For those who noticed, Practice of Wellness is evolving to a less frequent (monthly) but longer newsletter for wellness practices.
Hopefully you have been keeping up with your daily practice of taking care of yourself. Here are some ideas for this month. 

Open Access:

• This article about the business of publishing comes from an emergency medicine journal. Initially commenting on the documentary Paywall, about the $25 billion academic publishing industry, the article is full of interesting history on copyright, property rights, and data.
• I had never heard of Sci-Hub, a pirate archive originating in 2011. The hacker who started it is in hiding, “dodging extradition.”
• The quote: ‘Information wants to be free, but information also wants to be expensive.”
• They point out that now even when you might have free access to an article, you must supply your email address, a ‘datawall’ to replace the ‘paywall.’ What about the idea that plaintiff’s attorneys could someday see what you articles you searched, or perhaps what you didn’t look forwhen managing a patient!
• A cool Thomas Jefferson passage on divulging of ideas, and the [non-zero-sum] concept that spreading ideas makes others richer without cost to the giver (‘receives light without darkening mine’).
• Interview with an editor for PLoS One on the Robin Hood style of freeing up this knowledge for everyone. 
• If you are in academics, or care about how academic knowledge is shared, check out the article. Their documentary’s copyright status is what we use for Journal of Wellness: Staying true to the open access model, the film is free to stream and download, for private or public use, and maintains the most open CC BY 4.0 Creative Commons designation to ensure anyone regardless of their social, financial, or political background will have access.

Telomeres:

• Somewhat discouraging summary of what happens to residents during intern year. Looks like DNA ages 6 times fasterduring that year of life. Interns coming in with stressful early family environments had shorter telomeres at baseline. 
• Not surprisingly, longer work hours were associated with greater telomere intern telomere loss over the year. BUT, there was no association between sleep and telomere attrition over that year. They did not include some of the data, but in table 2 you see no effect of sleep on pre-internship telomere length or on change in telomere length. Very interesting that longer hours predicted worsened aging (telomere shortening), but less sleep apparently did not. 
• They do not offer much advice on how to mitigate these effects. Many behaviors have been associated with preservation of telomeres. So take care of yourself in every way that is in your control during residency: sleep, exercise, consume quality food, connect with family, avoid drugs. 

Smart Bar:

• Check out the IQ Bar for a low carb snack with solid ingredients. MCTs, Omega 3, even some Lion’s Mane mushroom extract. They taste sweet but not fake sweet. No artificial protein flavor. I have tried the peanut butter chip, almond butter chip, lemon blueberry, and chocolate sea salt, all very good. 

Squat:

• More reasons to squat. Darn toilets ruined everything. If you are reading this in a room alone right now, get down into a full squat for one minute.

Longevity Paradox:

• Dr Steven Gundry, a retired cardiothoracic surgeon, has been criticized for excessive lectinophobia in his last book Plant Paradox. Not sure why he is still talking about a paradox with longevity, but his new book The Longevity Paradox is actually full of great references.
• He is a bit obsessed with the microbiome, pointing out the different bacterial strains in people who live to be 100 years old, and in the famously long-lived naked mole rats. One bug is especially beneficial, Akkermansia mucinophilia, present in centenarians, in people taking metformin, and in people who do not have obesity / diabetes / metabolic syndrome.
• Gundry highlights research on the microbiome and cardiovascular disease (its all about the inflammation– apparently hay is giving elephants their first heart attacks).
• There is even a “pancreatic cancer microbiome.” You do not want those bugs.
• Exercise gives you more bacterial diversity, and more of the good bugs. I had the fortune of meeting with Dr Shirish Barve who is well-established and funded in this burgeoning domain. His research on the brain-gut axis, alcoholism and HIV will revolutionize medical therapy. 
• So eat a variety of plants and fermented food, exercise, meditate, hang out with the right people, and nurture that microbiome. Gundry wants us eating a liter of olive oil per week (10-12 spoonfuls a day). If all of that is too much, maybe get a fecal transplant. 

Overconsumption Impairs Cognition:

• Hormesis researcher Mark Mattson has written many articles on plant toxins making us stronger and on exercise and fasting as ways to damage the body to make us live longer. This article looks at the cognitive advantages of fasting.
• “Natural selection favored individuals capable of outperforming their competitors, cognitively and/or physically, when in a food-deprived state. The range of cognitive capabilities throughout the animal kingdom (spatial navigation, decision-making, sociality, and creativity) are largely concerned with food acquisition and reproduction.” Basically, humans took over the world in part because we get pretty creative when we are hungry. 
• Since the agricultural revolution (10,000 years), humans have had less and less food scarcity. Cranial volume measurements suggest a 10% decrease in brain volume in that time. Chronic excessive energy intake is associated with impaired cognition, reduced temporal lobe gray matter volume, and poorer clinical outcomes in patients with major psychiatric disorders, including depression. This effect is marked in children. 
• Mattson ends with data on Intermittent Fasting which (along with running) enhances cognition by synaptic plasticity, mitochondrial biogenesis, and cellular stress resistance. 
• Take home point: Exercise helps the brain, especially when combined with fasting. Don’t eat too much often.

Mind-Body:

• Been reading several books on the power of the mind-body connection. If you are more into documentaries, check out Heal on Netflix. It is a little bit out there with some father healers, but several MDs and PhDs as well.
• It directed me to books such as Radical Remission (PhD who collected the cases of cancer remission with and without use of mainstream medicine and found 9 common threads) and How Your Mind Can Heal Your Body (chemist who left the pharmaceutical industry because his lofty goal of curing cancer was difficult too achieve there; this book is full of journal references on the placebo response, power of mindset, visualization exercises that enhance the immune system, the power of the mindset/enthusiasm of a treating physician on the patient’s compliance and outcomes, and much more) and You are the Placebo (book that goes into depth on the placebo effect and the power of the subjective mind to create objective epigenetic brain changes) or if you want to go old school, check out As a Man Thinketh from 1903, or even farther back to Hamlet “there is nothing either good or bad, but thinking makes it so.”
• The point of all of these books is that your mindset matters – how you approach the world will have a huge effect on how your life unfolds. Be optimistic, be hopeful, be responsible, be charitable, work hard, don’t look back at the past, don’t fear the future, and be open to the idea that you can change your circumstances for the better. 

Pili Nuts:

• Apparently there is a new kind of nut, Pili Nuts. Zero carbs (is that possible?). They taste buttery, smooth, similar to macadamia but prominent flavor. Available on Amazon. 

Pets:

• Owning a pet has health effects ranging from increased happiness to longer life. Pets improve: social attention, social behavior, interpersonal interactions, and mood; stress-related parameters such as cortisol, heart rate, and blood pressure; self-reported fear and anxiety; and mental and physical health, especially cardiovascular diseases.
• It can be challenging to train a new pet. Check out this book on dog training, the author McMillan also has a TV show. The book offers pragmatic tips on teaching basic commands, and on managing troublesome behaviors. Plus he invented the Shake and Break, an invaluable tool.
• But if you really want to extend your lifetime with some laughter while you learn, immediately go to Stonie Dennis’s YouTube channel. This guy is a highly skilled dog trainer who actually lives in KY. He is often funny and clearly cares for the “fine animals” he trains. He’s on Instagram for you kids.

 
Quotes:

It is not stress that causes burnout, it is your failure to periodically seek relief.

Burnout is nature’s way of forcing you to oscillate. Burnout is a forced timeout.

– Jim Loehr