Flabby, Inflexible, and Stagnant: How Aging Happens and What to Do About it

There is a saying about aging in Chinese Medicine: “Yang to yang and yin to yin.” To understand this, you must first know that the terms yin and yang have many definitions. They are qualities that can be used to describe all things in the universe, and they lie at opposite ends of a spectrum. Yang can refer to the exterior or surface of something, it can also mean excess, full, hot, dry, or rigid. Yin can refer to the interior, and it can also mean deficient, empty, soft, cold, moist or yielding.

“Yang to yang and yin to yin,” explains what tends to happen to the body as we get old. Yang to yang means the exterior or surface of the body (the muscles and connective tissue) becomes hard, dry, and inflexible. Meanwhile, yin to yin means the interior of the body tends to simultaneously become weak, deficient and flabby. So, we end up brittle and rigid on the outside with a soft, chewy center. What a poetic way of describing a thoroughly undesirable condition.

How can we avoid becoming like deep fried Twinkies? Well, of course aging isn’t quite as simple as developing a crispy outside with frosting in the middle, so let’s take a more detailed look at this process and some of the strategies we can take to slow it or reverse it. We’ll start with the skin.

Our skin, despite being our surface (yang), doesn’t necessarily get hard (yang). But this is a common phenomenon in the feet and lower legs, and it often goes along with diminished circulation. I have treated hundreds of older patients who have lower legs and feet that are both hard and purplish. Lotion might help a little, but the issue is deeper. Better overall circulation is the key. Frequently, this condition goes along with diabetes, where circulation is impeded by high sugar content in the blood, and stiff, thickened, and damaged blood vessels. The most valuable intervention you can make in such a case is to get back to your normal body weight, primarily by cutting out all sugars and exercising more.

Elsewhere in the body, the skin tends to become loose, soft, and wrinkly. The wrinkly part is relatively “yang” in its origin, since facial wrinkles stem from the tightening of the muscles beneath. For this reason, making the muscles soft by paralyzing them with botox erases wrinkles. A more holistic (though admittedly less dramatic) approach would be to cultivate a serene state of mind. One might say that if you’re happy and you know it, then your face will surely show it. Hmm. That’s catchy. Of course, not all wrinkles come from stress and frowning. Smile wrinkles are, in my opinion, worth cultivating. And if you’re happy and serene, you just won’t care about them.

So, you have your homework until next time: become serene, stop eating sugar, and exercise more. We’ll revisit this topic in next week’s article, where I’ll have more insights into the aging process and more easy things you can do to age gracefully.

PART TWO

Last time, I introduced a saying from Chinese Medicine: “Yang to Yang and Yin to Yin.” Yang refers to the exterior or surface of something, and it can also mean excess, full, hot, dry, or rigid. Yin refers to the interior, and it can also mean deficient, empty, soft, cold, moist or yielding. So, “Yang to yang and yin to yin,” explains what tends to happen to the body as we get old. The surface of the body (the muscles and connective tissue) becomes hard, dry, and inflexible, while the interior of the body tends to simultaneously become weak, deficient and flabby.

There are many ways to interpret this, and many steps that can be taken to deal with it. I began by discussing the how the aging process affects the skin, and we’ll continue that discussion this time.

The loose and soft quality our skin develops as we age doesn’t quite fit with my earlier interpretation of “yang” (surface) as inflexible, but it is indicative of a deeper yang quality of dryness. Actually, this dryness is a condition of relative “yangness,” that is more importantly a symptom of diminishing yin.

What I mean is that the term yin also refers to the vital moisture of the body, which makes us pliable, resilient, and well-lubricated. The skin’s loss of elasticity can be understood as an expression of the decline of this vital moisture (specifically in the form of collagen, a protein that plumps and elasticizes our skin). As with the hardening of skin in certain areas (lower legs and feet especially), lotion isn’t going to be a total solution. But in the case of loose, saggy, wrinkly skin, it can be of considerable benefit. The key is to start early in life, when the skin is still youthful. Find a good, all natural lotion that your skin seems to like, and use it at least once every day.

Our skin is much more permeable than we give it credit for, and regular use of a high quality lotion with beneficial oils in it can nourish the underlying tissues in a way that makes a lasting difference in our skin tone. Besides putting good fats into the surface of your body, you’ll get even more benefit by actually consuming them. Don’t eat lotion. I repeat: do not eat lotion. Instead, eat plenty of “good fats” like oily fish and fish oil, walnuts, almonds, macadamias, hemp seed, chia seed, flax seed, avocados, olive oil, omega-3 eggs (the yolks specifically) from free range chickens, and coconut.

In addition, our skin is quite responsive to our overall hydration. A dry body will have looser, drier skin. If you pinch up some skin on the back of your forearm (a few inches up from the back of your wrist) and it doesn’t immediately return to its previous flat state when you let it go, you’re really dehydrated. (By the way, this is not at all the only sign of dehydration. You could be dehydrated even if your skin doesn’t show it.) I generally prescribe half the number of pounds you weigh as ounces of room temperature water each day. For instance, a 100 pound person would drink 50 ounces a day. And this should ideally be consumed in small amounts, spread out over the course of the day.

Finally, protect your skin from the elements. I don’t think people should avoid the sun, since it’s a great source of vitamin D and wonderful for our spirits, but I do think it’s important to avoid sun damage. Avoid getting burnt at all costs. Get a high quality sun screen – ideally one that contains nourishing oils and that is mineral-based, such as zinc oxide or titanium oxide – and use it. If you’re prone to burning, take the natural supplement called astaxanthin (it’s a pigment related to beta carotene, and it may reduce your tendency to burn). After a day in the sun, wind, or dry air (including air travel), always drink extra water and put on some lotion.

If you follow these recommendations, you’ll not only stay beautiful for longer, you’ll reap some deeper health benefits as well!

PART THREE

Previously, we looked at how our skin is affected by this process. Now let’s look at what happens to our muscles. When I said above that the muscles can get “hard,” I unfortunately didn’t mean in the toned, “hard body” kind of way. I mean that they have a greater tendency to go into spasm, to lock up, to shorten and become less elastic and less responsive.

We mainly experience this hardness by feeling more aches and pains, more soreness after exertion, a greater tendency for the back (or another area) to “go out,” more difficulty touching our toes, reaching behind the back, or doing other things that require flexibility. But the internal and external changes aren’t quite as black and white as the saying implies. Because of the diminished tone of the interior (i.e., our organs), we tend to become malnourished with age (that is, we get less effective at absorbing the nutrients in the food we eat) and this results in a loss of muscle mass. The reduced muscle mass combined with diminished flexibility means we lose strength.

In addition to the straightforward aches and pains, there is a tricky secondary form of pain that often occurs from the dryness and tightness of aging muscle. Muscles frequently develop regions of irritation that refer pain deeper into the body. This is called “somato-visceral” pain, meaning it originates in the somatic (muscular) region of the body and radiates into the “visceral” (organ) region. This pain (and other forms of dysfunction) can appear to be due to an organ problem, and may mistakenly be treated as such by a doctor who fails to investigate the possibly of a muscular origin. Chest pains, for instance, are commonly diagnosed as a heart problem (angina) and treated with medication, when they may actually be referred from the pectoral muscles of the chest, the muscles of the front of the neck, or the muscles of the upper back. It is important to see a practitioner who is familiar with such patterns.

There are three main ways to fight this progression toward unhealthy muscle. (1) Body work – acupuncture, massage, rolfing, etc. (2) Stretching (3) Exercise.

Stretching is essential. Although it was twenty years ago, I’ll never forget something my first yoga teacher told me: “You are as young as you are flexible.” And speaking of yoga, yoga is absolutely the best way to remain flexible. I say this not because I think there aren’t equally effective ways to stretch the body, but because you will get so much more out of a good yoga class than just the stretching aspect. You’ll breathe deeply, you’ll relax, you’ll get stronger, and you’ll become more focused and peaceful.

As for the exercise, yoga can also be an excellent way to get strong, too. However, not every yoga class is equal in this regard, particularly since strength building is not expressly a goal of traditional yoga. So, take your pick from among the many ways to get strong. You can do weight training using machines, free weights, or bands (I recommend working with a knowledgeable trainer, at least in the beginning, who can teach you good form). You can do body-weight-based compound exercises, such as squats, pushups, pull-ups, dips, deep lunges, etc. (again, I recommend working with a knowledgeable trainer, at least in the beginning, who can teach you good form). You can do tai ji quan – AKA “tai chi” – or another martial art (again, I recommend working with a knowledgeable teacher; if you’re not sweating and working all your muscles, you’re not doing traditional tai ji quan). And, of course, there are other forms of exercise to keep your muscles strong. It should be weight bearing, so that it also enhances your balance and supports bone strength.

Next time we’ll look at some of the nutritional measures we can take to keep our muscles healthy. In the meantime, like Olivia Newton John says, let’s get physical.

PART FOUR

Last time I wrote about the main things we all should do to keep our muscles in good shape as we get older (therapeutic body work, stretching, and exercise). Now, let’s look at some of the internal measures we can take for lifelong muscular health.

A number of degenerative changes happen to our muscles as we age. We get injured and muscles remain semi-damaged. We develop myofascial trigger points – regions of irritation and shortening in muscles that cause them to become taut, less flexible, weaker, and to produce (often complex) pain patterns. We lose muscle mass – a process called sarcopenia. Muscle loss is estimated at 0.5% to 1% per year after the age of 25. (This is an average, of course – if you start weight training in your 20s or later, you might actually increase your muscle mass.) The process really kicks in during our 40s and 50s. Muscles not only get smaller, but the quality of our muscle also declines. This is due to the infiltration of muscle with fat, hardening (development of scar tissue) in muscle, changes in muscle metabolism, oxidative stress (the primary aging mechanism, and the reason why anti-oxidants are so valuable), degeneration where nerves enter muscles, and more.

Before I continue, let me reiterate that the single most valuable intervention one can make to thwart this degenerative process is . . . (drumroll) . . . exercise. We all should be exercising on a daily basis (one day off per week is fine), and this should include a mix of weight training and aerobic movement. This is a vital practice even if you have no interest in big muscles. The primary goal should be simply to maintain health, functionality, and independence as we age. With a modest exercise practice, just about everyone should be able to continue to carry their own groceries and clean their house until nearly the end of life.

Now, what else can be done?

Essential fatty acids: Due to the unfortunately short-sighted recommendations of the American Dietary Association and others, many Americans are still programmed to thing that dietary fat equals body fat. But, as can be plainly seen by the disturbing upward trend in obesity while we’ve simultaneously gone low-fat, this thinking is just plain wrong. Essential fats are just like they sound – essential. A preliminary study in Scotland showed a decrease in muscle loss in women who supplemented with essential fats. Essential fats are required in the creation of every cell! Also, they help reduce inflammation, which is a culprit in muscle wasting. Get good fats from things like oily fish (salmon, cod, tuna [no more than twice a week with the tuna]), chai seed (easy to throw into a smoothie), flax seed (grind it right before using, and don’t cook it), avocados, coconut, hemp seed, pumpkin seed, walnuts, almonds, and omega-3 eggs.

Protein: Protein is essential for muscle production. Make sure to eat modest amounts several times a day. Four ounces of high quality protein (lean meat, fish, organic whey, non-fat hormone-free Greek yogurt, egg whites) or somewhat larger amounts of beans, rice protein, and organic (non-GMO) soy, three to five times a day, is usually sufficient. However, with protein consumption, the issue isn’t just eating it, but actually digesting it.

There is a major impediment to digesting protein as we get older: decline in stomach acid. We need a highly acidic stomach to start the protein digestion process. Like a vat of acid. But there is a natural decline in acid production as we age, and, even worse, many people are on acid-blocking drugs to manage acid-reflux.

If you’re on acid-blocking drugs, I highly encourage you to start working with a naturally-oriented doctor who can help you get off of them. Stomach acid is not intrinsically bad. The problem with reflux is only that the acid is ending up in the wrong place (the esophagus instead of the stomach). A holistic (meaning, respecting the health of the whole individual) fix for acid-reflux is not to stop stomach acid production or neutralize it, but to simply keep it where it belongs. There are ways to do this. Besides actually repairing the real problem instead of covering it with a band-aid, when you have healthy amounts of stomach acid, you’ll be actually breaking down your food and absorbing nutrients more efficiently and you’ll feel better!

Besides protein, another major class of nutrient that is highly depending upon an acidic stomach to be absorbed is minerals. Low stomach acid is a nearly epidemic problem in our elderly population (part of the yin to yin facet of the saying, which we’ll explore more later), so it is important to address this. You can work with a naturally-oriented healthcare provider to test your stomach’s acidity. Many people find that simply taking some apple cider vinegar (with the “mother”) at the beginning of meals makes a big difference. Others may need to take a stronger acid, called betaine hydrochloride.

There’s more to come, my friends. Let’s not be dragged kicking and screaming into our elder years, but accept that there are certain biological trends that are bound to occur. We should accept them, while simultaneously doing everything reasonable to keep our bodies youthful.

PART FIVE

A big part of why so many of us start to get more aches, arthritis, chronic back pain, stiffness, and all the other quirks of a . . . how shall I say it? . . . a mature body, can be explained by the Chinese medical saying, Yang to Yang and Yin to Yin. As I explained more thoroughly in the previous installments of this article (you can’t start with part one here), as we get older, the exterior of the body – the connective tissue (muscles, skin, fascia, joints) – tends to become dryer, less flexible, less resilient, and sometimes hard (not the strong kind of hard, the rigid kind of hard). Meanwhile, the internal organs tend to get weak and flaccid.

In parts two and three, I discussed how the skin is affected by this process – and what you can do about it. In parts three and four, I discussed how the muscles are affected by this process – specifically the process of sarcopenia, the muscle loss that occurs with aging, and how to fight it. Besides the athletic and dietary recommendations I gave, there are a few more factors worth discussing.

Hormones: As we age, levels of the hormones DHEA, human growth hormone (HGH) and testosterone tend to decline. In men with a confirmed deficiency of testosterone, supplementation can improve lean muscle mass (as well as energy, libido, mood, and cognitive function). Although women produce much less testosterone than men do, low testosterone can still be detrimental – diminishing libido, energy, and mood. Generally, I’m not a huge fan of hormone therapy, but I have seen small doses of testosterone sometimes make a dramatic difference in a person’s overall wellbeing. If you’re interested in having testosterone testing, I strongly recommend going through a naturally-oriented physician. Testosterone should only be prescribed in its natural (“bio-identical”) form.

There may be similar benefits to taking supplemental DHEA when tests indicate we have too little, although it is a significantly weaker hormone than testosterone in this regard. (I have, however, seen DHEA affect energy levels and immune function when it was needed.) Finally, HGH has gotten a lot of press in recent years due to its use by athletes (which is now banned in many sports). It stimulates muscle and bone growth, immune function, breakdown of fat and many other processes. It seems natural to consider it as an anti-aging drug, but many medical experts consider it too big of a wildcard – due to its very broad and complex effects on the body – to advocate its use by everyone who wants to be more lean, muscular, and energetic (which is just about everyone). However, lifestyle factors that enhance our own production of HGH are safe and worthwhile. HGH levels can be elevated by vigorous exercise. In particular, interval training, or more specifically “high intensity interval training” has been shown to deliver impressive benefits in terms of fat burning and cardiovascular enhancement – plus big increases in HGH. One more reason to exercise.

Deep sleep also enhances HGH production. The quantity of time we spend in bed is less significant than the quality – depth – of sleep we are able to achieve. Individuals with sleep disorders, particularly sleep apnea – which hinders deep sleep, tend to weigh more, have less energy, and have diminished mental focus, and the HGH factor may be part of the equation.

Fasting also increases growth hormone production. It’s not exactly realistic to do long term fasts with the hope of increasing muscle mass, but the occasional fast is probably good for virtually everyone. Conversely, high blood sugar (and increased levels of the hormone insulin as part of a condition known as insulin resistance, where our cells become insensitive to insulin and don’t readily take up sugar from the blood) decreases growth hormone production. There are lots of other reasons to avoid high blood sugar – most specifically that it is a precursor to or sign of diabetes. So, avoid simple carbohydrates (refined grains, flour, and sweet things) and keep up with good fats and regular modest servings of high quality protein. Losing excess fat, particularly in the abdomen, can also contribute to more growth hormone secretion.

Certain supplements may enhance our native HGH production. HGH may increased through supplemental vitamin B3 (niacin), although there is only one study reviewing this correlation. The amino acid l-glutamine (in rather high doses) may elevate HGH levels, although I do not recommend using large amounts of it for more than about a week at a time. Another nutrient called choline also appears to enhance HGH levels. Health enthusiasts have long taken soy lecithin as a source of choline (which occurs in the form phosphatidyl choline), but there are two much better forms for cognitive function and growth hormone enhancement: the first is called CDP-choline or citicholine, and the second is called alpha-GPC. Both are available through the supplement manufacturer Jarrow, and others. Please speak with your medical provider before beginning a new dietary supplement regimen.

Statins: If you take a cholesterol lowering drug in the statin family (which is most of them), you should know that, among their wide range of potential side effects, is the risk of muscle weakness and wasting. If you have experienced a notable loss of muscle and/or muscle aches, cramps, weakness, or soreness since being on cholesterol medication, this is worth discussing ASAP with your doctor. Also, everyone on statin drugs should take a supplement called coenzyme Q10, which is depleted by these drugs. If you’re over 40, the best form of Co-Q10 to take is called ubiquinol. Look for it by name.

PART SIX

Here’s a quick review and some additional notes on the Yang to Yang part of the equation before we get to Yin to Yin. As the Yang (surface) becomes more Yang (rigid, dry) and less Yin (flexible, resilient, moist), the skin loses its tone, elasticity, and moisture. Muscles get dry, taut, weak, and inflexible. Joints become crunchy, rigid, dry, and inflamed. Muscle and joint pain is increasingly common. In addition, our eyes tend to become dryer, with a less pliable lens (making vision decline) and sometimes increased pressure (glaucoma). Our nails tend to become dryer, more brittle, and ridged. Our hair dries, breaks, splits, and loses its pigment.

As I explained previously, the terms yin and yang have many meanings, both positive and negative. In the positive, yang can refer to strength, movement, warmth, and energy. When it’s used to describe imbalance, it can mean dry, inflamed, and tight. In the positive, yin can refer to vital moisture and lubrication, luster, elasticity, and flexibility. When it’s used to describe imbalance, it can mean deficient, weak, cold, flabby, and congested. Are you still with me?

So, as the surface of the body becomes more yang (imbalanced) with aging – meaning dry and tight – there is a simultaneous deficiency of the positive qualities of yin (moist, flexible, and resilient). With the internal body, as it becomes yin (imbalanced) – meaning weak, sluggish, and congested – there is a simultaneous deficiency of the positive qualities of yang (energetic, active, firm, and strong).

As we age, we need to look as both sides of these coins. The “too yin” side of the coin here is that our organs tend to become less efficient with age. Digestive movement and efficiency usually becomes slower, we usually produce less stomach acid and pancreatic enzymes (the juices that break food down into its elemental components), the heart pumps with less power, the lungs are less efficient at taking in oxygen, the liver is less efficient at breaking down toxins, the kidneys are less efficient at filtering blood. It’s not necessarily all of these for every person, but almost always, as we get into our 40s (though perhaps not until our 60s or 70s) we begin to experience some decline in organ efficiency. These processes can be understood not just as a progression toward yin, but also as a decline of yang.

Meanwhile, the other facet of “too yin” is the accumulation of gunk in our bodies. In Chinese Medicine, this gunk (“yin accumulation”) falls under the heading of dampness or phlegm, and it’s stuff we don’t need – such as excess body fat, mucus, cholesterol deposits in our blood vessels, and even the phlegm-like amyloid plaques and neurofibrillary tangles of Alzheimer’s disease.

The two main strategies for combating this trend are to avoid/eliminate the accumulation of (negative) yin and to strengthen the (positive) internal yang. First, let’s talk about keeping our yang strong. As with the tone of the surface, exercise is again exceedingly beneficial. Just as it strengthens our muscles, it keeps our organs in good shape, twisting them, shaking them, flushing them of debris, and infusing them with plenty of fresh blood. Tai chi (real tai chi, which should be a demanding workout, not just a bunch of easy, flowing movements) is especially valuable because there is a component of it (nei kung, meaning “internal work”) that specifically focuses on building energy and coordinating and connecting all the parts of the body. Traditional yoga also has deeper benefits than simple improvement in muscle tone.

You can also keep yang strong by eating a high quality diet, including mostly vegetables, a modest amount of lean protein with each meal, plenty of good fats (almonds, olive oil, avocado, oily fish, walnuts, fenugreek seed, omega-3 eggs, chia seed, virgin coconut oil, etc.), and as little flour-containing products, sweeteners, and processed food as possible. Homemade soups are great, and if you eat meat, you can use marrow bones to make a bone broth as the base. Consume plenty of spices, such as basil, rosemary, fennel, fenugreek, clove, chive, horseradish (wasabi), ginger, garlic, clove, cinnamon, and cayenne (I think cayenne is best added after cooking the food).

The other facet of maintaining internal youthfulness – avoiding the accumulation of yin (gunk) – is also integral to preserving the vigor of our yang. We’ll discuss this more thoroughly next time.

PART SEVEN

As I explained last time, the progression of the internal body toward weakness and congestion can be understood as the result of two processes: the decline of vital Yang (metabolic rate, circulation, organ efficiency, sex hormones) and the accumulation of harmful Yin (fat, mucus, arterial and neural plaques, and other “gunk.”) In part six, I explained some strategies for keeping Yang strong: exercise and eating well. There are a few more to mention before I get into dealing with harmful Yin.

The decline of Yang is simply part of getting older – the body wears out. This process is worsened by the accumulation of harmful Yin, over-stressing the body and mind, underworking the body (insufficient exercise), eating poorly, and, in men, excessive ejaculation. By over-stressing the body, I mean working too hard (either physically or mentally) in proportion to the amount of rest and leisure time we take: thinking about work all the time, not getting enough sleep, using stimulants (caffeine is the main one) to get more energy out of the body, not playing, being anxious, etc. You know what I mean – the stuff that feels bad. It consumes vital Yang beyond our capacity to replenish it.

As for excessive ejaculation, this is a really foreign concept to most Americans, but something that most men can get a firsthand experience of pretty readily. As with other organisms, the human body devotes a lot of energy into producing “seed” (i.e., semen) in order to reproduce itself. In the process of ejaculation, everything momentarily shuts down, following which most men are notably tired. It doesn’t take a rocket scientist to deduce that doing this frequently demands a certain cost in biological energy. In their teenage years, boys can usually get away with ejaculating daily, since their bodies are flooded with hormones, but classical Chinese texts advise that as men get older, they should ejaculate less and less often.

If men wish to continue to have frequent sex (which is good for our health), one solution is to learn to withhold ejaculation – which does not mean avoiding orgasm. Again, there is close to zero familiarity with this concept among American men, but there are some good resources available for the curious, the most popular of which are the books by Mantak Chia – in particular, The Multi-Orgasmic Man. That doesn’t sound too unpleasant, does it? The originators of these techniques were ancient Daoists who believed that limiting ejaculation was a way to prolong one’s life.

This also means reducing one’s frequency of masturbation – or, again, withholding ejaculation (something that is a bit harder for men to fathom when there’s not a partner involved). Most of the time we hear that we should be masturbating less, it’s coming from a conservative, religious source. I definitely do not want to push any of your sin buttons; I’m coming at this entirely from a health perspective. And I don’t want to imply that masturbation or ejaculation are bad. (In fact, semi-regular ejaculation is probably good for men’s prostates.) I only wish to put out there that many athletes, performers, and of course, the Daoist progenitors of Chinese Medicine, have recognized that some energy is lost is the act. If you’re unconvinced (and you’re a man), try working out one day after having ejaculated and see how your strength and stamina compare to a usual workout.

Now for preventing and dealing with the accumulation of harmful Yin. First and foremost: it is much easier to avoid accumulating gunk in the first place than it is to get rid of it. This harmful Yin, which is classified as a form of “retained dampness” or “phlegm” in Chinese Medicine, is considered to be sticky and tenacious. It is difficult to break down and expel from the body. If you’re overweight, you have probably already had a firsthand experience of this.

There are many reasons why we’re gaining more weight, faster than ever before in human history. Rather than going into all of them here, I’m just going to focus on the big ones. Here they are:

Generally speaking, we are less active than we have ever been before. (One more vote for exercise.)
We eat more food than ever before – portion sizes in restaurants and prepared foods are bigger, and food shortages in the developed world are rare.
We eat more sugar than ever before – an average of nearly a half pound per person per day in the U.S. – much of it in the especially harmful form of high fructose corn syrup.
In general, we sleep less, use more stimulants, and are more stressed than ever before (stress hormones and sleep deprivation contribute to weight gain).
We are exposed to new chemicals (plastics, pesticides, synthetic fibers, etc.) that disrupt our endocrine system (hormones) in a way that may throw off our metabolism.
With modern heating and cooling technologies and increasingly good winter and summer gear (even heated clothing and shirts that become cooler when activated with sweat!) we now live almost entirely in thermo-neutral environments (i.e., around 65 to 75 degrees) – and rarely get exposed to extremes of heat and cold which would stimulate our metabolism.
With changes in lifestyles including things like our work routines, office environments, and children’s activities, it’s less and less common for people to have a regimented eating schedule of sitting down for three meals a day, and more common for snack continuously throughout the day, to gobble down meals whenever we can snag a few minutes, and to eat while engaged in other activities.

Looking at that list, you can see that, in order to disrupt the alarming obesity trend, we have our work cut out for us. It’s not so daunting on an individual level, but we really need some big changes on a cultural level. Why not take your time with your next meal? Sit down, turn off your electronics, put away the newspaper, and just savor it.

PART EIGHT

Last time I talked about the main factors involved in excessive weight gain. Now let’s look at some of the other ways internal congestion occurs and how we can prevent it. As Traditional Chinese Medicine (TCM) sees it, many of the problems of aging are due to poor circulation – or, in TCM language, blood stasis or blood stagnation. Whether they know it or not, many biomedical doctors treat blood stasis all the time. All cardiovascular disease, the leading cause of death in the United States, amounts to insufficient blood movement – whether it’s due to blockage of vessels by plaques, hardening of vessels, clots, weakening of the heart, etc. A heart attack is due to impeded flow of blood to the heart muscle itself. The third leading cause of death – stroke – could also be considered a vascular disease, since it’s a matter of insufficient blood flow to the brain.

Biomedical doctors treat their versions of blood stasis mainly with cholesterol lowering drugs (the most popular of which are statins), blood pressure lowering drugs (including beta blockers, ACE inhibitors, diuretics, and others), blood sugar lowering drugs (such as metformin and insulin), and anti-clotting drugs (the most popular of which is Coumadin). While I will allow that these substances sometimes have a place in holistic and ethical medical care, they are hugely over-prescribed. If you’re on any of these drugs, please don’t change anything without talking to your doctor.

There are many natural interventions that can improve circulation, and I’ll discuss a few here. The first is fish oil. Fish oil seems to make blood cells more “slippery” and less prone to clumping. It helps prevent clots from forming, slows the buildup of atherosclerotic plaques, lowers triglycerides, modestly lowers blood pressure, and reduces the risk of heart attack, stroke, and death in those with diagnosed cardiovascular disease.

There are two caveats for using fish oil. One, in very high doses over a long period of time, like the blood thinner, Coumadin (Warfarin), fish oil may increase the risk of brain hemorrhage (bleeding) if a stroke does occur. For most people, one tablespoon of fish oil morning and night is safe and effective. (It’s not easy to get a therapeutic dose using soft gels, unless you like swallowing lots of pills – like 10 to 30 a day.) Two, fish oil can contain dangerous pollutants, like pesticides and heavy metals. Only use the stuff that has been independently tested for contaminants. I like Carlson’s and Nordic Naturals. Fish oil should be combined with vitamin E, which also has some blood thinning effect. Look for a brand that lists “mixed tocopherols” on the label, and always choose the “d-“ form of vitamin E, not “dl-“, which is synthetic and less effective.

When it comes to cholesterol, the conversation isn’t nearly as straightforward as many conventional doctors want to make it. Cholesterol-lowering drugs certainly lower cholesterol, but they haven’t been shown to be useful for nearly the wide range of scenarios in which they are now prescribed. And they have risks, including elevating our chances of developing type 2 diabetes, developing muscle wasting and weakness, and causing flu-like symptoms.

If you’re on a statin, you should take the nutrient coenzyme-Q10 (“Co-Q10”), which is integral in energy production and an important anti-oxidant, but is depleted by the use of statin drugs. 100 to 200 mg a day is usualy adequate. Meanwhile, cut way down on sweeteners, since sugar is a major contributor to inflammation (one response to which may be cholesterol deposition in our vessels) and the production of triglycerides. Your doctor may agree to let you try the Chinese herb red yeasted rice, which is a natural source of the cholesterol drug, lovastatin. The main differences between using red yeasted rice versus a statin are that people who get bad side effects from statins generally have minimal to zero side effects from red yeasted rice. Second, a smaller dose of naturally-occurring lovastatin in red yeasted rice gets the job done as well as a larger dose of a statin drug, indicating that there may be some synergistic effect between the various other compounds that occur in red yeasted rice.

Next time we’ll continue the conversation on staying vital and keeping your vessels in good shape. Meanwhile, let me once again plug exercise. I’m sure you’re not surprised that, for cardiovascular health, it’s of great value – hence the portion of exercise we now refer to simply as “cardio.”

PART NINE

Continuing our discussion on circulation and cholesterol, I’d like to offer several additional non-pharmaceutical interventions that help favorably improve your cholesterol profile.

Dietary fiber (soluble fiber, found in large quantities in pears, apples, nuts, seeds, konjac, beans, lentils, oats, and most other fruits and vegetables) lowers LDL (“bad” cholesterol) and raises HDL (“good” cholesterol).
Quitting smoking raises HDL, improves circulation, and significantly lowers overall cardiovascular risk.
Exercise improves your overall cholesterol profile and greatly enhances cardiovascular health.
Drinking small amounts of alcohol (a few ounces a few times a week) raises HDL and protects against hardening of blood vessels. Alcohol is understood in Traditional Chinese Medicine as having the property of enhancing blood circulation; herbs that are used to improve circulation are frequently prepared by soaking them in wine to enhance this effect.
Avoid consuming trans fats (these occur mostly in hydrogenated and especially partially-hydrogenated oils and in deep fried foods in general), which lower HDL and raise LDL. They contribute to heart disease, stroke, and diabetes.
On the other hand, certain beneficial fats, such as olive oil, coconut oil, avocado, fish oil, and flax oil, raise HDL.
Avoid sugars and flour. They are a major contributor to triglyceride production, vascular inflammation, and obesity.
Lose weight if you’re overweight. Even modest weight loss is associated with a favorable improvement in blood lipids.
The amino acid taurine lowers cholesterol and benefits heart muscle.
Garlic mildly lowers total cholesterol and LDL, reduces inflammation, inhibits clot formation, kills a variety of microorganisms, and tastes good in all kinds of food.
The herb guggul (a relative of myrrh) lowers cholesterol and triglycerides and has strong antioxidant properties.
The herb hawthorn has a variety of benefits to cardiovascular health, including reducing the deposition of cholesterol in blood vessel walls, lowering blood pressure, and improving the heart’s rhythm and the strength of its contractions.

From all that I’ve written thus far, it would seem that I support the idea that high cholesterol is a useful indicator of cardiovascular risk, but I think this is an over-simplification of the role of cholesterol. Total cholesterol tells us nothing useful about a person’s risk of heart disease. A more useful indicator is the ratio of your triglycerides to your HDL (“good” cholesterol) – the lower the better, meaning your triglycerides should be low and your HDL should be high. A ratio of 2 or lower is best. Above, I mentioned numerous lifestyle choices that can help raise HDL. The best way to keep triglycerides low is to AVOID SUGAR (by which, I mean all caloric sweeteners). Not only does sugar turn into triglycerides, it promotes inflammation – a much more important indicator of cardiovascular and other health risks.

Inflammation in blood vessels is the key to cholesterol getting deposited there and forming plaques. But not all cholesterol can do this – only small, dense, oxidized particles of LDL cholesterol contribute to this process. Therefore, a general test to indicate the presence of inflammation, called the CRP (C-reactive protein) test, and a more specific cholesterol test to determine the particle sizes of your blood cholesterol are much more useful. Make sure you’ve had these tests before allowing your doctor to put you on cholesterol lowering drugs. And even if they have ordered these tests and still feel a cholesterol lowering drug is warranted, get a second opinion. Remember, statins have only been proven to (modestly) lower one’s risk of death from cardiovascular disease in men who have already had a heart attack.

So, try the recommendations above, and finally, if you want to keep your heart and vessels unclogged, be open. Love freely, be flexible about other’s points of view, and let your stresses pass through you instead of holding onto them.

PART TEN

Bodies change with age. It’s a fact of life. But sometimes we see a person in their 90s who looks more vibrant than someone in their 50s. What are the factors involved in this disparity? Well, I’ve tried to address many of them – and what can be done to turn out more like the vibrant 90 year old – over the past few months, through the Chinese medical saying, “Yang to Yang and Yin to Yin.”

This time I want to continue the circulation discussion by going a little deeper. I wrote previously about the dubious role of cholesterol as the scapegoat in cardiovascular disease, and in the last article, I introduced the vital role of inflammation in the deposition of cholesterol in vessel walls. Testing for CRP (a marker of inflammation) is an important step in the right direction; however, with pharmaceuticals still viewed as our best hope for managing this process, many medical professionals fail to understand or convey to their patients the pivotal role that lifestyle can play in promoting and reducing inflammation.

Where does chronic inflammation come from? There’s a wide array of contributing factors. The most prevalent are:

Toxic chemical exposure, both outdoors (pollution, pesticides, etc.) and indoors (building materials, synthetic carpet and other furnishings, cleaners, air fresheners, etc).
Dietary sources, such as trans fats, sugar, food sensitivities, and oxidized fats.
Chronic muscle tension, postural stress, joint disorders, and poorly healed injuries.
Immune dysfunction – since inflammation is a process mediated by our immune system, improper immune function is a fairly common cause of chronic inflammation (multiple sclerosis, lupus, and rheumatoid arthritis are just a few such conditions).
Infective agents, such as viruses, bacteria, and other parasites.

Regardless of the cause, it behooves us to take measures to reduce inflammation. Below are some great ways to reduce inflammation and improve your overall health. Some of these I’ve mentioned in earlier installments in this series of articles, but I think they all bear repeating:

Avoid foods you’re sensitive to. Unless you feel great all the time, chances are there are certain foods your body reacts negatively to, and it is worth knowing what these are. Consider getting a food sensitivity test, or try an elimination diet, or check out the Coca Pulse Test book.
Consider an anti-inflammatory diet. If you Google “anti-inflammatory diet” or “anti-inflammation diet,” there is a trove of information out there. The basics are: Avoid sugars, wheat flour, fried foods, processed foods, hydrogenated oils, fruit juice and other soft drinks, and coffee. Be moderate with red meat and (skinless) chicken, dairy products, grains, alcohol, and polyunsaturated oils (corn, cottonseed, palm, sunflower, etc.). Eat plenty of vegetables, berries, olive oil, avocado, walnuts, coconut, salmon, sardines, green tea, fiber, mushrooms, spices (see below), pumpkin seeds, flax seeds, hemp seeds, chia seeds, and choose organic whenever possible.
Exercise regularly. I much prefer that people exercise for relative short periods at a time (15-30 minutes) every day (or multiple times a day, if your constitution can support it), rather than exercising for a long time (60+ minutes at a time) a couple times a week.
Reduce stress – physical, mental, and emotional. Get enough sleep. Don’t overwork. Avoid static postures – for example, don’t sit at a desk for too long at a time (break up the day with periods of movement and stretching). Practice focused relaxation (meditation, biofeedback, floating, restorative yoga, etc.).
Drink plenty of clean water (half the number of pounds you weigh as ounces of water per day), spread out evenly over the course of the day.
Consider supplementing with anti-inflammatory foods and nutrients. These include vitamin C, vitamin E, fish oil or flax oil, alpha lipoic acid, zinc, quercetin (derived from fruits and vegetables), MSM (organic sulfur), coconut oil, pineapple (or its derivative bromelain), and many spices, such as turmeric (or its derivative curcumin), cinnamon, dill, marjoram, parsley, ginger, basil, oregano, thyme, mint, sage, rosemary.
Reduce all sugars. Cane sugar, beet sugar, evaporated cane juice, fruit juice, honey, maple syrup, brown rice syrup, malt extract, high fructose corn syrup, agave nectar, etc. Sweeteners should be used sparingly. Learn to enjoy unsweetened food.

Inflammation goes hand in hand with oxidation. Oxidation is too broad a topic to cover in detail here, but as it pertains to organic material, oxidation is usually a process that causes deterioration. (Although, both inflammation and oxidation are healthy and necessary when appropriate.) Oxidized foods (such as rancid oils and proteins that have been frozen or cooked on high heat) are generally bad for us. Many of the ways in which our cells become worn out through age, pollution, and junk food are due to oxidation. Cancer is frequently initiated through oxidative damage to our DNA. When there are high levels of LDL cholesterol circulating in our bloodstream, it is more likely to be retained in the walls of blood vessels if it becomes oxidized. Thus, oxidative stress plays a key role in the development of atherosclerosis.

Many of the contributors to inflammation (pollution, stress, poor diet, etc.) are also major contributors to oxidation, so the recommendations for reducing inflammation overlap with those for reducing oxidation. In addition, antioxidants can help undo oxidative damage and they can stabilize free radicals (unstable molecules that cause oxidation). Many vitamins, minerals, and foods have antioxidant activity. It seems every day brings news of a food or nutrient that is the new “strongest antioxidant” – blueberries, green tea, red grapes, garlic, beans, pomegranates… Just remember that the most potent naturally occurring antioxidants all come from plants. Plant matter should comprise the bulk of human diets. Some potent antioxidants are also available in pill form from natural food stores. These include vitamin C, vitamin E, vitamin A, selenium, beta carotene, coenzyme Q10, alpha lipoic acid, and glutathione, to name just a few.

When we broaden our focus to consider all the factors that contribute to inflammation and oxidative stress, and all the interventions that can favorably influence these conditions, the cholesterol issue is put into proper perspective. It is a consequence, after all, of these conditions, not a cause in itself of cardiovascular disease.

Be well,

Dr. Peter Borten