With all the different types of workouts available to someone who is setting out on a new course of fitness it is easy to be overwhelmed by all the variety of yoga, crossfit, spin classes, swim classes, etc. They are all wonderful fitness options that offer the support of a teacher and fellow participants who may share common goals of getting more healthy and reducing stress. They also require financial commitments, schedule conflicts, and a variety of quality among those who teach them. Knowing how to do a particular activity is not the same as knowing how to teach another person, whose fitness level may be vastly different, how to safely practice that activity.

I always recommend that people who are new to exercise start out the most simple way possible. Walking once or twice a day can be a phenomenal way to start the process of becoming more healthy and can do wonders for reducing stress and anxiety. Walking can be done in the early morning, at work breaks, and at the evening to reduce anxiety before bedtime. It is cheap and does not require special classes or equipment although joining a meet up group or REI class can be a great way to meet friends. There are a variety of wrist bands, such as the Fitbit, out there now to help you measure and reach your goals while providing a number of other insights into sleep and diet. Our community is surrounded by wonderful trails which can be starting places or future goals as your health grows.

Start walking today and push yourself to always increase the time and pace as you progress and eventually you may feel ready for something more challenging. When you do you will be at a better starting place to jump into yoga or crossfit than you were at the very beginning. Don’t forget to swing those arms and feel the weight come off your shoulders with each evening walk.

Here is a great New York Times article I recommend about getting started with walking. To Age Well, Walk

New guidelines are being promoted for medical doctors concerning their nutritional advice for patients managing chronic illnesses like diabetes, hypertension, and cardiovascular disease. With some areas of the country now showing averages of 39% of the population suffering from obesity and its associated diseases there is even more pressure for medical doctors to actively discuss and monitor diet as a key component in managing the health of their patients. I believe that many health providers find the discussion of diet to be a very difficult one to have with patients and one which many patients are offended by when it is brought up. Our society has a tremendous disconnect between what our illnesses are caused by and who has the power to control those causes. The abstract from the NIH includes a number of studies that show the benefit of plant based diets, even in the absence of increase exercise, on reducing blood pressure, blood glucose, and coronary artery disease. It has long been promoted by the meat and dairy industries that the path to health and strength comes through milk and animal protein. This has been a phenomenal advertising campaign that stands in contrast to the listed causes of the chronic diseases plaguing our modern American society. Thankfully more funding for studies is being granted to look at the links between plant-based diets and adult onset illnesses like type two diabetes. While the recommendations for plant food in these studies always include a list of potential nutritional deficiencies these only serve to worry the public about theoretical risks of not eating enough protein, Vitamin B, and Iron. While this has long been the warning cry of the meat and dairy industries, there is no lack of either protein or iron in plant foods and with little effort Vitamin B can be added through a supplement. Remember that enormous rates of osteo-arthritis and Vitamin D deficiency are actually found in our society despite the world’s leading consumption of animal protein. Our rates of diet induced illness seem to point towards nutritional deficiencies in the general American diet rather than the plant-based diets of health conscious individuals.

Please take the time to read the NIH Article: Nutritional Update for Physicians: Plant-Based Diets. I also recommend the response letter from Dr. John McDougall, Plant-Based Diets Are Not Nutritionally Deficient, who runs his own plant based treatment center in Sonoma County.

I am always on the lookout for ways to improve the web site for the clinic and I recently was lucky enough to do some photography work with local artist, Emily Merrill. Emily prefers to work in natural settings, utilizing sunlight and outdoor locations to highlight the strengths of her model. She has a great deal of experience with weddings, portraits of mothers and child, as well as large fashion/marketing projects.

She has a easy going personality which makes the act of being photographed feel very un-conscious and allows her professional side to shine. I found it a joy to work with Emily and I would highly recommend her for any projects you may have in mind for your business or family.

Her contact information can be found at:

http://www.emilymerrillweddings.com (wedding photography)

http://www.emilymerrill.com (lifestyle photography)

In the most recent edition of National Parks Magazine there was a excellent article contributed by a University of California San Francisco physician, Daphne Miller, MD, about the need for doctors to start prescribing nature to patients who are ill. In her article, A Prescription For Nature, she talks about the links between open green spaces in cities and body mass index in local citizens. Children who are now so frequently medicated to control their behavior in class can show improvement by spending more time outdoors and even doing some active learning in a natural environment rather than in a fluorescent one. With over 60% of Americans now medically overweight we should also be considering the importance of city parks and green areas when we vote for the use of our tax dollars. One of the reasons many people move to Marin in the first place is to have access to better weather, well maintained trail systems, and rolling hills to get our hearts pumping. Let’s all get out in nature and use its beauty to reduce our mental stress, increase our focus and sense of calm, and drop a few points off of the blood sugar. Your prescription is to read this great article and get out there and hike!

I am grateful to have the opportunity to work with many women who are pregnant at Marinwood Community Acupuncture. It allows me to hear many stories about the approaches of different hospitals and Obstetricians throughout Marin County. My patients share information about the regularity of their check ups, whether or not they include ultrasounds or stress tests, and how often they are performed. I get to learn the differences of opinion between different medical approaches for conditions such as nausea and vomiting in pregnancy and each doctor’s prefered solutions, which range from just telling the patient to ‘tough it out’, to the administration of medications to remove the symptoms when they become severe. It is all a wonderful way for me to absorb more information about the process of a woman traveling from pregnancy through to delivery. It can be a source of great happiness for myself to work with a patient through the treatments which aid in fertility, to management of the onset of nausea, to efforts to control (or at least try to control) the troubles with low back pain and sleep, and finally to helping to bring on labor once the baby is at full term.

Through all of these talks I have noticed a shifting trend among patients of different ages concerning the frequency with which elective delivery by C-section are taking place. It seems to be a very prevalent story among those patients who have had one or two previous pregnancies in the last five years or more that a C-section delivery was performed because the women was ‘late’ in delivering naturally. Usually the pattern also included the promise that subsequent vaginal deliveries would be possible but in the end each of the following children were also delivered via Cesarean. I can see the complex emotions that my patients feel just by watching their faces, or listening to their tone of voice, as they talk about the desire they had for a natural birth and all the planning they had made for a home delivery. Things, for one reason or another, ‘just didn’t look right for a natural birth’ to the Obstetrician.

In those Women who are newly pregnant, with their first child, there seems to be less talk about a push for surgical deliveries. While I do still encounter a seemingly majority of patients who end up being induced with pharmaceuticals in the hospital I do not seem to hear of elective/scheduled C-sections. While thinking about the reason for the change between those women who delivered children in the past versus those I have worked with in the last two years I came across a very interesting article on health policy trends in the New York Times.

Times writer Tina Rosenberg, in her article Reducing Early Elective Deliveries, covers the trends over the last ten years in nationwide hospitals for early deliveries among pregnant women. She also does a really nice job of discussing how health practices that have been found to be unhelpful or dangerous for the outcome of the patient can continue to stay in practice in the large hospitals around the country. Thankfully, she also shows how just a few well read and well placed articles in major health journals can be the spark needed to start national health reform to reduce the incidences of these procedures and provide better patient outcomes. She does note sadly, that the real impetus for change in those states where the practice was most firmly entrenched was financial. It was the refusal of Medicaid to pay for the procedures of low income women that got the hospital to actually reduce the numbers and follow the national health policy trends. I found this article to be very education and I recommend that you take the time to read it as well.

Orthorexia Nervosa is a condition that has only recently entered the discussion of eating disorders in the community of Psychology. Sutter Healthcare defines the condition as, “an obsession with eating proper foods”. It is a condition that I come across every few months when first meeting patients during their initial consult at the clinic. It often comes up as I review the paperwork and see a list of supplements or food allergies that is so long that it requires a separate printed out piece of paper to list all of them. Usually the diet is extremely restrictive with an initially well thought out approach to sensible eating becoming an all consuming quest to ingest more and more vitamins, supplements and less foods that they perceive to be harmful. The supplements often become more important than the food itself and the person’s ability to take pleasure in eating becomes limited as they worry about calories, mercury, pesticides, toxins, GMO crops, PH, and so on. These are all things that we should be thinking about when we shop but not things that should make us live in fear. When we eat it should be a true pleasure born of cooking with our hands and shared with our friends and family.

People who suffer from this obsessive condition can place grave and even life threatening danger in certain foods. One patient suddenly began eliminating all products which may have come in contact with the world’s oceans because of Fukushima and the Japanese Tsunami. We should all consider the impact on pollutants in the ocean but to suddenly and fearfully start avoiding large amounts of food, not to mention stockpiling Iodine tablets, because of a highly publicized media event is not healthy if not balanced by the scientific evidence on the issue.

These patients are especially vulnerable to alternative healthcare practitioners and health food stores where they are surrounded by advice, driven by practitioner profits, and isles of supplements and superfoods from all over the world that promise to make them even healthier. This seems so appealing because it promises exactly what the illness craves, the illusion of even better levels of health through super fruits from Brazil, berries from China, or mushrooms from Tibet without any thought given to their traditional uses or therapeutic doses in medical practice. Part of the illness is that each person will only try a new product for a few weeks before deciding that is in fact not helping them be healthier and may in fact be making them sick. This prompts a switch to a new product and a new promise of better days just around the corner.

As recommended on the Sutter Health website, “if you think you or a friend suffers from something that sounds or feels like this description of orthorexia nervosa, you should visit either a nutritionist or doctor for help”. Your visit should always be to a wholistically minded practitioner who honors your concerns and education about food and works with you to make you both physically and mentally at peace with your food.

Often patients will share an interesting fact about a study or medical opinion that they found while researching their condition online. I always encourage people to be active participants in their healthcare and to advocate for their rights as a patient. Medical Doctors are often overwhelmed by the tremendous amount of work needed to keep track of the health of their patients while still staying on top of the medical journals within their speciality. Add to that all the many other journal articles on topics that are from other medical specialities or even topics only tangentially related to that MDs work. Being informed about our treatment options and health maintenance needs is the best way we can help our medical providers manage their extensive work loads while still giving us the highest level of care. It also allows us to gage whether or not we have found a good fit in our provider or if we need to perhaps change to a provider that better understands our needs.

The significant risk in doing ones own research, as a lay person outside of the medical profession, is that it is very difficult to comb through all the information that is out there to be found. Just the lack of a background in statistics alone makes reading any study extremely limited for most of us. Perhaps the largest problem is that almost all of us turn to the internet as a starting place for our research and nearly everything on the internet is based on people’s opinions rather than any sort of scientific or peer review. With the understanding that many people in medicine do not agree with each other on valid forms of care, it must also be acknowledged, that most of what is said on websites is based on a bias opinion, outright misrepresentation, or the attempt to sell a product to the consumer for profit People are promised revolutionary forms of care that standard medicine does not know about or superfoods and vitamins that promise to be the key that will solve your chronic ailments, all for the low low price of… It is very easy to cherry pick facts from scientific articles in order to make them seem as though they support a claim made on a provider or salesperson’s website. When a person has been suffering for a long time with an illness, or is faced with the initial fear of a new diagnosis, it is very easy to read these online promises and not follow through with diligent fact checking. I get very worried when I receive an email from a patient telling me that they read about a new product on a website claiming to be a cure for their illness and that, without any scientific review, they already are ingesting it to see if it works! This happens much more often than one might think. If a product has the ability to heal than it also has the ability to hurt and we should be more careful about where we get our medicines and the information about their efficacy.

One of the better ways that people can now access scientific journal abstracts online is through the website www.Pubmed.org. This allows lay people to access the abstracts, not the entire study article, for a brief summary of what a study set out to prove and what it did or did not succeed in proving. This is a wonderful gift from the internet for both practitioners like myself as well as for my patients. However, it is very important to note again that you are not, with few exceptions, able to see the entire article. This means that you do not get to see how the study was set up, what were the exclusion criteria for the patients, what kind of study was it, and most importantly, who funded the study. Obviously, it would be good to know if the study touting the health benefits of alcohol was funded by Budweiser or Coors or if the health benefits of the super antioxidant pomegranate was funded by the United Pomegranate Farmers Association. These things really matter as the tell us if the study was very small, or if many of the patients in the study were excluded at the end to make the results look better, or if the study had a poor blinding which allowed for participants or researches to play a role in the outcomes, and lastly who stood to benefit from the outcomes.

I hope that patients will continue to research online for their own awareness and to better educate us in the medical profession about all that is being studied out in the world. I hope that they will use sites like Pubmed and Jama (Journal of the American Medical Association) to look for peer review studies. Please always take them, along with everything out there on the internet, with a large grain of salt.

It was a 4 hour drive to the city of Hue from our last stop in the central highlands. Multi-hour drives in Asia are never easy on busted roads and always seem to involve a surprise 40 minute bathroom stop at the driver’s “cousin’s” pearl/jade/silk store. We opted to take a semi-private tour of the former Demilitarized Zone instead with the hope of making some of the stops more meaningful.

Our first stop was the incredibly impressive Vinh Moc tunnel complex when we reached the coast. During the war the US suspected that this village was supplying Anti Aircraft weapons and ammunition to a small island, which they were, that was shooting down planes flying north from Da Nang to bomb Hanoi. The town was north of the DMZ so was out of the reach of Marine or Army patrols making it a target of Naval Warships and Aircraft. An unbelievable amount of firepower was unleashed, up to 3 hours a day, causing the villagers to begin moving their village underground. The initial complex was 30 feet under the ground and was mainly a bomb shelter during attacks. The advent of American bunker busting bombs which could penetrate 10 meters into the earth before exploding rendered this depth up safe and the villagers would dig, with their hands, picks, and shovels, another 60 feet down for a total of 90 feet. There was a school, kitchens, a hospital and delivery room with 17 births during the war, guard houses and  homes for families. An entire family would live in dug outs along the corridors maybe 8×5 feet in size. While there were two wells for water there was one bathroom for several hundred villagers. All three levels of the tunnels stretched 1800 meters in length with exits in the village above, where a network of trenches connected houses, and at the beach below where they were resupplied by boats from the north. Not a single person was ever killed in the tunnel system during the war despite warships and planes dropping massive tonnage of ordinance, and they effectively disrupted US flights the entire time.

Spending 15 minutes bent over double moving in those dark tunnels and thinking about all dirt above us was enough for Vanessa and I. We were very happy to emerge at the beach and breath fresh air.

After the tunnels we visited the memorial at the crossing of the Ben Hai River which the was traditional border of the north and south. Attached is a picture of how extensive the bomb damage was to the north where the tunnels were. The meuseum had a collection of US relics from captured pilots and a large collection of American weapons and explanations of how they were used to kill Vietnamese. A sobering experience to say the least and not as overtly propaganda driven as the Chinese museum in Tibet that we visited last year. Just uncomfortable in your face images of Americans waging war that needed to be looked at even if it smarted a little bit.

We arrived to the beautiful city of Hue and the not-so-perfume-smelling Perfume River. The dominating center of town is the old capital complex called the Citadel which was fashioned after the forbidden city in Beijing. A sprawling complex of ruins in various states of repair with some very nice exhibits of old imperial life. During the 1968 Tet Offensive Hue was over run, almost every single US outpost in Vietnam was attacked overnight, and the Vietcong held the Citadel for 4 weeks against the full US military. Hue saw the worst fighting along with the fire base Khe Sanh, and nearly all of the Citadel was destroyed by plane and artillery bombardment. Evidence off machine gun and grenade damage was everywhere along the walls and buildings and the battle was well documented by US journalist whose pictures were displayed thoroughly the exhibits. Projects supported by Dutch, German and Japanese grants are restoring many of the buildings to their former states but probably 50% is completely leveled. It was a great on your own tour and about 3 billion times

Less crowded than Beijings version!

Following a classic Dempsey Deathmarch to a pagoda, “come on honey the map says its only 4k”, we called it a day. The pagoda was a operating temple which was also the sight of the famous Monks self-immolation during the war in protest to the regime of South Vietnamese president Diem. One of the most published pictures of the war, it was hard to imagine as we sat looking out over the river, surrounded by Buddhas and the sound of monks gently ringing bells.

Our second excursion was by bike out to the suburbs and the old imperial tombs of the kings. They are vast and gaudy tombs with amazing architecture and sculptures. Some became castles of sorts after the people grew rebelliousabout the amount of money, and forced labor, used to build them. They represented the height of the great Nyugen Dynasty which ruled for much of the past thousand years. About 90% of the people carry that last name in Vietnam as a result we are told. Needless to say, biking through a Vietnam city in rush hour was a wild experience, especially when the breaks on your bike necessitate putting your feet on the ground to be effective, and we felt very accomplished after living through it.

Hue was a great city to spend a few days. For some some reason many Vietnamese had told us to blow through or skip it but we had a wonderful time. There was a great old city and backpacker seen there and it was fun to drink some beers, eat some pizza and watch all the grubby, bearded, and fresh dressed in “yes I bought these yoga pants in Thailand” outfits.

Now for a few days at the beach and then on to the great wonder of the world Angkor Wat and Cambodia.