Mental Health

The Mechanics of Stress Response

July 21, 2016 By Dr. Chris Hardy 3 Comments

Chris Hardy Navy Diving School

This is the first in a series of articles developed from Dr. Chris Hardy’s live presentation at Dragon Door’s Inaugural Health and Strength Conference.

I was 23 years old and had graduated from one of the toughest schools in the military. It was designed to mentally and physically beat you down. After 5-6 months, I came out thinking I was super human—of course at 23 we think that anyway. We were crushed with physical training twice a day with academics in between. But, when I graduated, I really didn’t know anything about training others. I thought training and getting better was all about getting beat down as hard as possible. But, I didn’t know that I would soon be facing a different challenge.

When I arrived at my new unit as the new guy, and they put me in charge of their training. They were all seasoned deep sea divers—a very physically demanding job, probably one of the hardest on the planet. Training military divers is like training athletes. They’re a very resilient, self-selected group. My dive school class started with 35, and 13 graduated. So the people who graduate are pretty hard to break. They put me in charge of their training, and over the next two years I developed my own routine of mashing them as hard as I could, because that’s what they wanted.

Overweight General Population Client During that same time, I got interested in medicine. I didn’t always want to be a doctor, but at 25, I decided I needed a change of pace. I went to college and thought that since I was already a trainer, I would train people while I went to college.

I was used to dealing with military deep sea divers, and all I was working with people who have diseases and were out of shape. I didn’t know how to deal with any of these conditions and it blew my mind. I decided to learn more and started getting certifications. Over the next 20 years, I tried to hone my training craft and I even became a doctor along the way!

I wanted to know how to get results for these people without breaking them in the process. I couldn’t train them like Navy divers, because they wouldn’t come back and I would certainly break them. In 22 years as a trainer, and 12 years as a physician I don’t have all the answers, but I have developed a framework.

Your clients want results from you, but what’s your responsibility to them? Safety, or as in medical terminology, “do no harm”. We want them to achieve their goals, but we want them to do it safely. Sometimes you have to save your clients from themselves, because they think they know what they want but you really need to educate them. We also have a popular culture that creates more challenges for us in the perception of what exercise and weight loss should be like.

Quote Primum Non Nocere TV shows like The Biggest Loser and other transformation programs are what our clients are seeing. They’re getting the message that every workout needs to be a beat-down, and if you’ve watched that show or others like it, there’s a calorically restricted diet. And that’s what our clients think will get them results. How many of you have new clients come to you expecting that kind of workout—and who aren’t happy when they don’t get it? Or maybe you aren’t getting clients because they are too scared to even come to your gym.

We have a huge opportunity. As a good coach, we need to educate our clients on why the beat down workouts are not a good approach.

What is Coaching?

Coaching is an art with a scientific foundation. If you’re a professional, you have the art down, so now we will look at our foundation to answer some key questions:

How can I optimally dose the training on any given day for my client?
How can I prevent overdosing but still training the client hard enough so that they achieve their goals?

We aren’t letting our clients off the hook, this is the holy grail of training.

When I look at any problem, I want to go back to underlying foundations—that’s how I wrote Strong Medicine, and it’s how I approach medicine. I look at the foundations of the problem in the first place—it’s what I call first principles. Next, we can build a conceptual framework to answer the questions from the bottom up.

Before we could build a space shuttle, we first had to figure out how to make fire. In building up our conceptual framework, let’s begin by defining exercise. Exercise is a form of stress. What is stress? , Hans Selye defined stress as an engineering term as the amount of force per unit area. Now we say, “I’m under a lot of stress” or, “I am stressed out”.

Stress Examples

Anything that triggers the stress response is a stressor—including exercise. Getting attacked by a bear, traffic, or doing dumbbell presses are all sources of stress. External stress examples include food, water, activity, your work environment, traffic. Internal stress can come from diseases—it all activates in the brain.

Is Stress Good or Bad?

Both, it depends. Short term stress is necessary for survival and if you want to make any gains in the gym. Marty Gallagher will tell you that, you can’t have sub-optimal stress if you want to make gains in the gym. But the chronic stress in an over-trained endurance runner or someone who is just completely burned out at their job is not good.

These chronic stresses actually lead to physical changes in the brain and nervous system, and over-activates our stress response. You could argue that the modern environment has toxic levels of stress and that our physiology is at odds with our modern environment. We are probably not wired to handle what we’re dealing with on a daily basis. We can easily recover from short term acute stress, and most of the time we’re not under it. But, many people are now under constant chronic stress, including your clients. And, you can’t train your clients as if they live in a vacuum.

Brain The brain is command central for the stress response. It receives, evaluates, and responds to stress in our environment from all sources. It is very important to understand that stress is everything the brain perceives as stress—whether or not the issue is a threat to life or limb. If your brain perceives something as stress, then you will trigger the stress response.

It is especially true in modern society. If your boss is a real jerk and you’re under stress at work, that same fight or flight response will be active as if you were running from a bear—maybe not to the same degree, but it will still be active.

We have fast and slow pathways. Simply put, the hypothalamus is a very small part of the brain but it’s actually central to the stress response. When the brain perceives something threatening—if someone scares you—then you get that fluttering heart, “all-jacked-up” feeling. That’s the fast pathway, and it’s direct to the adrenal glands. It dumps adrenaline, epinephrine, and norepinephrine. Afterwards, about twenty minutes later, the slow pathway through the pituitary gland and down to the adrenals is active. It’s a hormonal system that secretes cortisol which helps you recover from the stress. For the purposes of this post, that’s all you need to know about neuro-anatomy.

Those of you who have also trained in Chinese Medicine or follow Taoist philosophy know that the Yin/Yang concept works very well to describe the autonomic nervous system. (Autonomic just means that I don’t have to think about it for it to happen—I don’t have to think to raise my heart rate or to breathe at night.) The autonomic nervous system has two branches, sympathetic (fight or flight), and parasympathetic (rest and recovery). The “fight or flight” system is actually the most inflammatory response in the body. The parasympathetic system is the opposite. Typically, the parasympathetic system should be dominant most of the time, and the sympathetic should only be active when we need to use it for a “flight or fight” response or during exercise. The sympathetic system is used in response to stress—but it should be used minimally.

Autonomic Nervous System Diagram

The parasympathetic system is dominant for the recovery to all of the exercise you’re doing (and that your clients are doing). It’s also when that anabolic response to exercise occurs. But, if the sympathetic system is on all the time—as it is for many of our clients and ourselves—in the long term it will lead to muscle-wasting and chronic diseases.

How the Brain Controls Stress Response

Three main parts of the brain control the stress response to perceived threats. The prefrontal cortex (we also use it to maintain attention) right behind the forehead determines if something is truly a threat using higher reasoning. Our memory center, the hippocampus also helps us determine if something is threatening or not. The prefrontal cortex and hippocampus can override the threat response together if they have determined something has been seen or experienced before and is probably not threatening. The amygdala is the brain structure which drives the threat response, it responds to learned fear and the emotional reaction of stress. If I got an electric shock every time someone rang a bell or hit a gong, then pretty soon every time I would hear a sound like that, I would have a severe stress response. That’s what the amygdala does.

Normally, the hippocampus and prefrontal cortex inhibit the stress response, and the amygdala will activate it. It’s a three prong connection, and the brain will perform normally if the parasympathetic system is dominant most of the time. For example, if you see long cylindrical object across your path while walking in the woods, the prefrontal cortex will pay attention to it, the hippocampus will respond that it recognizes that it’s probably a stick, and will generally keep the brain from triggering the stress response.

Brain Diagram Stress Structures But over time, a brain will change in response to chronic stress. The word neuroplasticity means that the brain can functionally and structurally change. We used to think that psychological stress was “all in your head”, but in fact the brain can change its structure and how it functions—and you can actually be lose neurons. A person who is stressed out or depressed over a long term will have a physically different brain—the hippocampus will shrink under chronic stress.

Epigenetics is how the genes in our DNA are expressed. In Strong Medicine, I used this example: genes are a recipe that says I need four eggs to make a cake. So, if I do a mutation and use five eggs, then that’s a mutation to the genes. Epigenetics doesn’t change the genes, it just tells me how many “cakes” (if any) will be made from the recipe. When someone is under constant stress, everything is involved including hormone pathways. Everything involved with the stress response will be amped up and producing more products for the stress response.

So, someone under chronic stress will respond differently to exercise. If their stress response is overactive, it won’t take much to activate it, and they will have a harder time recovering from exercise because the sympathetic nervous system will be more dominant. If they are already in such a fight or flight state, it will take longer for the parasympathetic nervous system to allow for recovery. Normally the brain would use these mechanisms for survival, not a chronic perceived stress.

Stress Examples 2

Going back to our example with the stick across a path in the woods, if the brain is under chronic stress it will become more animal-like. The structure has changed and when someone with a chronically stressed brain sees something lying across the path, and the hippocampus memory has shrunk, you might jump straight to the conclusion that the object is a snake and trigger the stress response. The chronically stressed brain responds and reacts as opposed to focusing, maintaining attention, and drawing on previous memories.

How does all of this relate to fitness and training? As trainers—and I’ve done this myself—we often focus only on physical stresses. But, we aren’t training in a vacuum, so we must consider our environments. Our clients are faced with many sources of stress outside exercise stress, and we want to train them effectively. Allostasis is a broad concept that basically means “achieving stability through change”. While homeostasis means that a specific equilibrium is maintained, allostasis changes the point we come back to maintain that equilibrium. The stress response is part of this process. If you are trying to achieve stability with the environment, then we are also trying to achieve stability with anything perceived as threatening, challenging, or dangerous, right?

Allostasis is the mechanism responsible for adaptation to any challenge, exercise, or social, psychological activity. We need some psychological stress to become resilient, but too much of it and we can become depressed and anxious. Nutrition is similar, we need to be adequately nourished but not overly so, since the body will adapt to over-nutrition, and we see that all the time. The same is also true for sleep—too little sleep and the body adapts with a stress response, and new science is showing that too much sleep is also bad.

As far as the brain is concerned, recovering from a training challenge with endorphins, and growth hormone building bigger muscles and more mitochondria is allostasis—the brain will think that you need to get stronger to survive that type of challenge/stress again. Allostasis brings you to a new set point as opposed to homeostasis taking you back to the same equilibrium. This is a relatively new concept. Total stress is also called the allostatic load—allostasis is the change, and allostatic load is everything that the brain perceives from the environment as stress.

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The next post in this series will outline a visual representation of the Stress Cup and how to use it to optimize your training and client training programs.

Chris Hardy, D.O., M.P.H., CSCS, is the author of Strong Medicine: How to Conquer Chronic Disease and Achieve Your Full Genetic Potential. He is a public-health physician, personal trainer, mountain biker, rock climber and guitarist. His passion is communicating science-based lifestyle information and recommendations in an easy-to-understand manner to empower the public in the fight against preventable chronic disease.

Journey to the Center of the Physiological Universe

December 2, 2015 By Marty Gallagher 3 Comments

Journey to the Center of the Physiological Universe

“We here in the Western world are top-heavy. ‘Shoulders back! Chest out! Stomach in!’ Thus the center of gravity becomes elevated. In zazen, Zen training, the tanden (or hara) is the source and foundation of deep meditation. When moving, the tanden is the source of bodily strength. Abdominal breathing generates strength: we live from this centremost point of gravity. This is Zen breathing. Sekai tanden means spiritual field. The tanden is located below the navel. Here, in the Western world, we don’t think in terms of having a singular point of gravity, a vital center; in Zen this vital center is our wellspring source.”

Tanden: Source of Spiritual Strength, Kongo Langlois, Roshi

Since 1970 I have been pondering this odd oriental concept of “the body’s singular point of gravity.” Why was this concept so important in meditation and certain martial arts? This exact center of balance even has a name; it is called the hara, or tanden in Japan, in Chinese medicine and Taoist martial arts the exact same thing is called the dantian. Conceptually, the idea was to initiate the breath from that epicenter of balance. This center of gravity exists within every human body at all times. Whether we are aware of (or attuned to) this bodily gyroscope is another matter entirely.

I got some high level schooling from an elite martial master very early on. I was first trained in dantian breathing when as a 20 year old, I began five years of study under America’s foremost expert on the Chinese “internal” martial arts, Robert Smith. Bob was, at the time, 50ish, a famed author, a hardcore judo man, a former CIA station chief, a sophisticated yet earthy man fluent in several Chinese dialects, brilliant, funny as hell, ingratiating and never off-putting. He was an amazing dude that just happened to live in my neighborhood.

I trained with him twice a week for many years. After each session I took home what he taught me to work on in lone solo sessions. On Thursday night and Saturday morning he taught me the three interrelated internal martial arts of Pa kua, Hsing I and Tai Chi. Bob Smith was singlehandedly bringing attention and western scholarship to these obscure fighting styles.

During our training sessions he would talk endlessly and incessantly about the concepts of “rooting” and “sinking,” and “breathing deep and low from the dantian.” He preferred the Taoist phrase and would place his hands on his own lower ab area and make it throb to demonstrate that his “chi” breathing originated at his “exact center of balance.”

Even during the execution of lightning fast, highly exertive Hsing I katas, he expected the athletes to attain, maintain and retain deep abdominal breathing; nose breathing went out the window with the fast and intense stuff as we couldn’t pull in enough oxygen (using nose-breathing) to forestall oxygen debt and the resultant lactic acid build-up. Though we had to breathe through our mouths, we were still expected to use diaphragm breathing, though no one called it that back then. Linking the concentrated breathing with form and movement was far easier to successfully attain when engaging in slow-motion tai chi.

While I preferred the dynamic and circular Pa Kua and the slashing and linear Hsing I, I found it far easier to get “into the zone” and successfully sync deep and concentrated breathing with precision glide-path tai chi. I would practice alone in my basement and would repeat the first third of the 36-posture sequence endlessly; I would really get lost in the whole thing and eventually I “got it.” I knew I had gotten it when one day (a year in) he looked at me and did a double-take. He laughed, “Hey, you got it!”

Tai Chi Chart

Smith was a famed writer, a great writer in fact and a huge influence on my emerging writing style. He was a fabulous alpha male role model: smart, a genuine bad ass, simultaneously erudite and streetwise, he was formidable but approachable. He put me in mind of a soldier of fortune character out of a John LeCarre novel set in Hong Kong. He was getting a kick out of teaching earnest locals right in his own backyard and he had the writer’s ability to communicate verbal concepts with crystal clarity. Vladimir Nabokov once marveled, “To me, spontaneous eloquence is miraculous.” When Bob Smith instructed you, it seemed miraculous.

I learned all about rooting my feet, sinking and relaxing. I learned to breath in such a way as to expand my “orb of chi.” Regardless if we were “walking the circle” in Pa Kua, throwing the “five fists” in Hsing I or floating across the landscape using his sublime tai chi style, we were always expected to be breathing from the “expanding and contracting” dantian.

Before each training session, as a group we would stand at relaxed attention, performing “quiet standing” with our heels together, sinking down into the soles of the feet. We focused on the mechanics of breath. He would speak to us as we stood in mute, relaxed, erect, alert attention…

“When Cheng Man-Cheng accepted Ben Lo as a student he made the youngster do quiet standing—and nothing else—for one hour each day seven days a week for one year. Why? This is a rhetorical question so please allow me to answer: the Master was teaching the neophyte about root and about how to truly relax and really sink and how to access dantian breathing. At the end of the year Cheng taught Ben the actual forms and Lo mastered all of them effortlessly and quickly. When asked how this was possible Cheng said, ‘Because all the hard and important work was done that first year.’”

Smith was an expert explainer of the concepts that prefigured technique…

“Imagine a steel rod running through your body at hip level. One end of the rod starts at the absolute center of your right hip joint. A thin chrome rod runs through your abdomen and ends in the exact center of your left hip-joint. Now imagine that at the absolute epicenter of this thin steel rod that runs right through the middle of your body, that there is a round chrome orb, a ball the size of a golf ball. As you inhale this orb swells to the size of a tennis ball. As you slowly exhale, the tennis ball-sized orb shrinks back down to the size of a golf ball. This is your dantian powering the breath process.”

I loved that image. It enabled me to conceptualize was being asked of me: I could attain low breathing via the dantian because I now understood it and could mimic the image using his imaging. Smith would pace between our rows, talking to us as he inspected our quiet standing posture. He would stop to make minute adjustments to our shoulder or arm position. I remember him always adjusting my elbows. His voice sounded like Charleston Heston playing God…

“Expand the waistline outward in a level and even fashion…push the bottom of the belly downward…actually you create a vacuum effect, similar to the downstroke of a piston drawing fuel into the cylinder of an internal combustion engine…pull the breath into the body with mouth closed…pull air in through the nostrils. Listen to the sound, the noise the air makes around the nostrils. This requires close attention.”

You could hear a pin drop as he talked us into breathing just right. Unbeknownst to us, he was also maneuvering us into a placid headspace.

“Contemplate the breath with the care and attention it deserves…observe it with complete focus on both inhalation and exhalation. No need for thinking or thoughts…breath deep and low from the dantian…relax…sink…stay focused please. No passengers, everyone is a participant.”

He was the personification of Nabokov’s spontaneous eloquence; he said things that I have never heard said before or since…

“Pay particularly close attention to the breath at the ‘turnarounds,’ the little dead space that appears in short gap at the end of each breath, that transitory instant when inhalation becomes exhalation and again when exhalation becomes inhalation. Stray thoughts love to slip into these crevices and attach and germinate and take root inside these tiny gaps of inattention…every breath has four parts: inhalation, turnaround, exhalation, turnaround; draw the breath from down deep, using an expanding and contracting dantian to power everything.”

He could tell when a person had lost focus just by looking at their posture.

“If you engage in internal conversation, you ruin the quiet standing effort. If a stray thought arises, note it and let it pass by. Just because a thought drops by doesn’t mean you have to invite it in for a cup of coffee.”

When he was satisfied that we as a group had the requisite focus, he would set us in motion; guiding us through the circles and “palm changes” of Pa Kua, the straight-line power slams of Hsing I or his unique and stylized brand of tai chi, with its combination of grace, power, flow and relaxation. He had specific techniques for each posture and every transition. He was a superstar in that world.

Diaphragm breathing is a relatively popular topic (deservedly) in the world of high-level fitness. This strategy has deep roots in meditation and martial arts. In formal Taoist, Zen or Hindu meditation, deep breathing, low breathing, is always a foundational technique and a core principle. Breath and mind always seem to walk hand in hand. Where there is meditative breathing invariably and quite naturally (and not coincidentally) “mindfulness” invariably appears.

There is tremendous interest in the subject of mindfulness. Almost without exception, mindfulness books, articles, strategies and tactics emphasis some type of focused attention on the mechanics of breathing. To be able to concentrate fully and completely on breath for an extended period is the surest way to attain true mindfulness. But there are pitfalls: as someone noted, “Mindfulness has become the new folk religion of the secular elite.” It seems everyone everywhere has leapt on the mindfulness bandwagon.

For those of us that have been on the mindfulness bandwagon for decades, our initial amusement at its newfound popularity has been replaced with successive emotional phases of puzzlement, befuddlement and repulsion. The repulsion comes from the ultimate awareness that money and financial gain have successfully corrupted and diluted the effectiveness of true mindfulness. Mindfulness-lite is watered down, user-friendly, anemic and ineffectual. But the ease of the method and the wildly exaggerated promised results makes faux mindfulness eternally popular.

We were mindful before mindful was hip. We achieved our mindfulness without striving for it; it was a by-product of what we were after: improved performance in the martial arts. Our mindfulness was attained by focusing 100% of our attention on the mechanics of breath. In our meditational sitting, during our quiet standing, or while performing martial katas, we focused on breath with every fiber of our being. In doing so we become mindfulness personified.

A smart trainee expropriates Smith’s concept of the physiological epicentre, the expanding and shrinking dantian orb. Use this image to find your physiological center of balance. Sync breath with posture and simultaneously acquire the mindfulness mindset. How appropriate that Smith’s ancient martial strategy of “breath before everything” turns out to be the perfect gateway into modern mindfulness. The fact that his forgotten lessons are still relevant and important seems weirdly appropriate. I am happy to pass along even a sliver of his iconic wisdom.

Mr. Smith joined the U.S. Marines in 1944 at age 17, served overseas in the Pacific theater with the Fifth Division as a combat rifleman at Peleliu and Guam. He was among the first troops into defeated Japan. Mr. Smith received his undergraduate degree in History from the University of Illinois and his master’s degree in Far Eastern and Russian Studies from the University of Washington in Seattle. In 1955, he joined the CIA as an intelligence officer, going to Taiwan four years later in 1959. There he continued his pursuit of martial arts practice and research. During this time he went to Tokyo and won his third degree black belt in Judo at the Kodokan, the international Judo headquarters.

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Marty Gallagher is the author of Strong Medicine, The Purposeful Primitive and Coan: The Man, The Myth, The Method. Gallagher coached the United States team that won the IPF powerlifting world team title in 1991. He is a 6-time national masters champion and national record holder. He was the IFF world master powerlifting champion in 1992. He currently works with elite athletes, spec ops military and governmental agencies.

Folding Inner Space: Part I – Iron Zen: Exercise-Induced Altered States

October 1, 2015 By Marty Gallagher 12 Comments

Iron Zen

Tibetan Lama Dungse Jampol is the son of a Tibetan meditation master. At a young age he asked his father to explain to him, “What is the nature of the mind?” and “What is ‘pure existence” and what is the meaning of “enlightenment?” His father sat down and said to the boy, “Come closer.” The boy came within arms length of the father who gestured him even closer by wagging his finger. When the boy’s forehead was within six inches of the father, the elder lama unleashed a blood-curdling scream that literally sent the youngster reeling. Dungse recalled, “That scream was so loud and so intense and so unexpected that I was paralyzed; shocked, my mind was completely cleared of everything – instantly. My father excitedly said, “See! There it is! There it is!”

It is my contention that intense physical effort, the kind of effort generated during limit-exceeding weight training sessions, offers an entranceway into higher realms of consciousness. My Zen master friend, Ken O’Neil, and I have talked frequently about this phenomenon at length and in depth. I have long sought out others that have experienced this Iron Satori in my ongoing effort to bring attention to this rarified and refined quality of consciousness attained during “Iron Zazen.”

Exercise-induced altered consciousness, or, alternatively and more poetically, The Zen of Pure Physical Effort, is a higher awareness induced by intense physical exercise. Superhuman effort opens the “heavy door with rusted hinges.”

I have been a hardcore weight trainer for 54 years and a meditator for 43 years. Nietzsche once noted “true greatness requires long obedience in the same direction.” To which I would add, over time and with continual repetition the ability to enter into exercise-induced altered states of consciousness becomes easier. The longer and more often the athlete enters these zones of heightened sensory awareness, the deeper the experience becomes and the easier it is accessed: vividness and clarity magnify with repeated visitations.

The exercise-induced altered mindset offers a “shortcut” method, a meditational way in which to fold inner space.

We can jump the beginning meditator ahead; throw them into the deep end of the pool, metaphorically speaking, through the precise application of Iron Zen. Intense physical effort shortens the meditation learning curve, depositing the Iron Zen adherent into an advanced state-of-being. Entry is dependent on the quality of the individual workout: if the effort is deep enough, sincere enough, intense enough, Huxley’s Doors of Perception swing open and the exerciser is predictably enveloped in blissful state of exercise-induced nirvana.

Conscious thought is the enemy, the destroyer of optimal human performance. The elite athlete understands this fact: they embrace and inhabit a wordless state that characterizes optimal human performance. Intense physical effort attacks the human body on a variety of fronts in a variety of ways: we self-inflict body trauma in order to induce beneficial stresses. The optimal workout creates stress. The poison is in the dose.

Our subtle task is to create sufficient stress to invoke the adaptive response–this in order to reap all the considerable benefit associated with expertly applied progressive resistance training. Too little self-induced stress and nothing of any physical or psychological consequence occur. What are the stress categories?

Mental stress
Hormonal stress
Central nervous system stress
Muscular stress
Internal organ stress

How do we create beneficial stresses and not overdo or under-do the dose?

The requisite stress dose appears when we approach, equal or exceed some measure, some current performance benchmark. Hypertrophy, strength, power and exercise-induced satori do not and cannot appear or occur in response to sub-maximal effort. Pushing up to or past capacity–in some way, shape or form–is what triggers all the good stuff.

The elite athlete is able to will his body to perform past its realistic capacity. This ability is one of the contributing factors to why the elite are the elite. At the highest levels of athletics, regardless the sport, everyone has the genetics and everyone has the work ethic, everyone is fast, everyone is strong and agile–so what separates 1^st form 5^th place?

In most cases superior or inferior placing correlates to the mental attributes (or lack there of) of the athlete. Some athletes are natural competitors and rise to the competitive occasion while others shrink and fall apart at the actual competition.

Human Nervous System

The elite athlete is willfully able to invoke the primordial fight-or-flight response, the necessary precursor to extraordinary effort. Successfully triggering the flight-or-flight response sets in motion everything of benefit that follows. How does one “artificially” invoke fight-or-flight? They create a system of psych.

Successful superhuman effort requires a singularity of mind. A person does not casually exert superhuman effort.

Elite athletes develop individualized mental methods by which they psych themselves up in order to achieve superhuman levels of performance. Athletes do not care one wit about attaining higher levels of consciousness; elite athletes only care about improved performance. An experienced, mature, seasoned athlete uses a highly developed psych designed to elevate the quality of the individual workout and elevate performance in actual competitions.

Recalibrating the mind is the necessary precursor to elevating performance. The “Psych” is a conscious, willful act. The athlete executes a mental checklist that they have developed over time. They recalibrate their mindset to prepare for the training session. Once the actual training session is underway, a highly individualized psych-up routine is used repeatedly in each exercise, drill or protocol.

By consciously focusing, concentrating and using tunnel-vision focus, the seasoned athlete optimizes their capacities and abilities. This singularity of purpose improves the quality of, and results derived from, the workout. The key to continual improvement is being able to string together long series of quality workouts, like pearls strung together on a necklace strand.

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Quieting the Mind-Monkeys

September 17, 2015 By Dr. Chris Hardy 10 Comments

Quieting the Mind-Monkeys

“This restless monkey, which is thought, has broken up this world and has made a frightful mess of this world, it has brought such misery, such agony. And, thought cannot solve this, however intelligent, however clever, however erudite, however capable of efficient thinking, it cannot, thought cannot possibly bring order out of this chaos. There must be a way out of it, which is not thought.”

J. Krishnamurti

This quote from the brilliant Indian philosopher Krishnamurti references the Buddhist concept of “mind monkeys” or what is sometimes known as the “monkey-mind.” These monkeys are the thoughts comprising an incessant internal dialogue driven by worry, fear, anxiety, and rumination. They are constantly chattering and screeching, creating a cacophony in our mind that pulls us away from the present moment. They create imaginary scenarios, reliving recent past events and anxiety-producing worry about potential future problems.

How many times have you arrived at a destination in your car and can’t remember exactly how you got there because you were so immersed in an internal dialogue? For many of us, the monkeys are chattering all day in the background without our full awareness of their presence. The monkeys are not just distractions, but have real health consequences.

Strong Medicine discussed in detail how the mind-monkeys of worry and rumination put us into a constant low-level flight or fight response (sympathetic nervous system) and activate the stress response with real physiological consequences, contributing over time to chronic diseases such as diabetes, heart disease, high blood pressure, and even cancer.

I knew I had a mind-monkey problem, but did not realize the magnitude until I removed all outside stimulus from my environment. I found myself in this almost unimaginable situation during my first experience with a sensory deprivation float tank. The float tank is a futuristic looking pod filled to a depth of only ten inches of water. The water is super-saturated with epsom salt (magnesium sulfate) and warmed to skin temperature. The high concentration of salt allows you to float effortlessly almost on top of the water, and because the water and surrounding air is kept at skin temperature, it is difficult to tell that you are even in water. When the pod door is closed, all light and sound disappear and you feel like you are floating in a void with minimal sensations coming from outside your body.

Floatation Tank

Inside the float tank, the call of my mind monkeys was deafening. There were no outside sounds or sensations to compete with the monkeys in my brain and they made their presence known in an alarming way. I have had training in mindfulness meditation practices, but it still took me almost 30 minutes of floating to quiet these chaotic creatures of thought. I use mindfulness practices often at home and usually feel that I can get to a quiet state, but this experience has led me to question how effective I really am in silencing the monkeys. At home, there are still background noises and bodily sensations that may dull my perception of the monkeys still likely whispering in my head.

After the first 30 minutes in the float tank I was able to start tuning in to the state of my body’s internal workings. I could feel and hear my heartbeat stronger and start to barely detect my intestines rhythmic machinations. I was finally able to strengthen my sense of interoception, sensations from within my body. I used the sound and feel of my heartbeat to get into a deep meditative state. The sound of New Age music drew me out of this sustained mindfulness, gentle notes hitting with startling force as I had been without external sensation for close to an hour.

The short time I spent in this deep state of meditation, tuned to the interoceptive sensations from within my body was the most profoundly relaxing experience I have had with mindfulness. This was the benefit of the sensory deprivation tank for me. It was nothing mystical or transcendental; it recalibrated my ability to detect the mind monkeys. Now I know how loud they really are behind the distraction of the modern environment, with products of industry and technology resulting in sensory pollution, obscuring the howl of the monkeys.

Knowledge is half the battle when confronting a problem. I have a new standard for my mindfulness practice, and re-tuning with periodic floats in the sensory deprivation tank will be integrated into my self care. Remember that the health benefits of reducing the chattering monkeys are real, with a foundation in modern neuroscience and wellness practice. This is a part of how we rebuild a brain physically and functionally changed by chronic stress (see more in Strong Medicine).

The availability of sensory deprivation float tanks is increasing. A one hour float is usually less expensive than a massage session. The experience of floating without external sensations has been invaluable to me personally. I was given a reality check; my monkeys were (and still are to some extent) running wild.

East Meets West

September 3, 2015 By Dr. Chris Holder 11 Comments

East Meets West

I’ve been waiting a very long time to write this blog post. Something near and dear to me, the state of the medical situation not only in the United States but everywhere in the world should create concern for all of this planet’s inhabitants. The answers are out there. We have them all. Unfortunately, money and egos have kept all of our citizens under the thumb of their illnesses and the medicine conversation feels more like an intentional tap-dance.

The good news is, this will not become some sort of political rant. It won’t become a push to convince people that all western doctors are corrupt and are only out to make a buck. I enjoy a good conspiracy theory as much as the next guy, but this is not going to be one of those either. Very much on the contrary. We live in an age where our doctors are developing technology, perfecting techniques and blazing trails like we have never seen before. And I can say with confidence that 99% of our doctors are true healers whose intentions are to eradicate disease and cure their patients.

I spent the weekend of August 15/16 at Dragon Door’s inaugural Health and Strength Conference. A gathering of some of the most forward thinking health, strength and fitness experts in the country, our intention for the weekend was to inform and celebrate the ideas of these exemplary people. I traveled alone, and looked forward to meeting the presenters and make some connections to continue my own growth as a coach and doctor. First up on Saturday morning, Dr. Chris Hardy. Within 20 minutes of his 90 minute presentation, I couldn’t sit still. The information he was sharing was so on point, his approach to health was so progressive and his delivery of the information was presented in a digestible way where even a high school sophomore could understand the value. By the end my head was spinning and my level of anxiousness and excitement to speak with Dr. Hardy was tangible. My good friend Mike Krivka introduced us, we saw the value of partnering, and now we are here.

My name is Chris Holder and I am the head of strength and conditioning at Cal Poly in San Luis Obispo, CA. I am a Senior RKC for Dragon Door but what makes me more useful for the Strong Medicine family is, I’m also a Doctor of Medical Qigong. One of the four major pillars in Traditional Chinese Medicine, my expertise lies in the study and manipulation of the bioenergetics of the patient to create healing. My training specialized in oncology and energetic psychology but my doctoral thesis was directed at athletic performance and how exposure to Qigong will give a competitive athlete an unfair advantage come game time.

Cal Poly Qigong

Since graduating in 2012, I have been on a self-imposed island testing some of my theories on my athletes with stunning success. We’ve been testing Qigong’s impact on flow state induction, concentration and focus during competition, accelerated healing in athletic injury and increased recovery as it relates to training. In the winter of 2015, I embarked on a formal study with my assistant and RKC Team Leader, Chris White, to investigate the potential benefits of a daily Qigong practice and its effects on strength gains. After 8 weeks of training, we found significance in nearly every single factor studied- and we had over 10,000 pieces of individual data at the conclusion. Years from now, I’m hoping, that this one specific study will be one of the propelling factors of moving mindful practices like Qigong into every locker room in America.

Enough about athletics and let’s talk about health. If you are reading this, you are likely an American or European born person whose health care system is firmly planted in western ideas. Great. You are the people who will benefit the most from reading this. Besides perhaps acupuncture, I will assume your familiarity with Eastern Medicine of any kind, but particularly Chinese Medicine, is limited at best. Awesome, you will extract the most from this article.

The differences between the western medical paradigm and the eastern medical set of ideas couldn’t be more different. When I was in medical school, I quickly realized I had to forfeit any notion of understanding what I was learning if passed through a western lens. They don’t match up in any way. Perhaps my greatest asset going into this study was an agreement I made with myself sitting out in front of the school building on night one. I made the deal that I was going to accept whatever I was being taught with no resistance whatsoever. A true “child’s mind” approach. This became enormously valuable from the onset because many of the ideas eastern medicine has challenge and even conflict with how a western trained doctor conducts business. I put up no fight whatsoever which helped expedite my understanding and quickly enhanced my abilities. I encourage you to do the same as you read.

Eastern medicine has been around for approximately 5,000 years. Compared to our western medical practices, which in contrast is a toddler in total years (around 150-200 years old), eastern philosophy is claimed to have been dated back before the written word. Medicine men, shamans and priests were credited for some of the fundamental practices that are still used in modern times.

Susan Meditating Traditional Chinese Medicine (TCM) is broken into four primary practices: Qigong (where my expertise resides); herbal medicine; acupuncture; and massage. Due to some feathers I have ruffled, I will qualify all of my medical knowledge to be isolated to the Qigong perspective only. I have done the herbs and the medical massage, and since I am not licensed to needle anyone, I have no experience with acupuncture from the provider’s vantage point. Lucky for you, the Qigong is not only the most interesting of the four, but also considered to be the mother of the other three, philosophically.

Please place your Eastern cap on now. All things in the universe are comprised of energy. The sun, your coffee cup, your dog, the water in your tub, the rocks in your backyard, your cell phone and your physical body are all-energy. Quantum physics supports this. At its fundamental roots, TCM is trying to restore the human body into perfect balance of Yin and Yang. Everyone is born with a special recipe of both (for the purposes of this blog we will say an even 50/50). When your balance has been established and all that is YOU is in harmony, the human machine thrives. Digestion, sleep, cellular regeneration, respiration, circulation, hormone balance, cognitive function, sexual performance, immune function… the list goes on and on. Imagine your body is a car that is not running well. You take it to the mechanic and he returns it to you tuned up and ready to go another 5,000 miles. When the Yin and Yang of your being is in balance, you are ready for another 5,000 miles.

Where the great divide between east and west begins (in my mind) is the way we approach health care and healing. Please let me explain. Here in the west we like to use the term “holistic”. It’s that all-encompassing word that implies there is an attempt to heal the body, the mind and in some cases, the spirit. Unfortunately, we have compartmentalized each component to the point where a true healing, under the above definition of holistic, would take around 8 different doctors, nutritionists, psychologists and ministers to achieve the desired effect.

In an eastern framework, the three (body/mind/spirit) are one. We’ve never separated the three. They are one system that work in rhythm to complete the human experience, to live a long, healthy abundant life. When a patient comes to me for my services, they are usually in fairly deep trouble. Because of the inherent obscurity of my practice, many of my patients are at the end of the road and at a stage where considering getting their affairs in order is recommended. Their team of doctors have performed the appropriate surgeries, prescribed all of the best drugs known and given this patient the most cutting edge care fathomable and yet, they are still declining. What gives?

What if I told you that in the current system of practice here in America, in many cases, is looking in the wrong place when it comes to healing? Let’s put together a hypothetical. Susan has just been diagnosed with breast cancer for a second time. She endured a lumpectomy, radiation and chemotherapy four years ago but is facing the same problem again. On paper, Susan has lived a very healthy charmed life. She’s happily married with three fantastic children. She has her dream job and is very successful within her thriving company. She’s not a smoker, her stress levels are as low as they can be, she eats a very healthy diet and exercises four times a week. Her support system is strong, she has a tight nucleus of loyal friends and has an incredible relationship with her family who all live nearby. She was surrounded by amazing doctors who followed protocol and now she and her medical team are considering a full mastectomy. Everyone is very hopeful for a full recovery this time but the entire team is mystified by the reoccurrence due to Susan’s lifestyle, demeanor and overall positive approach to life.

Five years ago Susan lost a pregnancy. It was hard on everyone, especially Susan. Her husband John was a rock and that amazing support system we mentioned above came to her side and helped her pick up the pieces. Susan is the posterchild of poise and perseverance and after a very short time away after losing the baby, she jumped back into life feet first. I mean let’s face it, she’s got three other children to take care of, a husband who couldn’t live without her and a company that needs her presence as much as possible. In doing so, she never gave herself a chance to fully grieve, if that is at all possible in this type of tragedy.

Unfortunately, her doctors will go more aggressive this time with both the surgeries and the drugs and Susan will be in a bigger fight than she ever imagined. In this case, her medical protocols are like taking a fishing pole and trying to catch the evenings dinner in a swimming pool. Yes, fish live in water… just not that water.

From my perspective (the Qigong approach), we begin with the timeline in which the original diagnosis was made. We understand that the doctors have determined we are stage two. The mass has returned. But we are not interested in the mass itself… we are more concerned with its fuel source and origin or root cause. Where the disconnect resides with her current care is in the lack of understanding by her medical team of the emotional/spiritual versions that make up Susan (the entire person). When I’m treating a patient, I’m not just looking at their physical body or managing their physical symptoms. We are looking at the emotional and spiritual bodies as well (think of a holographic copy of that person that represents one of the three aspects of their being). In many cases (more than you might understand) the illness is in the emotional or spiritual body and simply manifesting in the physical body. The emotion of grief/sadness is assigned to the lungs from this perspective. Each of what we call the five Yin organs (Liver, Lungs, Kidneys, Spleen and Heart) are responsible for setting the energetic stage for the entire body. The motion and fluidity of the energy moving in the body keeps everything functioning normally. But, when Susan lost the baby, the overwhelming grief that accompanies an event like that created a thunderstorm of sorts of dank, stagnant energy within the lungs. Since Susan didn’t get to take the time to care for herself emotionally and chose to dive back into life, her grief was never resolved. Over time, or in this case, the following year, that storm sat into the lungs until on a nuclear level, gave birth to a flower. That flower manifested into her breast and this is where our original story began.

Even though her doctors jumped on things in time and were able to remove the tumor, the root system (that grief which energetically becomes prime soil for regrowth) is intact and will bear fruit once again… unless she sorts out her grief. With the help of a savvy psychotherapist and some high end energy work, her chances at beating this disease once and for all goes up exponentially. It’s the grief, the emotion that is the fuel for the illness. Think of Qigong and other mindful practices as the grand gardener of all chronic illnesses.

See, the primary problem with our healthcare system isn’t that one side is right and one side is wrong. I’ve said for years now that if the greatest minds of both sides could meet somewhere and sort out philosophy, fill gaps in one another’s approach, we would have a complete system of care. Even the side I am most aligned with, the eastern side, is saturated with ego, stubbornness and an unrelenting need to be right… so much so that they regularly stifle the information to contain the power of the medicine. I was fortunate to study with a person (Dr. Jerry Alan Johnson) who was willing to put everything on the table for us. He was retiring at the conclusion of my doctoral work and closing the school, so we ended up getting the gold. Because my work is so heavily entrenched in the esoteric and what most would consider supernatural, many of the religious fundamentalists would rather suffer, and some willing to die, because of misled fear tactics their leaders have imposed on them. I’ve seen it over and over.

Listen, I understand that some of this information can be overwhelming. And I know that health care can be expensive, especially when most of the “alternative” services are not covered by conventional insurances. The purpose of this blog post is to open your mind. I want to expose you to a new way of looking at health and wellness. Along with the rest of the Strong Medicine team, I want to educate and create dialogue about healing and vitality.

In the months to come, I will be contributing extensively to the Strong Medicine blog about all things Qigong related. I look forward to answering questions and encourage all of you to keep an open mind and do a little research of your own. I’m excited about partnering with Dr. Hardy and Marty Gallagher and hope to become a valuable ally in helping you achieve lifelong wellness and longevity.

Editor’s Comment:

I have been trying to find a person with the requisite expertise for applying Eastern concepts to Western Medicine, and was fortunate to have crossed paths with Dr. Chris Holder. This article may raise some eyebrows for some of you, but I encourage you to open your minds to some of the concepts Chris has introduced above. “Mind-Body” techniques such as Medical Qigong are the missing link in contemporary medical care. They have been developed empirically for thousands of years with modern science recently starting to uncover the molecular mechanisms behind the observed benefits. Mechanistically, most of the mind-body practices work by reducing the stress response and inflammation, the primary driver behind many chronic diseases, including cancer.

Medical Qigong and other mind-body practices reduce the stress response (see Strong Medicine for more). Chronic stress response can dramatically influence the progression and growth of cancers (no convincing data for initiation of cancer at this point). Thus it is no surprise that these practices have shown to have a significant favorable impact of quality of life and even long term outcomes in cancer patients. I have put some links below to some recent research with Medical Qigong and cancer treatment for those interested in more information. Chris will be a regular contributor to the Strong Medicine blog.

http://www.ncbi.nlm.nih.gov/pubmed/18543381

http://www.ncbi.nlm.nih.gov/pubmed/21715370

http://www.ncbi.nlm.nih.gov/pubmed/19880433

****

Coach Chris Holder Chris Holder comes to the Strong Medicine Blog with over thirty years as an athlete and coach. A football player first and then spending his entire professional coaching career at the college level, Holder has been in love with everything weight lifting since he was a little boy.

Holder, a Senior RKC with Dragon Door, has an incredibly diversified training background that brings a unique product to his athletes. Known in many circles as a pioneer of kettlebell training at the college level, Chris opened the door in the early 2000s to break the mold and monotony of the traditional methods of training college student-athletes. Additionally, his preparation of football players for the NFL Combine has gained recognition from the NFL for years.

In his “other” life, Chris is a Doctor of Medical Qigong with an emphasis in oncology. Under the tutelage of legendary Kung Fu and Qigong Grand Master Dr. Jerry Alan Johnson, Dr. Holder has developed protocols to enhance every aspect of an athlete’s competitive life. Blending disciplines of both East and West, Holder has created a holistic training environment for his athletes and is at the forefront of Qigong research at Cal Poly in San Luis Obispo, California.

Eight Mental Health Benefits of Regular Exercise

April 23, 2015 By Bradley Sadler, M.D. 13 Comments

Human brain x-ray view

I’m a psychiatrist and a huge fitness enthusiast. It is gratifying to be able to incorporate exercise, something that I am passionate about in my personal life, as a powerful component in the treatment of my patients with depression.

Depression is a disease of the brain. It affects around 20 per cent of people men and women in their lifetime. It’s associated with a significant reduction in functioning and provides a large economic burden on society.

Most treatment consists of a combination of medicines and therapy. In addition to this conventional approach to depression, treatment can be supplemented or augmented with physical exercise with significant benefits. This is supported by my experience as a doctor treating depression and some evidence from scientific studies. The benefits of exercise in the treatment for depression are many:

Stress reduction: It’s been well documented in science that exercise improves the ability of the body to handle stress. Exercise acts to reset and strengthen the body’s ability to handle stress. In addition, I find personally that after a stressful day, fully immersing myself in a workout tends to bring me out of my head. While I’m working out I actually don’t even think about everything that was on my mind earlier in the day. After the workout, I use the calm to think through some of the problems that may have seemed without solution earlier in the day.

Improved self esteem: Many of my patients often have a negative view of themselves. They feel that they can’t do anything right. Regular exercise brings about improvements fairly rapidly. There are mental benefits of calm and stress reduction. Often there are improvements in body image or the joy of working through a progression and achieving a skill. Nothing boosts self esteem like being able to accomplish a goal through regular training.

Socialization: My depressed patients tell me they find it hard to leave the house. Some of them have significant social anxiety. Their world becomes closed in. Workouts rarely happen alone. Generally, people are going to the gym to begin to workout. Interaction with other people can occur at the gym. There are trainers who can provide help, group classes, and friends that can improve socialization. Even if the workouts are happening at home, often people will post their workouts on social media drawing support and encouragement through social media.

Improved Sleep: My depressed patients often have trouble falling asleep, or they wake up in the middle of the night and find it difficult to get back to sleep. It’s well known that regular exercise improves sleep hygiene. People begin to know and understand their bodies. If they stay up late watching TV, they won’t be able to perform optimally during their workouts the next day.

Elevated energy: It may seem backwards that you have to expend energy to get energy. In depression, patients have lost energy and motivation. The anergia (lack of energy) of depression kills motivation and people find themselves sleeping all day, staying up all night. Regular exercise improves the production of catecholamines (energy producers) in the body that help sustain energy throughout the day.

Mobility/Pain Reduction: Depression kills energy. Loss of energy leads to less movement. Once you stop moving, joints become stiff. Muscles ache. This leads to less movement and more pain. Movement loss leads to weight gain. The additional weight and pressure on the joints in the body, the low back, the knees, the hips compound pain. As you begin to exercise, mobility increases, reducing joint pain. As weight drops, pressure on the joints diminishes further reducing pain.

Improved eating habits: My depressed patients tell me they aren’t hungry, yet many of  them are overweight or have gained weight. In a misguided attempt to improve mood, patients often turn to the wrong types of food: foods laden in sugar, salt and fat. The result is weight gain and further reduction in self-esteem. The journey to physical fitness is often accompanied by a change in diet. Very often people get interested in a diet that compliments their fitness regimen. Foods that fuel exercise are often healthier: fruits, vegetables and protein. Many of my patients cannot treat their depression strictly through exercise alone. Depression is a disease and many of my patients will need medicine in order to feel better. Unfortunately, a side effect of many of the medicines I prescribe for depression is weight gain. Some of the stronger medicines worsen glucose tolerance and can lead to problems in metabolism of fats leading to elevated cholesterol. If I could add exercise to their prescription I know I could lessen this effect.

Joy : Accompanying depression is something called anhedonia. Anhedonia is the inability to feel joy. It’s one of the core symptoms of depression. Depression not only saps your motivation but it also saps your ability to feel happiness. My patients often look at me incredulously when I encourage them to engage in more activities. The act of engaging in activities may be difficult at first, but as they begin to consistently add activity like exercise back into their lives, the emotional shackle of anhedonia starts to disappear. Regular exercise will aid in reclaiming the joy in life.

There are different levels and severity of depression. It is important to understand that exercise tends to work best in patients with mild to moderate depression. Severe depression is a very serious condition and should be treated under the care of a mental health professional. There is not much evidence to suggest that exercise is beneficial to patients in the midst of a severe depression.

Depression is a disease and while exercise can be a very effective treatment, it has its best effect when used as an addition to traditional treatments such as medicine and therapy.

The benefits of exercise listed above are not just seen in people in the grip of mild to moderate depression. Exercise is a powerful preventive strategy for mental health. It’s well known that regular exercisers are happier, have more energy, sleep better, have more sex and are better socialized then non-exercisers. We often focus on the physical transformation that exercise can bring – the mind and the body are connected and as the body improves so does the mind.

Exercise is good for the brain

Editor’s comments:

This week I am privileged to introduce Bradley Sadler, M.D. to the Strong Medicine community. Dr. Sadler is a Johns Hopkins trained psychiatrist as well as an avid student of physical culture. As a practicing psychiatrist he is in the clinical trenches daily, working tirelessly to improve the mental health of his patients. Anxiety and depression are huge public health problems and often are not addressed effectively due to social stigma and incorrect beliefs that they are products of mental weakness or some other type of character flaw.

It is hard for me to take seriously any recommendations for nutrition and exercise given by an out of shape physician who looks like he would be winded from walking up a flight of stairs. Dr. Sadler practices what he preaches. I think we can all take exercise recommendations seriously from a psychiatrist who is coming close to a legit front lever!

Dr. Brad showing his PCC skills — Dr. Brad showing his **PCC** skills

Dr. Sadler has constructed an excellent overview of the positive benefits of regular exercise for mental health. His article an example of excellent public health messaging. It is clear, concise, and easy to comprehend for the layperson.

Within his article are some very important concepts. Among these is the statement “Depression is a disease of the brain.” This is actually quite a profound point that is a departure from previous paradigms looking at depression as a “psychological” condition. Depression and anxiety are the end results of structural and functional changes within the brain. As we have a very sophisticated readership in the Dragon Door community, many of you will want to know what is going on “under the hood” in the brain with exercise and depression. I will team up with Dr. Sadler to write a future post covering the latest theories on the underlying mechanisms behind the observed benefits of exercise for mild to moderate depression. We will also take some of his points outlined above and put them in the context of concepts covered in the Strong Medicine book such as allostasis (“Stress Cup”), neuroplasticity, and chronic inflammation.

Depression has a profoundly negative impact on the quality of life for so many people and is seldom talked about openly. Many thanks to Dr. Sadler for contributing this post on a topic that is not often addressed effectively, and certainly not given the attention it deserves in public health discussions.