TAKE A PLAYFUL APPROACH TO WALKING
Walking through the landscape at leisure has always been a privilege of the elite. You’ll see this in the philosophical schools of ancient Athens, of the Epicureans and the Stoics, where conversations were held while walking or sitting in the garden, but also in the Baroque period or the Renaissance. Great importance was placed on experiencing nature. In 2004, an American diabetes researcher named Neville Owen discovered that aimless strolling is superior to walking for a specific purpose.14
Therefore, you should take a playful approach to walking. Step counters may be of help as long as you don’t let yourself be terrorized by them but merely use them as a guide instead. You’ll soon find that the daily ten thousand steps that are considered to be beneficial to our health nowadays aren’t so easy to achieve. Step counters—which have been integrated into many smartphones by now—could serve to provide a kind of biological feedback and remind us to go get some fresh air and take a walk around the block.
I’m far less convinced by running, as I mentioned earlier. Not only can it cause problems with ankle and knee joints, it’s also not a form of exercise that brings many people joy or that can be done throughout your entire life. But continuity is essential. This is shown in the case of the previously mentioned “Blue Zones,” where many people live to the age of one hundred: In Loma Linda, California, many of these people are Seventh-day Adventists who walk a lot and do so quite fast. Similarly, the people living on the Nicoya peninsula or the island of Sardinia move a lot while working as farmers or shepherds. Beyond the physical exercise, the vitamin D and daylight that come from being outside are additional health-promoting factors.
If you can manage to exercise intensively for 150 minutes a week, maybe even for 300 minutes, you’ll be rewarded with an enormous benefit. Not only will you be preventing cardiovascular disease and diabetes, you’ll also be reducing your risk of cancer, particularly your risk of breast or colon cancer.15
Furthermore, you maintain your weight by exercising. Patients often ask me why they gain weight as they get older even though they pay attention to what they eat. I then explain to them that they shouldn’t move less, as is often the case, but on the contrary a little more each year. Since the metabolism reduces with age, the basal metabolic rate is lowered, as is the body temperature. That’s why elderly people tend to feel cold more quickly. If you exercise, you build up your muscles at the same time. That also keeps you slim, because muscles require more energy than fat reserves. And for that matter, it also helps us feel warm.
On principle, I recommend three kinds of physical activity: endurance training, strength training, and coordination training. There is no need to go to great lengths for strength training, it’s enough to place two dumbbells (5.5 or 10 lbs.) and a Thera-Band in locations you pass frequently and where you can do a few exercises here and there, but every day, of course. In addition, it’s important to foster coordination, which decreases with age. That’s the reason for the heightened risk for falls. Good exercises to help prevent this are walking backward in qigong, the one-leg stand in yoga, or using a small trampoline. I can wholeheartedly recommend qigong and tai chi in any case.
Overall, endurance sports are slightly superior to other forms of exercise, as they slow down the aging processes. A study conducted by cardiologists at the University Medical Center of the Saarland showed that the shortening of the chromosomes in cell division, which ultimately causes aging, is curbed by playing endurance sports.16 But since there are additional risks that occur with age—as muscle deterioration leads to instability while standing or walking, for example—it’s important not to neglect strength and coordination training over endurance training. Hop, jump, walk sideways or backward from time to time—variation is always good for you!
Interval training is also an interesting possibility. Physicians at the Saarland University in Homburg divided non-athletic, healthy volunteers aged thirty to sixty into different groups. Those who were asked to alternatingly sprint a short distance and then walk at leisure achieved results just as good as those who were going through continuous endurance training.
TRAIN YOUR CONNECTIVE TISSUE
Physical activity also benefits the fasciae. These bands of connective tissue surround muscles and tendons and have been the focus of a new way of looking at the body. For a long time, the physician’s gaze was focused on the skeleton. When the knee hurt, this was diagnosed as arthrosis caused by cartilage damage. If the back hurt, it was the spinal disk pressing on the nerves. Certainly, these phenomena can cause pain. But through recent clinical research it has become increasingly obvious that many of these diseases that cause pain have been successfully treated with therapies that don’t change these signs of wear and tear yet still bring relief: massages, yoga, or acupuncture.
In these therapies, it’s the connective tissue that has become the focus of attention. Modern imaging techniques allow for ever more delicate structures to be made visible. In the process, it became apparent that the connective tissue isn’t just padding material in the body, but a highly active tissue that surrounds and connects all muscles and organs. There are the fascial tissues with tendinous properties, but also the more delicate intermediate layers that together form a full-body network. It ensures elasticity and slippage of muscles and organs as well as the joints surrounding them. If the fasciae lose their elasticity they become stiff or even inflamed, and numerous pain syndromes can develop as a result.
Furthermore, the fasciae are connected to pain trigger points. Many people with painful diseases know them, as they are points of maximal pressure pain. A good physical therapist can locate these pain trigger points accurately, and sometimes you can even find them yourself. These points, in turn, are connected to other remote areas, e.g., the foot fasciae that are interconnected up to the head. That’s why a problem in the upper spine can have its actual causes in a heel spur, and vice versa.
The connective tissue possesses a great number of free nerves. This network of nerves enables proprioception, the perception of our position in space. It can also send out pain signals—studies with high-resolution ultrasound suggest that the flexibility of the different layers of connective tissue is often disrupted when that happens.17 Experiments have shown that fasciae react to stress hormones such as adrenalin and noradrenalin. They contract and convulse—an indication that stress causes muscles as well as their essential elastic coating to harden.
The connective tissue nourishes the fasciae and in naturopathy it is assigned an important role in health maintenance. It swims in a matrix of sugar-protein compounds in which toxic substances or insufficiently developed proteins are disposed. Dehydration leads to withering and to a loss of the tissue’s elasticity. Acidosis, which can be caused by wrong nutrition, e.g., by animal protein that acts as an acid in the tissue, can activate pain receptors and induce inflammation. When the fibroblasts, those cells in the connective tissue that produce the fiber structure of muscles and tendons, are overburdened as a result of dehydration or acidosis, the combination of overproduction and inflammation can result in tissue transformation and a painful fibrosis—a comparison that lends itself well here is that of a woolen sweater that was washed in water too hot.
This is exactly the point at which some naturopathic therapies start. By stretching the connective tissue with certain massage techniques, the healthy activity of the fibroblasts is stimulated. The same effect can be achieved with acupuncture—where the needle is placed and subsequently further stimulated by turning it. The meridian network of Traditional Chinese Medicine follows surprisingly close along broad bands of fasciae.
In 2009, I was rather astonished by one particular study. The discomfort of people suffering from carpal tunnel syndrome, a problem inside the hand, was significantly relieved if they received just a single cupping treatment in the neck area, in a completely different location from where the pain is felt, that is.18 Today I know th
at the cupping probably stimulated the connective tissue and the fasciae fifteen inches removed from the area. That’s also how we can explain the effect of the so-called foot reflex zones. It is considered disproven that the foot has reflex zones but massaging it can still have an effect on remote areas via the fasciae. In a similar way, the success of a gua sha, a Chinese scraping massage of the back to treat persistent neck pains, can be explained.
It is important to keep the connective tissue, which consists of up to 70 percent of water, moist. Presumably, physical activity and manual therapies mobilize and stimulate the water in the fasciae layer so that the entire area becomes supple again. Moreover, I am sure that nutrition plays a significant role in the elasticity of the connective tissue. During therapeutic fasting we can observe it recovering every single day—it’s visible even to the naked eye. The tone of the underlying connective tissue and thus the tension of the skin improve, and often the dreaded cellulite disappears, not just through fasting, but just as much through a wholesome, vegetarian diet.
But what is the best way to keep the fasciae and the connective tissue in good working order? Yoga helps, because here the focus is on stretching. Cupping also creates pressure, as does the traditional deep tissue massage that reaches deep and may thus cause pain, but significantly improves a chronic pain condition after two or three treatments. A similarly positive effect is achieved by Rolfing—physical manipulation of the fasciae. Ida Rolf was an American biochemist who was propagating the fasciae’s essential role as early as in the 1970s, at a time when their existence couldn’t even be proven yet.
Special fasciae rollers and similar contraptions have been available for a few years now, but a spiky massage ball or stretches with short, bouncy, fast movements against the edge of the desk or the wall are adequate. This leads to microscopically minute tears in the tissue which initiate repair processes in the fibroblasts as a result. A well-dosed strain therefore benefits the fasciae, while an excessive strain causes them to wither—here, too, the principle of hormesis is at work.
EXERCISES FOR PEOPLE WHO SIT A LOT
A few additional remarks on sitting: As a result of a daily routine that involves computers, smartphones, and tablets, people spend more and more hours every day sitting. Even the stroll to the wastebasket or to the colleague a few desks away has been made redundant by modern technology. The consequences of this are dramatic. Scientists are already speaking of the “sitting disease.” Not only does sitting down for too long cause bad posture, accompanied by back and neck pain and headaches, it also increases the risk of developing diabetes by up to 90 percent, and the risk of cancer and heart diseases by 20 percent.19 At least one hour of additional exercise a day is necessary to balance out the risk of an early death due to too much sitting.
But we shouldn’t abstain from sitting down completely. We will always be sitting while driving a car and during meals. But it doesn’t seem to be absolutely necessary to be sitting down all the time while working at a computer or during meetings. By now there are many suppliers of standing desks, and meetings can just as well happen while standing or walking—as part of a new work culture. Or as the poet Christian Morgenstern put it: “Thoughts—just like children and dogs—often want us to take them for a walk outside.”
PATIENT HISTORY
Heart Disease
Health Should Not Be Stressful!
The healthiest life is useless if it stresses you out. I have learned this from two twin brothers who came to my office for a consultation. Both were, naturally, the same age, forty-six years old, but they were leading very different lives. One of them was a diplomat, always on the road with a driver, always ready to have a pleasant conversation. He was slightly overweight and had rosy cheeks. The other was a businessman who traveled a lot and owned houses in Sydney and London. Lean and fit, the tension he was under manifested itself in his face in the form of constant twitches. During a stay in Australia, the businessman had three stents put in place to keep his coronary vessels open after he had experienced a sudden feeling of faintness. Hearing this, his twin brother became worried—after all, he had the same genes.
The diplomat was in great health, even though he liked to drink good wine and eat fatty foods. On the other hand, after his heart trouble, the lean businessman followed every dietary recommendation he was able to find on the internet and exercised for precisely one hour every day. The first thing he did was ask me how many minutes exactly one was supposed to meditate, what available data there was, and also how many breaths he should take precisely in which yoga position. But he had not changed anything about the level of stress he faced at work.
Living healthfully with the sole aim of being efficient can have the reverse effect: If you can’t relieve any pressure during exercise, if you are unable to relax even though you could benefit from a little rest, the stress hormones you accumulate can lead to inflammations in the cells of blood vessels. In the walls of the vessels, these often trigger the immune system’s repair processes which then lead to undesired residue in the vessels and finally dangerous blood clots. What this businessman and his heart needed most of all was rest. But he had a very hard time getting it. Four months after our meeting he had an additional bypass surgery, after his heart’s condition kept worsening. His diplomat brother, however, is doing great. He has his heart checked every few months, eats healthy but with pleasure, and doesn’t allow himself to be tyrannized by health dogmas.
The example of these two brothers demonstrates that while it is good and right to strive for a healthy lifestyle, if this pursuit is turned into a high-performance life, it doesn’t achieve anything. Of course, there are people who draw internal satisfaction from high performances, who can live well with constant stress. But most people don’t admit to themselves that they are only giving it their all because in periods of calm they would find that they aren’t happy with their life. Feeling happiness, no matter what life throws at you, is an important building block of health.
CHAPTER SEVEN
Yoga, Meditation, and Mindfulness
Mind-Body Medicine
Stress is the most severe risk factor for health in the twenty-first century. Even children are affected: In a 2015 study on stress, one in six children and one in five adolescents already showed clear symptoms of stress. In a survey carried out by the German medical insurance company Techniker Krankenkasse in 2016, 60 percent of the adults interviewed stated that they were agitated, and almost 25 percent declared that they were frequently under stress.
The most important stress factors are work (46 percent), high expectations of oneself (43 percent), a full schedule outside of work (33 percent), traffic (30 percent), as well as constant digital availability (28 percent). The stress level was especially high in those professionals (30 percent) who never turn off their smartphone, who are “always on,” in other words.
Stress heightens the risk of heart attacks and strokes, tumors and immune diseases, depression, and much more. And it shortens your life. But as you might recall, I wrote earlier about how stress can also be healthy. Isn’t there the positive eustress (controlled stress) and negative distress?
Over time, the scientific community has sometimes praised stress, other times it has been condemned completely in every shape and form. But the following viewpoint has finally emerged: Basically, four concurrent circumstances determine whether stress poses a healthy challenge or something that makes us sick. Those four factors are:
duration
intensity
how much control we can retain over it
whether the reasons for which we take on stress are meaningful to us or not
There are no hard and fast rules for these four factors, no data on the dosage like there is for medication. It always remains an individual question of how much stress can be endured. One person’s breaking point might be a comfortable level of stress for another person. But for every
one, a lot of stress increases the danger of becoming sick. Those who work more than fifty-five hours a week, as meta-studies from 2015 have shown, have a 33 percent higher risk of suffering a stroke, and a 13 percent higher probability of developing heart disease.1
Yet it probably doesn’t depend on the number of hours. Happiness researchers like the Swiss economist Mathias Binswanger (Die Tretmühlen des Glücks, “The Treadmills of Happiness”) have pointed out that while the weekly hours of work have reduced massively, and domestic work has become less demanding due to machines and ready-made foods, our time budget for relaxation has not increased accordingly.
The reason: Our free time has become filled with ever more tasks and to-do lists. On top of that, work processes have become more condensed and fast-paced. Prime examples of this are hospitals. The number of patients admitted has been doubling or even tripling year after year. Yet the basic workload for hospital personnel has stayed the same for each patient or has grown considerably. Gone are the times when doctors or nurses could catch their breath over a cup of coffee and have a conversation with colleagues. Even though actual working hours have been reduced, stress has increased because tasks have to be completed in a more efficient manner.
How Can I Recognize Stress? The Symptoms of Stress
Body
Cold hands
Pain in the back and/or the neck
Tension in the shoulders
Indigestion
Insomnia
Tinnitus
The Nature Cure Page 17