (the goal is @ 300 to 1 on salivary or blood spot testing). Men with mood problems and those with high estradiol levels can be greatly helped by progesterone if levels are low.
Hormone receptor positive breast cancer is the major contraindication to progesterone. All patients seeking bioidentical hormone replacement therapy need regular cancer screening before and for the duration of treatment. There have been no studies showing an increased risk of cancer with bioidentical progesterone. Ther have been studies (Women’s Health Initiative) showing that the bio-similar (not bio-identical) progestins in Prempro increase risks for many conditions including cancer. That is why progestins should be avoided. True progesterone is healthy and natural for our bodies.
Women who are having periods usually use progesterone from days 14 to 25 of their cycle. Sometimes it is started earlier, like day 10, if mood problems warrant it. Too much progesterone thins out the lining of the uterus and can throw off the normal menstrual cycle and cause spotting at random times. Too much progesterone can also increase appetite and sugar cravings. That is why your doctor needs to be experienced In managing your use of hormones via followup labs and consultations.
Women who have stopped menstruating can use progesterone 5-7 days a week.
Compounded topical and oral progesterone is best obtained from experienced nationally recognized compounding pharmacies. Topical progesterone in a cream or gel is calming and often mood elevating when taken once daily, usually in the morning, applied to the forearms which are rubbed together. Oral sustained release progesterone capsules are taken an hour before bedtime if insomnia is an issue. Some women use both forms in the beginning and often later switch to just oral or cream.
So if you are interested in hormone and potentially slowing the aging process, be sure your doctor evaluates your progesterone levels using salivary of blood spot (capillary blood) samples. These are collected on @ day 21 of your cycle if you are menstruating or any day if you are not. If they are low please see your fellowship trained anti-aging, bioidentical hormone specialist who can prescribe the best progesterone dose, vehicle of delivery and schedule of use to meet your needs. Your clinical response and progesterone levels will then be monitored and the plan adjusted accordingly.
It is well worth the effort to balance estrogen EVEN IF YOU ARE NOT TAKING ESTROGEN. Creating a healthier progesterone to estrogen balance will promote a better shape, a better mood, a better sleep and a better you!
Stephen A. Center, MD
ABAARM Board Certified
Fellowship Trained Anti-Aging Medical Specialist
What is 1,25 hydroxycholecalciferol?
Drum roll please!………………..you may know it as “Vitamin D”
“Vitamin” D is not a vitamin; it is a critical hormone!
It is produced largely by your body in response to direct sunlit to large areas of exposed skin (meaning with no protective sun block). In the middle of the day in the summer, if you are wearing a bathing suit with no sun block (watch out for sunburns and increased skin cancer risk) your body will make 1000 units of vitamin D per minute. Most of us don’t get this total body exposure very often–we walk and run with clothes on(except in Portland, where nude running outdoors is legal!). Also, as we age, our bodies produce less and less intrinsic factor, which is required to produce vitamin D. Therefore even with total body sun exposure older people are still usually vitamin D deficient.
Smaller amounts of vitamin D come from your diet. The Vitamin D3 form (from red meat and fish) is far more active than the vitamin D2 from plants.
Vitamin D receptors are located in the bones, pancreas, intestines, kidneys, brain, spinal cord, reproductive organs, thymus, adrenals, pituitary and thyroid. That is why it is so critical for our health and wellness.
Causes of deficiency of vitamin D include: aging, sunscreen, and medications such as steroids.
Optimal levels are 70-80 ng/ml. Less than 35 is called deficient, and your doctor will probably treat you, that is, assuming your doctor routinely tests your levels. Most don’t don’t even do that! If it is measured (the test is called 25 OH vitamin D), your doctor may not be concerned if you are 50 or above. However recent published studies have shown that 70-80 ng/ml. Is optimal for cancer prevention and bone health, and who doesn’t want that?
The vitamin D3 doses needed to reach optimal range usually range between 5000 and 10,000 units/day. Most people rarely take more than 1-2000 units. This is not adequate to bring levels up to optimal. Too much vitamin D can cause kidney stones, so calcium levels should be monitored periodically during treatment with high doses.
Besides its preventative properties, such as reducing breast cancer risk and risks of macular degeneration(blindness) and osteoporosis, Vitamin D can be used to treat 14 different conditions and diseases.
Anti-aging physicians who are board certified and fellowship trained, as are all doctors in BodyLogicMD, routinely measure, correct and retest vitamin D in their patients. If your doctor is not well versed in this important natural hormone balance you should consider finding a BodyLogicMD doctor in your area at www.bodylogicmd.com
It is quite common for female patients of mine to question me concerning the need for estrogen as part of their bioidentical hormone regimen This is especially true if they don’t have symptoms such as hot flashes and night sweats. In fact most physicians will only recommend estrogen to woman who have severe symptoms like these, and they still do it reluctantly, fearing it may cause breast cancer (i have addressed why this fear is unfounded based on many clinical studies in my previous postings).
So I thought I would list some of the 200 roles estrogen plays in a woman’s body, as well as a more comprehensive list of symptoms of deficiency
Decreases total cholesterol, triglycerides and bad cholesterol (LDL)
Increases good cholesterol (HDL)
Increases growth hormone
Helps maintain your bones
Improves (sustains) sleep
Works as an antioxidant
Decreased estrogen symptoms in women include:
More wrinkles/Aging skin
Decrease in breast size
Decreased sex drive
Increased insulin resistance/possible diabetes
Urinary tract infections
Increases blood flow to the brain
Improves the function of neurons (brain cells)
I hope these lists are helpful to you when it comes time to make a decision about whether or not estrogen is for you. Any fellowship trained, board certified anti-aging physician will not only consider estrogen (in the form of Biest cream or gel, typically) along with proper balancing with other important hormones like progesterone, testosterone, thyroid and cortisol.
Good health to you!
Today is November 1, the first day of American Diabetes Month.
Very often I hear the question how can I avoid diabetes as I get older?
The first step is to try to maintain and ideal body fat/body weight. If you have access to body fat testing, ideally men in their 30s and 40s should have less than 20% body fat while men in their 50s and 60s should try to maintain body fat in the low 20s. The other way of looking at diabetes risks is to calculate your body mass index.Your BMI can be determined by using your height and weight and finding a BMI calculator on any website on line. Ideally BMI should be less than 24 or 25. If your body fat is elevated or if your BMI is in the high 20s or 30s then weight loss and exercise are needed. There are many strategies for losing weight and body fat. The most well accepted plans today are a diet with reduced glycemic load, meaning reduction of starchy carbohydrates. At BodyLogic MD of San Diego our patients follow the excellent BodyLogic M.D nutritional guide.
Besides reducing the glycemic load of your diet it is also important to avoid eating only 1 or 2 meals a day to prevent diabetes. Many people are under the mistaken assumption that eating only one or two meals a day will lower their weight. Yes, it may lower their weight, but it also increases body fat, and increased body fat is one of the key risk factors for development of diabetes. So eating at least three meals a day with some small low glycemic snacks between meals is the healthiest way to maintain ideal weight body fat and prevent diabetes.
Exercise is important to prevent diabetes. Exercise improve blood sugar regulation and also lowers body fat which further reduces risk for diabetes. Aerobic exercise specifically is what is important. Weight training does not have as much and affect as aerobic exercise on blood sugar regulation.
Hormone balance is critical to avoid diabetes. High cortisol levels due to adrenal stress can raise blood sugar, promote diabetes, and also increase body fat and weight. Your bioidentical hormone specialist can perform special testing to see if you’re having significant adrenal stress and then start a strategy to normalize it using natural products ideally. Testosterone is the most important hormone for improving blood sugar regulation. Besides injections and transdermal creams, many studies support the use of testosterone pellet implantation as one of the best ways to improve blood sugar regulation in nondiabetic as well as diabetic patients.
Finally there are many nutritional supplements that can significantly improve blood sugar regulation. These include chromium picolinate, alpha lipoid acid, CLA, fish oil, magnesium, B vitamins, zinc, incinase, and coenzyme Q10. Bioidentical hormone specialists are familiar with quality pharmaceutical grade combination products that contain many of these ingredients in capsules, pills, or a powdered form to be consumed as a beverage with meals. Some of the products can even be used as a meal replacement.
While patients with early diabetes and even moderate to advanced diabetes can benefit from the above interventions, they’re especially important for those with family history of diabetes or those who are overweight and at risk for diabetes. Ask your doctor what your fasting glucose levels are and also request a hemoglobin A1C test. The number should be less than 5.5. If it is greater than 5.7 it means that you may be moving in the direction of diabetes in the future and should follow many if not most of the steps above to avoid developing this disease. Then be sure to follow up with your doctor for regular testing to make sure that the condition is not progressing but is in steady improvement.
If you are are medications for diabetes a bioidentical hormone specialist can work with you on possibly getting off of them if you respond well to the treatment plan described above, but don’t stop your meds on your own without a physician’s approval as that can be risky.
I just had the pleasure of speaking at a medical conference on bioidentical hormones sponsored by the International Hormone Society at the San Diego Harbor Marriott. My subject was testosterone deficiency and replacement, with an emphasis on testosterone pellet implantation.
I was struck by some of the questions the attending doctors asked me after the presentation. One included: “Why is it that some of my female patients still don’t have much libido despite being on testosterone?” I immediately knew that this dilemma related to elevated cortisol due to adrenal stress, among other causes, and I asked her how her patient’s adrenals were. She said she hadn’t checked them. I gently asked her what training she had in using bioidentical hormones. She said that she had attended only weekend seminars in the past. Rather than tell her how to work up and treat a woman with persistent low libido I told her she owed it to herself and her patients by taking at least one of the more than 10 available modules that are part of fellowship training given by the American Board of Anti-aging and Regenerative Medicine. The first module is 25 hours on hormones. I suggested starting with that,
After the flurry of questions from doctors practicing all over the country I thought about how many of the physicians in attendance actually had the knowledge base to prescribe bioidentical hormones in an optimal fashion. This means: maintaining adequate levels if each hormone, balancing hormones with others that interact with each other, addressing inflammation, immune status, diet, GI and liver health and optimally managing cancer and heart disease risk factors.
I immediately knew which 25 of the 300 doctors in attendance were able to claim to have this knowledge base. The BodyLogicMD doctors, who had completed fellowship training. I knew here were other fellowship trained physicians in the audience. But I also knew he majority of doctors were relative neophytes in this emerging branch of medicine
I earnestly hope that all physicians who wish to offer their patients bioidentical hormones take more advanced training leading to fellowship certification.
For now I encourage interested patients to seek out a doctor who has been fellowship trained. This will be listed on the physician’s web site.
Once in the doctor’a office for your initial visit you can expect to hear from your chosen physician about how your hormones are balanced, along with whether or not they are high or low Your initial testing will always include adrenal testing, using 4 saliva samples collected over the course of the day. It will always include measurements of the sex hormones and the free fractions of the thyroid hormones. The hormone vitamin D, (not a vitamin) will be measured Markers of inflammation will be examined. Heart disease and diabetes risk factor assessment will be done. After a thorough history and review of symptoms and goals for wellness is completed, a comprehensive treatment plan is then agreed upon and hormones and appropriate supplements are ordered. Followup labs and visits are scheduled. The doctor’s staff then reminds you when it is time to do the labs and be seen to optimize your compliance and ultimately your outcome.
If you are not getting this kind of personalized attention you deserve to. You can find board certified, fellowship trained bioidentical hormone doctors in your area by going to www.bodylogicmd.com
Quite often new patients ask me: “After I am seen for my initial consultation, why can’t I start all of my hormones at the same time? I really want to feel better as soon as possible!”
The answer is “hormonal balance.”. Starting all needed hormones together or in the wrong order can result in vey annoying side effects. For example, if the adrenals are depleted and thyroid is started before adrenal support kicks in, one can have major stimulatory side effects like racing heart or palpitations. Starting testosterone before correcting adrenal weakness can greatly aggravate existing fatigue, sometimes leading to a drop in blood pressure, lightheadedness when standing, dry mouth and other symptoms.
The discerning patient looking for anti-aging medical care can always tell when their doctor has been fellowship trained, as are all BodyLogic MD physicians. The treatment plan will pay close attention to the relationship between the hormones that the patient is lacking, based on lab tests and correlated with symptoms. The doctor will then suggest a plan that introduces the needed hormones in the correct order. This way the benefits are free or annoying side effects. Optimal hormonal balance takes a little time but proceeding in a logical, methodical fashion is often best for the patient and leads to far less frantic phone calls or emails from my patients! I tell many patients that it took many years to get where they are now and it may take a few weeks or months to bring hormone balance back to normal. However it is well worth the effort. Patience, time and compliance are all key elements in achieving the best possible outcome.
A chiropractor friend of mine, Skip George, taught me many years ago that we spend much of our lives in flexion. What this means is that our waist is bent forwards, our shoulders are rolled forwards, and our head is forward. If we do the exercise discussed in the previous blog with our back against the wall, what gives us relief of the muscle tension or spasm that comes on quickly as we struggle to hold this position? Easy! Bending at the waist, letting our shoulders droop forwards and letting our head drop forwards This feels good because it gives the weak extensors (the muscles that bring our neck, shoulders, hips and back in a backwards direction) a vacation. It also feels good because it permits the overly tight flexors (the muscles that bring our spine and hips forwards) to return to a shortened position, like a spring returning to a rest position.
So the quick and simple DAILY postural correction routine should start with a few simple exercises designed to do 2 things: stretch the flexors and strengthen the extensors of the neck, shoulders, back and hips.
Here is what I do — you can add many more or even get a “Theraball,” inflated to the proper size for your height (it say this on the box!). The Theraball (beach ball sized) comes with great exercises and helps with balance. With all of these excesses be sure not to hold your breath (yoga will teach you that!) Also, don’t overstretch! (true for all stretching)to the point of pain or spasm.
1. Stand in a doorway. Rest your bent elbows against the inside of the doorframe (or your arms if you are short). With the head held upright gently lean forwards until you feel tension in your armpits/shoulders. Hold is for 5 seconds, return to the starting position, and then repeat 5-10 times.
2. In the same doorway reach up to the lintel (the top of the doorframe). With the elbows straight stretch forwards gently as described above and follow the same time and repetitions. Keep the head facing forwards, not downwards for both of these stretches.
2. Lie prone on the floor with a towel under your face and place your palms flat on the carpet. Then slide your hands fowards 1-2 feet depending on how flexible you are. Then extend your arms, raising your chest upwards but still keeping your bellybutton on the ground. Your head and neck should either be in line with your upper back or gently tilted backwards–don’t overdo it or you will have some discomfort. Hold this position for 10 seconds, then return to the starting position. Repeat 3 times. In yoga the common name for this stretch is “Cobra.”
3. Start in the same position as #2. Bring your arms along you side while resting your chin on the towel. Slowly raise your arms off the ground a few inches. At the same time raise your legs(keep the knees straight) and the chest off the ground as much as you can. Hold this for a few seconds the return to the prone position. Repeat this up to 20 times (I try to hold each position for 2-3 seconds at least). This position is sometimes called “Superman.”.
4. Get into a position where you are kneeling on one knee while the other foot is flat on the ground in front or you with that knee bent 90 degrees. This is similar to the yoga position “kneeling warrior” (you can find that in Google Images). Do a pelvic tilt (like you are thrusting your groin forwards). Raise the hand overhead on the side where the knee is on the ground. Slowly stretch it to the opposite side, keeping it in line with tour body while tilting your spine in the same direction as you arm. After you reach your limit return to the starting position and repeat this 7 times. Then switch sides. This exercise, when done properly, stretches the hip flexors.
5. Finally give your hamstrings a good stretch (avoid this exercise if it causes an sciatica or back pain–there are modifications that would be better for you). Get a rolled towel (lengthwise), lie on your back, and bend one knee so the foot is flat on the ground. Bend the other knee so you can loop the towel around your forefoot. While maintaining tension in the towel so it doesn’t slip, slide your hands to both ends of the towel and then slowly pull the leg upwards while straightening out the knee fully. Keep your head relaxed on the ground or on a pillow. Don’t be surprised if you can only raise it @60 degrees. Hold this for 15 seconds, relax and repeat 3 times. Then switch sides. Done properly (and twice daily) you can improve from 60 degrees to nearly 90 degrees in 4-6 week. I did. Boy did it help my back!
This routine will take you 5-7 minutes. No excuses. Saying you have “no time” is a cop-out. People who say that really mean: “it is not a priority for me”. I hope you now see that it should be.
There are many neck stretches and back/hip stretches that can be added if you have time. If you sit a lot during the day it would be great to do this routine before AND after work. Do these and other exercises you find on-line or in books and consider joining a yoga class See a good practitioner if these exercises are not enough.
Remember, anti-aging is not only about using bioidentical hormones. It is also about getting older while standing tall, proud and free of pain. My 80 year old upright patients are justifiably proud of their youthful posture. If you want to reduce your need for medical care and drugs, get the most out of life, and be an upright, pain free 80 or even 90 year old one day, you just have to do a little daily w-o-r-k! Your body will thank you!