BOOK REVIEW: Low Back Pain ed. by Jeffrey N. Katz, M.D. [A Harvard Med School Guide]

Low-Back Pain: Healing Your Aching BackLow-Back Pain: Healing Your Aching Back by Harvard Health Publications
My rating: 5 of 5 stars

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This guide is one in a series put out by Harvard Medical School. It’s the second one that I’ve read, and I found them both to be beneficial reads. The first was on the health benefits of tai chi chuan (a Chinese martial art / system of health exercise [qi gong.])

Harvard Medical School’s willingness to report findings about unconventional approaches and self-care was part of the appeal of this book. When I first developed lower back problems, I went to the doctor, was diagnosed with arthritis via x-ray, and all I got was an offer for pain killers. To me this was much like going to the mechanic because the check engine light came on, only to be told that all they could do for me is unplug the pesky indicator light. At any rate, that’s why this kind of book can be useful, because one can’t always expect a given doctor within the modern medical establishment to be on top of treatments not involving drugs or surgery. This isn’t to denigrate those options, often times they are the best or only option, and they are covered in this guide as well. However, back pain is one of those rare areas in which sometimes the best option is outside medical norms. Much as many doctors hate having information thrust in front of them by patients, at least Harvard Medical School may garner more respect than a WikiMD post. There’s even a box talking about the mind-body connection, and options in that domain.

Low back pain is both extremely common and often still poorly understood. That’s because there are so many problems that can cause similar symptoms. [I guess this shouldn’t be a surprise because our pelvis had to rotate through evolutionary changes to take us from quadrupedal to bipedal. It makes sense that our nerves and blood vessels might be routed in such a manner as to cause troubles.]

While this guide is short, it does take on a range of issues, including: who’s most at risk, how the spine works [and doesn’t], what the basic categories of back injury are, how one’s specific ailment may be diagnosed, how to evaluate treatment options, what one can do on one’s own to help heal a problem back while preventing future injury, what medicines may be prescribed, what surgical options may be offered, and advice on facilitating a recovery.

As far as ancillary features are concerned, there are a number of line drawings. This artwork is generally either anatomical drawings used to show how the spine works or is injured, or show exercises that one can use to strengthen the back. There are a few pages each of resources and glossary. The resources are not so much printed resources (there’s only one of book, and that one is authored by the editor of this guide,) but rather organizations and even websites.

I found this guide to be informative and helpful. I would recommend it for anyone who has low back problems, or who might benefit from learning more about them (e.g. yoga teachers.)

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BOOK REVIEW: Piriformis Syndrome by Loren Fishman, M.D.

Piriformis Syndrome: Diagnosis, Treatment, and Yoga: Pain in the ButtPiriformis Syndrome: Diagnosis, Treatment, and Yoga: Pain in the Butt by Loren Fishman
My rating: 4 of 5 stars

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This short book (<50pp.) describes piriformis syndrome, what causes it and how it’s diagnosed and treated. Piriformis Syndrome is a malady in which a nerve is pinched by the piriformis muscle. Because of the way pain (and other sensations) radiate, it’s not necessarily easy to differentiate this syndrome from a low back injury. However, the descriptions of the specifics of this condition, and the test used to diagnose, it may give one insight as to whether one is looking in the right direction for the cause of one’s butt and leg pain.

One nice feature of this book is that it explains how yoga can be used both as part of the treatment regimen and as a preventive measure. The yogic treatment consists of just four classical postures of Hatha Yoga: Janu Shirshasana (head to knee pose), Parivrtta Trikonasana (twisted triangle pose), Matsyendrasana (a simple twisting pose named for a sage), and Parivrtta Parsvakonasana (twisted side angle pose.) However, yoga teachers who have students who’ve been diagnosed with this condition will find it nice that the book gives modifications and clarifications pertaining to use of the postures to help such people.

There are seven chapters in the book. The first describes the condition and its cause. The second chapter explains the connection between the condition of piriformis syndrome and the symptom of sciatica. Chapter three clarifies the ways in which this condition may be misdiagnosed, and this is followed up by the chapter that shows how it is diagnosed by both physical examination and by imaging technology. Chapter five gives a basic overview of the available treatment options including injections, drugs, physical therapy, surgery, and yoga. The next chapter talks about the state of research. The last chapter explores the yoga asana that can be used to help treat or prevent piriformis syndrome. There are a few graphics. These include line drawings such as of the diagnostic physical exam, and photos of modified versions of the yoga postures.

I’d recommend this book for those who’ve been diagnosed with this ailment, who believe they might have it, but also for yoga teachers who are interested in expanding their understanding of the afflictions of which their students may suffer—so as to be prepared to help them or, at least, not hurt them.

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BOOK REVIEW: Being Mortal by Atul Gawande

Being Mortal: Medicine and What Matters in the EndBeing Mortal: Medicine and What Matters in the End by Atul Gawande
My rating: 5 of 5 stars

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This may be the scariest, saddest, and most necessary book that I’ve read in some time. In it, Dr. Gawande discusses how medicine has proven increasingly effective at extending life, but—at the same time–we are less able to care for the elderly. The traditional approach, in which the elderly move back in with their families (or live independently near them,) often proves untenable. And it’s not necessarily because people are too busy, lazy, or indifferent to put up with granny, but rather that granny is likely to end up with needs that require a professional caregiver—in some cases for virtually every aspect of her daily life. In short, we’ve done a great job of extending life, but often with a sharp dip in the quality of life at the end.

The nursing home was the solution that the health care community came up with when this problem first became apparent. While the nursing home is both necessary and effective for many, for those of sound mind and sound-ish body, the move can be highly demoralizing. People revert from being independent and autonomous adults into a child-like status in which they have little freedom or privacy. Again, if grandpa has dementia or needs to be tube-fed, there’s no way around this, but if he’s just at risk for a fall that might break his hip, then it can be humiliating.

When it comes down to the end, fear of death has led to an unwillingness to ask important questions or even consider what might be just around the corner. This has led patients to keep asking for that one treatment that just might extend their lives—and doctors have been more than willing to allow this. This may be fine in the early days of a terminal illness, but once one has gone through—say–a couple of courses of chemotherapy, the treatment one is likely to get is some trial phase experiment that is as likely to kill one cruelly as extend one’s life—and to the degree that it does extend one’s life one may suffer a set of complications far more miserably than one would in letting the disease kill one. One of the most intriguing study results cited showed that people who took up hospice palliative care (making one comfortable) were found on average to live a little longer than those who kept seeking whatever treatment they could find.

This all sounds like bad news, but the author devotes much of the book to exploring the options that have been put forth in the face of these problems. One of these is the assisted living facility as an alternative to a traditional nursing home. These facilities work for people who are of sound mind and who aren’t too bad off physically. They allow the individuals to live as they might in a condo or apartment, but there are on-sight caregivers and assistance with all the tasks around the house that might prove too challenging for an older person. The other major solution is hospice care. Not that palliative care is new, but it’s increasingly being show to be a preferable option for all concerned. Another important outcome resulted from a major insurance provider’s decision to allow individuals to pursue palliative care while they were still being treated. [Historically, one only had the option of hospice once one had given up on treatment.] At any rate, the intriguing finding was that the insurance company actually ended up paying less because more people signed up for palliative care and those individuals used expensive health care elements like emergency rooms and intensive care units (ICU) less.

While I can’t say that I enjoyed reading this book, I would recommend it for everyone. It’s very readable. The approach is case-based. Dr. Gawande talks not only about his own patients and the patients and caregivers that he interviewed (his practice is not geriatric in nature, so he spoke with several experts), but also about the end of his own father’s life. It’s a short book of about 300 pages arranged into eight chapters. There are no graphics, and endnotes are the only ancillary matter, but nothing else is necessary for this book.

Read it.

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My Vipassana 10-Day Experience: No Solidified Gross Sensations, No Gain

woman-pointing-at-herself6

It’s 4:45 in the morning and I’ve been sitting on my cushion at the Dhamma Setu Vipassana Meditation Center in Chennai, India for a quarter-hour. It’s day one, and I’m observing my breath as it comes in and out through my nostrils—at least for seconds to minutes at a time before I have to coral my mind back from some random tangent. This breath exercise (ānāpāna-sati), I will soon learn, is a preparatory exercise used to reign in the mind enough so that actual Vipassana meditation can be introduced on the middle of the fourth day. In eleven days, I’ll be in the closing session of the course.

 

There are several approaches to Vipassana meditation taught throughout the balance of the course, but the gist is the same for all of them. One rotates one’s awareness throughout the body systematically observing sensations. As one does this, one works toward equanimity, a calm and quiet state of mind in which one neither covets pleasurable sensations nor shuns unpleasant sensations. The idea is to train the deepest level of the mind to not habitually lunge one toward pleasure or away from displeasure.  (FYI: displeasure = pain.  At least for a novice, such as myself, there is a fair amount of pain involved in sitting still for such long periods. It’s generally referred to a solidified gross sensation to differentiate it from the uniform and subtle sensations that one may feel in the parts of the body that aren’t in agony. I joke about it here, but there’s good reason to train oneself to not think in terms of pain, and the negative connotation the word evokes.)

 

At that course’s beginning, I knew a little about Vipassana from research, including reading the book “Equanimous Mind,” one man’s account of his experience in the course. For example, I knew that most people who quit, leave either on day two or day six. At the time, I didn’t know why, but would learn soon enough. It’s nothing about those two days, but rather the days that precede them. Day 1 seems to last forever, and it’s easy enough to discern why it might give students trouble. When one gets through day 1, an optimist says “yeah, I can do this because I’m through the first day” but a pessimist says, “I just barely made it, I can’t do this.” Day 5 is when the strong commitment (adhiţţhāna) is added, which means that one has three one hour sessions during which one is to commit to not changing one’s posture for the whole session. No opening eyes, but—more challengingly—no unfolding /refolding one’s legs.  This commitment to not changing posture steps up the difficulty of the course to another level.

 

It should be noted that one can opt to sit in a chair. However, that introduces an entirely new challenge—drowsiness. During the long sessions, when I’d get up to walk the lymphatic fluid out of my legs, there were usually two people in a straight-spined meditative position and six to eight who looked to be sound asleep.  (Drowsiness was one reason that I didn’t sit in a chair. I’m prone to get sleepy enough during meditation, especially in a complete absence of caffeine. The other reason was that I’ve not found chairs to be more comfortable for long-sits of meditation. Once your bony parts start pressing into the chair, one begins to wish one was cross-legged on a cushion. One can make the chair more comfortable by placing padding wherever it’s uncomfortable, but eventually one has a virtual La-Z-boy and the drowsiness factor becomes all the more problematic.)

 

With respect to these strong commitment (adhiţţhāna) sessions, I didn’t make it the full hour without moving on the fifth day–or any day until day 10, in fact. However, I don’t count this as a failure, because I did give it my all. I say that based on the endorphin-induced euphoria, simple hallucinations, and a proprioceptive form of Alice-in-Wonderland Syndrome that I experienced from toughing it out past mere discomfort. I’ll get to what that all means, but for now suffice it to say these happenings were symptomatic of sitting still through the period in which the pain came, grew, and then started to numb out.

 

In fact, these trippy experiences may, sadly, have been one reason why it never occurred to me to want to leave around day six. While I tried not to get caught up in them, these experiences were fascinating. I could see why day 2 presents a challenge to so many, but day 6 was a hoot, relatively speaking. The second most challenging day for me was day 8, because I’d reached a plateau but I didn’t yet feel myself in the homestretch. But by day 8, who’s going to leave? You’ve gutted it out that long, and are almost done. For those concerned about whether they can make it to the end, I can honestly say that I never seriously considered quitting. It’s not that hard to get through the 10 days, as long as one isn’t too addicted to comfort and communication.  That said, I wouldn’t offer a wholesale recommendation of the course as many do, but rather recommend it on a case-by-case basis. If you’ve done no meditation whatsoever, this is the meditative equivalent of going from couch-sitting to training for an ultra-marathon overnight. If you think you can’t get through nine days of silence–without no phones or books, maybe you can’t, and you should probably reevaluate your life.

 

I mentioned some of the unusual experiences that I witnessed during the course, and I’ll get into that a bit more. I should preface this by saying that one shouldn’t get caught up in these trippy happenings for reasons I’ll elaborate upon below, but they may happen so it’s worth being ready for them. Here’s a list of the unusual events I experienced:

 

-Extreme relaxation / lethargy: a little off topic, but between sessions on day 1, I noticed that I couldn’t be bothered to shoo away a fly that kept buzzing around my head with random touch downs. I don’t know how long I walked with the fly buzzing over me before it struck me that this was unusual. This was before Vipassana proper had been introduced, so it didn’t yet seem apropos.

 

-Olfactory hallucination / vivid scents: on day 2 I witnessed a distinct smell from my elementary school days (i.e. a mix of cleaning solution and milk cartons?) that theoretically could have originated at the Dhamma Setu, but which was quite probably an olfactory hallucination. It was short-lived and I never smelt it again. I did later experience an intense smell of flowers inside the meditation hall. This may well have been an actual scent as there were many blooming flowers there. These vivid scents were also short-lived.

 

-Endorphin-Induced Euphoria: on days 4 and 5, I experienced this as an almost intoxicated feeling. [Endorphins are the body’s indigenous pain-killers.] As drunks find unfunny things funny, so did I—including the pain in my legs and back. I wondered if anyone would be distracted by my occasional giggle-fits, but I think they were much more subdued than I suspected from my vantage point. Just like I’ve thought I was talking in my sleep in the past, only to be told that it sounded more like faint and indistinct whimpering. On day 6, I experienced a more sophisticated (not drunk-like) form of euphoria that expressed itself as a feeling of “oneness.” I’ve read about feelings of oneness being attributed to a form of transient hypo-frontality—i.e. a shutting down of the parts of the prefrontal cortex (PFC) that track the self / other distinction. There may have been more happening than endorphins (and other neurotransmitters) involved in that happening.

 

-Lifting sensation: This was the single most awe-inspiring experience that I was party to. For those unfamiliar with seated meditation, one of one’s chief enemies in long meditation sessions is a proclivity to slump. Slumping translates into agonizing back pain and labored breathing. So whenever one catches oneself slumping, one has to straighten one’s back. [If you wonder why a meditator would pretzel up his or her legs in full lotus (padmasana), the alignment of one’s legs helps one maintain a straight spine.] At any rate, on day 6 I experienced the feeling that I was being lifted up straight and it became effortless to maintain a straight back for the rest of that session—as if an outside force were doing the work. This lifting sensation wasn’t like being lifted by a person, but rather like the action of a “tractor beam” from the world of sci-fi. While I have some inkling of the causes of much of what I experienced based on the science of the human body, explanation of this “lift” is harder to come by. I did read an account in Oliver Sacks’ “Hallucinations” by a woman who suffered from migraine-induced hallucinations and Alice-in-Wonderland Syndrome that was a spot-on description of what I experienced as well.

 

-“Visual” [closed-eye] simple hallucinations: I didn’t experience anything even close to the what people usually think of as a hallucination—that is, there was nothing that could be confused with reality. I wouldn’t have even known to call these images hallucinations if I hadn’t been reading the aforementioned Oliver Sacks’ book. Mine were quite close to what are described as hypnogogic (falling asleep) hallucinations in the Sacks’ book. This makes sense. While I wasn’t drowsy at the time, my brain was probably in a pretty similar state of relaxation. Mostly, these were moving shapes that formed and dissipated in a field of black-fringed purple.  On day 7, there were more complete visuals—mostly of partial faces, usually with mouths wide open. I took this as my subconscious mind’s comment on the noble silence. (On the noble silence: from about 6pm on day 0 [orientation afternoon] until the morning of day 10, one isn’t allowed to talk or in any way interact with / acknowledge anyone except to direct questions to the teacher or staff. Whether one has questions or not, one will speak at least a few words to the teacher every day or two when he / she reviews one’s progress. For some, this may be the single biggest challenge of the course, but I’m a hardcore introvert and could do ten days of silence standing on my head.)

 

-Tactile Alice-in-Wonderland Syndrome: Alice in Wonderland Syndrome usually refers to a visual form of hallucination in which things appear a great deal taller, smaller, closer, or farther than they actually are. What I experienced was a great deal less whacky and traumatic than that. With eyes closed, I felt a distortion of the size and shape of my arms. Sometimes my arms felt like they were six-foot long from deltoid to fingertips, and sometimes the same points seemed to lie a foot and a half apart. Needless to say, those are both distortions of the actual length of my arms.

 

-Inexplicable Beatles’ Music: On day 8 my mind bombarded me with music from the Beatles for a little while. In particular I heard “Sgt Pepper’s Lonely Hearts Club Band”, “Lucy in the Sky with Diamonds”, and “All You Need is Love,” or parts thereof, in high fidelity. Now, while this is fine music, it’s not music that I’ve listened to recently nor have I listened to that album a great deal. When I was growing up, there was a copy of “Sgt Pepper’s…” at home, but I’ve only periodically heard these songs on the radio since. The experience was monotonous because only the parts that I knew the words to (i.e. the choruses) replayed on a loop, but the music and voices were crystal clear as if I were listening to the album.  Given the lack of personal relevance, I can only imagine that my subconscious thought this is the kind of music a person meditating would like to hear.

 

As I said, by about day 8 I’d hit a plateau. The aforementioned odd experiences were petering out, particularly when I did as I was supposed to do and gently returned my mind to the task at hand. Yet, the practice wasn’t getting any easier or smoother. I still had the same dead spots—areas that I could observe for extended periods without even the subtlest of sensations—and I still had growing pain zones in my back and legs—i.e. starting from isolated pains, the pain would become increasingly diffuse and of ill-defined boundaries—but often no less painful.

 

Now I’ll explain my comment about not allowing oneself to become captivated by the trippy experiences. If one seeks after these experiences, not only is one missing out on the value of the practice, one is actually moving in the wrong direction by coveting an experience while impulsive craving is what one is training oneself away from through Vipassana meditation. Beyond this, seeking out such experiences is likely to be frustrating because they are products of the subconscious mind and physiological processes that are beyond conscious control. They happen when they happen, on your body’s schedule. (Note: Some people think of these as spiritual phenomena. I don’t, but—for those who do—they still won’t happen on your schedule. Ostensibly, they’ll happen on some deity’s—presumably rather tight–schedule. And—divine as they may be—they are still a distraction from the objective of the practice—and that’s not my opinion, but according to the teachers of the tradition, starting with Gautama Buddha and through to S.N. Goenka.)

 

So when one experiences such phenomena, one should do the same as one always does in meditation, quietly and non-judgementally return one’s mind to the object of awareness—in this case, systematically witnessing the sensations on one’s body. I won’t say that this isn’t a challenge. It is, because your mind is presenting you with something fascinating and new, and you’re asking it to return to a task that has become rather mundane over hours and days of practice. It should be noted, I would broadly categorize the phenomena that I experienced into two slots, one of which is things the brain does to cope with a lack of external stimulation. (The other being, things the body does to cope with unrelenting pain.) So it takes some discipline, but one should remind oneself—as one is frequently reminded during the discourses—that you are there to give the Vipassana approach a fair trial, and as fascinating as these sideshows are they are a distraction from the practice.

 

That said, these things will happen and their unusual nature may make them points of concern or confusion, and so I’ll discuss them a bit more. I have a theory about the cause of the euphoric experiences, but it requires a little clarification and background. What makes Vipassana challenging for a new practitioner—at least for me— is that in systematically rotating one’s awareness to observe sensations, one has to ignore areas that are screaming with pain while carefully running one’s attention through areas that seem completely devoid of sensation. This requires quieting the mind and especially not feeding the anxiety about one’s pain and discomfort—hence, developing equanimity (steadiness of mind.) Sitting still for an hour at a time, lymphatic fluid piles up in your lower extremities (no pump in the lymphatic system but the one of movement), over time blood circulation may be inhibited, and this lack of circulation has ramifications for the cells not being adequately nourished. So your body notices this fluid build-up (a relatively minor concern, easily rectifiable, and which will take a while to be a serious problem for most people) and sends you some pain sensations to spur you to get up and move about. When you don’t get up and walk, it turns up the discomfort disproportionate to what’s happening with your body. You still ignore it. Eventually, your body starts to think maybe a boulder fell on your legs and you’re in shock (the conscious and unconscious minds don’t talk as much as you might think, and—even if they do—let’s face it, at least the conscious mind is a big, fat liar.) It’s at this point that your body starts to emit some feel-good chemicals. (I refer to “endorphin-induced euphoria,” but it’s more extensive than natural painkillers. In reading up on the subject, I noted references to serotonin and even melatonin (yes, the skin color chemical) in addition to beta-endorphins. I wouldn’t be surprised if there was some dopamine—a reward / feel good chemical—in the mix as well. Hence, the euphoria.

 

I don’t think it’s necessary to get into the hallucinations and other effects that the mind creates in order to cope with the lack of sensory input. This is a well-studied area, and there’s been a lot written on how the mind hates the dark and the quiet over extended periods. I would recommend the aforementioned book by Oliver Sacks on hallucinations as a case in point.

 

Saving the most crucial question for last, was it worth it? In his discourses, S.N. Goenka offers three criteria by which one might evaluate whether Vipassana is worth practicing. While all three are sound criteria, I’ll focus on just one of these, which is really the bottom-line, and that’s whether it makes an improvement in one’s life. That is, does one start to be less prone to impulsively react to craving and aversion and become more equanimous of mind?

 

On this, I’ll have to say that the jury is still out. Many come out of the 10-day course calling it life-changing. I’d say that it was beneficial because I learned a meditative technique that has a sound internal logic (even if one doesn’t believe every aspect of the mechanism by which it is said to work by Buddhists—which I don’t), an established track record of benefit for many, and the feel that it’s benefiting one. However, I’m still evaluating the approach. I’ve been doing Vipassana meditation twice a day with morning and evening affirmations. Let’s face it, 10-days isn’t a long time to overhaul one’s deeply ingrained modes of operation—even sitting in meditation for 10 hours a day. I’m optimistic, and the practice sure doesn’t hurt—except for those solidified gross sensations, they hurt.

 

BOOK REVIEW: The Story of the Human Body by Daniel Lieberman

The Story of the Human Body: Evolution, Health, and DiseaseThe Story of the Human Body: Evolution, Health, and Disease by Daniel E. Lieberman
My rating: 4 of 5 stars

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The story that this book tells is of a human body adapted and optimized for hunting and gathering that has been thrust by agricultural and industrial revolutions into conditions for which it is ill-suited. The central idea is that of the “mismatch disease.” The mismatch in question is a mismatch between the lives humans were evolved to lead and the ones that we have developed through cultural and technological progress. The human body is governed by what Nassim Nicholas Taleb calls “anti-fragility” or what biologists call “phenotypic plasticity.” Both terms say that our bodies get stronger when exposed to physical stressors and weaker in the absence of such stressors. We’ve now used culture and technology to reduce exposure to such stressors, while—at the same time—food is more available than ever and is in calorically dense / nutritionally sparse forms. This mismatch accounts for many problems. Of course, technology has also allowed us to reduce our exposure to dirt and germs, and this, after being once a boon, has begun to swing us into dangerous territory.

The 13 chapters (including the introduction) are divided into three parts in a logical manner to address the book’s objective. After an introduction that lays groundwork for understanding human evolution in a broad sense, the first part describes human evolution up to the point where culture became dominant force for our species. It clarifies how we became bipedal, how our diets developed, how we got smart, and the ways in which the aforementioned characteristics are interconnected. The second part shifts from Darwinian evolution to cultural evolution, and—in particular—elucidates the effects that the agricultural and industrial revolutions had on the human body. These cultural forces act much faster than evolution. While some argue that humans aren’t really subject to evolutionary forces anymore, owing to cultural and technological advances, Lieberman points out that Darwinian evolution does still effect humanity, but its effect is muted by comparison to fast-acting cultural developments. The final part looks at humanity in the present and projects out into the future. It considers what effect an over-abundance of energy and a declining need for physical activity have had on our species, and what can be done about it.

This book is thought-provoking, well-organized, and uses narrative evidence and humor to enhance readability. (A discussion of the absurdity of products in the Skymall catalog—e.g. luxury items for pet—is a case in point.) It certainly gives on a good education about human evolution. Furthermore, while there are many books out there that deal with mismatch as a cause of diseases like obesity and diabetes, Lieberman also addresses under-explored issues like postural problems from chairs, the influence of shoes on running gait, and the development of nearsightedness because of our close-focusing ways.

I’d say the book’s greatest flaw comes in its discussions of solutions at the end. The author puts all his eggs in the basket of wholesale solutions aimed to make society as a whole improve, while he could do more to share the details of what individuals can do to solve their own problems. Lieberman considers why natural selection won’t solve problems of mismatch and dysevolution. Then he considers how research and development and educational campaigns can only provide partial solutions. His ultimate solution is suggesting regulatory paternalism—e.g. what economists call Pigovian taxes–taxes designed to change behavior by making bad behavior (in this case sedentary lifestyles and over-eating / malnutrition) more expensive. Perhaps such solutions (which will remain political untenable for the foreseeable future in the US, at least) may be necessary, but one shouldn’t conclude that readers with better information and ways of approaching the problem can’t make a difference. I say this based upon the fact that a substantial (if minority) portion of the population is already doing the right thing—eating right, exercising, and not succumbing to modernity’s creature comforts. I, furthermore, say it as a one trained as an economist who has seen easier attempts at paternalism fail over and over again.

I’d recommend this book. I think it gives the reader insight into the problems caused by being evolved to be one thing while being groomed by culture to be another.

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BOOK REVIEW: Kokoro Yoga by Mark Divine

Kokoro Yoga: Maximize Your Human Potential and Develop the Spirit of a Warrior--the SEALfit WayKokoro Yoga: Maximize Your Human Potential and Develop the Spirit of a Warrior–the SEALfit Way by Mark Divine
My rating: 4 of 5 stars

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Like many yoga practitioners, I’m never sure whether to be dismayed, amused, or pleased by the explosion of new styles of yoga. It’s nothing new. Yoga has been branching out since its early days. But today’s flavors tend toward the frivolous, usually involve shoving yoga together with something else generally likable, and said two things are in some cases largely inconsistent. There’s marijuana yoga, dog yoga, karaoke yoga, and tantrum yoga. I wouldn’t be surprised if there was a Häagen-Dazs Yoga. Hell, if I was a bit less lazy and more unscrupulous I’d have made a mint from my patented SELFIE YOGA (™ -pending), which involves modifying impressive looking poses so that an individual can take their own pics for FaceBook. (You’re welcome; to whomever the driven sleeze-bag is that turns that idea into a thing.)

I, therefore, tend to approach books like Mark Divine’s “Kokoro Yoga” with a measure of skepticism. That said, I found that this book offered a respectable vision of yoga that might even succeed in bringing a new demographic into the fold. Divine is a former Navy SEAL who developed a fitness empire called SEALFIT, a system that combines fitness ideas from the famous Special Operations unit with ideas from civilian sports and exercise science, such as high intensity interval training (HIIT.)

Incidentally, “kokoro” is the Japanese word for heart / mind (heart and mind were inexorably entwined for Japanese in the era in which the term came into being.) Divine mentions that “Warrior Yoga” would have been his first choice, but that was already taken. The author appeals to warriors with this approach to yoga. He does this in several ways. Firstly, and encouragingly, he doesn’t neglect the mind, but rather puts it front and center by emphasizing the need for mental strength and clarity. My biggest problem with the plethora of new yogas is that they usually forget that it’s ultimately about calming the mind, and instead of providing an environment conducive to looking inward, they embrace or create all sorts of distractions (loud pop music, mirrors everywhere, nudity, animals, ice cream, circus clowns, etc.) Divine doesn’t just make a new fitness fad, he argues for the need for all of the eight limbs of yoga—not neglecting yama and niyama—and emphasizes how yoga served as a calming and clarifying tool for him and not just as a means to be more bendy.

Second, he adds components to balance out the dimensions of fitness. If you are a yogi / yogini, and you want a yoga body; yoga is all you need. However, if you are a martial artist, cop, or soldier, you also need strength, speed (then, by definition, power), and cardiovascular endurance, as well as those aspects yoga offers (e.g. breath control, flexibility, core strength, posture, and mental clarity.) Again, I’m often dismayed by attempts to round out yoga with functional strength building and cardiovascular endurance. I understand the desire to combine them into one workout. Besides the fact that some people need a more balanced approach to fitness, not everybody has time to do multiple workouts multiple times a day. Still, one can’t just ram these components together willy-nilly because if one needs to be in a space to observe one’s breath while being still and one is coming out of having done 100 burpees, it’s probably not going to work so well. I haven’t yet done any of the sequences from the book, but it looks like this shouldn’t a problem, at least not for individuals who are moderately fit. I’m less confident about the value of mixing in elements of chi gong and “cardio kickboxing,” which is suggested by the system. It’s certainly not that I’m opposed to either chi gong or functional martial arts training, but there’s a lot of important detail in those activities and this format risks some horrible half-assery. (Yes, sometimes you get chocolate in peanut butter and get a Reese’s cup, but more often you get sausage in the pudding. Two things being great, by no means ensures they will be great together.)

Finally, Divine puts his approach in the language of soldiers, using concepts like “strategy” and “tactics” and eschewing Sanskrit terminology. The book begins with an anecdote about going into a combat zone as a Reserve officer, which describes his use of yoga to help him get his mind in the right place. He also talks extensively about his practice of martial arts.

There are eight chapters and three appendices to the book. They proceed from the aforementioned story through a look at the general approach, looking at the eight limbs of yoga, before getting into the details. The penultimate chapter sums up research on some of the benefits of yoga, and the last chapter offers advice about how to set up one’s sadhana (personal practice) with the Kokoro Yoga approach in mind. The appendices offer information about functional conditioning exercises, combat conditioning, and module building.

Overall, I think this is a useful book that provides some interesting thoughts on yoga. You may or may not find that it’s the approach for you, but it’s worth checking out. The photos are well-done—though some readers may wish there were more related to the functional conditioning exercises (but he’s got other books for that, it seems.)

I’d recommend this book for those interested in how a yoga practice might be integrated with other aspects of fitness without losing track of the core yogic objectives.

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BOOK REVIEW: The Relaxation Response by Herbert Benson

The Relaxation ResponseThe Relaxation Response by Herbert Benson
My rating: 4 of 5 stars

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I read the 25th anniversary edition of this seminal work on stress reduction, which was released in 2009. Obviously, that makes this an oldie, but it’s clearly a goodie as well. The new addition has a substantial introduction, providing updated information.

The body’s “fight or flight” response to stressful conditions has long been recognized and it’s virtually a household term. However, despite the equally alliterative name and the fact that Dr. Benson’s original book came out well over 30 years ago, the relaxation response remains a lesser known phenomena. Decades ago, Herbert Benson, a Harvard physician, recognized that patients’ coping ability influenced their health outcomes–specifically with respect to hypertension (a.k.a. high blood pressure.) This led him to investigate how a state of reduced stress could be achieved, and whether this could have a positive impact on health outcomes.

Benson and his co-investigators found that Transcendental Meditation (TM) could trigger the relaxation response, and from that they further uncovered specific aspects of TM that were generalizable in achieving this state (i.e. an object of concentration and a passive / non-judgmental attitude.) From this it followed that activities such as yoga, chi gong, walking, and some types of exercise could achieve the same physiological state as meditation. There was scholarly pressure to establish that the relaxation response was more than a placebo effect. In proving that the relaxation response didn’t hinge on a patient’s beliefs and that it had a predictable effect (and hence it was inconsistent with the placebo effect) Benson also realized that maybe doctors shouldn’t be so dismissive of the placebo effect—people were getting better, after all, and there was some mechanism by which that wellness was achieved that would be worth understanding.

In the first chapter, Benson describes an epidemic of hypertension, the fight or flight response, and its opposite number: the relaxation response. The next chapter delves into the specifics of hypertension and related topics like cholesterol consumption. Chapter 3 makes a connection between stress and the proclivity to develop hypertension. The following chapter lays out various approaches to achieving a more relaxed physiological state, including: biofeedback, yoga, zen, progressive relaxation, and hypnosis. Chapter 5 is about altered states of consciousness, and, specifically, the meditative state. Various age-old methods of achieving a meditative mind are examined. That’s followed by a chapter which lays out the results of relaxation response training in reducing hypertension and drug use. Chapter 7 is an explanation of how to achieve the desired state that generalizes beyond the specific approach of TM. The last chapter is a brief summary.

I found this book to be both interesting and informative. It’s useful both as a practical guide to practice and an explanation of related information.

I’d recommend “The Relaxation Response” for anyone who is interested in learned to de-stress. It’s a classic, and the new edition offers substantial updates.

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BOOK REVIEW: Discovering the Power of Self-Hypnosis by Stanley Fisher

Discovering the Power of Self Hypnosis: The Simple, Natural Mind-Body Approach to Change and HealingDiscovering the Power of Self Hypnosis: The Simple, Natural Mind-Body Approach to Change and Healing by Stanley Fisher
My rating: 4 of 5 stars

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For many, hypnosis is the domain of stage artists who make people cluck like chickens. As with the feats of stage magicians, few give much consideration to wherein the trick lies, but they assume there’s a trick. In scholarly circles, hypnotic practices have been on a roller-coaster ride. Hypnosis was once mainstream psychology but then fell into disrepute but now there’s a resurgence of interest as neuroscience answers questions about what is happening in the brain during a trance state. Doctor Fisher’s book is an attempt to demystify the subject, and to explain how a personal practice can be used to achieve a wide range of benefits.

Fisher’s book culminates in a description of how to build one’s own self-hypnosis exercise to work toward change in one’s own life. However, there’s a lot of track that needs to be laid in anticipation of that final chapter (Ch. 9.) The first chapter counters seven of the most common myths about hypnosis. Given the aforementioned misapprehensions about hypnosis, this seems like a wise place to start to get readers on board. Chapter 2 starts where Fisher’s personal involvement with self-hypnosis began, with the use of it to prepare patients for surgery and surgical recovery. Here we get our first look at the technique of self-hypnosis as well as a discussion of cases of self-hypnosis used for surgical patients. Cases are central to Fisher’s approach, and are used throughout the book to inform the reader about how self-hypnotic methods worked for particular individuals in the pursuit of various goals. Chapter 3 explains what the trance state is and how it’s achieved.

Chapter 4 explains the process by which we make choices with an eye toward helping to disrupt destructive impulse behavior. In the next chapter the reader learns about how the state of mind can contribute to physical illnesses, and how changing the state of mind can help improve one’s health. Chapter 6 is about reevaluating ingrained beliefs that don’t serve us well. This includes the notion that one can’t change one’s behavior because it’s just how one feels, as well as the belief that one can simply quash one’s emotions through force of will. Chapter 7 examines cases involving a number of common problems resulting from stress and the pressures of everyday life.

The penultimate chapter offers comparison and contrast with a range of alternative methods that are used to achieve the same goals—some more advisable than others. The alternatives include: therapy, meditation, biofeedback, exercise, somatic desensitization, and drug use.

As indicated, the final chapter offers an outline for building one’s personal self-hypnosis practice to achieve one’s own goal. There are three sections to this chapter. The first is a simplified set of exercises to evaluate one’s capacity to enter a trance—including both a survey and physical methods (e.g. degree of eye roll.) Susceptibility to hypnosis varies widely. The subjects one sees at a stage show tend to be those rare specimens who are highly suggestible. Often, part of the act is separating them from the crowd. There are also those who can’t be hypnotized under any circumstance. Most of us are in the meaty middle, having some, limited capacity to be hypnotized. The second section offers advice about how one might go about setting up the suggestive part of one’s exercise, i.e. the core of the exercise carried out once one has induced a trance. The final section lays out three different methods of inducing a trance. The first of these is the eye roll-based method one is introduced to in Chapter 2, and the others are variants that may work better for some.

I found this book to be informative and useful. It gives the reader both the necessary background to understand how one’s subconscious mind can influence one’s life and how positive ideas are introduced through it, as well as a practical guide to setting up one’s own personal practice.

I’d recommend this book for anyone who wants to learn about self-hypnosis.

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BOOK REVIEW: Nutrition: A Very Short Introduction by David A. Bender

Nutrition: A Very Short IntroductionNutrition: A Very Short Introduction by David Bender
My rating: 4 of 5 stars

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Do you want to know what percentage of your diet should be carbohydrates because your personal trainer is telling you it’s zero? Do you know whether you need vitamin B12 supplements? How much energy does your huge human brain use? What the hell is Kwashiorkor? If these types of questions are of interest to you, you might be interested in this book.

There’s nothing particularly fancy or exciting about this book, but it’s still a useful book for a couple of reasons. First, it sticks to the science on the subject, and diet and nutrition is one of the most myth and disinformation riddled subjects around because there are so many people trying to shill their fad diets and because there are so many who desperately want to believe that they can cut pounds and still eat a case of Twinkies every week through some scientific loophole [psst, you can’t.] Here and there throughout this book, there are quick deconstructions of these myths and lies. (i.e. I should point out that some of this dietary “wisdom” will result in weight loss—but it won’t necessarily result in a net health gain. e.g. If you cut out carbs, you’ll lose weight—but your brain will also be starved of the glucose that it needs to conduct its business and will have to engage in slow and costly processes to get it from elsewhere.) Second, the book is short and to the point. If you don’t have a lot of time to devote to reading up on nutrition, this may be the book for you.

The book consists of eight chapters:

Chapter 1: Why eat? (deals with appetite and satiety, and not just the less-than-profound question of why a human body needs energy.)

Chapter 2: Energy Nutrition (gives the basics of food as an energy source—as opposed to food as building blocks.)

Chapter 3: Protein Nutrition (teaches one about food as building blocks.)

Chapter 4: Over-nutrition and Problems of Overweight and Obesity (addresses the causes of being overweight as well as explaining how to counteract those causes. One nice feature of this chapter is it gives a quick and dirty summation of the various types of diets, tells which are supported by science, and explains which have undesirable unintended consequences.)

Chapter 5: Diet and Health (explains many of the ways nutrition influences health. Contrary to popular belief, weight isn’t the only way [or, necessarily, the most critical way] in which dietary problems can adversely affect health. In other words, it’s possible to be stocky or curvy and in good overall health, or, alternatively, one can be svelte and running up on death’s door. This chapter also describes first-world ailments that are sometimes called diseases of affluence.)

Chapter 6: Under-nutrition (Marasmus, cachexia, and kwashiorkor. Don’t know what those words mean? Think they are towns in a sword and sorcery fantasy novel? You’ll know after finishing this chapter.)

Chapter 7: Vitamins and Minerals (Most of the dietary suggestions in the book up to this point are put in terms of macro-nutrients [i.e. carbohydrates, fats, and proteins], but this chapter focuses on micro-nutrients. There’s a reason micro-nutrients are addressed so late in the book, and that’s that most people who are getting sufficient macro-nutrients from actual food [as opposed to the “stuff” sold at McDonald’s or in convenience stores] get all they need of micro-nutrients. But there can be issues with micro-nutrients such as iron, calcium, vitamin D, and Vitamin B12 depending upon one’s unique life situation. In other words, unless your doctor tells you that you need a supplement, you probably don’t.)

Chapter 8: Functional Foods, Super Foods, and Supplements (Probiotics, prebiotics, synbiotics, super foods, and supplements. One area that gets short shrift in this book is the importance of one’s gut bacteria—which has become a huge part of the discussion of late. There is a little mention of it in this chapter, but not much.)

There are few graphics in the book, but there are many tables. I didn’t feel anything was missing in terms of graphics. None of these “Very Short Introduction” guides offers much by way of bibliography, and the “Further Reading” section tends to favor textbooks over popular works. This book is no exception in either regard.

I’d recommend this book for anybody who wants a quick low-down on the science of nutrition. As mentioned, the one area I thought it might have delved into in greater depth was the role of gut microbes. However, overall, I think it was well-organized and provided interesting food for thought (pun recognized, but not intended.)

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BOOK REVIEW: Hormones: A Very Short Introduction by Martin Luck

Hormones: A Very Short IntroductionHormones: A Very Short Introduction by Martin Luck
My rating: 4 of 5 stars

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Let’s face it; the word “hormone” is usually reserved for questions of why a male is so horny (e.g. “His hormones were raging.”) or why a female is so moody (e.g. “She’s hormonal.”) Yet, the endocrine system is about much more than horniness and moodiness. It’s the body’s lesser known communication system, transmitting signals more slowly than the nervous system, but over a broader area and with longer-lasting results. Yes, it’s instrumental in sex, but it’s also involved in regulation of almost everything else the body does. Though we associate hormones with sex, when it comes to mass appeal it’s clearly not the sexiest of systems.

Dr. Luck’s book allows one to rectify one’s ignorance of hormones without a major investment of time or money. This is one volume in a series put out by Oxford University Press that’s designed to convey the fundamentals of a subject in about 100 pages or so (in this case it’s more like 130pgs.) I’ve done several reviews of books in this series, and will likely do more. These “Very Short Introductions” are a good way to get the gist of a topic quickly and painlessly, and they are reasonably priced on Amazon Kindle and in hard-copy at my local discount bookseller. (FYI: Your results may vary. i.e. Hard-copies at some bookstores may be pricey for what these books are—i.e. subject summaries that are optimized for concision and not for entertaining reading.)

The book has nine chapters. The first is a history of the science related to hormones and the endocrine system. (It took a while to figure out that there even was a system because of the nature of hormonal action.) The second chapter hits the basics, such as what hormones are and how they work. Chapter three tells us about the role hormones play in reproduction. The next chapter is about how hormones regulate the body’s levels of water and salt (and the effects on blood pressure.) Next, there is a discussion of the calcium cycle and how calcium is banked in bone and borrowed for the purposes of other cells. There’s a chapter that educates one about diabetes and how hormones (notably insulin) regulate blood sugar. Chapter seven is devoted to the thyroid. Chapter eight describes the role of hormones in circadian rhythms and the cycles of the body. The final chapter is about where science is going with its knowledge of hormones and the advances that are being pursued.

There are few graphics in this book. Most of them are chemical diagrams in dialogue boxes that many readers will skip because of their ominous appearance. The lack of graphics isn’t a problem. Luck does use a narrative approach on occasion (such as his telling of the story of the giant William Rice of Sutton Bonington.) This enhances the book’s readability, and is noteworthy because it’s a rarity among books in this series, which—again—are written to shotgun information and not to be entertaining reads.

I’d recommend this book for those who want to learn (or brush up on) the basics of the endocrine system. It does what it’s supposed to do, and does it quickly.

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