The importance of sleep, the negative consequences of sleep deprivation and steps you can take to improve your sleep and therefore overall health.
Sleep. Why is sleep so difficult some nights? It was just a few nights into my family’s current road trip when I found myself wide awake, struggling to sleep. I lay awake in our tent in Morro Bay, California, and like many people that night, I was unable to sleep. My mind had started to clear from the recent stress of moving and embarking on an open ended road trip. I was in a beautiful location along California’s central coast. `We enjoyed dinner on the beach while watching the sunset. I was warm and toasty as I snuggled in my sleeping bag. So, why couldn’t I sleep? I decided to follow the advice of the professionals and not fret it and not fight it. I took a deep breath and felt my head sink into the pillow. I listened to owls hooting in the nearby trees. I focused on the big dipper shimmering in the clear November sky. A breeze blew, and I thought of the hundreds of monarch butterflies dripping from the eucalyptus trees surrounding our campsite, waiting for the warmth of day to spread their wings. Suddenly…it seemed…the birds were chirping, and I opened my eyes to see sunlight shining into the tent. Morning had arrived.
Unfortunately in our society, the importance of sleep is often overlooked. We try to fit more and more into our day, and sadly, sleep is usually what is compromised. In an effort to improve health, many people exercise and clean up their diet. However, improving one’s sleep is often a forgotten component in an overall health improvement plan. Functioning on little sleep seems to be a badge of honor when in reality it is more of a silent disease, slowly eating away at one’s health. Current recommendations for adults are 7-9 hours of sleep each day as reported by the National Sleep Foundation. One-third of our life is spent sleeping, and the other two-thirds is greatly influenced by one’s quantity and quality of sleep. Sleep is designed to heel, repair and stimulate growth, and when it is compromised, these restorative processes are also compromised. Prominent researcher, Dr. William Dement, stated in his book “The promise of Sleep”,
“There is plenty of compelling evidence supporting the argument that sleep is the most important predictor of how long you will live, perhaps more important than whether you smoke, exercise, or have high blood pressure or cholesterol levels.”
Whether or not you agree with Dr. Dement’s bold statement, it does force one to not underestimate the value of sleep. When was the last time you woke up feeling rested and rejuvenated? If you are like most people, sadly you can’t remember. Many people walk around each day sleep deprived. Sleep deprivation affects multiple body systems and therefore has potential to contribute to disease and lower quality of life. Let’s take a closer look at how our body is specifically affected by sleep deprivation.
The Immune system: When we are sick, we often want to sleep. This is no coincidence. Sleep promotes a stronger immune system. Two notable studies examined the level of protective immune system cells after one night of sleep deprivation. The first study published in 2004 in the Journal of Nature Reviews Immunology describes a reduction in the bodies natural killer cells after just one night of sleep loss. The second study published in the Journal of American Medical Association in 2002 describes a reduction of lymphocyte counts of up to 50% after one night of only four hours of sleep. Taking a red eye or staying up late to finish a project truly does make one more susceptible to illness. Research by JM Mullington in 2010 showed that sleep deprivation leads to an increase in inflammatory cytokines, small proteins released by cells which trigger inflammation. Chronic inflammation has been targeted as playing a significant role in the disease process.
The endocrine system: In the 1960’s, Americans self reported getting 8-8.9 hours of sleep each night. By 2002, Americans reported getting less than 7 hours of sleep each night as described in the National Sleep Foundation’s Sleep in America Poll. Interestingly, as Americans tended towards less sleep, the rate of obesity increased. One must wonder if there is a link between sleep deprivation and obesity. Perhaps the endocrine, or hormonal system, provides a vital answer. In his article entitled “Sleep and Obesity”, Beccuti Gugliemo looks at multiple studies aimed at analyzing hormonal levels after a short sleep duration of less than six hours. The studies found that three hormones contributing to weight control – cortisol, leptin and ghrelin – are each affected by diminished sleep.
Cortisol is a hormone released by the body in response to stress. Normally, cortisol levels decrease in the evening to allow for low levels before bedtime. If one is partially sleep deprived, the rate of cortisol lowering in the evening is slowed, resulting in unnaturally elevated cortisol levels at bedtime. Elevated cortisol levels are linked to the development of impaired glucose metabolism and insulin resistance, both known risk factors for diabetes and obesity.
Leptin is a hormone released by fat cells that triggers feelings of satiety and suppresses appetite while conversely ghrelin is secreted by the stomach and stimulates appetite. Both hormones affect food intake. With sleep deprivation (6 hours or less), morning levels of leptin are reduced, and levels of ghrelin are greater than normal. Sleep loss alters the body’s ability to accurately signal its caloric needs, and this results in more eating than necessary. In a society where calories are freely available, irregular levels of leptin and ghrelin can contribute to weight gain and obesity. Interestingly, carbohydrates were the food of choice when leptin levels were low and ghrelin levels were high after a night of sleep deprivation. No wonder bagels, muffins and doughnuts are often the food of choice along with coffee after a night of reduced sleep.
It does not come as a surprise then that there may be a relationship between body mass index (BMI) and sleep duration. BMI is an estimate of one’s body fat based upon height and weight. It is used by the medical community to help estimate one’s risk for various diseases. One is considered overweight with a BMI greater than 25. In both the Wisconsin Sleep Cohort Study and a study at the Eastern Virginia Medical School, both analyzing sleep habits of over 1,000 people, overweight participants reported less sleep than normal weight participants based on BMI. It is often recommended to increase activity in order to decrease weight or prevent weight gain. However, recommending an increase in the most sedentary activity there is, sleeping, may also need to be part of a healthy weight loss plan.
The neurological system: Sleep deprivations effect on the neurological system manifests itself in the form of car accidents, poor relationships and work related errors. The CDC reports that sleep deprivation contributed to 72,000 traffic accidents in the US in 2013. Sleep loss contributes to decreased attention span, increased irritability, slowed reaction times, decreased memory, lower enthusiasm and diminished creativity. When the brain is not firing efficiently with all cylinders, the outcome can sadly be deadly as seen in the Exxon Valdez oil spill, the Challenger explosion and the nuclear accident at Three Mile Island.
The musculoskeletal system: The human body needs growth hormone for muscle integrity, stimulating bone growth, healing, and body repair. As Mary O’Brian reports in her book, “The Healing Power of Sleep”, 80% of our daily allotment of growth hormone is made by the pituitary gland during deep sleep. When sleep is deficient, levels of growth hormone are also deficient. Growth hormone deficiency is associated with decreased muscle mass, decreased bone density, increased fatigue, depressed mood and delayed healing. A 2005 study described in the Journal of American Geriatric Society describes a link between insomnia, which is defined as difficulty falling asleep or staying asleep, and falls. Due to decreased production of growth hormone secondary to impaired sleeping, muscle mass and bone density are diminished, both necessary for protecting against falls. If so much healing occurs during sleep, one can’t help but to question the seemingly backward practice of waking hospital patients during the night for routine vital signs. No wonder patients express a desire to go home to get some sleep.
Sleep is defined as “the natural periodic suspension of consciousness during which the powers of the body are restored”. It is a complex state regulated by neurotransmitters in the brain. There are five sleep stages, and it takes an adult about 90 minutes to pass through all stages.
Stage 1: Light, shallow sleep, easily awakened, not refreshing.
Stage 2: Longest stage, some may still awake easily in this stage, older adults or those with chronic illness may spend most of the night in this stage.
Stage 3+4: Deep sleep, difficult to wake up during this stage, disoriented if alarm goes off. Growth hormone made. Neurotransmitters important for memory, learning and focus are also made during stage 4 sleep.
Stage 5: Dream stage or REM (rapid eye movement stage) characterized by shallow, irregular breathing, eyes move in a jerky manner, blood flow to the brain increases and arm and leg muscles are paralyzed to prevent us from dangerously acting out dreams. As morning approaches, more time is spent in this stage. Time in REM increases creativity.
Aging does not improve sleep, and changes in sleep start occurring in our 30s. As we age, the percentage of light stage 1 sleep increases, the percentage of deep stage 3 and 4 sleep decreases, there is increased waking up during the night, and increased time is needed to fall asleep. Although the odds are not in our favor for improving the quality and quantity of sleep as we age, there are things we can do to try and improve our sleep patterns naturally.
Follow natural light cues to help maintain the circadian rhythm. Circadian rhythm is our body’s “clock”. It is a natural cycle, based on 24 hours, that tells our body when to sleep, when to rise and when to eat. It is directed by sunlight and temperature. When darkness sets in, our body prepares for sleep with the release of melatonin. In the morning, daylight signals waking. Unfortunately, due to the shift work, travel, and most notably to the invention of artificial light, people no longer adhere to natural circadian rhythms when choosing sleep or wake times. When this rhythm becomes disrupted, one is at risk for sleep disturbances, obesity, diabetes, depression and seasonal affective disorder. Structuring your sleep based more on the environment’s natural light cycle by dimming lights at night, establishing an earlier bedtime, exposing your eyes to light soon upon waking and not “burning the midnight oil”, will slowly help restore your natural circadian rhythm.
Establish a routine before bed to help reduce stress levels and calm the mind and body. Meditation, yoga or a warm bath may be helpful.
Eliminate “screen time”, which refers to computers, televisions, phones and other smart devices, at least 30-60 minutes before sleeping. Our need to be “connected” up until the moment we go to sleep is damaging our sleep. Light from a computer or television enters the retina and delays the production of melatonin needed for the onset of sleep. Computer and television viewing also stimulates the brain and causes a release of cortisol, the stress hormone, all at a time when the brain should be calming down. Long before television, emails, and the internet, people spent their evenings reading books, (not electronic readers!) playing instruments or doing handwork such as quilting. I bet that Laura Ingalls Wilder and her family did not have issues with sleep like many people do today. Perhaps we should learn from history. However, reading before bed does come with mixed reviews. For some, reading provides a wind down period and promotes relaxation as cortisol is decreased. However, for others, reading stimulates the brain too much and is therefore not a relaxing activity before bed. Music has been shown to improve sleep, for it helps shorten stage two of the sleep cycle, and therefore one enters stage three quicker. Music helps to lower heart rate and slow breathing. Of course the music selection matters, and Guns and Roses may not be as beneficial as Beethoven. Music with a slower rhythm of closer to 60 beats per minute is optimal, for as you fall asleep, your heart rate slows towards 60 beats per minute. As long as the music has a slower beats per minute, the selection can be very personal. Check out songsbpm.com to see if your favorite music would be ideal for nighttime listening.
Be conscious of caffeine intake. Caffeine has a half-life of 3-5 hours which means it takes that long to clear half of the caffeine from your system. Caffeine’s effects may last for 8-14 hours depending on the sensitivity of the individual. A study in the Journal of Clinical Medicine found that consuming 400mg of caffeine, roughly the amount in a 16 oz Starbucks drip coffee, six hours before bedtime resulted in a one hour reduction in sleep. This lost sleep can add up quickly.
Be conscious of alcohol consumption. According to the National Sleep Foundation, alcohol is used by 20% of the population as a means to promote sleep. True, alcohol does help produce a faster sleep onset by increasing the brain’s production of adenosine, a chemical that contributes to falling asleep. However, alcohol then causes a reverse effect on adenosine levels resulting in wakefulness during the middle of the night. It also blocks REM stage sleep. Alcohol is a diuretic which makes nightly trips to the bathroom more frequent, thus further disrupting sleep. No wonder people often wake up feeling groggy and tired after consuming alcohol.
Make exercise part of your daily routine. Moderate exercise helps to relieve stress and thus reduce cortisol levels. However, timing of the exercise for optimal sleep benefit likely varies with each individual. Try moderate late afternoon exercise, preferably outdoors. The daylight helps with the circadian rhythm, and the exercise results in a body temperature increase followed by a natural cooling a few hours post exercise. This lowering of temperature contributes to a normalized circadian rhythm and prepares one for sleep. The key to improving sleep with daily exercise is consistency with exercise over time. It is important to physically tire out your body each day as much as mentally tiring your mind.
Avoid sleeping pills if possible. Try for natural ways discussed above for improving sleep before considering pharmaceutical agents. Unfortunately, many sleeping pills have unwanted side effects, poorly interact with other medications and can alter overall sleep architecture. Without a prescription, many people have taken an antihistamine such as Benadryl or Tylenol PM on occasion to help them sleep. These over the counter antihistamines do help you fall asleep faster, for the number one side effect is drowsiness. However, for an adult, it takes 7-8 hours for half of the main ingredient to clear from the body, and for the elderly, the half-life may exceed 100 hours as reported in Mary O’Brian’s book, “The Healing Power of Sleep”. Antihistamines also work against acetylcholine, which is the most important neurotransmitter for memory, and interestingly, it is the most deficient neurotransmitter in Alzheimer’s disease. If you need to be sharp in the morning, or you value your memory, stay clear of using antihistamines for sleep. Sleeping pills have evolved over time, and it is wise to do research before blindly starting a sleeping pill. They are not harmless as many doctors and advertisements may lead you to believe.
If after turning off the television, silencing your phone, sewing quilts by candle light and stopping your habit of a nightly glass of red wine does not improve your quantity and or quality of sleep, then perhaps you may benefit from a sleep consultation with a doctor. You may have an underlying medical disorder such as sleep apnea or snoring. Insomnia can also be a side effect of various illnesses and disease processes.
The value of sleep should not be overlooked or underappreciated. Taking steps now to improve your sleep will benefit you both tomorrow and in the long run. Remember though, lasting improvements happen slowly. As Rome was not built in a day, one cannot expect a restful 8 hour night sleep after years of sleep neglect. Ralph Waldo Emerson said, “Adopt the pace of nature. Her secret is patience.”
So, tonight if you find yourself unable to sleep, don’t worry. Perhaps listen to some music. I will listen to nature’s music from my tent, the most beautiful music there is. Good Night.
Change is a natural part of life and an opportunity for personal growth. However, too often fear prevents us from having courage and embracing change.
This is the conversation I had with my six year old daughter, Sam, while driving to the grocery store yesterday.
Me: “ Are you happy or sad about leaving school and going on an adventure?”
Sam: “Part of me is happy and part of me is sad.”
Me: “Which part is happy?”
Sam: “My left side is happy, and my right side is sad.”
Me: (Smile, pause…) “I feel the same way, but my right side is happy, and my left side is sad. And that is o.k. I think Pop feels the same way too.”
For everyone, change brings about mixed feelings. On one hand, change pushes us out of our comfort zones. Change can be hard. Change is often accompanied by fear and loss. On the other hand, change can be an exciting time of self discovery and personal growth. Musician, John Porter said, “People underestimate their capacity for change. There is never a right time to do a difficult thing.” When you sense change is on the horizon, do your embrace change, or do you shy away from change?
This was the question my husband and I grappled with this summer. Do we change courses and take the fork in the road, or do we continue on our current path, knowing we are not moving farther ahead, but it is a familiar, easy, and comfortable path. Our moment of clarity came while working in the kitchen together after dinner one night. My husband was washing dishes while I was putting leftovers away. We stood back-to-back discussing changing job situations, our housing situation, finances, life goals and our lack of time to pursue personal projects and dreams….all familiar things parents discuss over and over. Out of frustration, my husband suddenly said, “What we need is a year off, a year to travel and experience.” The words came out of his mouth so quickly. It is an idea that so many people talk about, dream about, and talk about some more. It is an idea that few people have the courage to act upon. Dish rags and spoons down, we turned to each other at the same time and with the same wide eyed look of excitement. The light bulb had gone on. This was our defining moment. “Let’s do it!”
Deciding to embrace change takes resilience and courage. Fears need to be set aside to allow the mind to remain open to possibilities. That evening in the kitchen our decision was made. We decided to take the fork in the road, leave the Monterey Peninsula, our home for over ten years, and head out to experience the country. We do not know where this adventure may lead or what we may discover along the way. But we do know we are making this journey as a family, with open hearts and open minds. It will be just one chapter in our life story – likely a chapter with lots of twist and turns, challenges and triumphs, exciting times and hard times, calm moments and tense moments. With less than one week until departure, despite our mixed feelings, we are ready to embrace change.
“To exist is to change, to change is to mature,
to mature is to go on creating oneself endlessly.”
(Henri Bergson, French philosopher)
As I crested the hill on my early morning run today, I noticed on my left side the full moon still lingering in the clear sky over the bay. On my right side, the bright sun had just rose above the hills, filling the sky with light. It was a rare moment. Night was giving way to day. I paused at the top of the hill reflecting on how I was witnessing nature change while at a precipice of change myself. As I looked to the bright sun on my right, I was reminded how I told my daughter just yesterday that Mom’s right side is happy about the upcoming change. The rising sun today filled me with more courage and excitement as I started off down the hill, ready to meet what ever challenges may be ahead.
A note to MEKPT blog followers…Although I may be leaving the Monterey Peninsula, rest assured that I am in no way leaving MEKPT. In fact, just the opposite is true. My goal is to create an online educational resource where people can come to learn and be inspired. I want to provide you with tools you can use to take greater responsibility for your own health and wellness. Please continue to follow MEKPT as it grows and share this site with others so they may learn and be inspired too.
The importance of resistance training and how to start a strength building program.
I was working in the kitchen when I suddenly heard my six year old daughter yell, “take the pillow out Mom! Hurry!” I ran into the other room and found her in a handstand against the wall, arms pushing up strong and legs straight as a pencil. I quickly removed the pillow that had been under her head as I marveled at her strength. This was a move she had been practicing in her weekly yoga class. I mentally compared the muscle strength she had five months ago when she started the yoga class with the strength she displayed in the handstand today. While I was reminded of the benefits to being consistent with an exercise program, my daughter, with her childlike fearlessness, encouraged me to try a handstand too. I quickly told her that Mom was too old and not strong enough to ever be able to do a handstand. But wait! After these words rolled out of my mouth, my scientific mind knew that I was not being honest. Muscle strength can improve at any age with a consistent resistance training program. I was also not being honest with my heart, as a good challenge is great self motivation. Could Mom really do a handstand? I have decided to embark on a strength building program, not only to be able to do a handstand and keep up with my daughter, but having strong muscles is truly important. If you neglect building muscle strength, you really are missing the boat. This is why.
Collectively, we are a physically weak society. Our current culture is dominated by too much sitting, too much commuting, too much fast food, too much screen time and too little play time. Long ago in hunter-gatherer times, humans’ muscles got stronger by doing heavy work required to live such as building shelter, farming and hunting. Today, we sit on riding mowers, hire out housework, drive a mile to the store instead of walk, choose to watch a movie instead of going outdoors to watch nature, and use a blower to remove dirt and leaves instead of using a rake, broom and good old man power. Muscles need to be stressed in order to strengthen. Both less physical activity and less stress on our muscles, combined with a natural muscle loss every decade, predisposes us to an overall state of muscle weakness. This weakness contributes to falls, a decline in physical mobility, postural imbalances, pain, and ultimately an inability to perform daily tasks.
How do you increase muscle strength?
Resistance training is the answer. Resistance training is any type of exercise that causes the muscles to contract against an external resistance with the goal of increasing muscle strength, muscle tone or muscle endurance. The resistance used can be of many forms including dumbbells, ankle or wrist weights, exercise tubing, your own body weight or cans of soup.
What are the benefits of resistance training?
As reported in a 2012 article in the Journal of Sports Medicine, resistance training has been shown to maintain and improve bone mass during the ageing process, a period normally characterized by bone loss. Resistance training is also beneficial in the prevention and treatment of osteoporosis, a disease in which the rate of bone breakdown (resorption) is greater than the rate of bone formation, leading to porous, fragile bones. A recent study published in August 2016 in the Journal of Osteoporosis describes how a long term exercise program which includes strength training and performed for two and 1/2 hours total per week protects bone health on a molecular level. This is the National Institute of Health’s minimum exercise recommendation for adults. This specific exercise program favorably shifted the balance between cells producing bone breakdown proteins and cells producing proteins that protect bone density.
Resistance training has been shown to reduce blood pressure, most notably in prehypertensive individuals. (blood pressure of 129-139 mmHG systolic / 80-89 mmHG diastolic) An increase in muscle mass may also contribute to weight loss as muscle burns more calories than fat when physically active.
Resistance training also helps to counteract the muscle loss associated with aging. After age 30, there is a natural loss of muscle mass, even in active individuals, called sarcopenia. Changing hormones are believed to be a factor. Physically inactive people can lose up to 5% of their muscle mass each decade after age 30. This muscle loss adds up quickly and accelerates at an even faster rate starting at age 65.
“That explains why we feel weak and tired as we age,
and we can prevent some of that with weight training.”
(Beatrice Edwards, MD, MPH)
The good news? Muscles can become stronger at any age. It will take longer to increase muscle strength at an older age, but with a consistent program, muscles will become stronger.
How does resistance training work?
In order to improve muscle strength, you must first break down the muscle fibers. When lifting weights or performing other types or resistance exercise, micro tears occur in the muscle fibers, a process called catabolism. With rest, these tears heal and result in a stronger muscle fiber, a process called anabolism. Catabolism of the muscle fibers must occur in order to increase overall muscle strength.
How to design a resistance training program?
Anything is better than nothing, but consistency is the key to building strength. Plan to incorporate strength building exercises into your routine 2-3 days a week, not on consecutive days, as the muscle needs time to heel. Next, decide what type of resistance you will use. Will it be free weights, machines, bands, or body weight? What is convenient for you? For a general strength building program, pick one exercise for each major muscle group (back, chest, shoulders, biceps, triceps, quadriceps, gluteals, hamstrings, calves, abdominals). With each exercise, perform 10 repetitions, one set, as recommended by the American College of Sports Medicine. Pick a weight amount that will make the last few repetitions very challenging. When the last few repetitions are no longer challenging, it is time to increase the weight. As with any exercise program, make sure you are using proper form to avoid injury and seek professional guidance if needed. Consult a professional before starting an exercise program if you have a specific diagnosis or restrictions. The internet provides a plethora of exercise videos to help guide you in picking exercises.
I have added strength training to my exercise program, choosing exercises that use my own body weight for resistance. Perhaps I will add bands over time. If you peer into my window in the early morning, you will see me doing squats, bridges and modified push-ups. Why? It is convenient for me, and it is important. My daughter’s many Barbie dolls cheer me on as I struggle through the last few repetitions. Will I be able to do a handstand with my daughter someday? I do not know. However, it really does not matter. It is truly the journey that makes me stronger.
Dessert ideas designed to help reduce added sugar intake while simultaneously providing a sweet treat.
After my post on sugar, many people asked if I have sweet treats in my household. Many wondered what my 5 year old daughter eats, or perhaps is allowed, for sweets. True, kids love sweets, and a child is born with a natural liking for sugar. Unlike the taste for salt, the taste for sweet does not need to be taught. As Michael Moss describes in his book, “Salt Sugar Fat” (2013) children are naturally attracted to sugar, and they have a higher “bliss point” for sugar than adults do. “Bliss point” is the exact amount of sweetness, no more, no less, that makes food and drink most enjoyable, and companies spend much money on research to determine the bliss point for their products. It is fair to say that I am very conscientious about what I serve to my family, as I view feeding my family well to be an important job. However, it is also true that I do not live in a bubble, I am not an ogre, and I have a soft heart. I enjoy a good dessert, a trip to the ice cream shop, and kettle corn at the farmer’s market. Baking with my daughter is a joy I will not give up. Here are a few strategies we use in our household to survive the dessert dilemma and keep our added daily sugar intake within (or as close to) the World Health Organizations recommendations of 24-36 grams of added sugar each day.
Make choices. At a young age, I taught my daughter that in our family we “make pickers”. Not sure why I used that term at the time, but it stuck. Everyday we make “pickers”, not only in food choices or sweet treats, but in daily activities. I engage my daughter in making choices. Should we have broccoli or cauliflower? Do you want to ride bikes or walk? Would you like to have a muffin now or dessert later? My daughter has learned that life is about making “pickers”, and we stick with the choices me make. If you chose to have your daily added sugar at breakfast, do not eat more added sugar later in the day. The choice has been made.
Water and milk only. These are the only two beverage choices available to my daughter at home. The “adult list” expands to include tea, coffee, and an occasional glass of wine or beer. No soda. Watered down fruit juice becomes an option while on vacation only. We did however, make lemonade this summer from fresh lemons brought over by a neighbor. Lessons were taught and memories made as my daughter cut and squeezed the lemons while I controlled the sugar. She added mint from the garden and raspberries . We sipped our lemonade from glass jars while enjoying a sunny afternoon on the patio.
No candy. This is an easy rule for our family. My daughter does not like chocolate. I repeat…my daughter does not like chocolate. Can you believe it? I had trouble believing it at first, but because my dad does not care for chocolate either, I knew that there were a few “unique” taste buds out there. When she was two, she was served a slice of chocolate chip zucchini bread at a family gathering. She happily grabbed the slice and ran off with the other kids. A few seconds later, I felt a tap on my shoulder. I turned around to find a small hand filled with a half eaten gooey mess shoved in my face. “I don’t like it”. It wasn’t the zucchini. It was the chocolate. How can my daughter not like chocolate? Is she my daughter? Over the past few years, she has tried chocolate on occasion, thinking perhaps her taste buds are changing as she gets older. No luck. She even tried a leaf from a chocolate basil plant recently, only to spit it out. Some would view this as a blessing. I prefer to call it a mixed blessing. Perhaps it is just my selfish side wishing my daughter liked chocolate, so I could have the experience of sharing warm chocolate chip cookies with her over a glass of ice milk.
Other types of candy are off-limits too. Halloween is a wonderful time, and we happily walked door-to-door with Snow White last year to collect treats. My husband bought all of our daughter’s candy, and she was thrilled to make some “pickers” in the toy department of Target. The opportunity to have her own money to pick out toys was enough motivation for her to give up her candy. However, she also believes that she is allergic to the dyes in candy. O.k. I have to confess. When she was young, we were heading on a long plane trip. She had a cold, so I bought a bag of gummy bears in case her ears became uncomfortable. She had some of the candy and developed a rash below her bottom lip. I know the rash had nothing to do with the few gummy bears she ate, but instead was related to her cold. However, I could not pass up this opportunity to convince her she was allergic to the dyes in candy just like other kids were allergic to peanuts. Three and a half years later, she still believes this lie, does not eat candy, and I have not been struck by lightning. I believe that sometimes it is o.k. for parents to tell a small lie when keeping their child’s best interest at heart. Right?? Agree?? Please!
Yogurt, custard or fruit for dessert. Unless it is a birthday or other special occasion, dessert options in our household include fruit, plain yogurt with healthy toppings (fruit, nuts, seeds, unsweetened coconut) or baked custard. My Mom made baked custard for the family when I was a kid. I liked mine topped with sliced bananas. This same family custard recipe has become a favorite at our dinner table. It is very low in added sugar, and I serve it in individual dishes. We each make our own “pickers” of how we would like to “dress our desert”. I try and allow my daughter to play a role in the food preparation, as she is then much more accepting of the meal, or dessert, that is served. Last night we pretended we were at a restaurant, and the dessert choices were baked custard or plain yogurt. She cut up fruit and presented the dessert in stainless cups, topped with some parsley to make things fancy. She was so proud to be serving the family, and we all enjoyed the dessert… only one mishap. The glass yogurt container slipped out of her hands and onto the tile floor. My restaurant experience was interrupted, and I cleaned up a soupy mess of yogurt and a million glass shards. No worries though. One benefit to not having ice cream for dessert: Custard doesn’t melt. Accidents happen. That is how we learn. My daughter sucked up her pride and offered to make dinner the next night.
Attach an experience to your choices. When we do have a traditional dessert such as cookies, ice cream or a piece of pie, I pick wisely and try and couple the treat with an experience such as the making of lemonade. A sweet treat has much more meaning and enjoyment when there is a memory or experience tied with it. I enjoy baking, and a good pie is a work of art. We usually start with a trip to the farmer’s market. From rolling out the dough to forming the crust and finally watching the pie cool on the counter, the entire process is a wonderful way to spend time with my daughter, and I also know exactly what is in my pie. When in the mood for a delicious pastry, we go to our favorite bakery, Pavel’s Backerei in Pacific Grove. We sit outside and people watch or take the treat to the beach. We still laugh about how the seagulls have on two occasions stolen our treat right out of our hands. We typically do not have ice cream in the house. I once had a coworker who never had treats in her house. If she really wanted a dessert, she had to bike or walk to get it. I thought this was a wonderful opportunity to be outside, exercise and experience the community. Locally, we enjoy MYO Frozen Yogurt shop. Not only can we control the portions, they have a wide range of toppings to make “pickers.” A small serving with fruit becomes a nice pit stop during a bike ride.
I admit that my family did eat more sugar in years past than we currently do. It has been a gradual process of reducing added sugar in our diet and arriving at the diet we have today. We do not deprive ourselves of sugar. We are conscientious and over time have gotten used to a reduced amount of added sugar. Our “bliss point” has altered, and our perception of sweetness has changed. My daughter returned from an end of the school year celebration in early June, and when I asked her how the cupcakes were, she said, “The cake part was good, but the frosting was just too sweet.” Wow. Could you say that again? My heart skipped a happy beat knowing that my work has paid off and even a kid’s perception of sweetness can change.
The desert dilemma is no longer a dilemma in our household. Our sweet tooth is happy, and I have successfully worked sweetness into our diet in a controlled, healthy fashion. I write this while sipping a vanilla latte from a nearby coffee shop. Yes, it does have added sugar. I made a “picker” as to how I will spend my sugar allowance today. How sweet it is.
Why is back pain so common and what can be done to reduce your risk.
Driving through California’s central valley on the way to a recent camping trip, I couldn’t help but notice the fields of fruits and vegetables. The green plants were such a stark contrast to the golden hills. I also couldn’t miss the field workers, dozens of workers with large hats and layers of clothing to protect from the sun. What struck me was their posture. Bent over arched backs with straight knees, reminiscent of an angry cat. How can they hunch over for hours on end picking berries? My back started to ache just thinking about it. I decided I had to try for myself. The following weekend I planned to go strawberry picking. I would use my therapy knowledge and see if I could protect my back.
The next Saturday morning, just as the fog was rolling back to the coast, my daughter and I drove into High Ground Organic farm in Watsonville, California, the strawberry capital. As we parked the car, I noticed a group of berry pickers taking a break on the edge of the field with their coolers open. They were sitting on a dirt mound hunched forward with their elbows on their knees for support. Although only 10:00 in the morning, they had likely been picking for a few hours already. They looked tired. We jumped out of the car full of energy with visions of strawberry jam and shortcake in our heads.
After just 10 minutes of picking, my back ached. I quickly understood why among crop workers strawberry picking is known as “la fruta del diablo’ (the devil’s fruit). I tried to squat and use good posture, everything I recommend to patients, but it just wasn’t productive. Intuitively, I knew that a hunched forward, bent down posture was not good for my back, but I realized this is the only productive way for a true berry picker to pick. Squatting to pick berries, standing up, moving forward and squatting again is just not productive, especially if you are getting paid by the amount of berries picked. I wondered how many field workers suffer from back pain due to maintaining sustained poor postures for such a long period of time. Given that 80% of American adults experience low back pain at some point in their lives, as reported by the National Institute of Neurological Disorders, and back pain is the leading cause of disability in Americans under the age of 45 years old (American Academy of Pain Medicine), I was sure that field workers suffer greatly from low back pain. Why is low back pain so prevalent not only among field workers but among our population as a whole?
First a little anatomy lesson. The back is composed of bones, called vertebrae. The vertebrae are stacked together to form three curves, one at the neck, one in the upper back and the final curve in the low back. The neck and the low back curve are designed to curve inward, while the upper back curve is designed to curve outward. The lowest five vertebrae collectively form the lumbar region. Disks, which can be simply thought of as jelly filled balloons, are located between each vertebrae and provide cushioning and shock absorption. Ligaments are the tape that attaches each vertebrae to the next. Nerves exit the spine through spaces in this vertebral column and provide sensation and motor movement to the limbs. Both abdominal and back muscles form the breading that holds the entire “back sandwich” together. When the three back curves are happy, the nerves have room to exit the spinal column without getting pinched, the jelly filled discs tend not to bulge, compressive forces on the joints are reduced and muscle pull on the vertebral column is balanced. When the three back curves are in balance and not too large or too flat, everyone is happy, including you. Problems occur when these natural back curves change, either becoming too large, or too flat and thus putting stress on the discs, joints, muscles and nerves. Back pain is now inevitable. It is a vicious cycle, and unless balance is restored, back pain will likely continue. Most back pain is not due to a single injury but instead due to years of poor posture, excessive sitting, poor movement patterns and general wear and tear.
As humans, we were not designed to sit so much. A sedentary lifestyle contributes to musculoskeletal pain, inflammation and weakness. Slouching in our favorite recliner or on the couch is common in our society and may feel comfortable in the short term. However, this poor sitting posture is not your back’s best friend in the long run. Try this experiment: Sit in your favorite comfy chair or couch and then slide your bottom forward to assume a slouching position, what many would view as comfortable. Notice how your low back curve just disappeared. Now slide back to the rear of the chair and notice how your low back tried to regain a natural curve. Slouching in a chair results in the loss of the low back curve and therefore places increased stress on the back. On the other hand, even with good posture and back support, excessive sitting often results in tightness of the hip muscles and leads to an excessive low back curve.
The back and supporting musculature are not created for maintaining sustained poor postures for long periods of time. Back muscles are relatively small in comparison to the the larger leg muscles such as the glutes and quadriceps. The general advice to lift with your legs and not your back is truly important as back muscles are not large enough or strong enough for heavy lifting or prolonged stress. Back muscles will naturally try and maintain the three spinal curves. However, these muscles eventually fatigue and weaken. The spinal curves are lost.
Perhaps a warm shower may take care of short term back pain caused by a morning of strawberry picking or an afternoon of slouching in the movie theater, but what can you do to decrease your risk of future back pain? The following simple recommendations may go a long way.
- Keep the curves! Maintaining three balanced back curves (not too big, not too flat) will go along way in protecting your back. If you have lost your natural back curves, try to restore the curves. In daily activities, think about the three natural spinal curves and provide support to these curves as needed. Lumbar and cervical pillows are designed to maintain spinal curves while letting the supportive muscles relax.
- Be mindful of your sitting posture. When working at a desk, sit at the back of the chair and pull the chair as close to the desk as possible. Sitting forward to view a computer monitor or read places significant stress on the low back.
- Move often! The more the better.
- Exercise. Be consistent with an exercise program that includes both flexibility and strength building exercises. Focus on abdominal, back and leg strength building. The stronger your legs, the greater the likelihood of lifting properly and thus reducing stress on the small back muscles.
- Be conscious of weight gain, especially excess abdominal fat. Excess weight places increased, unbalanced stress on the joints of the back.
After my morning of berry picking followed by some ibuprofen, I had a greater respect for the stress and strain field workers place on their bodies. I had a greater appreciation for the back as I enjoyed my strawberry jam. Sometimes in life we do not have choices. However, for many including myself, we have the choice of how we take care of our backs. Good choices today will pay off in the future.