Friday, January 4, 2019

Understanding and improving core strength

It may not seem possible to be able to write your way to better health. But as a doctor, a public health practitioner, and a poet myself, I know what the scientific data have to say about this: when people write about what’s in their hearts and minds, they feel better and get healthier. And it isn’t just that they’re getting their troubles off their chests.

Writing provides a rewarding means of exploring and expressing feelings. It allows you to make sense of yourself and the world you are experiencing. Having a deeper understanding of how you think and feel — that self-knowledge — provides you with a stronger connection to yourself. It’s that connection that often allows you to move past negative emotions (like guilt and shame) and instead access positive ones (like optimism or empathy), fostering a sense of connection to others in addition to oneself.
Making connections is key

It’s remarkable that the sense of connection to others that one can feel when writing expressively can occur even when people are not engaged directly. Think of being at a movie or concert and experiencing something dramatic or uplifting. Just knowing that everyone else at the theater is sharing an experience can make you feel connected to them, even if you never talk about it. Expressive writing can have the same connecting effect, as you write about things that you recognize others may also be experiencing, even if those experiences differ. And if you share your writing, you can enhance your connection to someone else even more. That benefit is energizing, life-enhancing, and even lifesaving in a world where loneliness — and the ill health it can lead to — has become an epidemic.

Maybe it’s time to pay greater attention to expressive writing as one important way to enhance a sense of connection to others. Social connection is crucial to human development, health, and survival, but current research suggests that social connection is largely ignored as a health determinant. We ignore that relationship at our peril, since emerging medical research indicates that a lack of social connections can have a profound influence on risk for mortality, and is associated with up to a 30% risk for early death — as lethal as smoking 15 cigarettes a day. Social isolation and loneliness can have additional long-term effects on your health including impaired immune function and increased inflammation, promoting arthritis, type 2 diabetes, cancer, and heart disease.
How expressive writing battles loneliness

Picking up a pen can be a powerful intervention against loneliness. I am a strong believer in writing as a way for people who are feeling lonely and isolated to define, shape, and exchange their personal stories. Expressive writing, especially when shared, helps foster social connections. It can reduce the burden of loneliness among the many groups who are most at risk, including older adults, caregivers, those with major illnesses, those with disabilities, veterans, young adults, minority communities of all sorts, and immigrants and refugees.

Writing helps us to operate in the past, present, and future all at once. When you put pen to paper you are operating in the present moment, even while your brain is actively making sense of the recalled past, choosing and shaping words and lines. But the brain also is operating in the future, as it pictures a person reading the very words you are actively writing. When expressing themselves in writing, people are actually creating an artifact — a symbol of some of their thoughts and feelings. People often can write what they find difficult to speak, and so they explore deeper truths. This process of expression through the written word can build trust and bonds with others in unthreatening ways, forging a path toward a more aware and connected life.

When people tell their personal stories through writing, whether in letters to friends or family, or in journals for themselves, or in online blog posts, or in conventionally published work, they often discover a means of organizing and understanding their own thoughts and experiences. Writing helps demystify the unknown and reduce fears, especially when we share those written concerns with others.
Write for your health

As a poet, I’ve personally experienced the benefits of expressive writing. The skills it sharpens; the experience of sharing ideas, feelings, and perceptions on a page; the sensations of intellectual stimulus and emotional relief — all are life enhancing. I’d like more people to discover that expressive writing can contribute to well-being, just as exercise and healthful eating do.

I’ve documented some of the research being done in the area of healing and the arts. After reviewing more than 100 studies, we concluded that creative expression improves health by lowering depression and stress while boosting healthy emotions. So pick up a pen, and start to write creatively. For the mind and the body, writing is a strong prescription for good health.
The rate of type 2 diabetes is increasing around the world. Type 2 diabetes is a major cause of vision loss and blindness, kidney failure requiring dialysis, heart attacks, strokes, amputations, infections and even early death. Over 80% of people with prediabetes (that is, high blood sugars with the high risk for developing full-blown diabetes) don’t know it. Heck, one in four people who have full-blown diabetes don’t know they have it! Research suggests that a healthy lifestyle can prevent diabetes from occurring in the first place and even reverse its progress.
Can a healthy diet and lifestyle prevent diabetes?

The Diabetes Prevention Program (DPP), a large, long-term study, asked the question: we know an unhealthy diet and lifestyle can cause type 2 diabetes, but can adopting a healthy diet and lifestyle prevent it? This answer is yes: the vast majority of prediabetes and type 2 diabetes can be prevented through diet and lifestyle changes, and this has been proven by 20 years of medical research.

Researchers from the DPP took people at risk for type 2 diabetes and gave them a 24-week diet and lifestyle intervention, a medication (metformin), or placebo (a fake pill), to see if anything could lower their risk for developing diabetes. The very comprehensive diet and lifestyle intervention had the goal of changing participants’ daily habits, and included: 16 classes teaching basic nutrition and behavioral strategies for weight loss and physical activity; lifestyle coaches with frequent contact with participants; supervised physical activity sessions; and good clinical support for reinforcing an individualized plan.

Perhaps not surprisingly, the diet and lifestyle intervention was incredibly effective. After three years, the diet and lifestyle group had a 58% lower risk of developing diabetes than the placebo group. Participants aged 60 and older had an even better response, with a whopping 71% lower risk of developing diabetes. The diet and lifestyle effect lasted: even after 10 years, those folks had a 34% lower risk of developing diabetes compared to placebo. Men, women, and all racial and ethnic groups had similar results (and almost half of participants represented racial and ethnic minorities). These results are not surprising to me or to other doctors, because we have all seen patients with prediabetes or diabetes get their sugars down with diet, exercise, and weight loss alone.

Meanwhile, the medication group had a 31% lower risk of diabetes after three years, and an 18% lower risk after 10 years, which is also significant. It’s perfectly all right to use medications along with diet and lifestyle changes, because each boosts the effect of the other. Studies looking at the combination of medication (metformin) with diet and lifestyle changes have shown an even stronger result.
Dietary recommendations to prevent diabetes (and even reverse it)

    Decrease intake of added sugars and processed foods, including refined grains like white flour and white rice. This especially includes sugary drinks, not only sodas but also juices. The best drinks are water, seltzer, and tea or coffee without sugar.
    Swap out refined grains for whole grains. Whole grains are actually real grains that haven’t been stripped of nutrients in processing. Foods made from 100% whole grain (like whole wheat) are okay, but intact whole grains (like farro, quinoa, corn, oatmeal, and brown rice) are even better. Swapping out grains for starchy veggies (like potatoes) is also okay, as long as these veggies aren’t in the form of french fries!
    Increase fiber intake. High-fiber foods include most vegetables and fruits. Legumes are also high in fiber and healthy plant protein. Legumes include lentils, beans, chickpeas, peas, edamame, and soy. People who eat a lot of high-fiber foods tend to eat fewer calories, weigh less, and have a lower risk of diabetes.
    Increase fruits and vegetables intake. At least half of our food intake every day should be non-starchy fruits and vegetables, the more colorful the better. Cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts, and high-fiber fruits like berries of all kinds, are especially healthy. All fruits and vegetables are associated with living a significantly longer and healthier life!
    Eat less meat, and avoid processed red meat. Many studies have shown us that certain meats are incredibly risky for us. People who eat processed red meat are far more likely to develop diabetes: one serving a day (which is two slices of bacon, two slices of deli meat, or one hot dog) is associated with over a 50% higher risk of developing type 2 diabetes. Eating even a small portion of red meat daily (red meat includes beef, lamb, and pork), like a palm-sized piece of steak, is associated with a 20% increased risk of type 2 diabetes. This may be because of the iron in red meats, and the chemicals in processed meats. As a matter of fact, the less meat you eat, the lower your risk of diabetes. People who don’t eat red meat at all, but do eat chicken, eggs, dairy, and fish, can significantly lower their risk of developing type 2 diabetes, by about 30%; those who eat only fish, 50%; those who eat only eggs and dairy, 60%; those who are vegan, 80%.
    Eat healthier fats. Fat is not necessarily bad for you. What kind of fat you’re eating really does matter. Saturated fats, particularly from meats, are associated with an increased risk of diabetes and heart disease. Plant oils, such as extra-virgin olive oil and canola oil, carry less risk. Omega-3 fats, like in walnuts, flax seeds, and some fish, are actually quite good for you.

Diet and lifestyle changes that can help prevent diabetes

Diet and lifestyle changes are so effective for diabetes prevention that as of April 2018, insurance companies are now covering these programs for people at risk. The CDC’s Diabetes Prevention Program, used in many clinics, is a free tool to help you learn and stick with the healthy diet, physical activity, and stress management techniques that reduce your risk of diabetes.

One helpful tool is the Harvard School of Public Health Nutrition Source Healthy Eating Plate, which shows you what your daily food intake should look like: half fruits and vegetables, about a quarter whole grains, and a quarter healthy proteins (plant protein is ideal here), with some healthy fats and no-sugar-added beverages. The Harvard Health Blog also offers many articles with recipes and cooking videos to help you create a healthier, diabetes-free lifestyle. When most people think about core strength, they think about an abdominal six-pack. While it looks good, this toned outer layer of abdominal musculature is not the same as a strong core.
What is the “core” and why is core strength so important?

The core is a group of muscles that stabilizes and controls the pelvis and spine (and therefore influences the legs and upper body). Core strength is less about power and more about the subtleties of being able to maintain the body in ideal postures — to unload the joints and promote ease of movement. For the average person, this helps them maintain the ability to get on and off the floor to play with their children or grandchildren, stand up from a chair, sit comfortably at a desk, or vacuum and rake without pain. For athletes, it promotes more efficient movement, therefore preventing injury and improving performance. Having a strong or stable core can often prevent overuse injuries, and can help boost resiliency and ease of rehab from acute injury. The core also includes the pelvic floor musculature, and maintaining core stability can help treat and prevent certain types of incontinence.
The problem with a weak core

As we age, we develop degenerative changes, very often in the spine. The structures of the bones and cartilage are subject to wear and tear. Very often, we are able to completely control and eliminate symptoms with the appropriate core exercises. Having strong and stable postural muscles helps suspend the bones and other structures, allowing them to move better. Scoliosis, a curving or rotation of the spine, can also often be controlled with the correct postural exercises. Having an imbalanced core can lead to problems up and down the body. Knee pain is often caused by insufficient pelvic stabilization. Some runners develop neck and back pain when running because the “shock absorbers” in their core could use some work.
Finding the right core strengthening program for you

A good core program relies less on mindless repetition of exercise and focuses more on awareness. People with good core strength learn to identify and activate the muscles needed to accomplish the task. Learning to activate the core requires concentration, and leads to being more in tune with the body.

There is no one method of core strengthening that works for everyone. Some people do well with classes (though it can be easy do the repetitions without truly understanding the targeted muscle groups). Others use Pilates or yoga to discover where their core is. Physical therapists are excellent resources, as they can provide one-on-one instruction and find a method that works for any person with any background at any ability level. It sometimes takes patience for people to “find” their core, but once they do, it can be engaged and activated during any activity — including walking, driving, and sitting. While building the core starts with awareness and control, athletes can further challenge their stability with more complex movements that can be guided by athletic trainers and other fitness specialists.

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