I have the greatest privilege of being associated with Native cultures of many continents.. thus satisfying my curiosity and desire to travel and the chance to help them with my medical expertise. these notes are from those travels. I am a professor at the University of Havana
MALAYSIA TO MALAYSIA MY LIFE IN BETWEEN VISITS TO MALAYSIA
Kuala Lumpur to Singapore. Singapore to Tokyo. Tokyo to London. London to Paris. Paris to Miami. Miami to The Indians, back to Miami. Miami to London. London to Paris. Paris to Brussels to Paris. Paris to Singapore to Kuala Lumpur.
I left on May 11th and was back on June 28th.
It is always Friends, Food, The Far East.
There are some very good quality friends here in KL but the main draw without doubt is my best friend, MC. Every person deserves and should have a friend of the caliber of MC, at least a similar relationship whereby so much of emotions, hopes, aspirations, learning and knowledge are shared and not to mention Food.
We are lucky to have her sister ML, who has excellent taste in Chinese food. I shall write down a list of restaurants and their food. More importantly, it is the time afforded for chats and discussions.
Yoga
This is of course something new for us. Yoga in its classical form arrived with a teacher from Bombay VY in February 2010. MC went to India and she has become an excellent teacher, able to precisely impart the philosophy behind Classical/ Raja Yoga. I have not learned many Postures but have been able to integrate Yoga Philosophy into my lifestyle. For those of you who think that Yoga consists of competitive sweating with many others in the same room, Classical Yoga enables you to cleanse your mind of deep problems. It is difficult to explain how to use the various aspects of Yoga to cleanse your personality complex but it does help to have a teacher like MC. Even my friends in France commented that they had noticed a change in me which they couldn't pin point. I have felt much calmer within myself and was not unnecessarily getting upset at small and silly things, especially during the many flights and travels.
There have been other intangible benefits. My cholesterol levels had gone down, especially the Bad one. There has been an improvement in my hydration.
There has not been any great change in my nutrition since I eat French food when I am in France and always try to make sure that I eat as close to good quality as available in the country. No great fan of Fast Food or Soft Drinks. In France, an average meal consists of many courses, including a glass of wine or two, cheese, baguette fresh from the bakery and predominantly fish based dishes and vegetables. On this occasion I was twice in London and it is probably the best place to eat the so called “Indian” food, as defined by the Colonial Masters, such as Chicken Karahi, Rogan Josh etc. It is interesting to note that the majority of the “Indian” restaurants in England are owned by Bangladeshis and in particular from the district of Silhet. An excellent Indian meal at Emperor of India at Maidenhead….. and of course London is London.. a Friend was visiting Paris from Miami so it was nice to show her the beauty of the French capital and also invite her to a good Moroccan Couscous..
Many of our diseases are caused by dysfunction and imbalance between our mind and the body, and many a times, dictated by the mind. Peace of mind, eating with friends and laughter are far more important than calories and the contents, of course always leave room in your stomach so that it can lazily inform the brain that it has had enough.
A glass of wine with your meals, especially if you can get hold of an Argentine Malbec or a south African Pinotage and any of the good varietals from Australia, is good, definitely for your heart. France has an immense variety of wines, varietals and vineyards so that one can only hope to skimp the surface. But it is nice to carry a short list of wines you wish to drink in your pocket in case you happen to pass a vinotheque!
I am at the Thai Golden Lounge at KLIA, my friend left me, for the fifteenth time, yet another contended departure from Malaysia which has become a home away from home for me. I am sure I will be back soon..
I left Malaysia nearly 40 hours ago and still have not reached my destination yet but I enjoyed NH flight BKK to NRT and the CO flight NRT to IAH, both served excellent Japanese food. was able to watch The Counterfeiters a german film about the jewish prisoners who were treated well under the threat of death trying to forge money for the Nazis, and the other movie was the last Almodavar one Besos Rotos the Broken Kisses....
I am here in KL, visiting my best friend who is also introducing me to the Philosophy and Techniques of Classical (“Raja”) Yoga and guiding me through a 7 day course of Yogic Lifestyle. She is a recent Graduate of Yoga Institute of Santa Cruz, Mumbai; the oldest organized Yoga Institution in the world (since 1918).
We met on a flight to Siem Reap in January 2008 and at that time you could say that she was quite representative of her people from Malaysia: Ambitious, hard working, a CPA and a traveller. As a Doctor and an Anthropologist, I also noticed that she was under considerable stress, was overweight, had an unhealthy lifestyle.
She was gently introduced to Classical Yoga by Vandana Yadav, a teacher from Bombay in February of 2010. Since then there has been a true revolution in her lifestyle and the worldview of hers; and incredible improvements in her mental, emotional and physical health.
I decided to discuss this matter with her, so that many hard working, stressed individuals in this world could gain some sort of guidance from her own victorious journey from Ill Health to Wellness, in a short period of time.
She has changed the way she eats, her activity patterns, incorporating Yoga techniques and uses Yoga philosophy in her every day life.
I have her medical records from 2009 and 2011, so I am able to offer you a medical perspective. In less than two years, she has lost 30 pounds or about 13 kg.
Her Total Cholesterol has come down 14 per cent, her bad cholesterol, LDL, has decreased by 25 per cent, her good cholesterol has improved by 11 per cent. Her Fasting blood sugar was bordering on Pre Diabetes stage and in June 2011, her fasting blood sugar was 77 mg/dl.
Her Family Physician had wanted to start her on Anti-Cholesterol medication, Statins, but she had declined that. Most doctors are not going to believe that patients are capable of reducing their cholesterol on their own, even if the patients know that high LDL cholesterol, the bad one is associated with a higher risk of Heart Attack and Heart Failure.
I asked her to tell me the changes she has made in her life in the last few months.
The earliest change was to consciously drink water. Starting with 1 liter of water in the morning, and another 2 liters of water during the course of the day. She has noticed that the bowel problems she suffered for most of her life disappeared.
In October 2010, she went to India and did 2 days of Yoga camp for Sinus Inflictions at the Yoga Institute and then returned to India in January 2011 to do a 3 months of intensive teacher training course. Since her return to Malaysia in May 2011, she has faithfully done Yoga. Before she went to India, she had gone to Yoga studios in Kuala Lumpur two to three times a week but her weight was fluctuating. She was not able to practice yoga on her own until she attended the Yoga Institute. This may have to do with the type of Yoga, Raja Yoga at the Institute versus Hatha, Power, Ivengar and Ashtanga Yoga at other places.
Malaysia is a paradise for food lovers and it is easy to obtain tasty food. Many people eat at least one meal a day outside the house and many more eat two meals outside the house.
She had reduced this habit of eating out twice a day to once a day, since she became aware of the ingredients used in cooking. Palm oil is used a fair bit and some of the dishes are fried and refried in the same oil. In Malaysia one can eat healthily but one has to be careful since the advent of an array of fast food restaurants, from overseas and locally conjured.
This morning we went to a neighbourhood Café the kind that dots the landscape of Kuala Lumpur. Both of us had Noodle soup, with fish and egg and local vegetables. The cost for two bowls of noodle soup amounted to slightly above 1 Euro! If we had ordered Char Kuoy Tiew, a very popular Malaysian dish, we would have gotten fried noodles, fried in used palm oil, and the Chinese cook may add the fat of the pork (high cholesterol) to give it an enhanced taste. So choosing the right dish, at slow or fast food places is important even in this Food Paradise.
Mun Ching the Nutritionist:
She has reduced eating Bread, from two slices per day to around two slices of white bread per week (Note: the quality of the bread from bakery is not that good in KL). She also eats less Rice (from one bowl at a meal to half a bowl. In the morning, the breakfast usually is Yoghurt, banana, Raisins, Walnuts, Cereals and Ground Nuts. A cup of Tea made Indian style with milk and two teaspoons of brown sugar.
At Lunch, half a bowl of rice, fish or chicken. Twice a week she may eat Pork. Various vegetables available locally are consumed.
Snacks are mainly Fresh Fruits, available according to the season here in Malaysia. At around 4 pm, a cup of Tea as described above.
One dramatic change has been the elimination of Processed and Stale Food. Of course, drinking fizzy sugar loaded drinks had not been her forte.
During the three-month education course in Bombay, she ate predominantly vegetarian food.
Mun Ching, the yoga practitioner:
The practice of Asanas (postures) are simplified for householders (as compared to challenging yoga she had done before ) that she was initially dubious about the effects of Yoga on her body and mind. This is a common misconception both in the East and the West, that Yoga consists of difficult and sometimes painful postures only few people can attain. Power, achievement and competitiveness are all built into the mass Yoga classes, which are attended by many students at any one time. The Raja Yoga advises to do Yoga at home, and preferably alone.
Currently Mun Ching’s Asana and breathing practice consists of
Breathing (Pranayama) 15 minutes
Asanas (postures) 45 minutes
Relaxation Therapy consisting of Shavasana (Corpse Pose), done twice a day whereby she consciously relax the mind and rejecting any thoughts from entering her mind.
Job: She left the corporate world in May 2010 and went on a spiritual tour of India to discover her next calling in life. She discovered Yoga in October 2010 and in May 2011, she started her social venture called “Meher Yoga Lifestyle Coaching”.
July 2009. Here she is seen at the annual Pow wow of the Hocank Indians of Nebraska, USA
Here is the same lady, in January 2011 at the beginning of her course at the Yoga Institute.
photo taken at an exhibition of Cuban painters in Malaysia.
Parameter 5/2009 10/10 6/2011 %change
I II III I-II II-III
Total Chol. 216 172 148 20 14
LDL 143 114 87 20 24
HDL 54 46 51 -15 +11
TG 105 58 52 45 10
Non HDL C 162 126 97 22 30
Total Chol means Total cholesterol
LDL Low Density Cholesterol is considered the Bad one
HDL High Density Cholesterol is considered the Good one
TG Triglycerides, a fat, reflects also the Insulin Resistance in the body
Non HDL cholesterol a predictor of risk for heart disease
Lipid and lipoprotein levels: optimal levels and lifestyle Recommendations of American Heart Association 2011
The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches:
LDL- C 100 mg/dL,
HDL - C 50 mg/dL,
Triglycerides 150 mg/dL,
Non–HDL-C (total cholesterol minus HDL) 130 mg/dL
No wonder the local FP/GP wanted to put her on Statin medications for high cholesterol. Look at her reading, when she was pre diabetic with a weight of 69 kg (BMI 27kg/m2, 28 is defined as Obesity in Asians) and a high normal Fasting blood sugar.
Now thanks to her lifestyle changes aided by Classical Yoga practices, her risk for Diabetes and Cardiovascular disease has vanished completely.
Her Blood Pressure is usually around 95/65 mmHg.
Currently she is truly a picture of Health and I am glad to be learning Raja Yoga Philosophy and practices of Asanas and Breathing/Pranayama from her.
I plan to take what I have learned from Mun Ching to the groups of American Indians that I work with, so that those oppressed people can get non drug relief from the diseases of “western civilization”.
Mun Ching in KL June 2011
Doctor and the Yoga Teacher, Kuala Lumpur June 2011
The world looks with some awe upon a man who appears unconcernedly indifferent to home, money, comfort, rank, or even power and fame. The world feels not without a certain apprehension, that here is someone outside its jurisdiction; someone before whom its allurements may be spread in vain; someone strangely enfranchised, untamed, untrammelled by convention, moving independent of the ordinary currents of human action. -Winston Churchill, politician and statesman (1874-1965)
My brother, like many good jewish men, sells shmatta but the quality of goods he sells, I cant afford to buy! so I am always happy when he gives me a few shirts.. Today I needed one as I was invited to lunch by a good friend who is returning to Cuba after his official duties here. Will miss him! but the blow was softened by nice lamb mussaman curry and genial conversation as well as the good company of my best friend. The view from the 28th floor of G Hotel was superb and one appreciates how green actually KL is. At the ground level, KL looks like a concrete jungle but the view from above tells another story.
It is Friday night, time to light candles and also to wish all my dear friends in the US of A (despite their governments irrational policies towards Cuba) a happy weekend celebrating the Independence.
For those of you who may not be aware, Cuban government educates free of charge close to 18 000 students from all parts of the world to become Doctors and return to their countries to provide health care. this year another five would be leaving for Cuba from Malaysia. There are students from TimorL'este and Bhutan studying Medicine and Cuba also provides medical assistance to Pakistan and Indonesia. I am so proud of this contribution to International Health of this poor country, just 90 miles south of USA.. It is a good lesson for the future of the world, even if you have little,you can afford to give away a little bit of that little..
The Flight, an Air France Boeing 777 left Paris Airport at 12 midnight. After a good flight of 12 hours, we reached Singapour Airport. The only turbulence was over the Bay of Bengal.
I expected a gaggle of Chinese and giggle of asiatique children on board but this flight, like most Air France flights was full to a Tee, not a single seat was vacant in any of the various classes.. but you could count the chinese on the fingers of one hand. Almost every one was European and possibly French.
I was amazed how quiet and well behaved the entire crowd was, no hanging around the galleys drinking beer or chatting loudly disturbing passengers sleeping.
The Best thing about Singapore is its airport, I have to say. so clean and orderly. many flights in, from oceania to europe to asia at Terminal 1 and the arrival hall was crowded to the brim but within a few minutes I was facing a Malay face who stamped my passport within about 30 seconds. I must confess that I looked at the various lines and chose the line with the largest number of Europeans and the least number of Indians.
Free Wi Fi and quiet places to sit down, recheck in for my flight to KL. Another Malay girl at the Jetstar counter and within seconds I was headed for the Departure lounge.
I chose to stand in line behind a couple and quickly my turn came. Fortunately yet another Malay. I had noticed that at Changi airport there is a disproportionate number of Malays and Indians working rather than the majority Chinese.
As he stamped my passport, I said Teremah Kaseh and asked him: Do you know why Singapore government employs Malays at the Immigration, the first contact of many foreigners to the country.
He said, a slightly firm face, politely: No
I have been dying to tell the joke, my chinese friend in Singapore, told me:
It is because Malays are better looking and they give a better impression!
on to Malaysia, which feels like home these days, feel very comfortable...
and my best friend would be waiting at the KLIA..
the first act would be the symbolic Roti Canai.. you may wish to read my blog on Mindless Eating Explained by Raja Yoga.
I am looking forward to my week of Yoga and Life style instructions in the Classical Yoga and of course:
a visit to A Cut Above at Bangasr
Lunch with the Ambassador from Cuba who is going home soon for reassignment
meeting some old friends and making some new ones..
but the best of all rewards
to spend time with my best friend in Asia!
Last night while having dinner with my long time friend Dr Mark Walker and his wife Greta, we talked about collaborating on a venture which would provide quality comfort to patients who are suffering from various diseases, at the same time for us to continue enjoying our present vagabond lifestyle. Dr Walker is an experienced sailor and boat captain and we had spent a few trips together in the Bahamian waters when we were both postgraduate students at the University of Miami.
I was also thinking of my dear friend, MunChing, a certified Chartered Accountant (CPA) from KL in Malaysia who after 12 years at responsible positions in Price WaterHouse and four years in New York and another two years at the financial centre of Astro Multimedia in KL, had wanted to do what her heart had always wanted. To become a Yoga Teacher and thus be in a position to help people who are confused by the new life style presented to them, with increasing wealth , accessibility and international connections.
The common theme is that we all are dedicated professionals and serious about what we do but at the same time not caught up in the web of the social characterizations and with a genuine desire to help those who need help, or who cannot get the help they need in the conventional world of health, care and wellness.
Because of our very wide spectrum of education and cultural and experiential backgrounds, we have arrived at this juncture where the strategic focus of our effort, whether in KL or Miami, is to offer to those who desperately seek it, the distinct and focused Health Care, Advice and Lifestyle Coaching.
I have heard this before, it is better to be very good at a narrow field than be a Jack or Jackie of all trades and master of none. We jokingly refer to the legendary Dr Catz of Los Angeles who treated only one type of Thyroid disease, he was so good that he could diagnose the condition at a distance. He is a master at what he does and thousands of patients are grateful to him whereas many other Jack in the Box doctors had not paid much attention to the symptoms of the patients.
Our lives are such that we place an optimum price on the wellbeing of our lives rather than the income that is accrued which indirectly contributes to ill health. So our thoughts about Growth is not to grow in a linear fashion but Innovate in a linear fashion, so that we think in terms of what we can do for the person who is suffering, rather than what can be done for me. The shift from ME to THEM.
As all of us know, and as emphasized in the article in the Economist just this past week. Alternative Medicine or Complimentary Medicine work in reality, because of the time and concern shown by the alternative medicine practitioner, whether through crystals or alignment of chakras or Iridology. My current practice is about 80 per cent psychology or culture based Practice even though I am hired to do Endocrinology. But wellness does not recognize your degrees or your specialization but it does recognize your caring. Early in my career with the Indians, I did a short study of bringing about 10 older patients with Diabetes, Hypertension and High Cholesterol, once a week for a social session, where I was present. They sat around, talked and gossiped and ate and chatted some more and at no time was any of the diseases mentioned nor treatments stressed unless they had some urgent queries. Lo and Behold, at the end of the four weeks, their laboratory tests all showed improvement: The Hemoglobin A1C , BP readings, Cholesterol readings all had gotten better, and more than that they felt better as well.
This lack of understanding of emotional intelligence or an aversion to the social sciences among the doctors is one cause of their failure to gain better results . one in three patients with chronic conditions such as Diabetes or Hypertension or High Cholesterol will attain good results with whatever treatments are given to them, as observed by the fact that even in the war zone of Basra, they could achieve that, also in the inner cities of North America. To achieve better results, one has to look to other non pharmaceutical non clinical methods of treatments, which includes TIME spent with them and also adjustments in their way of thinking about their lives. Yoga is an excellent medium in which the cluttered mind can be cleared through the understanding of the philosophy of endurance and repetition.
Whether in KL with patients now seeking out our friend for Lifestyle coaching using Yoga or our philosophy which Mark, Greta and I share is about an Emotional Engagement with persons who come in contact with us. We impart to them, on that vessel of compassion and understanding, the knowledge we have about human body and mind and our knowledge about medications and nutrition.
I am glad to be part of the project in KL, I know that it is better for that to grow slowly, because if it grows rapidly neither the teacher nor the people who seek refuge there would be satisfied.
We are in a way social entrepreneurs, using the knowledge we have in science and social studies, to bring comfort and relieve the suffering of those who seek our advice.
You can read this post in conjunction with the previous post: America by the numbers. You can substitute: Australia, UK, India... in every country, they predict that Diabetes would double in a few years time. and at the same time, they insist on intensive therapies for current patients and prevention therapies at all age levels.
Isn't there something wrong with this logic? Are we accepting defeat of our intensive treatment and prevention intentions, if we accept that Diabetes prevalence would double in a few years' time ?
New drugs are constantly being introduced and they all help a LITTLE BIT.. nothing dramatic.. whether the new generation of drugs or new class of drugs and a whole class is being withdrawn for side effects such as Heart Failure, Bladder Cancer. You get the feeling that everything is being done in a hurry without great thought going into it, so that teachers, professors and researchers (not all of them of course) can change their minds. I have seen prominent Endocrinologists and Diabetologists swearing by a specific drug and then changing their minds when its side effects are revealed. Don't be the first one in your region to use a newer drug, neither be the last one, said a professor of mine.
The fundamental problem is trying to tackle physiologically and pharmacologically diseases which are predominantly social in nature and manifest as cluster of abnormal laboratory values and symptoms (which do have deleterious effects). Always it was given that Blood Sugar be controlled and the world wide rates of control is only about 30 per cent ie seven out of ten people with type 2 Diabetes have uncontrolled blood sugar.
- Hide quoted text -
The newer medications bring down the A1C (laboratory measurement for control of blood sugar) by 0.7 to 0.3 ! which can be achieved by paying attention to Nutrition alone.
This week, some news which should receive greater attention among doctors and diabetes educators:
1. Intensive diabetes control does not provide any great protection to death from cardiac diseases. Since it is understood that cardiac diseases may begin even before diabetes is diagnosed, this makes you think pharmacological therapy is not what is needed, not by itself alone, by intense therapy of social nature is needed.
2. Newly diagnosed Diabetes was reversed by strict diet control, by decreasing the fat in the liver and decreasing insulin resistance.
Among the Native Indians of North America, with whom I work as a Consultant Endocrinologist, my personal experience has been:
the treatment of chronic diseases including Diabetes and Heart Diseases has to be based on a formula of society, social and family life with some help from the doctors and other providers(who would account for about a 1/4 of the help). This culturally oriented, respectful treatment of a disease in the context of suffering and oppression, has produced good results. The fact that Indian Health Service in the USA is not a fee for service system has also been helpful. Some of the best Diabetes care in America are to be found in the two non fee for service establishments: The Veteran's Administration Health Care System and the Indian Health Services. Here, a social illness is approached, not in a piecemeal fashion, but in much more holistic fashion.
May the rest of the Americans one day get such good total Care for Diabetes! !
After I had finished writing and put this blog up, further news came out at the ADA meeting which is being held in San Diego at this moment:
“The results of our research don’t suggest that standards of diabetes care for controlling blood sugar levels, high BP and cholesterol should be changed,” de Boer said in the release. “What the findings suggest is that these treatments alone are not doing an effective job of reducing diabetic kidney disease, and researchers need to find additional ways to do that.”
Diabetic kidney disease has become more prevalent in the US population over the past 2 decades and will likely contribute increasingly to health care costs and mortality,” Ian H. de Boer, MD, MS, and colleagues at the University of Washington, Seattle, wrote in the Journal of the American Medical Association.
if you are a patient with Diabetes, what would you think? Intensive therapy does not protect you from heart disease, medical therapy does not protect you against Kidney disease... wouldnt you look for something else?
AMERICA BY THE NUMBERS
SOMEONE IS NOT TELLING THE TRUTH
THE NUMBER OF PEOPLE WITH PRE DIABETES
79 million adult January 2011
57 million October 2010
25.6 million over the age of 20 have diabetes January 2011
THE NUMBER OF ADULTS WITH HYPERTENSION
68 million 2005-2008 (140/90)
48 million were receiving medications
31 million had adequate control (less than half)
THE NUMBER OF ADULTS WITH HIGH BAD (LDL) CHOLESTEROL
71 million adults had high LDL
34 million were under treatment
23 million had it controlled
All indices were poor among
Poor patients
Those with no insurance
Mexican Americans
It is incredibly difficult to find research on hga1c at a national level. NHANES studies do have HgA1c as part of the studies, looking for comparisons of A1C brings only spurious results. In one study it was noted that 2/3 of the white people had A1C less than 7 % which I find it hard to believe.
Among the Indians, the A1C of less than 7 per cent can be achieved in around 28-32 % of the patients. It has remained constant despite increase in diabetes services to the patients. It has not changed much and it does not change much across the geographical areas.
WHY IS THAT ONE IN THREE ADULTS IN THE USA HAS HIGH LDL LEVELS?
ONE IN THREE ADULTS HAVE HYPERTENSION?
ONE IN THREE ADULTS HAVE DIABETES OR PREDIABETES?
TWO IN THREE ADULTS ARE OVERWEIGHT ONE IN THREE IS OBESE?
CDC (Centre for Disease Control ) NOW BELIEVE THAT
45 % of adults had at least one of three diagnosed or undiagnosed chronic conditions—hypertension, hypercholesterolemia, or diabetes; one in eight adults (13%) had two of these conditions; and 3% of adults had all three chronic conditions. ( 2006)
We also know that only one out of 8 persons who has BP Diabetes Mellitus and Hypercholesterolemia is under control with treatment.
Perhaps most of the morbidity and mortality is in this group of people.
There are about 7 million people in USA, who has all three:
Uncontrolled BP (Blood Pressure)
Uncontrolled BS (Blood Sugar)
Uncontrolled LDL (bad) Cholesterol
Of the above, Hypercholesterolemia and High Blood sugar are Life Style Diseases, and to a good degree, Hypertension as well.
So the Doctor you go to see can tell you: Go and See a Dietitian, an Exercise Person, apart from visiting Laboratories for blood tests and Clinics to get various investigations done.
This reminds me of what a Meskwakia Indian told me: when you ask a white person in the country what is their heritage, they say: I am ¼ English, ¼ Irish, ¼ French and ¼ German. Four Quarters here do not make Whole but it amounts to Zero.
Lifestyle diseases need Lifestyle therapy and that is not accomplished by a little of dietary change, a little of exercise, a little of medication and a little of laboratory tests and 8 to 10 minutes spent with your Family Practitioner.
The Problem is identified, it is easy enough, now comes the hard part, what to do about it?
We are sick and tired of people telling us that we are sick and fat, tell us how to get rid of these? Asked a Lakota Indian Woman.
In other blogs I would be outlining various solutions based on the holistic approach to Health and the Person using American Indian and Yoga Philosophies.
