Cannabinoids, Alzheimer's Disease, and Yoga

by Ram

There�s some good news for people with Alzheimer�s disease (AD) and for those who are potential carriers of this disease! Researchers from the Salk Institute discovered that marijuana harbors several potent active compounds that clear the toxic amyloid protein that accumulates in AD brains and which is believed to elicit toxicity resulting in memory loss. Although previous other studies have offered similar evidence that cannabinoids (the chemical compounds present in marijuana) might be neuroprotective and reverse symptoms of Alzheimer�s, this particular study got a lot of media attention since the study also demonstrated the anti-inflammatory properties of cannabinoids. Inflammation is an underlying hallmark of AD and with its dual function of clearing toxic amyloid protein and blocking inflammation, gives marijuana a very unique and important role in allowing people with memory loss due to AD to function normally. But does this mean that we all turn to being potheads just to reap the benefits from this neuroprotective weed? Before we seek out alternative routes, let us look a bit deeper into this psychoactive plant and its natural properties. 

Cannabis, the botanical name for weed or marijuana, has three subspecies: sativa, indica, and ruderalis. Hemp, cannabis, and marijuana all belong to the same plant species: cannabis sativa. This plant is known to synthesize a wide range of psychoactive compounds. One specific class of psychoactive compounds is the cannabinoids that affect many important body-mind functions, including an individual�s movement, feelings, and reactions. Interestingly, cannabinoids are produced naturally in the body by humans and animals (endocannabinoids), plants (phytocannabinoids-in cannabis and some other plants), and synthesized artificially (synthetic cannabinoids). Tetrahydrocannabinol (THC), the most important plant cannabinoid, is also the most widely researched compound, although it is just one of more than 400 known psychoactive compounds. A myriad of physiological effects are attributed to THC including: euphoria, stimulant, muscle relaxant, anti-epileptic, anti-emetic, anti-inflammatory, appetite stimulating, bronchio-dilating, hypotensive, anti-depressant, and analgesic effects. 

Interestingly, one of the main endocannabinoids produced by the human body is termed Anandamide (from the Sanskrit and yogic term Ananda=Joy, bliss, delightful). Anandamide has manifold functions, both physically and physiologically, including eating and sleep patterns, pain relief, rewards, motivation, and pleasure. Studies are underway to boost its levels in the body to treat anxiety and depression. 

Remember the term �runner�s high?� It�s a short-term contentment, bliss, elation, and well-being experienced by people involved in all kinds of physical exercises, including but not limited to athletics, long distance running, and swimming. Yoga practitioners also experience similar feelings and we call it being in the zone (Positive Psychology vs. Yoga Philosophy). Recent studies have attributed these euphoric feelings to the release of various �feel good endogenous chemicals� that produce this response and one such compound is Anandamide. 

So how do THC, Anandamide, and other cannabinoids elicit their neuropsychotic function in the mind-body system? Located in the brain are numerous receptor proteins that specifically bind to cannabinoids. Just as a specific key opens a specific lock, so is the relationship between the cannabinoids and its receptors. When a cannabinoid (endo, plant, or synthetic) engages a specific receptor, it regulates numerous endogenous neurotransmitters and thus elicits physiological and behavioral responses including appetite, pain-sensation, mood, and memory. However, when a person takes the cannabinoid from outside, the combination of the external and the body�s own natural cannabinoid completely overwhelms the receptor system throughout the brain and body. This then disrupts the normal neural communication and throws the entire physiological system off balance. 

I have already written about Alzheimer's disease (AD) on this blog before (Memory Loss�Meditation to the Rescue). AD is a progressive disease of the brain and the predominant form of dementia, and is characterized by loss of memory and reduced cognitive abilities. As the disease progresses, the individual is unable to perform activities of daily living or recognize loved ones. AD is also the sixth leading cause of death in the U.S. and the total number of those affected by the disease is expected to double by 2050. At the moment, there is no drug to cure or treat this disease. The disease is characterized by an accumulation and build-up of toxic amyloid protein that: a) affects normal nerve-nerve communication, b) damages the areas of the brain involved in memory, and c) promotes neuronal cell death by triggering neuroinflammation.

In this new study Amyloid proteotoxicity initiates an inflammatory response blocked by cannabinoids by researchers at the Salk Institute, tetrahydrocannabinol (THC), the active compound in marijuana, not only appeared to remove the toxic amyloid beta protein in the brain, it also reduced inflammation in the cells thus revealing a dual neuroprotective function. The researchers have cautioned that the study was done in laboratory cell models outside of a human setting, and the findings are preliminary that need to be tested in humans in a clinical trial. What this means is that at this moment there�s no solid evidence to recommend marijuana for people with AD. What then is the alternative? 

Remember, I mentioned endogeneous cannbinoids and Anandamide in particular above. Well, as it turns out, meditation and deep diaphragmatic breathing (pranayama) triggers the production of endogeneous Anandamide and other similar compounds that not only trigger the feel-good response but also block anxiety and the sensation of pain (see High: Insights on Marijuana (The Endocannabinoid system and other Neuroscience) Sebastian Marincolo). While I did not find any scientific study of the effects of yoga asanas on the endocannabinoids system, from my personal experience, I can say that a daily practice of yoga will definitely stimulate the endocannabinoid pathways. When you are engaged in a posture where the asana challenge matches your skill, you have an undivided focus and get totally involved, forgetting everything else but the pose. You are in a state of �flow,� or as Desikachar puts it, �in the zone.� This state requires a whole lot of initial effort to make it accessible (Positive Psychology vs. Yoga Philosophy), but it offers unlimited opportunity to explore and control all mental aspects, including attitudes, emotions, concentration, intent, and faith. Notice how the experience builds contentment and brings a sense of accomplishment. It�s a great positive spiral, and it results in improved health and happiness. My belief is that this emotional state is due to the surge of endogeneous Anandamide and other feel-good chemicals. Thus, instead of smoking pot, one can derive the same benefits of the cannabinoid system through a combination of yoga, meditation and pranayama�I call that �yoga high�!

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The Ill Effects of Prolonged Sitting

by Ram

Paul Writing by Camille Pissarro

We live in a hyper-competitive world, where most of us work at stressful, sedentary jobs. In fact, nearly 86 percent of American workers sit all day at their jobs. Furthermore, accumulating evidence suggests that we spend a majority of our time sitting and indulging in sedentary activities. Sedentary activities includes the time spent sitting in an automotive on a long commute, sitting at a desk at work, sitting on the couch after work, watching television, reading, and playing games or surfing the internet. Recent research indicates that on an average, an American adult spends 10-12 hours each day sitting. Notice that sitting is now the norm and physical exercise is considered an intervention program advised by your personal physician to nullify the negative impacts on your health.

Prolonged sitting time considered as one of the major instance of sedentary behavior has emerged as a strong risk factor for various negative health outcomes. Study results have demonstrated associations of prolonged sitting time with premature mortality, chronic diseases such as cardiovascular disease, diabetes, and cancer, metabolic syndrome, and obesity. Those who spend a lot of time sitting have an almost eight-fold increased risk of dying prematurely compared to those who exercise often and are hardly sedentary. Medical experts agree that one of the reasons for a high rate of obesity, high blood pressure, diabetes, cancer, depression and other health issues seen predominantly in younger age individuals is due to prolonged sitting and physical inactivity. For people who engage in prolonged sitting activities, their risk of heart attack is about the same as smoking. The negative consequences are so alarming that medical experts have started referring to the poor health outcome from prolonged sitting as �sitting disease�. 

The ill effects from prolonged sitting are not restricted to the US population alone. In a recent study All-Cause Mortality Attributable to Sitting Time: Analysis of 54 Countries Worldwide in the American Journal of Preventive Medicine, researchers used survey data from 54 countries, analyzing the time spent sitting more than three hours a day along with data on population size, actuarial tables, and overall deaths. More than 60 percent of people worldwide spend more than three hours a day sitting down, and the researchers calculated that sitting time contributed to some 433,000 deaths a year (nearly 3.8% of all-cause mortality) among those 54 countries. 

The above findings agree with another survey of some 220,000 Australian adults Sitting time and all-cause mortality risk in 222 497 Australian adults that was published in the Archives of Internal Medicine. Those who sat for more than eight hours a day had a 15 percent greater risk of dying within three years than those who sat for fewer than four hours a day. The results were more alarming for those who sat for 11 hours or more a day; they had a 40 percent greater risk of early death compared to those who sat for under four hours. This risk sustained even for those who spent some time exercising. Experts now are of the unanimous opinion that even 30 minutes of physical activity is insufficient to neutralize the detrimental effects of 8 hours or more of sitting.

You may wonder why prolonged sitting contributes to negative health outcomes. There are evolutionary and biochemical reasons for this. As humans, our body was simply not designed to sit for prolonged hours. We were evolutionarily designed to "work out,� as evident from our ancestral hunter-gatherers. Hence our body reacts negatively to prolonged sitting. At the cellular level, numerous changes happen all of which trigger the detrimental effects. Prolonged sitting:

• decreases the activity and levels of an enzyme that helps burn fat
• reduces bone mineral density and blocks new bone formation
• reduces the diameter of arteries putting the individual at risk for heart disease
• makes the body insensitive to insulin thus resulting in type-2 diabetes

Additionally, prolonged sitting affects the architecture of the spine, hips and neck as well putting the individual at risk for skeletal fractures. Furthermore, a recent study Television Viewing and Time Spent Sedentary in Relation to Cancer Risk: A Meta-Analysis found that prolonged sitting whether at work or home increases the risk of three cancers namely colon, endometrial and lung. The study also found that high participation in sedentary activities and low participation in physical activities was linked with a 41 percent higher risk of recurrence of colorectal adenomas.

For many of us sitting for eight hours a day at our job is inevitable. This compounded with the extra sitting outside of work is what makes it harmful. Besides, too much sitting is harmful even if you're getting enough exercise. This means you could be meeting the recommended guidelines for a daily exercise but you will still be at higher risk of disease if you sit for long periods each day. So how can one avoid the dreaded effects that come from prolonged sitting? The best solution is to drastically change your lifestyle. While standing for long hours by no means is the answer, most experts recommend a 50:50 sit-stand allowance for optimal health. If your occupation involves sitting for long periods, work at a standing desk. The potential benefits from a standing desk are manifold including: higher productivity, reduced absenteeism, and lower health care costs among many (see A Neutral Posture White Paper). Experts also agree that it is beneficial to interrupt sitting time as often as possible. One way to do this is to move or stretch for at least 10 minutes for every hour of sitting time. 

For those of us who have an active yoga practice, you can either bring in a mini office yoga series (Featured Sequence: Mini Office Yoga Practice) or supplemental yoga with you (Yoga, Your Companion Through the Day). If you need to stretch your back and do not have too much time at hand, you could think of the mini series for the back (Featured Sequence: Low Back Care). Since prolonged sitting is not only having an impact on public health but also has effects on the health span of the individual, it is never too late to make simple changes and maintain a reasonable amount of activity particularly across the middle and later years to avoid early death and serious illness. 

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What Really Causes GERD (Gastroesophageal Reflux Disease) and How Should It Be Treated?

by Ram

Damage by Melina Meza

GERD (gastroesophageal reflux disease) is a digestive disorder characterized by recurrent reflux of acid from the stomach into the esophagus triggering heartburn or acid indigestion. The esophagus is a muscular, tube-like structure that connects the throat to the stomach, which is lined by a moist, pink, gel-like tissue called mucosa. The food that you eat moves from your throat down to the esophagus. Two valve-like muscular structures exist in the esophagus to regulate the flow of the nutrients to the correct destination (from the esophagus to stomach to the small intestine). The upper esophageal sphincter (UES) at the top of the esophagus prevents food and other secretions from entering the windpipe by opening or closing at the appropriate time. The lower esophageal sphincter (LES) present at the esophagus-stomach junction prevents the stomach acids from traveling into the esophagus through its appropriate open-close function. 

Gastroesophageal refers to the stomach and esophagus. Reflux means return or flow back. Thus, gastroesophageal reflux is the reverse flow of stomach acids back up into the esophagus, either due to weakening of the lower esophageal sphincter muscles or due to inappropriate closure of the lower esophageal sphincter valve. Certain foods, fermented or fizz drinks, acidic fruits, cigarette smoke, and chronic stress can all cause the lower esophageal sphincter valve to relax, resulting in acid reflux into the esophagus. If this situation happens as a one-time event or acutely it is termed as a heartburn/acid reflux. If it is long lasting and a more serious form or a chronic issue, it is termed as gastroesophageal reflux disease (GERD).  

The most common symptom of gastroesophageal reflux disease (GERD) is heartburn. If the condition persists, additional symptoms may also appear, including a sour taste in mouth, chest pain, difficulty swallowing, dry cough, sore throat, and spewing of sour solids or liquids. Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. Over-the-counter treatments that may help control heartburn include:

1. Antacids that neutralize stomach acid
2. Acid production blockers, also called as H-2-receptor blockers, which provide longer relief and may decrease acid production from the stomach for up to 12 hours
3. Proton pump inhibitors, which are even stronger than H-2-receptor blockers of acid production

However, prolonged use of any of the above-mentioned medications can produce side effects, such as diarrhea, constipation, fatigue, confusion, or bone loss. If the heartburn and other symptoms don�t improve with lifestyle changes and medications, surgery may be the ultimate option. And while the symptoms of the heartburn may temporarily cease through the use of the above-mentioned medications, blocking the acid production is not a good remedy. There is a reason for the presence of acid in the stomach: it is necessary for proper digestion of food. The enzymes that digest the food completely work efficiently in the acidic environment. It is this combination of the acid and the enzymes in the stomach that facilitate efficient digestion of food to a form that can be easily delivered to the small intestine for further digestion and absorption. While the strength of the stomach acid is strong enough to burn a hole through a piece of wood, the stomach itself is well protected from its own acids. However, unlike the stomach, the esophagus does not possess any protective inner lining, resulting in its damage by the acids that shows up as a burning heartburn. This has been the premise so far. 

But now a new research study is changing this long-held paradigm (see Association of Acute Gastroesophageal Reflux Disease With Esophageal Histologic Changes). According to this new study, the stomach acid backing up into the esophagus does not cause chemical burns and damage to the lining of the esophagus as thought earlier. Instead, the researchers from UT Southwestern-Dallas VA hospital suggest that the damage in patients with GERD actually occurs owing to an inflammatory response prompted by the secretion of inflammatory proteins called cytokines. The research work done in mice demonstrates that it takes several weeks for the stomach acid to initiate any damage in the esophagus. So it is unlikely that acids are the cause of the chemical burn since burns develop immediately. In follow-up studies on humans, the researchers followed 12 patients who suffered from chronic GERD. The patients who were taking proton pump inhibitors to control the acid reflux were asked to stop taking the medication. The researchers thought that GERD might redevelop if the medication were to be stopped, providing an opportunity to observe the early changes of GERD. Nearly all of the patients showed damages to the esophagus after stopping the medications. More importantly, the damages that reoccurred were not consistent with acid-triggered burns. Rather, the changes revealed all the tell-tale signs of an inflammatory response, suggesting that the stomach acid in the esophagus actually triggered a pro-inflammatory response by stimulating the production of small molecules called cytokines that trigger�s the body�s own defense system to go awry (see Chronic Inflammation and Yoga: Combating the Fiery Killer).

So what�s in this for the doctors and pharmacists? Since the study challenges a long-held belief about the role of the acid in damaging the esophagus, it is important for medical personnel to have the correct understanding of the mechanisms underlying GERD in order to facilitate novel GERD in order to facilitate novel GERD treatments. 

And what does it mean for people who have the condition and are desperate to jump off the antacid/PPI bandwagon? Good eating habits and good lifestyle practices that include a regular yoga practice go a long way in strengthening the gut. A balanced yoga practice includes asanas, resting poses, pranayama and meditation, all of which support the best possible digestion via our conscious mind and the autonomic nervous system (see The Digestion System and Yoga). As I mentioned in the beginning, chronic stress�which can over-activate the sympathetic nervous system (your Fight or Flight response)�is the single most common trigger of GERD (Our Hyper-Competitive, Stressful World), so consider meditation and restorative yoga practices when you know you are under lots of stress (see How to Practice If You Have Digestive Problems). All of the above practices together with healthy food choices and timely meals will promote a healthy digestion that is required to maintain a long health-span (Why You Should Care About Your Digestive System). So one alternative to consider working your way to healthy aging is by closely listening to your gut!

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Infection: Possible Cause of Alzheimer's Disease?

by Ram

Roads and Fences by Marie Lossky

Alzheimer�s disease was first described in 1906 by a German physician Alois Alzheimer and the disease that got its name from this physician continues to baffle neuroscientists to date about the exact cause, cure, or treatment. Alzheimer�s disease (AD) is a progressive brain disorder that damages specific cells in the region of the brain called hippocampus. Death of neurons in the hippocampal area of the brain triggers short-term memory failure, and often the person's ability to do familiar tasks begins to decline as well. Alzheimer's disease also attacks other areas of the brain responsible for functions such as language and reasoning, resulting in the loss of language skills and judgment. As the disease progresses, patients often exhibit personality changes, emotional outbursts, and disturbing behavior, such as wandering and agitation. People with AD eventually require comprehensive care, thus the disease presents a considerable problem in patient management as well. It may sound strange that despite a century having elapsed since the disease was first described, there is still no cure or proper treatment for this disease.

According to recent statistical data, an estimated 5.4 million Americans of all ages have Alzheimer's disease. By 2050, the number of people with Alzheimer's disease may nearly triple, to a projected 13.8 million. In the last 10 years of the 244 compounds that went to clinical trials only one was approved. And that one approved drug works with limited efficacy only when given to patients during the early stage of the disease. Finding drugs for AD is especially difficult because: 

1. The exact cause of AD is not yet known.
2. The brain is relatively inaccessible, and harder to test and deliver compounds to.
3. No proper animal models exist that recapitulate? exactly the disease in humans.
4. Less is known about the biology of the condition.

 While the exact cause of the disease is still unclear, most of the attention has been driven towards a protein called beta amyloid, which forms toxic aggregates or plaques in the brain of AD patients. When not properly cleared, the toxic beta amyloid blocked transport of essential nutrients and disrupted communication between neurons that ultimately resulted in death of nerve cells, cognitive decline, and memory loss. Evidence suggests that amyloid is deposited early during the course of the disease, even before clinical symptoms appear. Thus, this protein became a major drug target in the search for a cure to Alzheimer�s, with pharmaceutical companies spending billions of dollars designing drugs that bind to and trigger clearance of the toxic beta amyloid. In all these trials, not only were these drugs ineffective in reversing the AD symptoms, in several cases, patients exhibited severe side effects very early on and the trials had to be abandoned prematurely. So targeting beta amyloid in patients with AD may not be the correct approach to stop the disease, and several researchers continued to debate passionately about the amyloid hypothesis while looking into other theories. 

Now a team of researchers is proposing a very different story. In a study published last week, the collaborative team from Harvard and MIT report that beta amyloid may actually have a critical neuroprotective role in the brain: protecting the brain from infections (bacterial or viral). The neuroscientists suggest that beta amyloid acts as a foot soldier by trapping potentially invading harmful bugs and alerting the other defense teams in the brain to their presence. By forming a mesh like structure, beta amyloid traps the microbes and prevents them from traveling deeper into the brain. The researchers also pointed out that animals that overproduced beta amyloid were more resistant to infections and had longer survival rates compared to animals that did not produce the protein. The higher the expression of beta amyloid, the greater was the protective effect from the infection, suggesting that beta amyloid acted as a natural antibiotic. This meant that getting rid of amyloid, as most drug trials tried in the past, could actually be dangerous, especially when the patient contracted any infection. 

So if beta amyloid is actually a protective protein, what eventually triggers Alzheimer�s disease? According to the researchers, the disease could be inadvertently triggered by an infection that causes the formation of excessive beta amyloid. As people get older and their immune system becomes increasingly compromised, it paves the way for microbes to sneak into the brain, resulting in an overabundance of the beta amyloid protein that exceeds the normal protective threshold. An excessive buildup of the protein may trigger the body�s own defense system to go awry that which we know as inflammation (see Chronic Inflammation and Yoga: Combating the Fiery Killer). Thus, what may be a neuroprotector, over time changes its face into a neurotoxic molecule. It is like the soldiers who stage a coup instead of defending their country. 

So what does this mean for pharmaceutical companies? Well, instead of attempting to completely eliminate the beta amyloid protein from the brain, drugs need to be engineered such that they dampen the beta amyloid levels to a stage where they continue to elicit the protective anti-infective properties. And what does it mean for people who have early stages of the disease? Or what does it mean for people who do not have the disease yet but who have a family history of AD? For now, some of us maybe able to avoid the chronic mind-ravaging effects of AD by making healthy changes to our lifestyle, remaining active, achieving ideal weight, reducing stress, and in some cases, taking vitamins, herbs and/or nutraceuticals that are recommended by a physician or licensed practitioner. The brain, like muscles in the body, requires exercise to remain functionally strong and resist infections. Stimulation of the brain increases the branching of brain cells that provide resilience to the brain and also support cognitive function. Thus, it is important to pursue intellectually challenging activity throughout life (see The Power of Mental Exercise, Part 1). 

Maintaining mental agility and learning new tasks as we age will also contribute to our own well-being and independence (see What is Healthy Aging, Anyway) Additionally, brain changes associated with meditation and stress reduction play an important role in slowing the progression of age-related cognitive disorders including AD. Furthermore, maintaining good sleep and sleep habits helps to clear out harmful toxins, a process that may reduce the risk of AD (see Sleep, Alzheimer's Disease and Yoga). If you�re having trouble sleeping, yoga�s stress management techniques can help quiet your nervous system so you fall asleep more quickly and more soundly (see Five Tips for Better Sleep). And if you'd like to add any additional practices to encourage brain health, start meditating on a regular basis (see Memory Loss�Meditation to the Rescue) and keep practicing your yoga asanas (see More on Yoga and Brain Strength: Neuroprotection). It�s not too late to start all these techniques and practices to keep a healthy brain and a strong mind, so better start today! 

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Recent Thoughts About Hoarding Disorder and Yoga

by Ram

Taking Out The Garbage by Edith Vonnegut*

I was at an Ayurveda conference last year when one of the participants approached me to discuss her mother, who was diagnosed with HD. Being a neuroscientist, I assumed HD to be Huntington�s disease, a neurological condition that results in the progressive breakdown of nerve cells in the brain. In the middle of the conversation I realized that she was referring to another condition: Hoarding disease. I was puzzled because I never thought of hoarding as a disease.

As I kept reading about this condition from various sources, I was amazed to learn that hoarding disorder (HD), as it�s officially known, is a serious condition that is as common as schizophrenia, bipolar illness, and obsessive-compulsive disorder (OCD). In the latest version of the DSM manual (Diagnostic and Statistical Manual of Mental Disorders), hoarding, which was previously classified under OCD, is now classified independently of OCD suggesting the higher prevalence and seriousness of this disease. A recent review published in the �Journal of Psychiatric and Mental Health Nursing� found that 2-5% of the population met the criteria for hoarding disorder. According to the Mayo Clinic:

�Hoarding disorder is a persistent difficulty discarding or parting with possessions because of a perceived need to save them.�

As a result, any thought of getting rid of the items triggers serious mental stress to the individual. Excessive accumulation of items, regardless of the actual value, often creates cramped living conditions with homes/garages that are filled to capacity and narrow pathways leading through mounds of clutter. The clutter may include but is not limited to household utensils, paper materials (e.g., mail, cards, books newspapers), clothing, containers (e.g., boxes, paper and plastic bags), garbage, rotten food, pet�s stuff, and, of course, wealth. Hoarding disorder ranges from mild to severe, and may not have much impact in some cases, while in other cases it seriously affects the individual�s functioning on a daily basis. Symptoms of hoarding disorder begin relative early (around 30) and worsen with age. People with hoarding disorder often don't see it as a problem, making the diagnosis and treatment challenging. Attempts to �de-hoard� usually fail since the problem may recur, often within a few months. Moreover, hoarders whose homes have been cleared without their consent are known to experience extreme distress and may become further attached to their possessions thus putting them in a downward spiral of the disease.

Medicines alone may help reverse some of the associated symptoms such as depression, fear, worry, and/or anxiety but does not appear to reduce the hoarding behavior. Psychologists and counselors suggest the following:

1. Hoarders need to be sympathized and held with respect
2. Help the person to recognize that hoarding interferes with every aspect of life
3. Find out what will help motivate the person to discard or organize 
4. Encourage the hoarders to come up with suggestions to clear the clutter to make their living environment safer

What does this have to do with yoga? Well, in the yoga philosophy, the first of the eight rungs or limbs is the yamas, and are considered as universal morality (see Yama Drama: Considering the First Branch of Yoga). Yamas serve as moral, ethical, and societal guidelines to lead a healthy, conscious, honest, and ethical life. Of the five yamas that help us to relate to our surroundings and environment and to achieve oneness with it is aparigraha. (see The First Branch of Yoga: The Yamas). The term can be translated to mean noncovetousness/non-possessiveness/non-hoarding. Aparigraha means to limit possessions to what is necessary or important, and having what is truly necessary and no more. The more we accumulate and hoard material possessions, the more we get attached to and worry about losing these possessions. 

According to Patanjali, coveting material wealth increases greed and possessiveness, and distracts an individual from doing a charitable act. But hoarding is not just about accumulating material possessions but also about filling/holding thoughts and emotions that affect our normal mindset and thinking process. We tend to fill our minds with fear, worry, anxiety, grief, anger, rage, jealousy, and judgments, among others ,and we do not let go of these emotions. Over time, these emotions build up and accumulate as unexpressed or suppressed emotions that can trigger mental and/or physical pathological conditions (see Aparigraha (Non-Hoarding) and Healthy Aging for more on this topic). Was Patanjali was referring to acute hoarding or chronic hoarding leading to a neurobehavioral disorder? Whatever be it, the very act of hoarding can be devastating to both mind and body, and need to be seriously addressed. 

Since yoga can help both the body and mind to function at their best, there is a possibility that yoga can also get rid of compulsive hoarding or hoarding disorder. What is the easiest and effective way to ward off emotional hoarding? Meditation helps to bring the awareness of oneself from moment to moment. While meditation may not cure a person from the act of hoarding, it may help the individual to react to life differently. This reaction and suitable action measures comes from a true awareness to the physical or emotional turbulence. Additionally, yoga asanas may also help, and there are several anecdotal reports about various asana posture for HD. In the scientific literature, there are several published reports about the effectiveness of Kundalini yoga for the treatment of psychiatric disorders including OCD. According to the authors of one such study, the Kundalini OCD protocol includes techniques that are useful for other neurobehavioral conditions, including anxiety disorders, fear and anger management, and reversing mental challenges, and for converting negativity into positive thought. According to the authors of An Introduction to Kundalini Yoga Meditation Techniques That Are Specific for the Treatment of Psychiatric Disorders, the yoga protocol also successfully addresses phobias, addictive and substance abuse disorders, major depressive disorders, grief, and insomnia. Additionally, the authors also provide information about contraindications and list of dos and don�ts to keep the yoga practice safer. 

Let me also add that while I consider yoga to be a powerful tool for improving neurobehavioral health problems, such as HD or OCD, it is one of the many solutions. One may need to use it as an add-on practice to western medicine, including drugs and/or therapy. You need to do whatever it takes to help you get better and the yoga mat is one of those solutions.

And if you�re a parent, spouse or significant other, or a family member of an individual with HD, kindly encourage the individual to take some form of yoga class as it has been shown to successfully address phobias, addictive and HD. Consider taking these classes yourself so you can provide the most calm and supportive environment possible for the HD individual.

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How Mother�s Stress Affects the Fetal Brain

by Ram

Prenatal Yoga by Melina Meza

Chronic stress is a world-wide problem. Irrespective of the country, when you compare the statistics of chronic stress and its adverse effects, the numbers are nearly similar world wide. Within the USA (see Stress a Major Health Problem in The U.S., Warns APA) , nearly 33% of Americans are living with chronic stress and 48 % percent of Americans believe that their stress has increased over the past five years. Seventy two percent of adults report that money is their single cause of stress. And 50% of Americans report that chronic stress has a negative impact on both their personal and professional lives. Chronic stress causes the body to overreact resulting in two main events:

1. overproduction of stress hormones including cortisol and adrenaline
2. an inflammatory response

Both these events in turn disrupt almost all of the body's processes putting the individual at increased risk of numerous health problems, including: anxiety, depression, digestive problems, heart disease, insomnia sleep problems, metabolic disorders, and memory and concentration impairment. 

In addition, there�s a very serious issue that is the focus of Stress a Major Health Problem in The U.S., Warns APA: what about a mother who is chronically stressed and who is also pregnant? There is some data to show that chronic stress in pregnant women and poor coping skills to deal with it may be associated with lower birth weight of the baby or delivering pre-maturely. Some women deal with stress by smoking cigarettes, drinking alcohol, or taking drugs, all of which lead to pregnancy problems. Data also indicates that chronic stress can affect the baby�s brain development or immune system. Chronic stress especially during the first trimester of pregnancy may also contribute to differences in brain development that might lead to behavioral issues as the baby grows.

In a study Impact of Maternal Stress, Depression & Anxiety on Fetal Neurobehavioral Development published in 2011 in The journal of child psychology and psychiatry, researchers followed 116 women throughout their pregnancies, testing their levels of cortisol. Testing took place every month in the second and third trimesters. After the babies were born, the researchers measured each infant's cortisol after a routine blood draw from the foot, and also recorded each baby's response to the blood draw. Researchers found that the greater the exposure to mother�s cortisol in the womb, the larger was the infants' own cortisol spike in response to a blood draw. These cortisol-exposed infants also calmed down less readily after the blood draw ended. Furthermore, researchers also found that the rostral anterior cingulate are of the brain is thinner in the children exposed to high levels of stress hormones in the womb, compared to children of a similar age who were not exposed to the stress hormones. (The rostral anterior cingulate region is associated with emotional regulation, and the children with the thinning were generally more fearful and anxious.) 

According to How the First 9 Months Shape the Rest of Your Life, omen who suffered from severe emotional issues give birth to children who had a higher risk of developing depression, schizophrenia, and anxiety, suggesting that the intrauterine environment is another pathway by which emotional and mental illness is passed down in families.

Soon�to�be mothers need to cultivate good stress management techniques. And, interestingly, all of the literature searches on stress management for pregnant women unanimously describes the positive impact of yoga, meditation, and guided relaxation in alleviating stress. The Mayo Clinic has detailed information for pregnant women on how to deal with stressful situations through yoga (see Prenatal yoga: What you need to know). And even a short session of yoga provides numerous benefits, including the rejuvenation of the body and mind. At the cellular level, yoga, meditation and relaxation techniques destresses the mind and body by:

• releasing brain chemicals that contribute to a feel-good response and ward off anxiety and mental stress, 
• normalizing blood pressure and stabilizing the heart beats
• reducing anxiety and depression
• improving the ability to sleep by de-activating the hypothalamic-pituitary-adrenal stimulus (HPA) and lowering the hyperarousal phenomenon 

Thus, when it comes to pregnancy, yoga not only helps to deal with stresses of all kinds, it also enables the mother to move toward equanimity by stabilizing her mind, body, and spirit for motherhood (see Yoga for Pregnancy.). Making the commitment to take care during the nine months through a gentle asana, meditation and relaxation techniques may seem to be a huge undertaking, but remember, not only does it empower the mother�it keeps the baby free from the mercy of stressful forces. And if you�re a future father, grandparent, or family member of a pregnant woman, encourage the future mother to take prenatal yoga classes and consider practicing stress management yourself so you can provide the most calm and supportive environment possible for mom and baby.

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The Amazing Variety of Meditation's Benefits

by Ram

Open Gate by Melina Meza

Studies on meditation and its effects on brain structure and function have been rolling in steadily for a number of years. Using state of the art technology and imaging techniques, researchers are confirming numerous independent observations with detailed precision about brain structure, behavior, and function. The unanimous conclusion from all these findings is that meditation appears to have an amazing variety of neurological benefits. 

We have written several articles about meditation (dhyana) in this blog. Articles by Baxter (see Thoughts on Dhyana: Meditation over the Holidays), Nina (see Meditation and Compassion), and others have provided a lucid explanation about how to meditate, the benefits of meditation on body and mind, and empirical evidence of these benefits. Undoubtedly, meditation has been shown to:

• reduce fear, worry, anxiety, anger, and rage
• reduce chronic pain
• increase cognitive function
• lower blood pressure
• alleviate post-traumatic stress syndrome
• slow down cellular aging. 

For those suffering from age-associated memory impairment, meditation has been shown to reverse hippocampal (one of the areas in brain involved in memory) degeneration and improve neuronal connectivity (see Memory Loss�Meditation to the Rescue). 

Several studies also confirmed the role of meditation in actually reducing pain perception. In my post Mindfulness Meditation andPain Management: Recent Findings! I discussed about the study in which people with lower back pain who practiced a mindfulness meditation technique showed greater improvements in pain perception. That study led to the conclusion that meditation activates several regions of the brain, and this global effect of mindfulness meditation helps to prevent pain and painful information from spreading throughout the brain and body.

The question that arises from all these studies is that in addition to functional changes, does meditation also have a structural effect on the brain? Does it increase or decrease the volume of any areas of the brain or does it promote any new neuronal connectivity? Results from recent studies do point to the role of meditation in structural changes in the brain in addition to functional changes. In a study Reduced age-related degeneration of the hippocampal subiculum in long-term meditators that was published last year, a group of researchers reported that long-term meditators had better preserved brains associated with less reduction in brain volume than non-meditators as they aged. Participants who had been meditating for an average of 20 years had more grey matter volume throughout the brain. The volume of the grey matter is a measure of the density of brain cells and appears to correlate positively with various abilities and skills. While older and more experienced meditators exhibited some grey matter volume loss compared to younger meditators, this loss was less pronounced compared to non-meditators.

Just as a reminder, the grey matter contains mostly the brain's neuronal cell bodies and non-neuronal cells, and is chiefly involved in muscle control, sensory perception, such as seeing and hearing, memory, emotions, speech, decision making, and self-control. You may wonder why the loss in grey matters so important or critical. Turns out, as we age, there is a significant loss of grey matter volume in multiple areas of the brain, resulting in loss of function associated with those specific areas. Age-associated grey matter decline is significant in the memory centers of the brain, the hippocampus, and entorhinal cortex, leading to dementia. The aging process also affects normal cerebral blood flow that in turn triggers the grey matter loss and dysfunction. While there is no drug to stop this natural age-associated loss of brain cells, meditation actually helps to delay the age-associated loss by strengthening those areas. The widespread effect of meditation throughout the entire brain may partly explain the brain�s resilience exhibited by seasoned meditators. 

This effect of meditation on reversing/delaying grey matter volume triggers favorable functional outcomes as well. There is very good evidence for concomitant functional changes in brain with meditation, with studies reporting that meditation:

• helps to relieve chronic stress, anxiety and depression
• curbs inflammation
• improves attention and concentration
• promotes overall psychological wellbeing

Most of these functions are associated with the grey matter. Specifically, with regard to its role in inflammation (see Chronic Inflammation and Yoga: An Update), a couple of recent research studies point to meditation�s therapeutic benefit in lowering stress and curbing chronic inflammatory conditions. In one such study, meditation training resulted in a significantly smaller post-stress inflammatory response together with reduction in emotional disturbances (see A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation). Additionally, in patients with Inflammatory Bowel Disease, participation in a meditation program resulted in significant improvements in psychological, emotional and physical symptoms, quality of life, as well significantly lowering the levels of C-reactive protein that serves as a marker of inflammation (see The Effect of Breathing, Movement, and Meditation on Psychological and Physical Symptoms and Inflammatory Biomarkers in Inflammatory Bowel Disease: A Randomized Controlled Trial).

The health benefits from meditation are so striking that researchers are swearing by it, and more doctors are recommending this practice to their patients. Meditation has gained millions of converts, helping them ease a myriad of modern ailments. People who meditate agree that it is not difficult to learn, but let us also agree that it's a skill that is mastered with practice, and in time people develop the ability to achieve the meditative, relaxed states very quickly. I know if I have to choose between drugs or meditation practices to curb stress and strengthen my brain, I would choose meditation. How about you?

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Mindfulness Meditation and Pain Management: Recent Findings!

by Ram

Branches by Melina Meza

This is part one of two articles that focus on some of the latest findings on meditation and its an amazing variety of neurological benefits. Dhyana or meditation is a state of being where the mind stops wandering, is calmer, and maintains a period of stillness. In this state of mind, an individual no longer possess bodily awareness, the sense organs are not distracted, and the stillness produces few or no thoughts at all (see Yoga Meditation Techniques). One of the original goals of meditation was to quiet the mind. Because our minds are typically busy with thoughts and emotions�many of which disturb our equanimity�quieting the mind and letting go of these daily dramas of life allows us to experience feelings of peace and contentment. Meditation also fosters feelings of compassion, which improve relationships with others. And you can also use meditation to cultivate feelings of gratitude that in turn fosters contentment (Honesty and Contentment in the Yoga Room). There are many different kinds of meditation. Some are designed to help us relax; others are meant to produce altered states of consciousness. 

Mindfulness meditation is one of the techniques where your mind is not only fully aware of the stillness but also keeps observing when your attention starts to wander from the object of the meditation (in most cases the object of meditation is the repetitious breath, flow of thoughts, emotions or feelings). And as you observe these objects with a sense of detachment, you will notice familiar patterns that may seem irrelevant to harbor and you may want to let go these patterns. Detachment or letting go of these patterns helps in cultivating equanimity in your daily life (Meditation and Equanimity). Thus, mindfulness meditation allows you to observe your habitual thought patterns and emotional responses and provides the opportunity to change them to more positive ones. Mindfulness meditation helps us become aware of what is already true at every moment, providing us with an opportunity to become more present with ourselves just as we are. This, in turn, helps us to overcome the unnecessary suffering that results from trying to escape the discomfort and pain that we experience in our daily lives.

Today�s discussion is about mindfulness meditation and its role in alleviating the acute pain response. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage and is part of the body�s inherent protective mechanism to motivate the individual to pull out from a damaging situation and prevent further damage to the tissue, allow the damaged tissue to rest and heal, and avoid similar encounters. Thus, the phenomenon of pain is beneficial in a true sense when, for example, your back sustains a blow and the injured tissues need care and protection (Understanding Pain). 

Just like inflammation, the phenomenon of pain is generally transient, and recedes when the stimulus is removed or the damaged tissue has healed (How and Why Yoga Helps with Pain). When your body encounters an acute pain stimulus, your brain releases a large number of pain reducing chemicals called opioids. Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, gastrointestinal tract, and other organs in the body. The binding of the endogenous opioids to their specific receptors results in reduction of the perception of pain. However, there are certain abnormal pathological conditions where pain is a constant feature and persists for a long time (chronic pain). While in some chronic cases the levels of the endogenous opioids are not sufficient to alleviate the pain response, in most cases the body becomes insensitive to the body�s levels of opioids. Chronic pain that lasts beyond the expected period of healing can interfere with a person's quality of life and general functioning. Unfortunately, chronic pain brings with it other health issues including constant fear, worry, anxiety, depression, and memory deficits and turns out to be the most common reason for individuals to visit their physician (Techniques for Managing Pain with Yoga). 

One of the methods of pain management is the external administration of opioids like vicodin, morphine, codeine, or oxycontin. These external opioids not only blunt the pain response, they also produce a euphoric response since they also affect the brain regions involved in reward. Regular or long-term use or abuse of opioids can lead to physical dependence and, in most cases, addiction. Naloxone is a drug that works as an antidote to the opioids and is mainly used to reverse an opioid overdose. Naloxone works by blocking the analgesic (anti-pain) and the euphoric response of the opioids in the system. Naloxone only works if a person has opioids in their system; the medication doesn't work on other drugs. 

Now what does all this have to do with mindfulness meditation? Well, we know that meditation produces relaxation and the lovely blissful feelings that result from release of tension. The question is: does meditation trigger the release of endogenous opioids which in turn produces the pain relief and the pleasant effects thereafter? This was the premise of a new study Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids in which the researchers set out to ask a simple question, �does mindfulness meditation (MM) produce pain relief and if yes, then does it do so through the release of endogenous opioids�? 

The double blind randomized study involved 78 healthy, pain-free people who were randomly assigned to receive different interventions. The first group was trained in mindfulness meditation for 20 minutes a day for four days. And the second group, which served as a control group, spent the same amount of time listening to a book read aloud. The scientists then exposed all the participants to a pain stimulus by placing a hot probe on the back of their legs. The group that practiced mindfulness meditation experienced significantly reduced pain intensity and pain unpleasantness than the control group. 

The next thing to determine was if the pain reduction in the mindfulness meditation group was due to release of endogenous opioids. One way to test this was to block the release of endogenous opioids (if any) by administering the drug Naloxone, which would then reverse the beneficial analgesic effects of mindfulness meditation. (A control group was given simple saline as a placebo.) To the surprise of the researchers, the meditators who received the drug Naloxone before being subjected to the hot probe continued to experience significantly reduced pain intensity and pain unpleasantness than the control group, suggesting that Naloxone administration failed to reverse the meditation-induced pain relief. There were also no significant differences in pain intensity or pain unpleasantness reductions between the meditation + naloxone and the meditation + saline groups.

The findings clearly demonstrate that mindfulness meditation eases pain through some distinct pathways that are independent of the endogenous opioid mechanisms, suggesting that meditation-based pain relief does not require the role of endogenous opioids. The researchers do not have a clear explanation of the effect of mindfulness meditation on the brain that results in the pain relief. But based on their past results, they believe that meditation activates several regions of the brain that are associated with emotion regulation, focus, and cognitive control. At the same time, meditation also down-regulates the thalamic activity that transmits painful information from and to the body. Thus, the global effect of mindfulness meditation helps to prevent pain and painful information from spreading throughout the brain and body. 

It remains to be determined whether mindfulness meditation would be helpful in the treatment of chronic pain and also be effective in overcoming opiate drug abuse. For now though, mindfulness meditation seems to be a very attractive technique for acute pain relief and for those seeking a non-opiate pain therapy. And, if this is the case, getting hooked on meditation would also be a perfect panacea for pain and other pathological systems some of which we described earlier (Meditation: Effects on Gene Expression). 

This reminds me of an anecdotal report of a senior monk who underwent a complicated surgery without the use of any anesthetics. His years of meditation practice helped him to tide over the pain during and after the surgery. But based on the above-mentioned scientific study, it is also clear that you don�t need to be a monk to reap the benefits of mindfulness meditation. 

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Circadian Rhythms, Jet Lag, and Yoga

by Ram

Pollard Willows and Setting Sun by Vincent van Gogh

The Ayurvedic scholars and yoga gurus certainly knew about circadian rhythms. Termed as dinacharya (day routines), ratricharya (nightly routines) and ritucharya (seasonal routines), traditional observances were encouraged in order to maintain the synchronicity of circadian rhythms with time of the day/night and seasonal fluctuations. These practices allowed an individual to tune the circadian rhythm and coordinate it with the earth�s movement (rotation and revolution). The masters were aware that if circadian rhythms went out of sync, disease and imbalances developed. And this is now understood by scientists and health experts who recognize that disharmony in the circadian rhythm contributes to physical, mental, and behavioral problems, including but not limited to mood disorders, heart disease, metabolic syndrome, cancer, and neurodegeneration. Conversely, if we are able to align our circadian rhythm, we can maximize our health span, mental alertness, immunity, awareness, and physical strength. 

A circadian rhythm is any biological process�physical, mental, or behavioral�that follows a roughly 24-hour cycle, and is modulated primarily by sunlight, darkness, and temperature. Circadian rhythms have been widely observed in humans, animals, plants, and tiny microbes, and primarily influence the sleep-wake cycles, feeding, hormone release, body temperature, and other important bodily functions. Present in all living beings are biological clocks throughout the body that regulate and coordinate our circadian rhythms. Furthermore, there is a "master clock" in the brain that controls all the biological clocks and consequently the circadian rhythms.

This master clock (aka the suprachiasmatic nucleus or SCN) is a group of ~20,000 nerve cells in the hypothalamus area of the brain that coordinates all the body clocks and downstream physiological processes. There are certain circadian rhythms in our body that are optimally active during the day and subside when the sun sets. Similarly, there are other circadian rhythms in our body (for example, sleep) that are optimally active during the night and ebb when the sun rises. These biological rhythms represent the optimum performance of different organs at certain times and their relaxation at other times. The circadian rhythms can be easily disrupted by several factors, including but not limited to time zone difference, environmental stress, emotions, and diet. 

Now that we have some idea of circadian rhythms, it is easy to imagine all those situations where the circadian rhythm can go awry. Specifically, long-distance travelers, pilots, and night shift workers among others will often suffer from circadian rhythm imbalance. I experience similar imbalances when I have to go to India to visit my folks. A difference of 12 hours between the two time zones (Pacific time and India time) disrupts my circadian rhythm causing what we call jet lag. The consequences are disturbed sleep, daytime fatigue, sluggishness, difficulty concentrating, and digestive issues.

One of the most important biological processes that is regulated by the circadian rhythm is the sleep response. The SCN, which controls the production and release of melatonin, a hormone that triggers sleep response receives information about the incoming light via the optic nerves (from the eyes to the brain). During sunset when there is more darkness and less light, the SCN triggers the release of melatonin that induces sleep. Come sunrise, there is more light that strikes the optic nerves so melatonin production is halted, thus triggering the wakefulness response. When I fly from California to India, I lose 12 hours of time. So when I wake up at 8:00 am in India, my biological sleep clock thinks it is 8:00 pm of the previous day, thus making me feel groggy, dazed and disoriented. My body's clock will eventually reset itself, but this often takes anywhere from two to seven days, depending on my physical and mental state. It is generally believed that it can take up to one day for each time zone crossed for the body to adjust to the local time. 

There is a lot of information out there about overcoming jet lag and disturbed sleep cycles and correcting the out of sync circadian rhythm. But in my case, I always turn to yoga. I discussed this issue briefly in my post Yoga in the Skies (Airplane Yoga). In addition to the poses that I described in the post that I do on the plane, after I reach my destination I continue my yoga practice with:

• a few rounds of Sun Salutations
• mild inversions (headstand and supported handstand)
• hip stretches, including High Lunge (Vanarasana), Dropped-Knee Lunge, Warrior series (Virabradrasana), Triangle pose (Trikonasana), Extended Side Angle pose (Utthita Parsvakonasana), and Wide-Angle Seated pose (Upavista Konasana)

I focus on fostering both strength and flexibility, especially in my legs and shoulders, and a good overall hip opening (after sitting for nearly 24 hours in the plane) because they have positive impact on posture, locomotion, balance, and agility (see Opening Your Hips without Knee Pain). The inversions I include are effective at stress reduction, as I find much needed relaxation that is probably achieved from the reverse blood flow (All About Supported Inversions). The entire practice lasts for about 30 minutes followed by 5 minutes alternate nostril breathing and 5 minutes of mindfulness meditation. 

I have noticed that in the last few long-distance trips, I am able to adjust to the new day/night schedule within 24 hours of my arrival to the new destination. There is no doubt that yoga has been helping me to recover quickly from travel-associated sluggish moods, fatigue, lethargy, and disorientation. But I wondered, is there a research study to prove this anecdotal personal experience?

So I was happy when I came across this recent poster presented at the American Society of Clinical Oncology (ASCO) meeting Effect of YOCAS yoga on circadian rhythm, anxiety, and mood: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. Since this work is not yet published, I do not have all the details. But I did learn that, as it turns out, chemo and radiation therapies disrupt the circadian rhythm and exacerbate the anxiety and mood disorders experienced by cancer survivors (75% breast cancer) that impair ultimate recovery and quality of life. To study the role of yoga on circadian rhythms and mood behavior, the researchers divided cancer survivors into two groups: 

1. Those who received standard care.
2. Those who received standard care plus a four-week yoga intervention. The yoga intervention group (75 mins each yoga session and two sessions per week) received a specialized program (YOCAS) that consisted of pranayama, 18 gentle hatha and restorative yoga asanas, and meditation. 

All subjects were tested for their circadian rhythm, anxiety and mood before and after intervention. The YOCAS intervention seemed to have favorably altered circadian rhythm, improved anxiety and mood among cancer survivors, which lends credence to my personal experience. 

So the next time your travel takes you through several time zone boundaries, remember that yoga is there to help you ward off the jet lag and the disturbed circadian rhythms. Happy Travels!

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