Surviving the Medical Meltdown (15 page)

I lift weights but do not pretend to be an expert on training weight lifters. The general thinking of today’s lifters is to focus on compound lifts, not small, single-muscle repetitions. For beginners I refer you to an excellent book by Mark Rippetoe,
Starting Strength: Basic Barbell Training
. It is simple to use and understand, and it explains the correct way to do compound lifts for functional weight training. It is far less helpful to do a bunch of barbell curls than it is to do a standing dead lift or a bent-over row. Compound lifting not only builds muscle in the extremities but also creates trunk strength and coordination. This is why Midwest farm boys have traditionally been such champion wrestlers – because baling hay produces more overall functional strength than isolated individual muscle exercises in a gym.

The other important principle to understand is that the body never stagnates. It either builds muscle or stores fat – it never pauses in between. And this happens on a day-to-day basis. If you exercise today, your body (whose genes go back in time at least to Cro-Magnon hunter-gatherers) thinks it is hunting, that there is food on the Serengeti, and that it needs to build muscle to chase the antelope. On a day you sit with a book all day, not doing much, your body thinks it is in a cave, that food is scarce, and that it needs to survive until there is food available. So it stores fat and/or chews up muscle for energy. Although oversimplified, our metabolism is somewhat
like a two-position switch, which is either growth or decay.

The truth about exercise is very simple: you should move and you should lift things. If you do that at least thirty minutes a day, you will maintain adequate fitness. The more you do, the fitter you will become – to a point. This new extreme-sport lifestyle is often counterproductive. Women who exercise to the point of extreme thinness are not helping their long-term overall health. While they may have aerobic capacity, they have lost their body fat and therefore their estrogen storage capacity. This leads to infertility, thinning of bone, and other metabolic problems. Men who run marathons or do extreme cycling or any exercise that results in a slightly cadaveric appearance, are not really helping their health. Extreme exercise that breaks down a lot of tissue creates too many toxins in the body and destroys muscle. It may make people feel some psychological boost from the achievement, but it is not a longevity or wellness prescription.

I lift weights three days a week for thirty minutes to an hour on average. On another three days I either do a twenty-minute run down and up a steep hill (to work crosswords at the local Chat ’n Chew) or run intervals for thirty minutes on a treadmill when it is icy or too cold. I take one to two days off. And if I take an extra day off, it is from running – not the weight program.

A good way to gauge your fitness is to check your resting pulse in bed as soon as you open your eyes. Adults (children normally have faster rates) who are in poor condition often have resting heart rates over eighty-five beats per minute. Well-conditioned people will have resting pulses of around sixty or even slightly less.

Another way to check for cardiovascular fitness is to note how long it takes for your pulse to return to normal after exercise. If you are still tired and have an elevated pulse thirty minutes after stopping your exercise, then you have some conditioning work to do.

In sum, strength is king. Complex exercise is better for strength and coordination. Aerobic conditioning should be done in moderation, and interval training is better than long, slow distances, which do not facilitate muscle gain.

10
PREPARING YOURSELF: SLEEP

I
n
chapter 8
, we dealt with a natural diet, the diet the caveman would have eaten. Similarly, sleeping should mimic the caveman’s habits. In her excellent book
Lights Out
, T. S. Wiley outlines the hazards of electric lights and artificially prolonging our days. We were meant to sleep with the sun cycle. When the sun comes up, you start the day. When it gets dark, you go to sleep.

This natural sleep cycle is important for health and longevity. It has been shown that disruption of animals’ circadian rhythms shortens their life span. Humans are cyclic animals. We live by sun and moon.

Women’s fertility in a natural state is timed to the moon cycle – ovulation occurring around the time of the full moon. Our sex hormones – testosterone, estrogen, and others – as well as our adrenal and thyroid and growth hormones are produced in response to cycles of day and night and to light from the moon cycle. As humans have adopted modernity, living in artificial electric light has changed our natural rhythms. By artificially extending our days, we are sacrificing our hormonal rhythms. For example, it has been shown that just applying a light to the back of the knee in a dark room can shut off hormone production.

In studying patients’ hormones I have noted that adrenal function was normal only in my farmer patients… even though they were in their seventies and eighties. They generally lived by the sun cycle. Conversely, my young doctors and nurses, with totally abnormal schedules, were all adrenally insufficient to the degree that their sleep was disrupted.

When I was doing trauma surgery I was frequently awakened in the middle of the night or would spend the whole night in the operating room. Although at thirty this didn’t seem like such a problem, by the time I was fifty, it was a big problem. I couldn’t get to sleep without reading for hours, and at two to three in the morning, I would awaken and not get back to sleep for another few hours. I felt more and more dreadful as I became more sleep deprived. After starting a full anti-aging program of hormone replacement, exercise, and supplements (including supplements for sleep, described later in the chapter), I was better. But laboratory testing still showed my adrenal function to be flatlined, and usually I still was not sleeping well through the night. My stamina was still down. For this and other reasons, I sold my big solo practice, quit my trauma call, and moved back to my rural roots. After two years of sleeping in a quiet bedroom that faced a dark, forested backyard, I was much better. I chose a bedroom in the house that faced away from all streetlights so the only light entering my bedroom at night was the moonlight. I slept with no curtains, and during the full moon I noticed that I did not sleep as soundly. But I accepted that as part of normalizing my hormonal cycle. Now I still take sleep supplements, but I sleep through the night. My adrenal function is significantly better on lab testing. I feel great and awake refreshed – not drugged out or dragging. But it didn’t happen overnight. It took years and patience to overcome many years of bad sleep. I took melatonin on faith for three months before I realized that I was falling asleep more easily. Then little by little the corrective measures paid off.

As we get older, our sleep often becomes more and more difficult. Here are the major culprits, but I’m sure there are others:

1.
Artificially extending the day with electric lights.

2.
Caffeine. Caffeine can build up. What you can tolerate at twenty-five may not be tolerable at fifty-five.

3.
Noise. Noise can come in a variety of forms, from the street noise to a spouse’s snoring.

4.
Hormone problems. Hot flashes can be very disruptive of sleep, and although primarily a woman’s issue, it can actually affect men if they lose their testosterone rapidly.

5.
Loss of brain transmitters and hormones with aging and disease (melatonin and serotonin being the most important for sleep).

6.
Deconditioning.

7.
Anxiety.

8.
Medications.

It is not always possible to find
one problem
that is the issue. Although you may have an idea what is causing your sleeplessness, you really should run the list and correct everything that might be a culprit. Begin with good “sleep hygiene.” As noted earlier, sleep with the sun cycle, and avoid extending your day with electric lights. Suzanne Somers, in her excellent talks on wellness, tells of her evening ritual. When it starts to be dusk, she dims her lights and may add candles. You should also get rid of TVs, radios, and computers in the bedroom.

If there is a noise problem, consider a pink noise generator to block annoying sounds. (Pink noise is simply white noise with the harsher tones removed.) Unfortunately, one of the very common noise problems is a snoring spouse. It may be God’s little joke, or maybe it is for child rearing, but the fact is, women sleep less soundly than men. And men are overrepresented in the population with sleep apnea – often characterized by loud snoring. If your partner is filling the room with loud snoring and you are tossing and turning, then
you may need to sleep in a separate room while you are convincing him to get evaluated. (The snoring in sleep apnea is due to upper airway obstruction from the tongue or soft tissues in the oropharynx. Sleep apnea is a major cause for sudden nighttime death and heart attack due to oxygen levels falling from the obstruction.)

Wean yourself off all caffeine. Caffeine is often used to get started in the morning because you feel sleepy. But it becomes a positive feedback loop. The more you juice yourself to get going in the a.m., the worse you sleep in the p.m.; then you up the dose of caffeine. Once you are caffeine-free and sleeping well, however, you can try adding it back in the early morning a little at a time. I do find a little caffeine helps sport performance, but it can easily get out of hand.

Consider bioidentical hormone replacement if hot flashes are disrupting your sleep. This is discussed at length in a later chapter, but trust me: hormone supplementation works to improve sleep and generally to make you feel better.

If you have difficulty getting to sleep, try melatonin sublingually (under the tongue). As we age, melatonin production goes down, and it is the hormone that gets you to sleep. Melatonin not only helps you get to sleep but is also an anticancer hormone. So, there are many reasons to take melatonin. It must be sublingual to have the best sleep-inducing effect. Begin with 3 milligrams at night. I would not increase the dose for a month. After a month, if you still need more than thirty minutes to get to sleep, double the dose to 6 milligrams under the tongue at night, and continue to do this until you have no difficulty falling asleep. Generally, no more than 12 milligrams under the tongue should be required. A sign of having too much melatonin is having very vivid, unpleasant dreams. I once dreamt that my husband turned into a big green lizard and slithered out the end of the bed. That is typical of melatonin-induced nightmares, which tend to have a very bizarre, surreal quality. I find that sometimes I need more melatonin than other times. When I have taken on too many projects and my mind is running away with me, or on Sunday nights – probably because I have to get up
especially early to drive eighty-two miles to my job – I take an extra pill under the tongue.

If you can get to sleep but cannot stay asleep, or have early-morning awakening, you can benefit from taking 5-HTP at bedtime. This drug produces serotonin, a neurotransmitter that helps one stay asleep. For this reason it should be taken with caution by people on antidepressant medications (SSRIs) that inhibit the reuptake of serotonin. It is good to understand your medications and discuss this with your doctor before starting this over-the-counter pill. For most people, though, I would start with 25 to 50 milligrams at night. This can be swallowed or taken under the tongue. Again, I would not up the dose for a month unless it fails to give you the required result. Then I would double the dose to up to100 milligrams. If you’re still having morning or midnight awakening, then you might consider taking another 50 milligrams at noon.

Loss of the American electrical grid would be an unmitigated disaster. We would lose critical manufacturing, critical drug production, and more. I can think of only one good thing to come out of an economic crisis or other problem that would shut down the electrical grid for a prolonged period – we might get back to nature and sleep better. But we can voluntarily take steps to re-create nature, and that is clearly the better alternative. So as T. S. Wiley exhorts, “Lights out!”

11
PREPARING YOURSELF: SUPPLEMENTS

F
or years physicians have been saying that “vitamins just make expensive urine.” That statement is cute, but it is simply not true. Recently the news reported studies presumably showing a deleterious effect of fish oil. And almost like a Greek chorus, the medical community was quoted as saying, “There is no evidence that supplements are beneficial.”

This is clear nonsense, and doctors know it – they take supplements themselves. And for their patients, they know that vitamin C supplements prevent or treat scurvy. They give vitamin B
₁₂
shots to patients with pernicious anemia, and they advised the milk industry to add vitamin D to prevent childhood rickets. This is “supplementation.” What they are really saying is – they don’t want you to make your own decision to supplement your diet in the absence of their medical input. But as I have pointed out previously, scientific advances are slow to percolate into the actual practice of medicine. So, even if it were proven beneficial to significantly elevate blood levels of vitamin D (as it has been), it would take decades for the medical establishment to be fully on board.

As a consequence of individual genetics, diminishing capacity to absorb nutrients as we age, and eating a generally poor American
diet, many people develop deficits of certain nutrients over a lifetime. These nutrients are involved as “cofactors” in chemical reactions that convert food to energy, detoxify, support cell growth, and provide immunity. Our understanding of these processes over the last thirty years has expanded tremendously, and now we can test for very specific deficiencies of these vitamin cofactors. Then we can tailor supplements to the individual.