Three Stonemasons

During the early years of the fourteenth century the foundations of a magnificent cathedral were being laid in central Europe. The Clerk of Works was a monk who was charged with the task of supervising the work of all the labourers and artisans. This monk decided to carry out a study into the working practices of the stonemasons. He singled out three stonemasons as being representative of different attitudes towards their profession.

He approached the first stonemason and said, “My brother, tell me about your work.”

The stonemason stopped what he was doing for a moment and replied in a clipped voice full of anger and resentment, “As you see, I sit here in front of my block of stone. It measures a metre, by half a metre, by half a metre. And with every blow of my chisel against the block I feel as though I am chipping away a part of my life. Look, my hands are callused and hard. My face is lined and my hair is grey. This work is never-ending, the same day in, day out. It wears me out. Where”s my satisfaction? I”ll be dead long before the cathedral is even a quarter finished.”

The monk approached the second stonemason. “Brother,” he said, “tell me about your work.”

“Brother,” replied the stonemason in a soft, even voice, “as you see, I sit here in front of my block of stone. It measures a metre, by half a metre, by half a metre. And with every stroke of my chisel against the block I sense I am carving out a life and a future. Look, how I am able to shelter my family in a comfortable house, far www.atoledo.com better than that in which I grew up. My children attend school. No doubt they will look forward to even more in life than I do. All this is made possible by my work. As I give to the cathedral through my skill, the cathedral gives to me.”

The monk approached the third stonemason. “Brother,” he said, “tell me about your work.”

“Brother,” replied the stonemason smiling and in a voice full of joy,” as you see, I sit here in front of my block of stone. It measures a metre, by half a metre, by half a metre. And with every caress of my chisel against the block I know I am shaping my destiny. Look, see how the beauty trapped within the form of this stone begins to emerge. Sitting here, I am celebrating not only my craft and the skills of my profession, but I am contributing to everything that I value and believe in, a universe – represented by the cathedral – where each gives of his best for the benefit of all. Here at my block I am at peace with who I am, and I am grateful that, although I will never see the completion of this great cathedral, it will still stand a thousand years from now, a beacon celebrating what is truly worthy in all of us, and a testament to the purpose for which the Almighty has put me on this earth.”

The monk went away and reflected on what he had heard. He slept more peacefully that night than he had ever done, and the next day he resigned his commission as Clerk of Works and apprenticed himself to the third stonemason.

Taken from “The Magic of Metaphor” by Nick Owen and credited to Rachel Naomi Remen

Stress Management Could Help Decrease Pain

A recent study by Dr. Pierre Rainville and Étienne Vachon-Presseau from the University of Montreal has shed some light on the relationships between stress, the brain and pain. Their study compared 16 patients with chronic back pain with a control group of 18 healthy subjects. They found that back pain patients had higher levels of cortisol than subjects from the control group. Cortisol is produced by the adrenal glands and is secreted in response to stress. It’s a steroid hormone that increases blood sugar levels, suppresses the immune system, and may decrease bone formation; so an excess, particularly when maintained over a long period, is detrimental to health. The higher cortisol levels were associated with smaller hippocampal volumes. The hippocampus is a part of the brain that is involved in learning, memory and regulation of emotion. People with depression and post-traumatic stress disorder have been found to have hippocampal atrophy. The subjects with chronic back pain had stronger responses to pain stimuli in a brain region involved in anticipatory anxiety in relation to pain. Brain activity in response to the painful stimulus partly reflected the intensity of the patient’s current clinical pain condition.

The findings can be summarised in the following flow chart.

The authors suggest that stress management techniques such as relaxation and meditation should be used to complement medical treatments in patients with pain. They believe this can help to decrease the impact of pain and perhaps even prevent chronicity.

Physiotherapy Is As Good As Surgery For Meniscal Tears

Last week Yahoo! News reported that physiotherapy was as good as knee surgery. The claims were based on results of a recent study by Jeffrey Katz, Professor of Medicine and Orthopedic Surgery at Harvard University. The randomised controlled trial involved symptomatic patients aged 45 years or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. They randomly assigned 351 patients to surgery and postoperative physiotherapy or to a standardized physiotherapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months.

They did not find significant differences between the study groups in functional improvement 6 months after randomisation; however, 30% of the patients who were assigned to physiotherapy alone underwent surgery within 6 months. “Since both the patients who received physical therapy and those who received surgery had similar and considerable improvements in function and pain, our research shows … there is no single ‘best’ treatment. Patients who wish to avoid surgery can be reassured that physical therapy is a reasonable option, although they should recognize that not everyone will improve with physical therapy alone.” Katz said.

Having undergone a successful menisectomy last year I can personally attest that surgery can sometimes achieve results that physiotherapy can’t but conservative management such as physiotherapy should always be the first port of call.

Dwelling On Stressful Events Can Increase Inflammation

A new study by Zoccola and colleagues found that people that were asked to dwell on a stressful event had higher levels of C-reactive protein (CRP). CRP is produced in the liver and its blood levels rise in response to inflammation e.g. infections, injuries, rheumatic or other inflammatory diseases, etc. Patients with high CRP concentrations are more likely to develop stroke, myocardial infarction and severe peripheral vascular disease.

The fact that rumination increases inflammation means that dwelling on negative thoughts has an adverse impact on pain and recovery from soft tissue injuries. Yet another brilliant example of the mind-body connection at work!

“Make the most of the best

and the least of the worst“

Robert Louis Stevenson

Chronic Pain Alters DNA

The team of researchers led by Prof. Laura Stone at McGill University recently found that 6 months after inflicting nerve injuries on mice, the mice still displayed signs of skin hypersensitivity and motor impairment. This was associated with epigenetic changes in the amygdala and prefrontal cortex of the brain. Epigenetics explains how genes can be switched on and off. It’s the study of mechanisms by which the environment controls gene activity. Interestingly, the DNA changes were reversed by placing the mice in a more stimulating environment (three mice per cage, a running wheel mounted on a plastic hut and marbles). Whereas, placing the mice in an impoverished environment (one mouse per cage in the absence of a running wheel, marbles or any other forms of enrichment) didn’t restore normal DNA. DNA changes were found to correlate to hypersensitivity. In other words, placing the mice in a stimulating environment helped decrease their pain.

Long-term Use Of Opioids Lowers Testosterone Levels

A recent study by Rubinstein et al. published in The Clinical Journal of Pain has shown that long-term use of opioid painkillers by men is associated with lower levels of testosterone. This effect is much more prevalent when using long-acting opioids. Low testosterone or hypogonadism, as it’s also known, has been linked with decreases in muscle mass, bone density, cognition, mood, sex drive and general quality of life.

The Perfect Human Diet

Last week I came across a documentary entitled “The Perfect Human Diet”. It was released last year and directed and produced by C J Hunt. Hunt had serious health problems from an early age and experimented extensively with diets. At the age of 46 he decided to travel the world in search of the perfect diet. His findings  support the Paleo diet. Those that are unfamiliar with it will find the documentary fascinating. Here is a summary.

We’re in the midst of an obesity and diet-related chronic disease epidemic. The US alone accounts for 300,000 to 400,000 deaths a year! There’s a lot of confusion related to diet, it’s complicated, the recommendations change and seem to be based more on beliefs than science.

The nutritional pioneer Weston Price studied native diets among tribal populations and found that they had better teeth and better facial bone structure than westerners. More recently, Kerin O’Dea from the University of Southern Australia conducted an experiment with a group of overweight Aboriginals living in cities. She sent them for seven weeks in the outback where they lived a hunter-gather lifestyle with a diet that was 50% to 60% animal based. They all lost weight and improved their health. Jay Wortman has studied Inuit populations and found that today a lot of them suffer from obesity, type II diabetes and metabolic syndrome. Traditionally they lived on low carbohydrate diets and so it’s hypothesised that the disease is linked to the modern high carbohydrate diets.

In 1863 a London undertaker named William Banting popularised a diet recommended to him by the famous physician Dr William Harvey. At the time Banting was 65 years old, overweight, had poor eyesight, poor hearing and joint pains. Two years later he had lost 50 pounds and regained his health. Dr Harvey had recommended that he stop eating bread, butter, sugar, potatoes and  stop drinking milk and beer. Instead he advised meat, fish, poultry, dried fruit, vegetables and wine.

From 1865 to 1965 the standard hospital treatment for obesity was to decrease carbohydrate intake. In the 1950s  the idea that fat causes heart disease, by it’s effect on cholesterol, began to spread. The fats were replaced by carbohydrates. They had suddenly become good! Today the US Diet Guidelines are to decrease portion size, decrease sugar, decrease salt, and decrease saturated fats.

Professor Loren Cordain is a leader in evolutionary diet and author of “The Paleo Diet”. In order to understand the Paleo Diet we need to go back in time…2 million years back in time! About 2 million years ago Homo Erectus appeared on the savannah of Africa. They were anatomically similar to us and evidence of hunting tools suggests that they consumed a lot of meat. This is backed up by recent analysis of Homo Erectus bone fragments. Their diet contained a huge diversity of food which differed from their predecessors’ diet which was mainly plant-based. The increased amounts of omega 3 fatty acids are thought to have been a precursor for brain growth and behavioural sophistication. Then, 230,000 years ago, Neanderthals appeared in Europe and 192,000 years ago modern humans appeared in Africa. They left Africa 75,000 years ago and entered Europe 45,000 years ago. Bone analysis suggests that the diet of Neanderthals and the first modern human was very similar to that of Homo Erectus.

Everything changed 10,000 years ago. Man decided to settle and use agriculture. Diets changed. Dairy and grains, like wheat, were included and the variety of food decreased. The period before 10,000 years ago is known as the Paleolithic era and the period after is known as the Neolithic era. In the 18th and 19th centuries the industrial revolution led to the refinement of sugars, grains and other foods. More recently processed foods have flooded the market and can constitute up to 70% of modern human diets.

The Paleo Diet theory is based on the fact that the Paleolithic era is much, much longer than the Neolithic era and it’s during the Paleolithic that modern humans evolved. Therefore, we have evolved to eat the diets of our Paleolithic ancestors which is why we struggle and have become unhealthy on modern diets. Voila!

Interesting though the documentary was, it didn’t give a full list of foods to eat and avoid, so I had a look on Wikipedia. The Paleo diets advocates: fish, meat (grass-fed), vegetables, fruit, fungi, roots and nuts. It suggests to avoid: grains, legumes, dairy, potatoes, refined salt, refined sugar and processed oils (Wikipedia).

Although the arguments in favour of the Paleo diet are compelling, I’m not entirely convinced. If obesity and ill-health are the result of the change in diet 10,000 years ago, how come obesity has only become more prevalent in the last 150 years (see “The Obesity Paradox“)? Are grains and dairy really that bad for us? In my opinion there are 2 influential factors that have driven the obesity and diet-related illness epidemic. Our physical activity has gradually decreased since the industrial revolution. Mechanisation and lately the widespread use of computers has meant that most of us spend our working days sitting and a lot of us spend our leisure time sitting as well. During the same period our diets have changed drastically and now include a lot more refined and processed foods. These convenience foods as they are also known are high in sugars, salts and saturated fats.

I agree that variety is key to a balanced diet and the Paleo diet does put forth a solid case for eating meat…or against vegetarianism and veganism. That said, we should bear in mind that the meat our Paleolithic ancestors ate is very different to the meat we eat today. Theirs came from wild, lean animals whereas today’s commercial meat comes from sedentary fattened stock!

The search for the perfect human diet continues…

Best Wishes For 2013!

May the New Year bring you health, wealth and happiness!

The Caged Bird

The bird in the cage had lived there for a very long time. Often it would look through the bars of the cage, out of the window to the meadows and trees beyond. It could see other birds flying free in the open air and often it would wonder how it would be to feel the sun on its back, the wind in its feathers, to swoop and soar and catch mosquitoes in flight.

When the bird thought of these things it could feel its heart beating with excitement. It would sit tall on its perch and breath deep into its belly, sensing the thrill of possibility.

Sometimes another bird would land on the window sill, resting from its travels, and look inside at the caged bird. The traveller would put its head on one side as if quizzically asking itself how such a thing could be. A bird in a cage. Unimaginable.

And it was at these times that the caged bird felt most miserable. Its little shoulders slumped, it felt a lump in its throat and a heaviness in its heart.

One day, the owner of the caged bird accidentally left the door of the cage open. The bird looked through the door. It saw the birds swooping and soaring outside, the sun on their backs and the wind in their feathers, and it felt a stirring inside. The caged bird noticed that the window was open, and its heart beat even faster.

It considered its options.

It was still considering them at sunset when the owner returned and closed the door of the cage.

Taken from “The Magic of Metaphor” by Nick Owen and credited to David Werner and Bill Bower