exercise and activity, my journey

yoga for the atopically inclined

pexels-photo-588561.jpeg

This is a post I initially wrote after talking about the different alternative medicines and their content. I never ended up posting it because I had the baby and promptly forgot I wrote it. But without further ado, here is a post that focuses a bit more on the physical aspects of one of those holistic practices; yoga.

Though I love exercising, I am no stranger to avoiding heavy aerobically-intense exercise because of the nasty skin side effects that occur during a flare (the flushing sensations, the heating skin, the sweating/wetness in flexor surfaces, the rashes, and the insatiable itching). One of the times I got the best reprieve from my flares and related skin symptoms was February of 2016 when I was doing a 200-hour yoga teacher training. I took anywhere from 1-3 classes, 5-7 days of the week in rooms with high temperatures and lots of humidity. As I breathed through new poses and slowly worked my muscles and  focused on breathing and meditation, I felt stronger and better day by day. I won’t say my eczema went away because it didn’t, but the movements and concentration on my breathing did help my skin improve a lot, and in February no less (usually the winter months are worse for my skin).  At the same time, practicing that much yoga naturally made me want to eat cleaner because I felt heavy if I tried to practice after eating unhealthy foods (so at the time I tried out the Whole 30 Diet).

As I tried to recover from the particular cold, damp prolonged and lingering last bit of the Northeast winter weather, I decided I wanted to make use of my teacher training and research the best exercises to promote blood flow, skin healing, and stress reduction. My goal? To help my own skin maintenance (and the skin of anyone else who wishes to try this routine). So first I’ll give a brief explanation of some the theories behind how yoga can help eczema. Then later in the post I’ll show a few poses that have been said to be most beneficial to add to a yoga practice (and mostly ones that a beginner could do) to help the skin.

From my teacher training I learned that in yoga, there are 7 major chakras, or energy cluster points, that line up with the spinal column where nadis, or channels intersect. These channels carry prana or our life force energy. Of the 7 chakras, each corresponding to a respective spot on our spinal column, the 3rd chakra, Manipura is said to be unbalanced when we see skin conditions like eczema. Manipura is located in the solar plexus and corresponds to physical body parts such as the detox organs (liver, spleen, etc). When this chakra is unbalanced, as in it is underactive, people may feel a lack of control or a tendency to withdrawal from social situations.  Poses said to help invigorate this chakra include core strengthening poses such as those that entail isometric contractions, and breathing focus. This can include poses that entail twists (because they engage the core muscles to be able to do the poses well, and are said to help with detoxing).

So first off, does yoga truly help eczema? Well, some studies have show that it helps reduce inflammation after moderate to strenuous exercise. Others indicate it helps with the glycation process (mentioned in my post about sugar’s effects on eczema), by increasing the muscles’ glucose uptake, and therefore reducing blood sugar levels.

Yoga also entails a lot of focus on breathing (which can be beneficial for both getting you to distract your mind away from the itch and improving circulation of O2). It also often includes a meditative component, and meditation has also been seen to help eczema. It can be useful for reducing stress levels and improving sleep as well.

In general all of those effects would help alleviate a lot of the issues that eczema comes with, and personally I got more into yoga because it was one activity that didn’t induce worser flares for me. Plus getting a good night’s sleep is huge, since we do so much healing when we are catching some z’s.

Here is my take on poses for eczema, though most of these poses are somewhat “general” because they are known to help symptoms of eczema (such as inflammation, bad circulation, stress), aka they benefit the skin generally. Then again, there is no “cure” for eczema in isolation, so getting up and moving and in this case doing yoga will most likely help with eczema too.

Here are specific poses I found listed on various websites that were said to help the skin (with photos of me demonstrating! Note: I won’t demo the twists as I am over 8 months pregnant at the moment).

Livestrong.com suggests a lot of inversions (or poses with the head below the heart) including:

  • Legs Up a Wall (beginner friendly. I only stayed here for a few seconds to take this picture before getting off my back because it’s not the most comfortable when 38 weeks pregnant).

tumblr_inline_pafskloZNE1rq3xim_500.jpg

  • Camel Pose (can be modified to be more beginner friendly. Note: keeping your hips pushing forward so they are lined over your knees. Also note that I am not reaching for my ankles because I am too pregnant to keep good form attempting that so I’m just reaching my arms downwards).

tumblr_inline_pafsmwbr7U1rq3xim_500.jpg

  • Wheel (needs a level of back/hip flexor mobility… wouldn’t suggest it for pure beginners and I will update myself doing it when eventually).

From healthline.com we have asanas for beginners to yoga with the intent to decrease stress (in this case for psoriasis, but stress is stress):

  • Child’s Pose (my big toes are touching and my knees are out wide as the mat, and I am sinking my hips down and back while reaching my arms forward. Though I am limited to how far I can stretch downwards by the baby).

tumblr_inline_pafsp2DUDl1rq3xim_500

  • Salutation Seal (never knew it was called this, but essentially you sit cross-legged, keep your back nice and tall, and bring your hands to your chest like you are praying).

tumblr_inline_pafsppyjn51rq3xim_500

And lastly, a few from HolisticVanity who brings up poses to help with inflammation:

  • Seated Twist (again I’ll get around to adding this photo)
  • Revolved Chair (ditto this one)
  • Warrior 1  (note that my lower back has a lot of curvature here, which is not ideal. The baby is pulled me forward and it’s hard to compensate, but generally you want to reduce some of that low back curving to make sure you are setting yourself up for the best alignment to continue the safest practice).

tumblr_inline_pafsqg5StS1rq3xim_500

  • Chair (note: I have my feet hips width distance apart to accommodate the baby, but normally the feet are together will a little space between the heels. Also I need to relax my shoulders down more and pull my ribs in to have better form, but my ribs are also flared out because I’m 38 weeks pregnant!!).

tumblr_inline_pafsqqSWK11rq3xim_500

 

REFERENCES

Beri K. Breathing to younger skin: ‘reversing the molecular mechanism of skin aging with yoga’. Future Sci OA. 2016 June; 2(2): FS0112.

NEA. “Can Mediation Help Ease Eczema Itch?” National Eczema Association, https://nationaleczema.org/meditation-ease-eczemas-itch/. Accessed 30 Jul 2018.

Vijayaraghava A, Doreswamy V, Narasipur OS, Kunnavil R, Srinivasamurthy N. Effect of Yoga Practice on Levels of Inflammatory Markers after Moderate and Strenuous Exercise. J Clin Diagn Res. 2015 Jun;9(6):CC08-CC12.

Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga. 2011 Jul-Dec;4(2):49-54.

Ziel, Erica. “The 5 Best Yoga Poses for Pregnancy and 4 to Avoid.” Livestrong, https://www.livestrong.com/article/332706-yoga-poses-avoid-during-pregnancy/. Accessed  30 Jul 2018.

Advertisements
eczema, food and nutrition, sugar

skin deep it’s not so sweet: all about sugar

pexels-photo-867452.jpeg

[For background context: I am currently still interning with EChO-Eradicate Childhood Obesity Foundation, and so I spend a lot of time thinking about and researching sugars].

Ask anyone- I love sweets. I’m pretty indiscriminate about what types (though I tend to prefer baked goods to pure candy). At either rate, one thing I have worried about over the years (and not necessarily due to any scientific reasoning) was that my previously very high sugar consumption as a child/teen had somehow contributed to my global body eczema flares now (despite not eating as much sugar these days). This has led me to be particularly interested in researching more about sugar, and it’s potential links with eczema.

So let’s get into the nitty-gritty about sugar. The term sugar, much like the term bacteria, often gets a bad rep. Sugar is a type of carbohydrate (the others being polysaccharides and oligosaccharides), that is best defined as either monosaccharides or disaccharides (‘saccharide’ means ‘sugar’). Monosaccharides include simple sugars like glucose (dextrose), fructose (levulose), and galactose. Disaccharides includes sucrose (or what we know as table sugar) which is made of glucose and fructose, maltose (a sugar from grains made of 2 glucose molecules), and lactose (a sugar from milk and made of glucose and galactose). You may have heard fructose (the sugar that makes fruit sweet) getting a bad rap, and that’s because the way the brain processes fructose versus glucose differs. Studies done on rats show that when glucose was consumed, a “satiety” response eventually kicks in because glucose triggers the hormone insulin to be released, but when fructose was consumed, there wasn’t enough of an insulin response to cause the same feeling of satiation. What does this mean globally? Well, consuming fructose sugars may take longer for you to feel full or done eating, and so as a result you are more likely to eat/consume more of whatever food/drink it’s in before you feel done. But why are fruits okay to consume (in moderation)? Because they are packaged naturally with fiber and other nutrients and are not just added fructose (think like how many products, like sodas, often have/had high fructose corn syrup, or extra fructose in them but no fiber or other healthier aspects to balance them out).

It is also worth noting about polyols. Some sources consider this to be a type of sugar (such as the World Sugar Research Organization), while others say it is not a sugar, but it is a carbohydrate (Polyols Organization). Polyols can sometimes be called ‘sugar alcohols’ because their structure looks somewhat like a sugar molecule and somewhat like an alcohol molecule. Polyols include: erythritol, hydrogenated starch, hydrolysates, isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol. They are seen as a new alternative to sugar because they don’t spike blood glucose levels, and they generally have fewer calories per gram. Currently the warning with them is that they may make still be addictive and cause people to consume larger quantities of foods that contain them and/or start to dislike products that don’t have them. The adverse side effect listed by the FDA of excess consumption of polyols is usually related to digestive issues (gas, bloating, diarrhea, etc). Anyway…

The function of sugar in our bodies is to produce energy. When we eat carbohydrates our body breaks it down into glucose and uses those molecules to do important functions like activating our muscles. However, the rates at which sugar affects our blood sugar levels varies. Simple carbohydrates (like sucrose, or table sugar) increases our blood glucose levels quickly, while complex carbs (whole grains, beans, etc) affect blood glucose levels more slowly. In this case we have another example of how slow and steady wins the health race- fast blood glucose level spikes means insulin is released quickly (insulin is used to help cells take in glucose), as a result, you’ll want more sugar again more quickly after eating a blood glucose spiking diet and also, diseases like diabetes and heart disease are related to blood glucose level spikes.

So why are some sugars considered worse than others? The term “added sugars” is a more recent addition to our nutrition world vocabulary and is used to talk about when products include sugars that are not naturally in food (such as when we add a table sugar to the cake batter we are making for a birthday). For example as mentioned before, fruits contain the sugar fructose, but it is considered a natural sugar because one, it is naturally created by the fruit, and two, because it is packaged in the fruit with a balance of fiber and other micronutrients. The problem is that a lot of our processed foods have more added sugar than we think, and dietary guidelines about how much sugar we should maximally eat in a day are being exceeded (according to the American Heart Association, women should eat no more than a total of 6 teaspoons of added sugar a day, and men no more than 9 teaspoons). So if you had a seasonal tall (aka a small) Starbucks Pumpkin Spice Latte this fall with 2% milk and no whipped cream, you consumed about 37 grams of added sugar, or 7.4 teaspoons, exceeding the max a women should have in a day and getting close to the men’s max as well, with one beverage.

But how does sugar impact skin? It affects it in a few ways: by causing inflammation, by aiding candida infections (people with eczema often have a higher risk of candida infections), via glycation, and by messing up our sleep.

When it comes to inflammation, the issue tends to be that sugar (fructose in particular) as its metabolized by the liver can cause free radicals to be made, which are known to cause inflammation. Inflammation results in cell damage, and with a condition such as eczema where your body is already in hyperdrive of attacking its own cells, increasing cell damage is the last thing you want. Interestingly enough, studies on rats have shown that strength training helps to control inflammation even with a high-fructose diet, but I’ll talk about exercise and activity in another post.

Candida albicans is a type of yeast (or fungus) that many healthy people carry orally, and can be non-pathogenic if there is not an overgrowth of it. When there is too much (or any other type of Candida yeast), the condition is called candidiasis. Though there are many reasons for why we’ve seen an increase in candida infections, some of the major culprits are increases in antibiotic use, use of topical or oral corticosteroids (or other local immune suppressors), as well as refined sugars changing our pH, and allowing for easier growth of this yeast. The problem with candidiasis is it can lead to bloodstream infections, and it can cause increased production of acetaldehyde, a chemical that breaks down DNA and impairs cellular repairs. Now it stands to say again that sugar isn’t the only cause for increased risk of candidiasis, but in tandem with taking corticosteroids and antibiotics, it doesn’t help.

Glycation (or more technically described as advanced glycation end products, or AGEs), are products created by a reaction called the Maillard/browning reaction- a reaction that occurs in normal metabolism, but if too many AGEs are made that’s when it becomes a problem because they can increase inflammation and oxidation stress in the body. Usually, AGEs are released by cooking animal-based foods at high heats, more so than by cooking fruits, veggies, whole grains, etc (unless the fruits/veggies/whole grains are made with added fats, in which case the dietary AGEs are also drastically increased). Increased AGEs can also impact collagen and elastin production (due to the oxidation effects), which would impair wound healing. So how does this relate to sugar? Well sugars such as fructose, in combination with some animal protein components heated together increases the dietary AGE production. A low dietary AGE intake, much like a low sugar diet, can help fix insulin sensitivity and improve wound healing (especially with the subsequent decrease of inflammation that occurs). But if your snack/sweet of choice are baked goods made with animal/protein-rich products and includes fructose, chances are you are upping your AGEs, therefore decreasing wound healing, increasing inflammation, and impairing insulin sensitivity.

And lastly, sleep. Simply put, if you eat a lot of sugar, your body has to spend more time trying to convert it into energy and/or store it as fat, and so if you are eating enough to have the ‘food coma’ effect at night, chances are you are slowing your body’s recuperating abilities as it spends the time trying to handle sugar, instead of focusing on general repairs (such as healing eczema rashes and cuts). When we ultimately hit the sugar crash point, our bodies produce cortisol, which results in a higher heart rate, and subsequently less good sleep. Ironically it’s a cyclical pattern. The more you lose good sleep, the more likely you may be to crave sweets!

So the takeaway? Sugar (and specifically added sugars) definitely don’t help eczema, especially when eaten in excess.

 

REFERENCES

Aubrey, Allison. “Sugar and Sleep: More Rest May Dull Your Sweet Tooth.” National Public Radio: The Salt, https://www.npr.org/sections/thesalt/2018/01/18/578604700/sugar-and-sleep-more-rest-may-dull-your-sweet-tooth. Accessed 12 Apr 2018.

Botezelli JD, Coope A, Ghezzi AC, Cambri LT, Moura LP, Scariot PPM, Gaspar RS, Mekary RA, Ropelle ER, Pauli JR. Strength Training Prevents Hyperinsulinemia, Insulin Resistance, and Inflammation Independent of Weight Loss in Fructose-Fed Animals. Scientific Reports. 2016 Aug 4;6(33106).

Gainze-Cirauqui ML, Nieminen MT, Novak Frazer L, Aguirre-Urizar JM, Moragues MD, Rautemaa R. Production of carcinogenic acetaldehyde by Candida albicans from patients with potentially malignant oral mucosal disorders. J Oral Pathol Med. 2013 Mar;42(3):243-249.

“Healthy Eating Tip of the Month: Does Sugar Feed Cancer?” University of Michigan, https://www.med.umich.edu/pfans/_pdf/hetm-2016/0416-sugarcancer.pdfAccessed 12 Apr 2018.

Lawson M, Jomova K, Poprac P, Kuča K, Musílek K, Valko M. Free Radical and Antioxidants in Human Disease. Nutritional Antioxidant Therapies: Treatments and Perspectives. 2018 Mar 11;283-305.

Ott C, Jacobs K, Haucke E, Santos AN, Grune T, Simm A. Role of advanced glycation end products in cellular signaling. Redox Biology. 2013 Dec 19;2():411-429.

Page KA, Chan OC, Arora J, Belfort-DeAguiar R, Dzuira J, Roehmholdt B, Cline GW, Naik S, Sinha R, Constable T, Sherwin RS. Effects of Fructose vs Glucose on Regional Cerebral Blood Flow in Brain Regions Involved with Appettite and Reward Pathways. JAMA. 2013 Jan 2;309(1):63-70.

Patil S, Rao, RS, Majumdar B, Anil S. Clinical Appearance of Oral Candida Infection and Therapeutic Strategies. Front. Microbiol. 2015 Dec 15.

“Sugar 101.” American Heart Association, https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/sugar-101#.Ws9onWbMzowAccessed 12 Apr 2018.

“Sugar Alcohols.” FDA, https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/sugar-alcohol.html. Accessed 12 Apr 2018.

Uribarri K, Woodruff S, Goodman S, Cia W, Chen X, Pyzik R, Yong A, Striker GE, Vlassara H. Advanced Glycation End Products in Foods and a Practiacl Guide to Their Reduction in the Diet. J Am Diet Assoc. 2010 Jun;110(6):911-916.e12.

“Your Questions Answered.” Polyols, https://polyols.org/frequently-asked-questions/. Accessed 12 Apr 2018.

 

eczema, flare-up, topical steroids

how to find dr. right (dermatology edition)

pexels-photo-433495.jpeg

As one of many people who sees a dermatologist for some kind of reoccurring eczema or atopic dermatitis (AD) and as someone who has cycled through the what feels like all options for treatment (often never finding that perfect product, the lifestyle management, or that patient-doctor connection), and as someone always searching to get to my dream skin, I am always hunting for ways to build a relationship with my future Dr. Right.

The most important part of having a good working relationship with your dermatologist is being able to speak your concerns. I have gotten to a point in my life where, when meeting a new dermatologist, I throw out my entire skin background in a verbal paragraph; the goal being to test the waters of this new budding relationship. Here are some examples below for personal context:

  • I have had topical steroid withdrawal (TSW) before because of my excessive use of steroidal topical ointments in my earlier years, and I am somewhat hesistant to use them now. I am also not entirely interested in oral steroids again, because of their shopping list of side effects. It is important to speak your fears of strong medications, so your derm knows what you need to discuss.
  • I have been using coconut oil on my skin and have had no problems with it except that it didn’t prevent a flare. This bit of information is shared because it’s true (and you never know when new research will come out saying that coconut oil is not as good as we thought it was… e.g. what happened with olive oil) but it also can be used to get the derm’s opinion on natural products/non-dermatologically created alternatives.
  • I have been avoiding gluten and soy (because they are common allergens and because I have other legume allergies) for a while and worry that me starting to eat them again this summer may be part of the reason for my flare. This is brought up to bridge into the field of nutrition to figure out my new derm’s opinions on diet in regards to its effect on eczema and management.
  • I know about the current new drugs on the market (Dupixent) and wonder about its effect on pre/peri/post natal women. It’s crucial to remember to bring up reproduction-related information if you are going to start a drug that hasn’t been tested on men or women for reproductive side effects, if you are interested in having children one day.
  • What is the plan for me and what will my management entail going forward? After all, I want to know she isn’t just going to prescribe me a crap ton of drugs and wish me the best with my life… continuity of care is extremely important for preventative care and management.

In the case with AD, I was hesitant about both topical and oral steroids as the major component of my management, and my derm was receptive to my initial hesitation. However, she also argued with the need for inflammation management, because in an untreated state, chronic inflammation will damage other organs and systems in time. So she walked me through the details about what she was thinking for both types of steroids- the dosages planned and how long she planned to keep me on them. If you are confused about what the drugs do or their safety, it doesn’t hurt to inquire more (for example 60mg of prednisone is on the high end of how much doctors will prescribe).

My derm told me of her roadmap for my management (an important thing you want your dermatologist to bring up!)- how long she’d want me on the oral steroids, which topical steroid was for my face versus which for the rest of my body, how we’d cycle through a 2-week steroidal/1-week non-steroidal topical cycle, and the need for more frequent bleach baths to prevent staph infections from other healthy-skinned people (because everyone carries some level of staph on their skin).

When I asked her my big question — what can I do to prevent these flares from coming back aggressively again, she also brought up diet changes, as well planning future appointments to monitor how the preventative measurements were going. All in all I left with a sense of her being committed to making sure things worked, not just prescribing me all the meds I could carry and hoping I didn’t ever need to come back.

The big takeaway from being a frequent flyer of the dermatology world is that it is okay to need to find a dermatologist who fits with you. You want someone you feel comfortable with, who you can talk to openly and feel like they both have the time to listen and are receptive to your ideas and where you are in your health literacy (i.e. do you like written or oral directions, how familiar are you with the drugs/treatments/interventions, how much you feel you understand or care to understand about the condition as a whole, how it works genetically, immunologically, neurologically, etc).

You should feel like you are leaving with enough information to get you by AND also with your questions answered, but also that you know what to expect and when to reconnect with the derm in the event that something isn’t working just right. You don’t want to feel like you’ve heard it all before, or that there is something the derm just isn’t getting about you. The relationship needs to be out on the table and the communication level high. If you have persistent remaining questions- ask them! If you are frustrated by something, voice it!

With any chronic disease, management relies on the ability to be able to communicate your feelings and symptoms, and on the ability of the provider to be able to give you the support and care contingency to make sure that you don’t falls through the cracks in the system. So when working to develop a fruitful and useful relationship with your dermatologist, don’t be afraid to be a bit selective and work through difficult questions to see if you have found your Dr. Right.

 

Here’s a photo of my own hands October 2016 (left) and March 2017 (right):

1*HWwcwnJ-Kwuv-BO8yRogmQ