Category: Health

Mindfulness versus Concentration

From the excellent Mindfulness in Plain English:

Concentration and mindfulness are distinctly different functions. They each have their role to play in meditation, and the relationship between them is definite and delicate. Concentration is often called one-pointedness of mind. It consists of forcing the mind to remain on one static point. Please note the word force. Concentration is pretty much a forced type of activity. It can be developed by force, by sheer unremitting willpower. And once developed, it retains some of that forced flavor. Mindfulness, on the other hand, is a delicate function leading to refined sensibilities. These two are partners in the job of meditation. Mindfulness is the sensitive one. It notices things. Concentration provides the power. It keeps the attention pinned down to one item. Ideally, mindfulness is in this relationship. Mindfulness picks the objects of attention, and notices when the attention has gone astray. Concentration does the actual work of holding the attention steady on that chosen object. If either of these partners is weak, your meditation goes astray.

Concentration could be defined as that faculty of the mind that focuses single-pointedly on one object without interruption. It must be emphasized that true concentration is a wholesome one-pointedness of mind. That is, the state is free from greed, hatred, and delusion. Unwholesome one-pointedness is also possible, but it will not lead to liberation. You can be very single-minded in a state of lust. But that gets you nowhere. Uninterrupted focus on something that you hate does not help you at all. In fact, such unwholesome concentration is fairly short-lived even when it is achieved— especially when it is used to harm others. True concentration itself is free from such contaminants. It is a state in which the mind is gathered together and thus gains power and intensity. We might use the analogy of a lens. Parallel waves of sunlight falling on a piece of paper will do no more than warm the surface. But if that same amount of light, when focused through a lens, falls on a single point, the paper bursts into flames. Concentration is the lens. It produces the burning intensity necessary to see into the deeper reaches of the mind. Mindfulness selects the object that the lens will focus on and looks through the lens to see what is there.

Concentration should be regarded as a tool. Like any tool, it can be used for good or for ill. A sharp knife can be used to create a beautiful carving or to harm someone. It is all up to the one who uses the knife. Concentration is similar. Properly used, it can assist you toward liberation. But it can also be used in the service of the ego. It can operate in the framework of achievement and competition. You can use concentration to dominate others. You can use it to be selfish. The real problem is that concentration alone will not give you a perspective on yourself. It won’t throw light on the basic problems of selfishness and the nature of suffering. It can be used to dig down into deep psychological states. But even then, the forces of egotism won’t be understood. Only mindfulness can do that. If mindfulness is not there to look into the lens and see what has been uncovered, then it is all for nothing. Only mindfulness understands. Only mindfulness brings wisdom.

Three Fundamental Activities of Mindfulness

Mindfulness is at one and the same time both bare attention itself and the function of reminding us to pay bare attention if we have ceased to do so.

According to the excellent, Mindfulness in Plain English, there are three fundamental activities of mindfulness.

We can use these activities as functional definitions of the term: (a) mindfulness reminds us of what we are supposed to be doing, (b) it sees things as they really are, and (c) it sees the true nature of all phenomena.

Here are the three.

1. What You Should be Doing

In meditation, you put your attention on one item. When your mind wanders from this focus, it is mindfulness that reminds you that your mind is wandering and what you are supposed to be doing. It is mindfulness that brings your mind back to the object of meditation. All of this occurs instantaneously and without internal dialogue. Mindfulness is not thinking. Repeated practice in meditation establishes this function as a mental habit that then carries over into the rest of your life. A serious meditator pays bare attention to occurrences all the time, day in, day out, whether formally sitting in meditation or not. This is a very lofty ideal toward which those who meditate may be working for a period of years or even decades. Our habit of getting stuck in thought is years old, and that habit will hang on in the most tenacious manner. The only way out is to be equally persistent in the cultivation of constant mindfulness. When mindfulness is present, you will notice when you become stuck in your thought patterns. It is that very noticing that allows you to back out of the thought process and free yourself from it. Mindfulness then returns your attention to its proper focus. If you are meditating at that moment, then your focus will be the formal object of meditation. If you are not in formal meditation, it will be just a pure application of bare attention itself, just a pure noticing of whatever comes up without getting involved—“ Ah, this comes up… and now this, and now this… and now this.”

Mindfulness is at one and the same time both bare attention itself and the function of reminding us to pay bare attention if we have ceased to do so. Bare attention is noticing. It reestablishes itself simply by noticing that it has not been present. As soon as you are noticing that you have not been noticing, then by definition you are noticing and then you are back again to paying bare attention.

Mindfulness creates its own distinct feeling in consciousness. It has a flavor— a light, clear, energetic flavor. By comparison, conscious thought is heavy, ponderous, and picky. But here again, these are just words. Your own practice will show you the difference. Then you will probably come up with your own words and the words used here will become superfluous. Remember, practice is the thing.

2. Closer to Reality

Mindfulness adds nothing to perception and it subtracts nothing. It distorts nothing. It is bare attention and just looks at whatever comes up. Conscious thought pastes things over our experience, loads us down with concepts and ideas, immerses us in a churning vortex of plans and worries, fears and fantasies. When mindful, you don’t play that game. You just notice exactly what arises in the mind, then you notice the next thing. “Ah, this… and this… and now this.” It is really very simple.

3. The True Nature of all Phenomena

Mindfulness and only mindfulness can perceive that the three prime characteristics that Buddhism teaches are the deepest truths of existence. In Pali these three are called anicca (impermanence), dukkha (unsatisfactoriness), and anatta (selflessness— the absence of a permanent, unchanging entity that we call Soul or Self). These truths are not presented in Buddhist teaching as dogmas demanding blind faith. Buddhists feel that these truths are universal and self-evident to anyone who cares to investigate in a proper way. Mindfulness is that method of investigation. Mindfulness alone has the power to reveal the deepest level of reality available to human observation. At this level of inspection, one sees the following: (a) all conditioned things are inherently transitory; (b) every worldly thing is, in the end, unsatisfying; and (c) there are really no entities that are unchanging or permanent, only processes.

Mindfulness works like an electron microscope. That is, it operates on so fine a level that one can actually directly perceive those realities that are at best theoretical constructs to the conscious thought process. Mindfulness actually sees the impermanent character of every perception. It sees the transitory and passing nature of everything that is perceived. It also sees the inherently unsatisfactory nature of all conditioned things. It sees that there is no point grabbing onto any of these passing shows; peace and happiness cannot be found that way. And finally, mindfulness sees the inherent selflessness of all phenomena. It sees the way that we have arbitrarily selected a certain bundle of perceptions, chopped them off from the rest of the surging flow of experience, and then conceptualized them as separate, enduring entities. Mindfulness actually sees these things. It does not think about them, it sees them directly.

When it is fully developed, mindfulness sees these three attributes of existence directly, instantaneously, and without the intervening medium of conscious thought. In fact, even the attributes that we just covered are inherently unified. They don’t really exist as separate items. They are purely the result of our struggle to take this fundamentally simple process called mindfulness and express it in the cumbersome and inadequate thought symbols of the conscious level. Mindfulness is a process, but it does not take place in steps. It is a holistic process that occurs as a unit: you notice your own lack of mindfulness; and that noticing itself is a result of mindfulness; and mindfulness is bare attention; and bare attention is noticing things exactly as they are without distortion; and the way they are is impermanent (anicca), unsatisfactory (dukkha), and selfless (anatta). It all takes place in the space of a few mind-moments. This does not mean, however, that you will instantly attain liberation (freedom from all human weaknesses) as a result of your first moment of mindfulness. Learning to integrate this material into your conscious life is quite another process. And learning to prolong this state of mindfulness is still another. They are joyous processes, however, and they are well worth the effort.

Exercise as a Tool to Manage Stress

For any of you who have experienced a ‘runner’s high’ or endorphin rush while exercising you know how powerful the feeling can be. But there are many more chemicals at play than just endorphins and they can do much more than just make you temporarily feel good. Regular exercise can help you combat high levels of stress and anxiety.

In Spark: The Revolutionary New Science of Exercise and the Brain the authors explain how exercise can become your best medicine.

Aside from elevating endorphins, exercise regulates all of the neurotransmitters targeted by antidepressants. For starters, exercise immediately elevates levels of norepinephrine, in certain areas of the brain. It wakes up the brain and gets it going and improves self-esteem, which is one component of depression.”

“Another factor from the body that comes into play here is the atrial natriuretic peptide (ANP). Produced by the muscles of the heart itself when it’s really pumping, ANP travels through the bloodstream and into the brain, where it helps to further moderate the stress response and reduce noise in the brain. It’s a potent part of a cascade of chemicals that relieve emotional stress and reduce anxiety. Along with pain-blunting endorphins and endocannabinoids, the increase in ANP helps explain why you feel relaxed and calm after a moderate aerobic workout. When you talk about burning off stress, these are the elements at work.

We all know that chronically high levels of stress are very unhealthy but did you know that it can actually destroy the connections between nerve cells in the brain?

If mild stress becomes chronic, the unrelenting cascade of cortisol triggers genetic actions that begin to sever synaptic connections and cause dendrils to atrophy and cells to die; eventually, the hippocampus can end up physically shriveled, like a raisin.

But this process can also be reversed.

Studies show that if researchers exercise rats that have been chronically stressed, that activity makes the hippocampus grow back to it’s pre-shriveled state

It’s important to note that while a lot of stress is bad, a little stress can be very good. Physical fitness is one discipline that has always advocated introducing controlled stress to your system. That is, after all, how we break down and build up our muscles. The neurons in our brains benefit from a bit of stress in the same way our muscles do.

What’s gotten lost amid all the advice about how to reduce the stress of modern life is that challenges are what allow us to strive and grow and learn. The parallel on the cellular level is that stress sparks brain growth. Assuming that the stress is not too severe and that the neurons are given time to recover, the connections become stronger and our mental machinery works better.

To get the most mental benefit from your exercise program ideally, you need to spend some time pushing yourself and getting a bit outside of your comfort zone.

Psychologically, this is where you ‘confront the self,’ in the words of my colleague Robert Pyles … By going beyond where you thought you could, straining and stressing and lingering in that pain for even just a minute or two, you sometimes transcend into a rarefied state of mind, in which you feel like you can conquer any challenge. If you’ve ever experienced the phenomenon of runner’s high, it probably came in response to a near maximum effort on your part. The euphoric feeling is likely due to the mixture of extremely high levels of endorphins, ANP, endocannabinoids and neurotransmitters pumping through your system at this intensity. It’s the brain’s way of blocking everything else out so you can push through the pain and make the kill.

You also need to build a routine. The stability of a routine can have dramatic effects on your mood and motivation.

Exercise immediately increases levels of dopamine and if you stay on some sort of schedule, the brain cells in your motivation center will sprout new dopamine receptors, giving you new found initiative.

Lastly, exercising at a moderate intensity serves another important function; it helps take out the trash.

Inside your brain cells, the higher activity level triggers the release of metabolic cleanup crews, producing proteins and enzymes that dispose of free radicals, broken bits of DNA, and inflammation factors that can cause the cells to rupture if left unchecked.

Okay, maybe I won’t skip yoga tonight.

Miracle Grow for Your Brain

spark

Right now the front of your brain is firing signals about what you’re reading and how much of it you soak up has a lot to do with whether there is a proper balance of neurochemicals and growth factors to bind neurons together. Exercise has a documented, dramatic effect on these essential ingredients. It sets the stage, and when you sit down to learn something new, that stimulation strengthens the relevant connections; with practise, the circuit develops definition, as if you’re wearing down a path through a forest.

I’ve talked about how different I feel after yoga or a long walk; things become clearer and I become calmer. The fascinating book Spark: The Revolutionary New Science of Exercise and the Brain, by John Ratey, explains biologically what accounts for these significant changes in our mind and body.

This is your brain on exercise.

… physical activity sparks biological changes that encourage brain cells to bind to one another. For the brain to learn, these connections must be made; they reflect the brain’s fundamental ability to adapt to challenges. The more neuroscientists discover about this process, the clearer it becomes that exercise provides an unparalleled stimulus, creating an environment in which the brain is ready, willing, and able to learn. Aerobic activity has a dramatic effect on adaptation, regulating systems that might be out of balance and optimizing those that are not – it’s an indispensable tool for anyone who wants to reach his or her full potential.

Exercise can have a dramatic affect on our ability to learn.

Darwin taught us that learning is the survival mechanism we use to adapt to constantly changing environments. Inside the microenvironment of the brain, that means forging new connections between cells to relay information. When we learn something, whether it’s a French word or a salsa step, cells morph in order to encode that information; the memory physically becomes part of the brain.

Exercise affects how primed our brain is to take on this new information and create these new connections. If you think of your mind as a garden, the more you move, the more you enrich the soil with positive neurotransmitters like dopamine (attention, motivation, pleasure), serotonin (mood, self-esteem, learning), and norepinephrine (arousal, alertness, attention, mood). More importantly you sprinkle the ground with something called ‘brain-derived neurotrophic factor (BDNF), a protein produced inside nerve cells which Ratey has dubbed ‘Miracle-Gro for the brain.’

Researchers found that if they sprinkled BDNF onto neurons in a petri dish, the cells automatically sprouted new branches, producing the same structural growth required for learning.

Spark goes into detail regarding the types of exercise that best produce this cocktail of neurotransmitters and proteins for your brain to sip on but at the end of the day any movement is good, especially if it’s something you want to do.

“Experiments with lab rats suggest that forced exercise doesn’t do the trick quite like voluntary exercise”

So next time you get in a bit of a rut or you simply want to maximize your potential, get up and get moving.

No Risky Chances: The Conversation That Matters Most

Lacking a coherent view of how people might live successfully all the way to the very end, we have allowed our fates to be controlled by medicine, technology, and strangers.

Atul Gawande is one of my favorite writers. Aside from the amazing work he did getting us talking about the power of simple checklists, he’s also pointed out why most of us should have coaches. Now he’s out with a new book, Being Mortal: Medicine and What Matters in the End, which adds to our ongoing conversation on what it means to be mortal.

I learned about a lot of things in medical school, but mortality wasn’t one of them.

Although I was given a dry, leathery corpse to dissect in anatomy class in my first term, our textbooks contained almost nothing about aging or frailty or dying. The purpose of medical schooling was to teach how to save lives, not how to tend to their demise.

I had never seen anyone die before I became a doctor, and when I did, it came as a shock. I’d seen multiple family members—my wife, my parents, and my children—go through serious, life-threatening illnesses, but medicine had always pulled them through. I knew theoretically that my patients could die, of course, but every actual instance seemed like a violation, as if the rules I thought we were playing by were broken.

Dying and death confront every new doctor and nurse. The first times, some cry. Some shut down. Some hardly notice. When I saw my first deaths, I was too guarded to weep. But I had recurring nightmares in which I’d find my patients’ corpses in my house—even in my bed.

I felt as if I’d failed. But death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things. I knew these truths abstractly, but I didn’t know them concretely—that they could be truths not just for everyone but also for this person right in front of me, for this person I was responsible for.

You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. These days are spent in institutions—nursing homes and intensive-care units—where regimented, anonymous routines cut us off from all the things that matter to us in life.

As recently as 1945, most deaths occurred in the home. By the 1980s, just 17 percent did. Lacking a coherent view of how people might live successfully all the way to the very end, we have allowed our fates to be controlled by medicine, technology, and strangers.

But not all of us have. That takes, however, at least two kinds of courage. The first is the courage to confront the reality of mortality—the courage to seek out the truth of what is to be feared and what is to be hoped when one is seriously ill. Such courage is difficult enough, but even more daunting is the second kind of courage—the courage to act on the truth we find.

A few years ago, I got a late night page: Jewel Douglass, a 72-year-old patient of mine receiving chemotherapy for metastatic ovarian cancer, was back in the hospital, unable to hold food down. For a week, her symptoms had mounted: They started with bloating, became waves of crampy abdominal pain, then nausea and vomiting.

Her oncologist sent her to the hospital. A scan showed that, despite treatment, her ovarian cancer had multiplied, grown, and partly obstructed her intestine. Her abdomen had also filled with fluid. The deposits of tumor had stuffed up her lymphatic system, which serves as a kind of storm drain for the lubricating fluids that the body’s internal linings secrete. When the system is blocked, the fluid has nowhere to go. The belly fills up like a rubber ball until you feel as if you will burst.

But walking into Douglass’ hospital room, I’d never have known she was so sick if I hadn’t seen the scan. “Well, look who’s here!” she said, as if I’d just arrived at a cocktail party. “How are you, doctor?”

“I think I’m supposed to ask you that,” I said.

She smiled brightly and pointed around the room. “This is my husband, Arthur, whom you know, and my son, Brett.” She got me grinning. Here it was, 11 at night, she couldn’t hold down an ounce of water, and she still had her lipstick on, her silver hair was brushed straight, and she was insisting on making introductions.

Her oncologist and I had a menu of options. A range of alternative chemotherapy regimens could be tried to shrink the tumor burden, and I had a few surgical options too. I wouldn’t be able to remove the intestinal blockage, but I might be able to bypass it, I told her. Or I could give her an ileostomy, disconnecting the bowel above the blockage and bringing it through the skin to empty into a bag. I would also put in a couple of drainage catheters—permanent spigots that could be opened to release the fluids from her blocked-up drainage ducts or intestines when necessary. Surgery risked serious complications—wound breakdown, leakage of bowel into her abdomen, infections—but it was the only way she might regain her ability to eat.

I also told her that we did not have to do either chemo or surgery. We could provide medications to control her pain and nausea and arrange for hospice care at home.

This is the moment when I would normally have reviewed the pros and cons. But we are only gradually learning in the medical profession that this is not what we need to do. The options overwhelmed her. They all sounded terrifying. So I stepped back and asked her a few questions I learned from hospice and palliative care physicians, hoping to better help both of us know what to do: What were her biggest fears and concerns? What goals were most important to her? What trade-offs was she willing to make?

Not all can answer such questions, but she did. She said she wanted to be without pain, nausea, or vomiting. She wanted to eat. Most of all, she wanted to get back on her feet. Her biggest fear was that she wouldn’t be able to return home and be with the people she loved.

I asked what sacrifices she was willing to endure now for the possibility of more time later. “Not a lot,” she said. Uppermost in her mind was a wedding that weekend that she was desperate not to miss. “Arthur’s brother is marrying my best friend,” she said. She’d set them up on their first date. The wedding was just two days away. She was supposed to be a bridesmaid. She was willing to do anything to make it, she said.

Suddenly, with just a few simple questions, I had some guidance about her priorities. So we made a plan to see if we could meet them. With a long needle, we tapped a liter of tea-colored fluid from her abdomen, which made her feel at least temporarily better. We gave her medication to control her nausea. We discharged her with instructions to drink nothing thicker than apple juice and to return to see me after the wedding.

She didn’t make it. She came back to the hospital that same night. Just the car ride, with its swaying and bumps, made her vomit, and things only got worse at home.

We agreed that surgery was the best course now and scheduled it for the next day. I would focus on restoring her ability to eat and putting drainage tubes in. Afterward, she could decide if she wanted more chemotherapy or to go on hospice.

She was as clear as I’ve seen anyone be about her goals, but she was still in doubt. The following morning, she canceled the operation. “I’m afraid,” she said. She’d tossed all night, imagining the pain, the tubes, the horrors of possible complications. “I don’t want to take risky chances,” she said.

Her difficulty wasn’t lack of courage to act in the face of risks; it was sorting out how to think about them. Her greatest fear was of suffering, she said. Couldn’t the operation make it worse rather than better?

It could, I said. Surgery offered her the possibility of being able to eat again and a very good likelihood of controlling her nausea, but it carried substantial risk of giving her only pain without improvement or adding new miseries. She had, I estimated, a 75 percent chance that surgery would make her future better, at least for a little while, and a 25 percent chance it’d make it worse.

The brain gives us two ways to evaluate experiences like suffering—how we apprehend such experiences in the moment and how we look at them afterward. People seem to have two different selves—an experiencing self who endures every moment equally and a remembering self who, as the Nobel Prize–winning researcher Daniel Kahneman has shown, gives almost all the weight of judgment afterward to just two points in time: the worst moment of an ordeal and the last moment of it. The remembering self and the experiencing self can come to radically different opinions about the same experience—so which one should we listen to?

This, at bottom, was Jewel Douglass’ torment. Should she heed her remembering self—or, in this case, anticipating self—which was focused on the worst things she might endure? Or should she listen to her experiencing self, which would likely endure a lower average amount of suffering in the days to come if she underwent surgery rather than just going home—and might even get to eat again for a while?

In the end, a person doesn’t view his life as merely the average of its moments—which, after all, is mostly nothing much, plus some sleep. Life is meaningful because it is a story, and a story’s arc is determined by the moments when something happens. Unlike your experiencing self, which is absorbed in the moment, your remembering self is attempting to recognize not only the peaks of joy and valleys of misery but also how the story works out as a whole. That is profoundly affected by how things ultimately turn out. Football fans will let a few flubbed minutes at the end of a game ruin three hours of bliss—because a football game is a story, and in stories, endings matter.

Jewel Douglass didn’t know if she was willing to face the suffering that surgery might inflict and feared being left worse off. “I don’t want to take risky chances,” she said. She didn’t want to take a high-stakes gamble on how her story would end. Suddenly I realized, she was telling me everything I needed to know.

We should go to surgery, I told her, but with the directions she’d just spelled out—to do what I could to enable her to return home to her family while not taking “risky chances.” I’d put in a small laparoscope. I’d look around. And I’d attempt to unblock her intestine only if I saw that I could do it fairly easily. If it looked risky, I’d just put in tubes to drain her backed-up pipes. I’d aim for what might sound like a contradiction in terms: a palliative operation—an operation whose overriding priority was to do only what was likely to make her feel immediately better.

She remained quiet, thinking.

Her daughter took her hand. “We should do this, Mom,” she said.

“OK,” Douglass said. “But no risky chances.”

When she was under anesthesia, I made a half-inch incision above her belly button. I slipped my gloved finger inside to feel for space to insert the fiberoptic scope. But a hard loop of tumor-caked bowel blocked entry. I wasn’t even going to be able to put in a camera.

I had the resident take the knife and extend the incision upward until it was large enough to see in directly and get a hand inside. There were too many tumors to do anything to help her eat again, and now we were risking creating holes we’d never be able to repair. Leakage inside the abdomen would be a calamity. So we stopped.

No risky chances. We shifted focus and put in two long, plastic drainage tubes. One we inserted directly into her stomach to empty the contents backed up there; the other we laid in the open abdominal cavity to empty the fluid outside her gut. Then we closed up, and we were done.

I told her family we hadn’t been able to help her eat again, and when Douglass woke up, I told her too. Her daughter wept. Her husband thanked us for trying. Douglass tried to put a brave face on it. “I was never obsessed with food anyway,” she said.

The tubes relieved her nausea and abdominal pain greatly—“90 percent,” she said. The nurses taught her how to open the gastric tube into a bag when she felt sick and the abdominal tube when her belly felt too tight. We told her she could drink whatever she wanted and even eat soft food for the taste. Three days after surgery, she went home with hospice care to look after her.

Before she left, her oncologist and oncology nurse practitioner saw her. Douglass asked them how long they thought she had. “They both filled up with tears,” she told me. “It was kind of my answer.”

A few days later, she and her family allowed me to stop by her home after work. She answered the door, wearing a robe because of the tubes, for which she apologized. We sat in her living room, and I asked how she was doing.

OK, she said. “I think I have a measure that I’m slip, slip, slipping,” but she had been seeing old friends and relatives all day, and she loved it. She was taking just Tylenol for pain. Narcotics made her drowsy and weak, and that interfered with seeing people.

She said she didn’t like all the contraptions sticking out of her. But the first time she found that just opening a tube could take away her nausea, she said, “I looked at the tube and said, ‘Thank you for being there.’ ”

Mostly, we talked about good memories. She was at peace with God, she said. I left feeling that, at least this once, we had done it right. Douglass’ story was not ending the way she ever envisioned, but it was nonetheless ending with her being able to make the choices that meant the most to her.

Two weeks later, her daughter Susan sent me a note. “Mom died on Friday morning. She drifted quietly to sleep and took her last breath. It was very peaceful. My dad was alone by her side with the rest of us in the living room. This was such a perfect ending and in keeping with the relationship they shared.”

I am leery of suggesting that endings are controllable. No one ever really has control; physics and biology and accident ultimately have their way in our lives. But as Jewel Douglass taught me, we are not helpless either—and courage is the strength to recognize both of those realities. We have room to act and shape our stories—although as we get older, we do so within narrower and narrower confines.

That makes a few conclusions clear: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; and that we have the opportunity to refashion our institutions, culture, and conversations to transform the possibilities for the last chapters of all of our lives.

Being Mortal: Medicine and What Matters in the End

Ancient Wisdom For Lifelong Health

I was excited to read John Durant’s book The Paleo Manifesto: Ancient Wisdom for Lifelong Health. Whether or not you’re interested in paleo, it’s full of interesting nuggets.

Especially the part where Durant explains how fasting can help fight infections.

One indication of this effect comes from the behavior of sick animals, including humans, who often lose their appetite until an illness has passed. Farm animals, pets, zoo animals, and wild animals often just stop eating altogether when facing an acute infection or a serious injury. The widespread nature of this phenomenon suggests it’s an adaptive response. Loss of appetite isn’t a bug, it’s a feature.

Like attacking the supply lines of an invading army, dietary restriction weakens pathogens while the immune system mounts a counteroffensive. Tiny pathogens don’t have large nutrient reserves and rely on the host for nutrition—therefore manipulating our nutrition is a way to manipulate their nutrition.

This may help explain why religious fasting became so prominent.

The benefits of fasting transcend chronic infections. It’s one of the promising areas of cancer research, especially in response to chemo.

“Fasting alters the playing field by activating ancient starvation defences in the cell. Fasting is a signal to the body that resources are scarce. Healthy, nonmalignant cells take the hint and stop dividing as often, focusing instead on cellular repair mechanisms that conserve resources. So even as chemo damages healthy cells, they are hard at work repairing chromosomal damage. But malignant cells don’t stop dividing; they’re “cancerous” because they refuse to do anything but grow and grow.

This part on gluten was also interesting.

In wheat, for example, gluten makes up the majority of wheat protein. Even though gluten is associated with the small percentage of people with celiac disease, it causes gut inflammation in over 80% of people. The gut is the digestive tract, which plays a central role not only in digestion, but in metabolism and immune function as well. Persistent gut inflammation can damage intestinal lining, and large molecules and bacteria can ooze out into the bloodstream—which initiates a reaction from the immune system. Autoimmune disorders occur when the body chronically attacks itself, and a wide variety—lupus, type 1 diabetes, and multiple sclerosis—are associated with a leaky, inflamed gut and wheat consumption.”

The book is broken into three parts. The first part is a brief history of humanity through five ages of existence—Animal, Paleolithic, Agricultural, Industrial, and Information. Each of these stages provides lessons for how we can be healthier today. The second part looks at how we can apply these lessons to “multiple areas of modern-day life: food, fasting, movement, bipedalism (standing, walking, running), temperature, sun, and sleep.” The book wraps up with a speculative vision of how our ancient hunter and gatherer roles can inspire us to build healthy lifestyles.

Durant started eating paleo in September of 2006 and some amazing things started to happen. After ten days

“I had much more consistent energy throughout the day. There was no more “head on the desk” after lunch. My mood improved, too. I felt more confident and optimistic. When something negative occurred in my life, I found that I was able to weather it with greater ease. The energy and mood gains in and of themselves were enough to tell me I was on the right track. … Due to the low sugar content in my diet, I stopped getting a thin filmy residue on my teeth. Industrial food started tasting way to sweet, and I came to enjoy natural flavors more. I lost the cravings for refined carbs — cookies, cupcakes, pasta, muffins, and bagels — and I found bready foods to be both salty and bland. My immune system improved dramatically.

Overall, it felt like walking up from a perpetual state of hangover. And once I knew what “good” felt like, it made “bad” feel a whole lot worse.

When it comes to a healthy diet and overall lifestyle, here are Durant’s 5 recommendations.

1. What to Eat: Mimic a Hunter-Gatherer (or Herder) Diet

Stop counting calories. Eat the right foods: meat, seafood, roots and tubers, leafy vegetables, eggs, fruit, and nuts. Experiment with full- fat fermented dairy. Aim for a diet where the bulk of calories comes from seafood and animals, but the physical bulk comes from plants. Don’t be afraid of fat, eat nose to tail, and eat a variety of plants.

2. How to Eat: Follow Ancient Culinary Traditions

Respect ancient culinary wisdom. Follow traditional recipes. Eat fermented foods (sauerkraut, kimchi). Eat raw foods (sashimi, ceviche, tartare). Make broths and stocks. Cook at low heat, using traditional fats and oils (coconut oil, beef tallow, butter, ghee, olive oil). Eat your colors. Eat time-honored “superfoods”: liver, eggs, seaweed, cold water fish. Enjoy real butter. Salt to taste. Drink tea.

3. What Not to Eat: Avoid Industrial Foods, Sugars, and Seeds

Avoid processed foods of the Industrial Age, including sugar (sweetened foods, table sugar, dried fruit, plus artificial sweeteners) and vegetable oils (canola oil, soybean oil, corn oil, peanut oil). Avoid eating large, concentrated quantities of the seed-based crops of the Agricultural Age, such as grains (wheat, corn, barley, oats) and legumes (soy, beans, peanuts). If grains are eaten, go with rice.

Beverages: Drink water as thirsty. Drink traditional beverages in moderation, if desired (tea, coffee, wine, alcohol, milk). Avoid industrial beverages (soda, energy drinks, skim milk).

4. Make It Meaningful: Experiment, Customize, Enjoy

Use these guidelines as a starting point for your own experimentation. Modify according to your own health, goals, tastes and preferences, background, and budget. Make your diet meaningful (family recipes, ethnic cuisine). Be comfortable breaking away from it to enjoy life (celebrations, unique experiences).

5. Lead a Healthy Lifestyle

Sleep as much as possible. Move and exercise regularly. Stay on your feet (stand, walk, run). Get regular, moderate sun. Try some intermittent fasting. Try some hot and cold exposure. Make it meaningful in order to make it an ongoing lifestyle.

If you’re looking for diet tips, Durant personally follows the guidelines in Perfect Health Diet by Drs. Paul and Shou-Ching Jaminent.

No, this is not another paleo diet book; It is a lifestyle book full of ancient wisdom and practical advice on everything from diet and sunscreen to barefoot running and screen time. It just might change your life.