Tag: chronic illness

Move More: How I Actually Started Exercising with a Chronic Condition

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Move More: How I Actually Started Exercising with a Chronic Condition

Does just seeing another article about exercise make you want to turn the page? It often makes me want to. When I got diagnosed with my chronic condition all the information about exercise seemed so out of touch with the reality of my life. If I’m already tired, sore and busy then I’m not going to be able to go to the gym. I can’t afford a personal trainer. With my back pain there is no way I can participate in the group yoga classes I used to take in university. Even more frustrating was the fact that all the research I came across proved how beneficial exercise is to health. I knew that I should exercise but I felt like I couldn’t.

 

But what if I could?

One day I came across an(other) article reporting on research that showed yoga could improve fibromyalgia, my chronic condition (OHSU, 2010). The results were impressive – pain was reduced by 24%, fatigued by 30% and depression by 42%. Great, I thought, another thing I can’t do that would help. But in this case I also found that two of the researchers were part of a nonprofit organization that produces exercise DVDs for fibromyalgia, including one on yoga and Pilates (link below). I ordered the DVD and skeptically waited for it to be delivered. I was surprised and excited to find that I was able to do the routine – which was shown at three different intensity levels so I could modify the poses as needed. I found that the at-home instructional DVD format was affordable, convenient and accessible – I could do it when I was able, for as long as I could and without wasting energy traveling somewhere and back.

Woman stretching arms behind back

Photo by Steven Depolo

During my health coach training I learned that yoga, tai chi, qi gong, and stretching are all range-of-motion or flexibility exercises. These types of exercise can also build strength and promote balance, but primarily focus on lengthening tight muscles and moving joints through the full span of movement they are intended to achieve. “Limited flexibility can cause pain, lead to injury, and make muscles work harder and tire more quickly (p. 92, Lorig et al., 2013).

My positive experience with the yoga/pilates DVD encouraged me to find other programs with a similar format. One of my favorites is the Tai Chi for Health series by Dr. Paul Lam (link here), especially the Tai chi for Arthritis program that was designed in conjunction with the Arthritis Foundation. This instructional video that takes you step-by-step through 12 lessons until you have the movement sequence memorized.  I enjoyed learning an entirely new way of moving and began to feel more confident that I could include exercise in my weekly routine.

I also started seeing a physiotherapist who put together a thorough stretching routine for me to do daily. Without doubt, this is the single most effective thing I tried to improve my health and well-being. My pain has decreased and my daily functioning has improved, along with my quality of life.

Many flexibility/range-of-motion exercises programs also share a second common feature as mind-body movement practices. For example, “Yoga is a set of theories and practices with origins in ancient India. Literally, the word yoga comes from a Sanskrit work meaning “to yoke” or “to unite”. It focuses on unifying the mind, body, and spirit, and fostering a greater feeling connection between the individual and his/her surroundings” (Moonaz, 2015). Greater body awareness, stress reduction, emotional balance, and improved energy are all benefits of mind-body exercise programs (Moonaz, 2015).

Flexibility/range of motion exercise programs are a great starting point for anyone who has not exercised for awhile, or who has a health condition that makes movement challenging. They are easy to do at home or you can find many classes offered in your community. Gradually incorporating these routines 2-3 x/week and practicing daily stretching is how I was able to actually begin to  move more. Below is a quick primer on what these kinds of activities are so you can pick the right one for you and a link to programs that I have tried:

Yoga: “Yoga involves directing your attention and breath as you assume a series of poses, or stretches” (Gaiamlife, n.d.).

Qi Gong and Tai chi: “The term qi gong (or chi kung) describes the complete tradition of spiritual, martial and health exercises developed in China. Tai chi is one of the most common of these. Practicing qi gong involves performing a series of movements while paying attention to the body and staying aware of the breath. The exercises are especially effective for developing balance, focus, coordination and graceful, centered movement” (Gaiamlife, n.d.).

Stretching: Poses to lengthen muscles and increase range of motion in joints

 

References:

OHSU. (2010). OHSU Research Suggests Yoga can Counteract Fibromyalgia. http://www.ohsu.edu/xd/about/news_events/news/2010/2010-10-14-ohsu-research-sugge.cfm

Moonaz, S. et al. (2015). Yoga for Arthritis. Johns Hopkins Arthritis Center. http://www.hopkinsarthritis.org/patient-corner/disease-management/yoga-for-arthritis/

Gaiam Life. (n.d.) How to Choose a Mind Body Exercise. http://life.gaiam.com/article/how-choose-mind-body-exercise

 

 

 

It’s 3am, I’m wide awake, and feeling guilty about it

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This morning, I woke up tired. I know, big surprise for someone living with a chronic condition. Whether it’s painsomnia, stress induced insomnia or regular old insomnia, it’s all too common.

I take a prescription sleep aid every night. I’ve stayed away from more effective but more addictive sleeping pills and currently take a low dose tricyclic. I also take several supplements. I have found that melatonin, 5-HTP and l-theanine are an effective combo. However I still get those nights where I wake up every couple of hours or can’t get back to sleep. Sometimes I give up in frustration and take an over-the-counter sleep aid as well. Other nights, like last night, I feel guilty about taking anything extra and just try to get back to sleep.
Now I’m exhausted. Or maybe I should say extra exhausted, since I feel fatigued most of the time. I’m wondering, what is that guilt about?

I always feel like I should take the least amount of anything that I need. I worry about what everything I already do take is doing to my body. I feel like I need to justify all of my prescriptions. I wonder if I failed somehow because meditating and yoga don’t make me sleep.

But, I have a bonafide diagnosis for a debilitating condition. According to my sleep study I come out of deep sleep into light sleep 14 times an hour. If I need to take extra supplements in the middle of the night then so be it, right?

I think this comes down to a sort of internalised stigma about being sick. The assumption that you must have done something wrong to get sick in the first place. Or if you do the right thing you’ll get better. Or maybe it’s the assumption that if you try harder, or get tougher, you’ll get over it. Acceptance of my condition has come in stages. Recognizing my own internalized ableism is another stage. I think it’s good that I want to take the least amount of medication possible, and try to see where supplements can work instead of prescriptions. But that attitude is only ‘good’ to the extent it helps me manage my condition, not when it becomes a means of self-criticism for being sick. I already have enough fatigue without adding extra sleepless nights because I wouldn’t let myself accept that I need help to sleep.

Digestively Challenged: Overcoming G.I. Tract Problems when you have a Chronic Illness

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Digestively Challenged: Overcoming G.I. Tract Problems when you have a Chronic IllnessIs eating well with chronic illness a luxury? When I first got diagnosed, I thought so. The significant pain I was experiencing in the muscles around my shoulder blades made it impossible for me to chop, stir, or sauté a whole meal – basically, to cook. My partner was more than happy to help (as long as I showed him how!), but it felt unfair. After all, he was now supporting me financially and doing the majority of the housework – since laundry, vacuuming, scrubbing and dusting were similarly impossible for me. We tried to eat the healthiest convenient foods we could. Unfortunately, convenience isn’t healthy, at least when it comes to eating. In a previous post, I wrote about how my processed diet failed me, even though I was making supposedly healthy choices. In one year, I gained about 20 pounds, ate four times the daily recommended allowance for sugar, was woefully short on fruits and vegetables, ate too many servings of grain and too few servings of protein.

I also had hypoglycemic attacks if I did not eat on time. I remember that panicky feeling of being on transit, far away from a convenience store, and starting to feel shaky and sweaty.  I also developed a number of food intolerances.  I felt anxious about eating out or trying a new recipe for fear of having an ‘episode’.  Not only did I have unpleasant digestive symptoms but also strange neurological ones – sweating, pulse racing, excessive salivation, skin crawling, restless legs, and others.  It was these two problems that made me feel like I needed to understand what was going on in my body and to regain control over my eating. It’s important to begin with a good understanding of digestive problems that affect spoonies (people living with chronic illness).

Firstly, we need to avoid food intolerances (also known as food sensitivities). Food intolerances are defined as a physical reaction to eating certain foods, such as digestive symptoms like bloating, gas, diarrhea or constipation, or stomach cramps.[i] These reactions do not occur because of an immune response to a particular food – that would be defined as a food allergy. In the case of a food intolerance, some people may be able to eat a small amount of the trigger food without having a physical reaction, up until they reach a threshold level. Food intolerances may occur because of the absence of a necessary enzyme (such as lactase to break down lactose sugar in dairy), having irritable bowel syndrome, having a sensitivity to food additives, having a problem digesting certain carbohydrates (acronym FODMAPS), or for no known reason. Food sensitivities may be more common among people living with fibromyalgia and CFS/ME because of the overall sensitization of the central nervous system associated with these conditions. Research indicates that at least half of people with FM or CFS/ME experience significant relief by eliminating certain foods.

How can you figure out what foods you are sensitive to? Naturopathic doctors, integrative doctors and nutritionists can offer tests that pinpoint sensitivities. However, the least expensive way is to do an elimnation diet. You begin by cutting out the most common foods that cause intolerances and any foods that you are suspicious of for a period of time, usually 2 to 4 weeks. These foods may include: dairy, gluten, eggs, soy, corn, sugar, citrus, peanuts, shellfish, and coffee. Then you gradually reintroduce one food type at a time to notice your physical reaction. If your symptoms reappear, then you know you are sensitive to that type of food. In my case, I am intolerant of eggs, red meat, and to a lesser extent, wheat. I am also sensitive to high concentrations of fiber or resistant starch. The elimination diet is best done with the guidance of your healthcare professional.

A second problem associated with the digestive system and chronic illness is the development of Leaky Gut Syndrome. Essentially, leaky gut occurs when the lining of the intestines becomes more permeable, which allows particles of partially digested food or waste to leak into the bloodstream.[ii] Increased permeability occurs because of damage to the tight junctions between intestinal cells. When the immune system encounters foreign particles in the bloodstream, it launches a response, including inflammation. Symptoms of leaky gut syndrome include digestive symptoms, gas, bloating, diarrhea, fatigue, joint pain and rashes. In addition to chronic inflammation, leaky gut syndrome affects the ability to digest food and to absorb nutrients. Furthermore, it compromises the immune system by tying it up responding to foreign particles in the blood, which leaves it less able to respond to actual pathogens. The intestinal lining actually is a significant site of immune activity, but when it is damaged, overall immune function is impaired. How does the intestinal lining become damaged? Through food intolerance, stress, medication, flora imbalance and autoimmune disease. Emerging research shows that several autoimmune diseases share increased intestinal permeability as a characteristic[iii].

In terms of diet, the usual recommendations include treating Leaky Gut Syndrome through clean eating; in other words, avoiding commonly allergenic/intolerant foods, inflammatory foods, pesticides, herbicides, additives, or sugar and rebalancing intestinal flora by consuming probiotics. For autoimmune diseases in particular, some experts recommend the paleo diet, which emphasizes protein and vegetables, while cutting out grains and legumes. For example, Dr. Terry Wahls has written a book on how she reversed her MS through a nutrient dense paleo diet. Supplements that can help to repair the damaged intestinal lining and reduce inflammation include l-glutamine and DGL.

When it comes to diet recommendations, I think the most important thing to remember is that we are all genetically diverse. We will all have unique responses to different foods and there is no one-size-fits-all diet. For example, I feel terrible after eating eggs or after eating a large portion of cruciferous veggies (broccoli, cauliflower, etc) because I have a food intolerance to eggs and  am sensitive to large portions of insoluble fiber. The paleo diet isn’t for me. However, a high-protein vegetarian diet keeps my digestion happy, hypoglycemia at bay, and generally gives me more energy. The only universal truth when it comes to nutrition is that nobody benefits from eating a diet high in processed foods, sugar, sodium or fat. We all feel better on a whole foods diet. It can seem overwhelming to change your diet when you are dealing with the multiple, uncertain symptoms of chronic illness. The potential to improve your quality of life is worth the effort in experimenting to find what works. Here are a few resources to help you get started:

  • 100 Days of Real Food is a resource for transitioning to a diet free from processed foods (includes blog, meal plans, challenge, cookbook) http://www.100daysofrealfood.com/

Read other great blog posts by writers with FMS on the Fibro Blogger Directory http://www.fibrobloggerdirectory.com/

[i] http://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538

[ii] https://www.womentowomen.com/digestive-health/healing-leaky-gut-syndrome-open-the-door-to-good-health-2/

[iii] http://www.todaysdietitian.com/newarchives/021313p38.shtml

Convenience Isn’t Healthy: Chronic Illness and Diet

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When I was diagnosed with fibromyalgia three years ago, my diet was all about convenience. I came to the conclusion that eating healthily was just a luxury that I could no longer have. I tried to generally to choose healthier convenience food options. For example, a whole-grain cereal instead of refined grain, or a low-fat frozen lasagna instead of full-fat. A typical day looked like this:

Breakfast: Multigrain Cheerios with a banana (251 Calories)

Snack: Yogurt (115 Calories)

Lunch: sandwich with deli meat, granola bar, carrot sticks (348 Calories)

Snack: Trail mix (352 Calories)

Dinner: Spaghetti (store bought pasta sauce) (344 Calories)

Snack: Slice of Toast (69)

Total: 1538 Calories (Calculated at Super Tracker www.supertracker.usda.gov)

So, calorie-wise not so bad. However, as any nutritionist can tell you, calories are only a small part of the nutrition story. If I ate 1500 calories in chocolate, it would only be delicious, not healthful.

What was wrong with my diet?

  • Grain heavy: I had a total of 240 g of grains, which is over the USDA recommendation of 170g or 6 oz for a woman my age. While grains provide benefits like fiber, eating too much of this food group can lead to weight gain.
  • Protein policy: in total, 16% of my food intake was protein. While this is within the acceptable range set by the USDA, dieticians recommend your protein daily allowance should be calculated using this formula: 0.8 x weight in kg (easily converted using any online converter). For me, this comes to 52 g per day. Protein should be distributed between all meals to help sustain energy. In my case, breakfast and dinner were primarily carb based. http://www.livestrong.com/article/343966-how-to-calculate-protein-rda/
  • Sugar high: in total, I had over 90 g of sugar! The World Health Organization recommends that less than 10% of your daily energy consumption should come from sugar, with added health benefits coming from less than 5%, or approximately 25 g. My sugar total was almost 4 times that much! This is bad news for my blood sugar levels and weight management, never mind long-term health consequences. http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/
  • Nutrition deficient: I had less than four servings of fruits and vegetables (banana, carrots, raisins, tomato sauce). This means I was getting an inadequate amount of micronutrients (vitamins and minerals), and losing out on the many other benefits of these healthy foods such as antioxidants and fiber. Furthermore, the servings I did have were primarily starchy vegetables or high glycemic fruits, which only added to my blood sugar concerns and weight gain.

Overall, I gained 20 pounds in a year and went up a dress size. I was also permanently fatigued. For anyone coping with chronic illness, sustained energy is a significant challenge. Balancing macronutrients – carbs, protein and fat – along with factors such as fiber and sugar, is important for preventing spikes in blood sugar that inevitably lead to energy crashes. According to the Mayo Clinic, based on a 2000 calorie/day diet, the total daily allowances should be:

 

Nutrient Percentage Grams
Carbohydrates (vegetables, fruits, grains) 45-65% 225-325
Fiber   Female: 22-28; Male 28-34
Sugar   Female: 24g; Male: 36
Protein 10-35% 50-175
Fat 20-35% 44-78
Saturated Fat 7-10% 16-22

http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/how-to-eat-healthy/art-20046590?pg=1

Maximizing micronutrients (vitamins and minerals) is also key healthy eating. Adequate intake of nutrients like Iron and B vitamins have been linked to improved energy levels, while others like Vitamin D and Magnesium help reduce chronic pain. In addition, chronic illnesses like fibromyalgia have been linked to high rates of oxidation, so eating antioxidants is important to counteract these effects.

The USDA recommends at least 2 ½ cups of vegetables per day for women and 3 cups for men, and 1 ½ cups of fruit per day for women and 2 cups for men. The USDA recommendations have been critiqued, which is another post altogether, but provide guidelines that are much healthier than the Standard American Diet www.choosemyplate.gov.