Natural Health 101, Prevention: Yoga

Body partsThe second in Wooden Spoon Wellness’s Natural Health 101 series, this blog provides an overview of yoga. These three techniques have been shown to prevent injury or ailments when practiced correctly on a regular basis. [1] Yoga, as well as other Eastern traditional practices such as qigong, and tai chi, can all be considered ‘moving meditations’, which is to say that each modality includes a physical practice as well as a mental and spiritual practice. They each fundamentally originate from the belief that when the mind, body, and spirit are in balance, our wellbeing remains in balance. The Natural Health 101 series is intended to serve as entries to the practices or broaden your experiences if you already have an established practice. Even if you have practiced yoga, I hope you will read these articles and share your thoughts and experiences.

It is important to note that this blog provides a very broad sketch of each modality and is humbly written from my experiences and readings. Yoga has existed for thousands of years and derive from larger cultural, historical, and religious contexts. It is thus much more nuanced than I could possibly describe, though other blogs in the Natural Health 101 series will discuss other aspects of the healing traditions from which this practice emerges. In addition, the right teacher will be able to bring in comprehensive components of the practice and help you build holistic strength and immunity to prevent disease and injury. While each modality is complex, if you are open to learning, you will notice the benefits very quickly. Do not be intimidated! We all start somewhere.

Yoga: What is it?
In her article, “Yoga 101: A Beginner’s Guide to Practice, Meditation, and the Sutras,” one of my teachers, Cyndi Lee, writes: “The word yoga, from the Sanskrit word yuj means to yoke or bind and is often interpreted as “union” or a method of discipline. The Indian sage Patanjali is believed to have collated the practice of yoga into the Yoga Sutra an estimated 2,000 years ago. The Sutra is a collection of 195 statements that serves as a philosophical guidebook for most of the yoga that is practiced today. It also outlines eight limbs of yoga: the yamas (restraints), niyamas (observances), asana (postures), pranayama (breathing), pratyahara (withdrawal of senses), dharana (concentration), dhyani (meditation), and samadhi (absorption). As we explore these eight limbs, we begin by refining our behavior in the outer world, and then we focus inwardly until we reach samadhi (liberation, enlightenment). Today most people practicing yoga are engaged in the third limb, asana, which is a program of physical postures designed to purify the body and provide the physical strength and stamina required for long periods of meditation.” [2]

I appreciate Cyndi Lee’s overview of yoga because she highlights that the classes that are most widely available, and that you are most likely to experience, focus primarily on the physical practice of yoga (asana, or, postures). Asana can be very powerful unto itself. As another of my teachers, Aman Rai, says, “Your body does not help you come into asana. Asana helps you come into your body.”

I’ve experienced this in many ways since I took my first yoga class in 1999. Proper alignment was important to my teachers and I frequently would walk out of a class into a bustling part of Manhattan feeling taller, quieter, and lighter like air, or feeling the expansiveness of my lungs and chest. In 2008, when I sustained an injury that turned my world upside down, one of the physical therapists I worked with told me that I was more body aware than any client she’d had: because of my yoga practice, I was able to quickly understand her instructions, isolate the particular body parts or muscles she needed me to work, and ask questions about proper positioning. While I don’t have evidence, I believe it helped me to recover. If nothing else, I had moments of feeling empowered which is a rare feeling when your body is not where you want it to be or where it once was. (Perhaps some of you can relate to that. :))

Despite or perhaps because of my injury, I strengthened my work on other limbs of yoga as well– through breathing exercises, personal meditation, and guided meditation. Today, my asana (posture) practice is not as intensive as it once was but pratyahara (withdrawal of senses) regularly grounds me and the niyamas (observances) have helped me to grow Wooden Spoon Wellness. Yoga has become a path toward home for me; when my mind is foggy or I feel disconnected from my body or my purpose, my yoga practice brings me back to center.

Scientific studies support many of the claims teachers such as those suggested by Lee and Rai. They show that regular yoga practice can prevent heart disease, help heal cancer and high blood pressure. It also alleviates symptoms of some chronic conditions such as multiple sclerosis and diabetes. Scientists have also proven that relaxation techniques developed through yoga positively affect people’s mental health by decreasing stress, insomnia, and depression. Yoga even changes genes that affect immunity according to one study and slows aging according to another study. [3]

Yoga can also help prevent everyday things. If you are feeling ‘off’ or stressed, you are frequently sick with a cold, or you need to detox, for example, yoga can help. [4] Many different yoga schools and types of practices exist and have health benefits. Here are a few broad overviews of some of the yoga classes you might come across:

  • Hatha: These classes tend to be slower, address some of the more basic poses and cultivate some of the mental focus and discipline that is part of the larger yoga tradition mentioned above. These classes are generally good for beginners.
  • Restorative: These classes are designed to relax and recover. They often involve props, such as large pillows and blocks that will be made available in the class.
  • Iyengar: This school of yoga focuses on alignment and can thus be helpful for beginners. Classes often do not follow a particular sequence as you might in other classes and there is often more starting and stopping than you would experience in a flow class. Props, such as blocks, straps, or chairs are often involved and you may be asked to work in partnership with another class participant.
  • Vinyasa: Also sometimes called ‘flow’, these classes tend to be a bit more fast-paced than hatha and generally involve a similar sequence of postures from one class to the next.
  • Ashtanga: A more regimented version of vinyasa, it often has set sequences that do not vary from class to class. Ashtanga is often considered the more gymnastic version of yoga.
  • Bikram or Hot Yoga: These classes take place in a heated room and are generally fast-paced.
  • Kundalini: These classes are generally focused on developing the spiritual self and awareness through meditation, postures, breathing exercises, and chanting.
  • Yoga Nidra: These classes are less common in the US but if you can find one, they support you in cultivating deep relaxation through breathing exercises and guided meditation, amongst other things.

What does a typical class include?
Classes generally last 45 minutes to an hour and a half and are led by a teacher who will guide you through a variety of postures and/or exercises.

Wear clothing you can easily and freely move around in and that you can sweat in. You will likely bend over a lot or invert your body so very loose clothing may ride up and expose skin. Bearing skin is very common in yoga classes so if this is something you are not comfortable with you might consider wearing more form-fitting clothing and/or long, loose clothing with tighter seams at the waist and ankles.

Yoga requires a mat. You can buy and bring your own yoga mat but most places offer standard-sized mats for free or for a small fee (typically $1). Standard-sized mats are about 72 inches feet long so if you are taller than that and you are compelled by the practice, I highly recommend investing in a longer mat.

Some classes may include props such as pillows, blocks, or straps that the teacher will make available for the duration of the class.

Things to consider when choosing a class:

  • If you have any injuries, be sure to tell your teacher before the class, even if it is a restorative class. Some poses can be difficult on your body but a good teacher will offer alternative moves for you to do.
  • Yoga can cause injury. Before EVERY class you take, it is very important to be aware of your limits. It is also important to work with a teacher or teachers who are attuned to proper alignment and can minimize the risk of injury. [5]
  • How big is the class? If you have the option and especially if you are just starting out, I recommend finding a class with fewer students where you can have more of the teacher’s attention.
  • Yoga classes are driven by the teacher’s directions so the teacher’s training and personality greatly influence your experience. There are MANY different kinds of yoga as mentioned above and even within a particular school different teachers will create very different class vibes—some classes will be very mellow and calming, the teacher will burn incense or play Indian chant music and rub your temples with scented oils, some teachers will play no music, provide basic instruction and take a hands-off approach, some will make adjustments while you are in certain poses, or play pop music—the possibilities are endless. See what you are in the mood for before you go to a class and call the studio to learn a bit what to expect if it is not available on the website. Or just go for it and see what’s up.
  • Are you comfortable having a teacher touch you to adjust your pose? Sometimes for example, a teacher may put their hands on your shoulders while you are standing or they might stand behind you and pull your hips back… If you are not comfortable being touched, be sure to speak with the teacher before the class and ask if they tend to make adjustments to students. If so, tell them to give you verbal instructions instead.

Here are some key terms that you might come across when looking at class descriptions:

  • asana (posture): Sometimes class descriptions will say that you will explore certain asanas or hold asanas for a longer period of time and thus will help cultivate discipline as well as awareness of those particular body parts.
  • prana (life force or energy): Classes that include a focus on prana generally give special attention to your breath. They may include breathing exercises (pranayama).
  • kirtan (a form of chanting): Sometimes classes include kirtan. The teacher may have a musical instrument or live musicians. The chants generally are in Sanskrit (an ancient Indian dialect) and blessings to invoke certain Hindu gods and/or the things the gods represent.

What does it generally cost?
The price of yoga classes varies greatly. Classes typically run from $10-$20. Bikram or hot yoga tends to be more expensive. Many cities have a chain called Yoga for the People which is by donation. http://yogatothepeople.com Some schools also offer “Community classes” or donation-only classes. These classes are often taught by new teachers or yoga teacher students and suggest a minimum donation of $5 or $7.

Videos and free online classes are widely available though I’d strongly recommend working with a teacher at least to start because of the risk of injury.

Yoga mats, should you choose to purchase one, range significantly in cost, anywhere from $10 to about $100. Cheaper mats will generally not last as long and may not have much grip. You can get a pretty solid mat though for about $30.

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[1]  These modalities could also be included in my “Movement Therapies” blog as they have also been shown to heal certain ailments or injuries such as lower back pain. In addition, while this blog only covers three preventative techniques, other practices such as martial arts or various forms of dance, could be added to this blog as well.

[2] Cyndi Lee. “Yoga 101: A Beginner’s Guide to Practice, Meditation, & the Sutras.” Yoga Journal, October 7, 2014.

[3] See “Evidence-Based Research, Studies on Yoga and Health.” Center for Yoga and Health. ; Dr. Dean Ornish, et al. “Effect of comprehensive lifestyle changes on telomerase activity…The Lancet Oncology. 17 September 2013; Massachusetts General Hospital press release, “Study finds relaxation response triggers genomic changes.” May 10, 2013.

[4] Dr. Marc Halpern. “What Does An Ayurvedic Yoga Therapist Do?Yogacamp, June 20, 2013.

[5] See Ananda School of Yoga and Meditation. “Can Being Too Flexible Be Harmful?” and Roger Cole. “Yoga Shouldn’t Hurt.” Yoga Journal, June 26, 2008.

Is Your Sunscreen Killing Coral Reefs?

woman in bikini applying sun block cream on bodyOn a recent escape from New York City’s wintry mix, I found myself struggling to find a sunscreen that I could feel good about. I try very hard not to use products with chemicals, especially in large quantities, but I am fair-skinned with a family history of skin cancer so SPF 45+ is a health must. When in the sun, I apply it liberally and frequently. I am normally very anti-checked luggage on flights but on this recent trip to Jamaica I went so far as to check my bag just so I could bring natural sunscreen that I thought I would not be able to find on the island.

At some point on the trip, friends and I were chatting with a guide from the area and one friend inquired about snorkeling. We learned that, while Jamaica once had corral teeming with wild life, the coral was now virtually extinct. Our guide informed us that part of the reason the coral may have been destroyed was because of the sunscreen that tourists wear. [1]

Cue the guilt. I had tried desperately to find sunscreen that was ‘natural’ and according to the label on the Nature’s Gate sunscreen I ultimately purchased, it was, “Free of Oxybenzone, Parabens, Phthalates, Fragrance, Animal Derived Ingredients and never tested on animals.” I just assumed that this meant that it was safe for the environment. My friends, I was wrong. The main culprits that can contribute to reef erosion, according to the 2008 Danovaro study, are Oxybenzone (benzophenone-3), Butylparaben, Octinoxate, and 4-methylbenzylidene camphor. The first ingredient in my ‘healthy’ sunscreen was Octinoxate.

It seems that in order to live our values and follow through on a commitment to protect our bodies and the environment from harmful chemicals, we must do our own research. When it comes to sunscreen, the keywords to look for are “Reef safe”. It’s also important to consider other chemicals we might carry into the water that may be harmful to reef or other marine wildlife, such as substances found in hair care products, face cream, or makeup. In these cases, it is unclear to me if a simple soapy shower prior to swimming will do the trick. Luckily there is a one-stop shop for MANY beauty products on the market. The Environmental Working Group’s database rates sunscreens, beauty products, perfumes, as well as makeup. They also have an app for those on-the-go decisions. All we can do is try…

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[1] This is supported by a 2008 study conducted by Roberto Danovaro, et al. on the effects of certain sunscreen chemicals on coral reefs in the Atlantic, Indian, and Pacific Oceans, as well as the Red Sea. See the study referenced in Ker Than, “Swimmers’ Sunscreen Killing Off Coral.” National Geographic News. January 29, 2008.

A Luscious Pre- or Post-Workout Smoothie to Build Muscle

SmoothieAccording to many professional trainers and sports doctors, working out may not be enough to build muscle. When we eat and what we eat pre- and post-workout can impact how much muscle we build or don’t build. Some of the things recommended for exercise lasting 45-minutes or more are:

— Eat within one hour of exercising, both pre- and post-workout

— Eat proteins and some carbohydrates that digest quickly in order for the muscle-building nutrients to reach your muscles quickly. Muscles are made of proteins and amino acids which start to break down during intensive workouts so if you do not do this, your body may draw on existing muscle to replenish itself after exercise. [1]

The smoothie recipe below includes whole foods that can help build muscle. Just throw everything into a blender and blend on high speed for 30 seconds.

  1. Quickly absorbed proteins: Yogurt and Milk (1½ cups total combined) Not only does this contain the essential proteins touted by all as essential muscle-builders, but the good bacteria in the yogurt will help quickly breakdown all of the goodness in your smoothie. The yogurt to milk ratio depends on how thick the yogurt is because if the yogurt is very thick, the smoothie can start to taste like banana bread batter. If your yogurt does not contain pectin, use 1 cup cow yogurt and ½ c. cow milk. Cow milk contains the most amount of protein of the milk options. In addition, I could not find non-dairy cultured products that contain sufficient protein except for cultured soy but I cannot in good conscious recommend these soy products because of their effect on hormones. (Stay tuned for that blog…) If you are lactose-sensitive and/or trying to reduce your carbon-footprint, you might try cultured goat milk with almond milk. There is one in the New York City-area from Coach Farm that is delicious in this smoothie when combined with Pacific Food’s Organic Unsweetened Vanilla Almond Milk. The cultured goat milk is thin though so add an extra ½ banana if you go that route.
  2. Quickly absorbed carbohydrate: Banana (2 medium-sized bananas) Glycogen is derived from glucose, a sugar molecule, and it is the primary fuel for exercise. It depletes as you work out and is one of the primary things you want to consume in order to restore your energy. Bananas are an excellent source of easily accessed glycogen for your body according to personal trainer and exercise writer, Mike Samuels. [2] While loaded with nutrients, the fiber in whole grains can take a while to breakdown and can slow down the breakdown of proteins. Bananas however are a good source of carbohydrate post-workout because they provide the needed sugars of a carbohydrate without a lot of complex fibers. Bananas are also an optimal carb because they contain potassium which is said to support heart health. Some believe bananas prevent muscle cramping as well. [3]
  3. Vitamin B6: Pistachios (1 tablespoon) Vitamin B6 helps break down proteins and carbohydrates and help get these things to your muscles quickly. It is also said to reduce inflammation in addition to supporting the nervous system which is activated during workouts. [4]
  4. Anti-inflammatory: Turmeric powder (1 tsp.) This powerful powder typically used in curry blends is derived from a root similar to ginger. It has long been used for its inflammatory properties and a 2009 study showed that turmeric’s pain-relieving effects comparable to ibuprofen. [5] Part of what enables turmeric to work its magic is that it thins the blood. This may be of concern for some people who have blood-clotting issues or who have recently had surgery or will have surgery. Turmeric is also contra-indicated for gallstones. If this is you, check with your doctor about regular turmeric consumption.
  5. Electrolytes: Salt (a small pinch) As is commonly known, you lose essential salts through your sweat so adding a pinch of salt will not only replenish your eletrolytes but it will also make you subtly thirsty for more fluids. [6]

 

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[1] There seem to be much debate about the precise window within which one should eat as well as the precise ratio of proteins to carbs but it seems clear that eating within one hour cannot hurt and waiting may hurt. Will Brink, “The Latest on Pre-Post Workout Nutrition” (2003); Alan Albert Aragon and Brad Jon Schoenfeld. “Nutrient timing revisited: is there a post-exercise anabolic window?Journal of the International Society of Sports Nutrition 2013, 10:5.

[2] Mike Samuels, “Should I Eat Bananas if I Want to Build Muscle?Livestrong.com, June 18, 2014.

[3]Bananas.” The World’s Healthiest Food.

[4]How to Help Your Body Absorb Protein.” Golden Gate Obstetrics and Gynecology blog. September 25, 2013; “Pistachios.” The World’s Healthiest Food.

[5] Journal of Alternative and Complementary Medicine August 2009;15(8):891-7; Anahad O’Connor, “The Doctor’s Remedy: Turmeric for Joint Pain.” New York Times, Oct 19, 2011.

[6] Marie Spano. “Postexercise Recovery—Proper Nutrition is Key to Refuel, Rehydrate, and Rebuild after Strenuous Workouts.” Today’s Dietitian. Vol 15 No 11, p. 18.

 

 

 

How to Pleasurably Cut Back on Holiday Sweets

Escape. Running woman refuses to eating tasty cakes. DietingSweets seem to be just about everywhere during the holiday season– between the holiday parties, the family gatherings, the strategically placed treats at the supermarket, and the vacations– the variety and bounty of sugar can be difficult to resist. How many of us end up eating foods around the holidays that we actually don’t want to eat simply because they are in front of us? We see it, eat it, and have a physical reaction—we just don’t feel good—but this can also be psychological– we feel bad/guilty/gross/oh my! In part we feel this way because we did not act according to what is important to us. Cutting ourselves off completely from sweets can feel un-festive and bad as well though. In addition, it may not be a realistic goal for many who have never successfully done that before. This blog therefore contains an eating strategy for those of us who are either not ready or don’t want to go cold turkey but are committed to being more intentional and disciplined in our holiday eating.

Many of us have one holiday treat that we really lust after. Mine is pumpkin pie— a fluffy, custardy pumpkin pie whose filling is so silky I could put it on like lingerie. Perhaps your treat involves chocolate or festively decorated gingerbread or candy canes or rich egg nog… In any case, how many of us end up eating all of it? At the office holiday party, we load our plates with whatever draws us in in that moment. For example, how many of us have eaten those powdery Italian wedding cookies that make an appearance this time of year even though we know they’re usually not that good.

This holiday season be choosy. Invest only in the thing you love and get monogamous with your favorite sweet. Let it be your primary source of sweet pleasure. Select one thing— chocolate Bon Bons, gingerbread, even that Italian wedding cookie—and refuse all other temptation. This increases the likelihood that you will ultimately consume less. In addition, your body has to work harder when you eat a lot of different kinds of foods and it becomes harder to realize when you are satisfied and when to stop eating.

In addition, each rendezvous between your favorite sweet and your tastebuds will be much sweeter. This is not to say that you should eat every last bite of your chosen treat available on the table or even as much as your heart desires in that moment. To the contrary! Start with a small amount. Eat slowly—make it a marathon and not a sprint. Relish in it. Savor. Every. Bite. Notice how the quality of this one compares to others you’ve had. What do you appreciate about this one, this moment?

Bringing more consciousness to your eating and cutting back on the things that do not serve you will not only help you to navigate the holidays with ease and enjoyment, but it also starts you off on a less guilty, more pleasurable New Year. Here’s to a happy and healthy 2015!

Postpartum Exercise: Running Tips from a Breastfeeding Mom*

Crossing the Finish Line.RealGuest blog by: Stephanie Harad

I’ve always hated running and I’ve never thought of myself as athletic but after becoming a mom I decided to train for and run a half marathon. Becoming a mom was a huge identity shift for me and I lost my focus on pretty much everything else. After a while I felt like I needed to re-ground myself a little bit.

I began jogging with the stroller once or twice a week when my daughter was about 3 months old. I found that leaning on the stroller actually helped with the discomfort of running with heavy, milk-full breasts because it minimized the bouncing up and down motion. I also hiked a lot as long as my baby was willing to sleep in a carrier. As time went on she became less and less interested in being in a carrier for more than a few minutes and I simultaneously felt more and more healed from the birth and wanted to exercise a little more vigorously, so I started to increase my running. Though it was difficult, I found that I really cherished those times that I was really in my body, using it to get fit and take care of myself after spending the rest of my time dedicated to my baby’s needs.

So why running? It seemed like a realistic form of exercise for me as a nursing mom. I love the bicycle but it took way too long to get a good workout on a bicycle and my toddler will not happily sit in a bicycle seat for hours. Swimming or going to the gym was out of the question for me because driving took an impossible amount of time. Running is something I could do with a stroller if necessary and I could do it right out of my front door. I could have used exercise machines and DVD’s at home of course but leaving the house was a very important mental health component of my exercise choice.

Eventually, I needed a goal that was going to be hard to achieve but possible, that was completely about me and something I’ve always kind of wanted to be able to do but never thought I could. I happened to hear that there was going to be a half marathon in my town in the fall and it felt like the perfect thing to try. There were many things that appealed to me about racing (though I had never done it before) but the social component was a huge factor. Being a new mom has been such an intense experience for me, figuring out so much on my own because no other baby is exactly the same as mine– it can be isolating. Running a race, however is an incredible feeling because there are hundreds or thousands of you all undertaking the same challenge in the same way and so many people cheering for you and supporting you along the way and after. And if you’re lucky you can even find a buddy to train with, though I did not regularly train with anyone because I wanted to make sure I was going to go slowly enough to avoid injury – more on that below.

When I started training, I was still breastfeeding on demand around the clock, about 6-8 times in a 24-hour period. I was concerned about the impact that increasing mileage would have on my body because I still hadn’t gotten my period so I wasn’t sure if I was already lacking something nutritionally and was going to further tax my body and thus deplete my milk supply. I was unable to find professionals to consult about this but I did know another breastfeeding mom who ran a great deal more than I would be running and I figured I would just try it and listen to my body. In terms of finding information about how to train for a run and what to do when injured, etc., I just used my social networks. I posted questions on Facebook and found that I had a lot of acquaintances who are experienced runners. I found them to be much more helpful resources than the local doctors I visited. For example, there are a lot of training plans out there and, after consulting my runner friends, I decided on the Hal Hidgon Novice program even though it is not geared specifically for mothers but it was the most reasonable for me.

Training for a distance race felt pretty rigorous as an inexperienced runner. Most training plans require you to run 4x a week and cross-train another day. If you are a nursing mom, that kind of time commitment can be really difficult to pull off but I also felt like it provided a very real and compelling reason for me to take a break from all my mom-related duties almost every day. I felt I couldn’t miss too many workouts or I wouldn’t be ready for the race so I was very motivated to carve out that time for myself in a way that I wasn’t when I was just running for fitness a few times a week.

Of course a nursing mom may not be the running-focused, shockingly unencumbered, fit and resilient male athlete who is the intended audience of running books and blogs. A nursing mom is full of bone- and ligament-softening hormones and is often getting very little sleep, not to mention giving most of her calcium and vitamin D away all day. So we are much, much more prone to injury and have to be a LOT more careful than most people. Running injuries are ubiquitous anyway and can be serious, sidelining athletes for 3-6 months or longer, which is also devastating on a mental health level. I sustained some minor injuries to my feet and knee always after running faster than I should have. Again my runner friends were incredibly helpful with advice on how to take care of myself when injured. While seeking professional help can be important, people who have a lot of experience running have usually dealt with a lot of injuries and can share what works and what doesn’t.

When you start training you will start to see how incredibly addictive running can become even if you used to hate it, even if you still hate it. The race itself was a party the whole time with people playing music and cheering all along the way. And that feeling when I crossed that finish line, achieving my goal is something I will remember forever. I’m grinning as I type this. I felt unstoppable, even as I choked on the watermelon Gatorade that I foolishly drank at mile 12.5. And my baby saw all of this. She saw that I worked so hard to do something that I used to dismiss as impossible. (Also, babies and toddlers really like race packets. My daughter still asks me regularly if we can go get a race packet.) Now I’m thinking of training for a full marathon next year. My breast milk supply was not affected and I’m still breastfeeding on demand. I am so glad I took on this life-changing challenge and was able to model this for my baby. I highly recommend it or something like it!

And if this is something you are considering, here is some advice to help you stay healthy:

  1. Don’t let the time commitment to train scare you off! You can totally adjust as needed! I went on vacation towards the end of my training and didn’t run for a week and I didn’t lose my fitness. An important thing that I was advised though, is that when you do miss workouts don’t try to make up the miles because that may lead to injury. Just skip it if you skip it.
  1. If you nurse right before running, wait until the fuzzy, gooey, gummy-boned feeling goes away before you run or stretch too much. That feeling happens as a result of a hormone surge and it increases your likelihood of injury because the hormones are softening your ligaments and tissues and bones. For me, it takes about 45 min to go away but it’s different for everyone. To protect those bones and ligaments and muscles further, I was advised to take calcium and Vitamin D supplements if you are not already.
  1. Go slow and don’t do speed work. Most of us with little time want to get the biggest bang for our buck when we exercise and are used to working out very hard. Training for long races is all about learning how to hold yourself back. It is hard in the beginning but so important to minimize the risk of injury and hopefully help you learn to run negative splits (not burning yourself out in the beginning of the race so you can run the second half of the race faster than the first half) . If this is your first long distance race a great goal is just to finish so you don’t have to worry about speed. Even if you do have a time goal remember that you generally go faster on race day than you do in training, especially in long distance races, so you don’t have to worry too much about speed in your training My race was mostly downhill but I ran about 2 minutes per mile faster in the race than when I trained.
  1. Hydrate! Breastfeeding mothers need a ton of hydration so hydrate more than you think you do. I’m all about sports drinks when running even though I know they’re gross.
  1. Always stretch after each run. Use a foam roller as often as possible at night before bed. I know as soon as you walk in the door you’re on baby duty and it’s very hard to stretch but some stretches you can do while nursing. Or stretch outside in front of your house before you walk in even if you feel ridiculous.
  1. And finally, make sure to eat healthy fats and carbs. Runners need increased amounts of fats and carbs and breastfeeding runners even more so. Pregnancy and the first year and a half or two after giving birth are such a special and intense time regarding your relationship with your body and the way that it changes. I know for me I was carrying around more weight than I ever had when I began running, and when I did introduce running I felt a not-even-totally-conscious desire to try to get my body back to my ideal of a totally fit/athletic body. But this really isn’t the time to do that and I had to work very hard to resist it. Your body is working so hard to provide fuel for you to breastfeed, to function on no sleep, and to do all this running. You need the carbs and fats that you are craving in order to stay healthy and keep making milk. (Wooden Spoon Wellness’s Pre- or Post-Workout Muscle-Builder Smoothie, for example, satisfies a lot of these needs, FYI.) Back in the thousands of years ago times, we used to live in tribes where there would be lots of lactating women who could feed each others’ babies in a pinch so evolutionarily your body is wired to keep your vitamins and minerals for yourself and stop producing milk if need be. You have to make sure your body feels like it has enough to go around. The positive side to this unique period of closeness with your body is that you are able to hear loud and clear what your body needs and it’s easier to listen to it.

Stephanie Harad is a social worker, mother to a very enthusiastic nurser, and an addicted runner. She lives in Santa Fe, NM with her wife and daughter and sometimes blogs at Dispatches from the Motherland.

*Health coach’s disclaimer: This post is not meant to provide medical advice. If you are considering taking up long-distance running, even if you ran at one point in your life, first check with a licensed medical professional to ensure that it is safe for your body. Once cleared, rock on with your bad self!

Maintaining Energy When You Just Want to Hibernate

Happy and Fun African WomanIt is official. What I call ‘hibernation syndrome’ has officially set in. This is what I call the phenomenon that develops each time the cool winter air blows into town and all many of us wants to do is to curl up in (or with) something (or someone) cozy. Plans start to be cancelled more frequently, errands are postponed, movement becomes limited and exercise time is traded for couch time.

Like other mammals, humans’ bodies change during the cold weather months and our lifestyle and body’s needs change. It is important to listen to your body but it can be easy to slip into unhealthy patterns. Here are a few tips to maintain energy and a healthy lifestyle if hibernation syndrome strikes you:

  1. Move your bowels regularly. I know, not the sexiest of topics but a sedentary lifestyle may not make you feel sexy either… Moving around less, especially if you’re eating rich holiday foods or warming but heavy stews, can lead to a slower metabolism. Because your body is processing food more slowly, constipation can easily happen. Here are some ways to prevent this from happening or address it when it does occur:
    1. Integrate fiber-rich foods each day. Cooked, dark, leafy greens are great, flaxseeds that you grind yourself (a small coffee grinder does the job well) sprinkled on plain yogurt. Almond milk with chia, flax and pumpkin seeds can help clear things out as well.
    2. Keep your inner flora lively. Even if you are tired, your body needs good bacteria to work for you to digest your food. Good bacteria can be introduced through fermented foods such as sauerkraut or other raw, pickled vegetables. You can find them at the store but be sure to buy ones that do NOT contain vinegar, citric acid or sugar. Fermented foods are actually really easy to make yourself and a great way to preserve some of the autumn produce through the winter months. Sandor Katz has some great recipes on his blog and in his book, Wild Fermentation.
  1. Move your hips regularly. Just because you are not at the gym or bopping around outside, doesn’t mean that you can’t remain active.
    1. Buy or stream low-cost or free dance and exercise classes, like Gaiam’s Wake Up Workout, or Crunch gyms’ Crunch Live. Wii has fun dance and workout games as well.
    2. Stream gentle movement classes. If you’re feeling lower energy and you want to support your alignment, you might try Katy Bowman’s low-cost movement classes.
    3. At the very least, get out of your seat every 15 minutes. Stand up, roll your hips and neck around, change positions when you return to where you sit, or change where you sit. Move to the floor, a balance ball, a chair instead of the couch. A good way to ensure that you move frequently is to drink a lot of water or herbal tea.
  1. Reduce the quantity of food you eat (unless you are pregnant or breastfeeding, have an eating disorder, or already eat small amounts of foods in which case, skip this one.) The average American tends to eat more during the winter months according to Dr. Rallie McAllister but there are many reasons why we may not need to eat as much in the winter months.[1] As mentioned above, you may move less so you do not need as many calories.[2] In addition, the food you are eating is likely to be denser and heavier: a bowl full of lentil soup for example can be more than double the calories of a bowl of gazpacho.[3] Here are a few ways to adjust your eating according to the new season:
    1. Experiment with eating smaller portions. If you eat heavier, denser foods in the winter, such as stews, potato and root vegetables, eat smaller portions than you would in the warmer months. Take what you might normally take and then put a quarter of it back. After you’ve eaten this portion, wait 10 minutes and see if you are still hungry. If so, take a small amount more, i.e. a couple of tablespoons of the squash puree, half a potato, etc.
    2. Stay warm. Sometimes we might feel an unconscious instinct to eat a lot because it is a way to put on weight and keep our bodies insulated from the cold. There are other ways to stay insulated without gaining weight. This can be accomplished by eating cooked, warming foods and not cooling, raw foods, drinking hot beverages, maintaining good blood circulation by regularly moving your body, and having the right clothing.
  1. Have on-hand warm winter clothes that you are excited to wear. In addition to potentially helping to curb over-eating, good winter gear may just give you more incentive to go out, even when Jack Frost is nipping at your toes.
    1. Clothes that keep you warm: for this, we turn to the animals who are able to stay outside without needing a coat. My favorites are tightly woven wool and silk. These materials when kept close to our skin are amazing insulators. There are a variety of price points for winter gear and the warmest of the warm can get expensive quickly. Online stores often have deals, like Amazon for silk long underwear or eBay for brands like Ibex, which makes lightweight but SUPER warm wool clothes. This type of clothing is an investment but one that can save you money on having to buy multiple layers.
    2. Clothes that you make you feel HOT or fun. Find yourself a sexy sweater, maybe there’s a furry color involved, or a fun-colored hat or pair of gloves (Freezy Freaky anyone????) Having clothes you want to wear can make the difference between a night sitting on the couch with a large bowl of popcorn and a night accomplishing all of your errands or bopping around with friends.

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[1] Colette Bouchez. “Control Your Winter Appetite.” WebMD.

[2] See the USDA’s guidelines for estimated calories needed for a sedentary lifestyle as compared to an active lifestyle.

[3] One cup of lentil soup is approximately 136 calories according to CalorieCount. Two cups of gazpacho is approximately 59 calories according to the same source. Please note that I cite this calorie comparison only as a means of displaying the density of the foods we tend to eat during the cold months as compared to the warm months. I do not incorporate calorie counting into my health coaching philosophy.

“Violet! You’re turning violet!” or, How I Turned Orange from Eating Too Many Orange Vegetables

Concerned young woman looking in mirror

As it turns out, Roald Dahl’s violet-colored plot twist in Charlie and the Chocolate Factory was not pulled from thin air. People can actually turn a different color from eating certain foods, especially this time of year when colorful vegetables abound. I know some people enjoy their pumpkins and fall produce like it’s nobody’s business (you know who you are!) so I thought I’d share a bit more about this largely harmless condition.

When I was in my early twenties, I worked for a museum and, as happens with all jobs, I went through a very busy time at work. I was at the office for 10-12 hour stretches and felt like I couldn’t break for lunch so my response was to nosh on a bag of baby carrots dipped in Hampton Chutney Co’s cilantro chutney. (It is made with coconut and chiles and dates among other things and it is highly addictive.) It was delicious and easy and filled me for the day.[1] When I wasn’t working, I would nest at home and eat copious amounts of a kabocha squash, a Japanese winter vegetable I’d just learned about. It was hearty and sweet, as if a potato and a butternut squash had a baby, and I could not get enough.

One day at work I went to give one of my co-workers something from the archive and as I handed it to him he asked what happened to my hands. “What are you talking about? Nothing.” “You’re orange,” he said. I looked more closely and realized that he was right. I immediately called my mom, who is a nurse, and she told me to check the bottom of my feet as well. Sure enough, they glowed like the setting sun. She asked if I’d been eating a lot of orange vegetables and, after telling her about my carrot and squash obsessions, she told me that there was a good chance my skin was taking on the color of the vegetables as a result of carotenosis, a condition caused by the consumption of copious amounts of beta carotene. In light-complexioned folks, carotenoids cause skin to turn a yellowish-orange color, not unlike a light spray tan. In darker-complexioned people, the skin turns a yellowish-brown. Luckily, my new chameleon qualities were the only side effect I experienced but I was definitely curious to learn more.

Beta carotene is found in orange-yellow vegetables (e.g. pumpkins, carrots, and winter squashes such as butternut, acorn, spaghetti and honeynut), as well as tomatoes and dark, leafy greens. It converts to Vitamin A in the body and can be helpful to the skin, tissues, lungs, mucous membranes, as well as vision.[2] Beta carotene is also an antioxidant of the carotenoid variety which means that it supports the immune system. In addition, regular consumption can help prevent some kinds of cancers[3] and regulate blood sugar. Some scientists and nutritionists believe that you can gain these benefits from eating at least 5 servings of beta carotene-filled fruits and vegetables per day but this is not conclusive and the FDA has not issued a recommended daily allowance.[4]

Various medical studies show that carotenosis is not harmful when it develops from eating a lot of beta carotene-rich vegetables and fruits.[5] Carotenosis from beta carotene supplements however can lead to more serious issues such as hypervitaminosis A, or having too much Vitamin A in your system. This can be particularly dangerous during pregnancy and has been shown to lead to birth defects in some women.[6] Pregnant women are thus advised to source their beta carotene from fruit and vegetable if possible. If you must take supplements, including a multivitamin, talk with your doctor about safe dosages.[7]

Because my carotenosis occurred from natural sources, I was fine. I cleared the condition and my skin returned to normal by avoiding beta carotene rich foods for a few weeks and by diversifying my diet. I integrated brown and white vegetables such as potatoes, pears, daikon or white radishes, turnips and parsnips, as well as proteins of all forms and whole grains. Just because my health was not affected by carotenosis however, it is still not a good idea to eat pumpkins at every meal. Most nutrition experts recommend a varied diet with an array of colors and types of foods. However, if you’ve recently been indulging in a colorful-vegetable kick and you’ve noticed a soft glow that you have not seen before, try changing your diet before the oompa loompas come for you.

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[1] Health coach’s disclaimer: While eating a simple diet during stressful times can be helpful for maintaining energy levels, I do not recommend replacing meals with baby carrots and chutney. Baby carrots are processed foods and thus do not contain as many nutrients as fresh carrots. In addition, the dates in the chutney combined with the sweet carrots contain a high amount of sugar. I also advise eating a diet rich in a variety of types of foods (i.e. a mix of proteins, vegetables, and whole grains.)

[2] http://www.nlm.nih.gov/medlineplus/ency/article/002400.htm

[3] http://www.whfoods.com/genpage.php?tname=foodspice&dbid=63; http://www.nlm.nih.gov/medlineplus/druginfo/natural/999.html

[4] http://umm.edu/health/medical/altmed/supplement/betacarotene

[5] http://healthyeating.sfgate.com/can-much-betacarotene-cause-yellow-skin-2041.html; http://www.ncbi.nlm.nih.gov/pubmed/8449701; http://onlinelibrary.wiley.com/doi/10.1046/j.1365-4362.2003.01657.x/abstract;jsessionid=504472D38568D43F3B1A2CB671A08516.f03t03

[6] http://www.drweil.com/drw/u/QAA400486/Eating-Too-Many-Carrots.html; Dr. Holly Roberts. Your Vegetarian Pregnancy: A Month-by-Month Guide to Health and Nutrition. New York: Fireside, 2003. p. 52

[7] See http://umm.edu/health/medical/altmed/supplement/betacarotene

Game of Tongues: How to Develop Your Palate (& Have Fun)

Closeup of lips with red lipstick holding pepperminThe tongue is perhaps one of the more complicated parts of the human body and innumerable blog posts could be written about this magical muscle. This particular post will focus on the particular experience we have when tongues touch food as well as ways to expand this experience (or just have fun).

The process of tasting occurs when something (i.e. food) stimulates receptors on the tongue (taste buds) that then send a message to the brain. The brain interprets the transmission as “Taste!” and associates it with a specific kind or kinds of taste: sweet, salty, bitter, sour. [1]

The tongue learns many other things when it touches something: it learns the temperature and texture of the substance, it evaluates the substance according to our likes and dislikes, and sometimes it can detect whether or not a food is harmful to us. This complex muscle has plenty of time to evolve because taste is one of the first senses to develop in humans. Many believe that babies put just about everything in their mouths in order to understand the world around them. As Robin Goldstein, Ph.D. says, “Babies don’t just put things in their mouths for pleasure or comfort; they also use their mouths for exploration. They learn about objects by tasting them, feeling their texture and experimenting with them.” [2]

Certainly, not every toy needs to be tasted or opening licked. (See for example, this hysterically awesome Discovery article, “Things You Shouldn’t Lick,” which was written in response to eye-licking trends in Japan.)  But when was the last time you used your tongue to explore and learn more about the world and the food in it?

Especially as the weather starts to grow colder, here’s a fun game to play while you’re bundled inside. This can be totally G-rated and played with a friend or you can modify it and turn it into a sensual game. To add some extra spice to the game, if your partner agrees, throw a blindfold into the mix. It can also be fun to play on your own. Ask a friend to identify some foods you’ve never tried before or just create a shopping list yourself, and rock out on a solo expedition!

Game of Tongues

  1. Choosing the foods: Create a list of foods and beverages that have different textures and temperatures and hit different notes on the palate (sweet, salty, sour, bitter). Be sure to choose foods that you know your partner is not allergic to and that will not burn their tongue or crack their teeth. Have your partner do the same, creating a list for you. Here are a few ideas: sweet/smooth- peach nectar; sweet/salty/crunchy- good quality chocolate bar with fun things inside like brown butter or sea salt and almonds; sour/sweet- mangoes w/chili and lime, kumquat; sour/salty/crunchy- pickled green beans, kimchi; sweet/bitter/smooth- Aperol (an alcoholic beverage), grapefruit with all of the white pith removed—just the pods of juiciness; bitter- arugula, mustard greens, cocoa nibs; cold/smooth- frozen cherries; warm/chunky- baked mashed yams.
  1. Preparing the food: Remove foods from any packaging and put in glasses or bowls so they are not easily recognizable.
  2. Blindfold your partner if they’ve agreed to it in advance.
  3. Ask your partner to lick the item and describe it. Here are some prompting questions if they need help: What did you notice about the texture? Tell me about the temperature. Does it remind you of anything you’ve tasted or smelled before?
  4. Have your partner take a small bite or sip and roll it on your tongue: What new do you learn? Describe it. Can you guess what this is?
  5. In between the foods, have your partner suck on a lemon wedge and drink a few sips of water in order to clear their palate.
  6. When you’ve gone through everything, identify for your partner the foods they ate and debrief: What did they want more of? What would they eat again? What about the taste/texture/temperature did they enjoy?
  7. Switch! Now it’s your turn.

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[1] HowStuffWorks.com; University of Texas Health Science Center; Stanford University Psychology Department.

[2] Robin Goldstein, Ph.D. “Into the Mouths of Babies,” Washington Parent. September 2010.

 

Touch… for Your Health

As the weather begins to cool, it becomes easy to retreat into our caves. Hibernation syndrome starts to kick in (particularly amongst those of us who live in pedestrian or bike culture), we crave more sleep as the sun sets earlier and earlier, or we start to feel that change of season cold and stay inside to rest. While listening to our bodies is important, various medical practices believe that going the route of the hermit may not always serve us, especially if we are not feeling well or if we are low energy. In fact, safe touch with another human being in sexual or non-sexual ways can heal various physical and mental ailments.

A recent articleHolding hands on wooden background in Women’s Health magazine, “The Amazing, Beautiful Power of Touch,” discusses new studies about the many ways non-sexual touch can help cure physical and emotional ailments. [1] Massage, for example, has been shown to trigger immune-building cells. In addition, it stimulates the brain to release hormones that relieve stress, reduce pain, create a sense of peace, and sometimes even happiness. [2] Even a soft touch on the arm or back when you’re not feeling well… Perhaps it depends on who is doing the touching but in situations that feel safe, how do you feel when someone you trust makes even that small gesture? If you’re not sure, notice your body’s response the next time someone touches you in a platonic way.

Safe sexual touch can trigger similar responses according to many schools of thought. As my acupuncturist said to me the other day (and as if we need another reason), Marvin Gaye had it right: sex can be healing. This is a core tenant of ancient Indian Tantric philosophy as well as Traditional Chinese Medicine. Tantric beliefs posit that deep healing can result from sexual acts that stem from spiritual connection (as opposed to ego, pleasure-driven motivations). See for example, Dr. Rafe Biggs’ writings about the ways Tantric practices have enabled him to heal parts of his body and sexuality following a severe accident that left him quadriplegic. [3] Even WebMD asserts that doing the deed can cure the sneezes and a recent story published on CNN’s website claims that kissing can HELP migraines and cramps. (There goes the ol’, “I have a headache excuse…”) [4]

Whether we are in the mood to connect with other humans or not, platonically or sexually, if the opportunity arises and you are considering it, or you are craving connection, know that this can be a gift that you give to yourself. Ya know, for your health…

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[1]  Sushma Subramanian, “The Amazing, Beautiful Power of Touch,” Women’s Health magazine, March 7, 2014. See also Norine Dworkin-McDaniel. “Touching Makes Your Happier,” CNN Health.com, January 5, 2011.

[2]  See Ironson, G., Field, T.M., Scafidi, F., Hashimoto, M., Kumar, M., Kumar, A., Price, A., Goncalves, A., Burman, I. , Tetenman, C., Patarca, R. & Fletcher, M.A. (1996). “Massage therapy is associated with enhancement of the immune system’s cytotoxic capacity.” International Journal of Neuroscience, 84, 205-217; Aust N Z J Psychiatry. 2008 May; 42(5):414-22. “Pilot study evaluating the effect of massage therapy on stress, anxiety and aggression in a young adult psychiatric inpatient unit.” Garner B1, Phillips LJ, Schmidt HM, Markulev C, O’Connor J, Wood SJ, Berger GE, Burnett P, McGorry PD.

[3] Dr. Rafe Biggs, “Tantra as a Healing Modality.” AwakeningBody.com, August 2008.

[4] Kara Meyer Robinson, “10 Surprising Health Benefits of Sex.” WedMD; Valerie Reiss, “8 Health Benefits of Kissing.” CNN Health, February 7, 2014.

Moving through Varicose Veins: An Overview of Eastern and Western Paths for Smoother Transit

Stop light, the red traffic lightAccording to a 2014 report from the Chicago Vein Institute, women are 10% more likely to develop varicose veins than men but women who have at least one parent with varicose veins are 35% more likely than men to develop them. [1] Why do these tricky veins affect more women than men and what are the various treatment options to encourage smoother blood flow?

Varicose veins are veins that are twisted and close to the surface of your skin and most often occur on legs and ankles, i.e. the places furthest from the heart and the places that bear the most weight. They swell and act like a really long stop light for the blood: Instead of the blood flowing down the body and back up to the heart smoothly, the blood builds up in the windy veins like bad traffic and becomes delayed in its return north. [2]

Externally they create blue-ish bumps on the skin and even mild cases of varicose veins can make some of us self conscious enough to keep our legs covered at all times. More severe cases of varicose veins can contribute to serious body image issues because they do not meet the dominant perception in Western cultures that sexy legs are smooth legs. Varicose veins emerge sometimes for reasons that are outside of our control though.

In addition to the genetic susceptibility mentioned above, varicose veins can be caused or affected by numerous factors. If you are susceptible to varicose veins, various things can aggravate your condition such as constipation and hemorrhoids, smoking and being overweight or obese. Women may be more affected by varicose veins because of unsupportive footwear, such as high heels. In addition, estrogen and progesterone stimulate blood vessels to dilate so if you are low in either of these which happens during menstruation, pregnancy, and during menopause veins may have a more difficulty opening and closing. In addition, pregnancy increases the volume of blood flowing through the body, adds extra weight, and puts more strain on vascular walls. [3]

Chemical birth control methods that hormonally regulate your menstrual cycle (what I call CBCMs) may also worsen varicose veins according to the Office on Women’s Health. [4] Chemical birth control methods act like traffic lights for your blood flow on top of an already existing air traffic control system. Imagine the air traffic control tower saying that the plan can land and go to Gate 44. The plane lands and then the CBCMs act like a stoplight on the runway telling the plane when to go or slow down or stop altogether. Your blood flow throughout your body is one system and their intervention into your menstrual cycle can assure a reliable schedule but it can inhibit the flow of blood in other places and cause delays.

As I’ve discussed in my other blog about chemical birth control methods, CBCMs help a lot of women but it is important to understand the risks on the rest of your body. Obviously, one way to potentially address varicose veins if you are on CBCMs is to stop taking them but this has other implications and may not be a realistic option for many women.

Eastern and Western medicine have treatment options as well as methods for easing symptoms. A (not-so-comprehensive) comparison is available on Natural Health Magazine’s website and includes suggestions from a yoga therapist, a naturopath and a dermatologist. In addition to putting your legs up the wall each day as mentioned by the yoga therapist and the supplements recommended by the naturopath, alternative treatments include acupuncture, massage, and low impact movement which can be very helpful in stimulating the circulatory system to move. [5]

Western health practitioners advocate for wearing supportive footwear and compression stockings, among other things. Surgery may be recommended for acute cases as well. This surgery used to be quite intensive and risky from what I understand. It involved a catheter through the groin and something called ‘vein stripping’ but according to WebMD, new, less invasive interventions have emerged. [6]

Many Eastern and Western trained health practitioners advocate for strong digestion that enables nutrients to nourish your connective tissues, strengthen veins, and help your body generally flow well without undue strain. Fiber in the form of ground flaxseeds, whole grains, vegetables and fruits can help with digestion. Fermented foods like sauerkraut or pickles without vinegar, yogurt, and probiotics introduce healthy bacteria to the gut to help break down your food. In addition, bioflavanoids which are compounds found in berries, dark leafy greens, and onions, Vitamin C which is found in citrus fruits, and anti-inflammatory foods such as green tea, cayenne, and turmeric are all believed to support vein health. [7]

Regardless of the path you choose, there may be emotional components to your varicose veins as well. Generally speaking, are there other places in your life where you are experiencing a pooling of some sort—of toxic people, of non-nourishing thoughts that have lived in the back of your mind for some time, or an aversion to change or growth? Are there metaphoric red traffic lights that are stalling you and if so, what will it take to remove them from your path?

Here’s to a smooth journey.

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[1] Chicago Vein Institute. “Varicose Vein Statistics.” May 5, 2014.

[2] National Institutes of Health. “What Are Varicose Veins”.

[3] ibid.; Dr. John McDougall. “Constipation, Hemorrhoids, Varicose Veins.”; MotherNature.com. “Varicose Veins.”; A. Mashiah, et al, “Estrogen and progesterone receptors in normal and varicose saphenous veins,” Cardiovascular Surgery, 1999 April 7(3): 327-31.

[4] http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.html; See also Jamie Hergenrader, “The Dangerous Side of Birth Control,” Huffington Post, 7/31/13.

[5] Check out “Varicose Veins? Natural Secrets for Restoring Beauty,” by Maoshing Ni for more information on traditional Chinese medical approaches.

[6] WebMD. “New Treatments for Varicose Veins.”

[7] University of Maryland Medical Center, “Varicose Veins.”; Hamilton Vein Center, “Eat This, Drink That for Healthier, Stronger Veins.” February 12, 2013; “Health Advice: Varicose Veins.” The Telegraph.18 January 2010.