Friday, July 31, 2015
Tuesday, July 28, 2015
Weed Dispensary
OP-ED CONTRIBUTOR
What I Learned at the Weed Dispensary
By DAVID CASARETT
Traditional health care should copy the best elements of the medical marijuana industry.
By DAVID CASARETT
Traditional health care should copy the best elements of the medical marijuana industry.
Monday, July 27, 2015
Reinvent Yourself
Becky Blanton
Creative Director and Editor of VABusiness Reports
Jul 20, 2015
I learned to kayak in college. I took a job as a director of operations for a small rafting company on the Chattooga River (Of Deliverance fame). My job sounded like a big deal, but mostly it meant I ran the cash register, sold t-shirts, drove the shuttle and helped the cook feed a crew of mostly male raft guides. I eventually learned to raft, then kayak. My white water experience was primarily Class 1 to Class III water with the occasional class IV water thrown in on days I felt brave. I also learned rescue techniques and was good with a rope.
Once that job ended I rarely got in a boat again, just because I didn't know anyone who ran rivers in Colorado, where I'd move to. I dragged my boat along, but never used it. I sold it when I moved back east.
Forty years later I got back on the water, trying ocean kayaking, and loved it. Why had I waited so long? As I was sitting in the middle of some swells on the Chesapeake Bay on Saturday it occurred to me that I was surrounded by five other women, all about my age or older, who had waited too. We were all taking up kayaking, or had been kayaking off and on and were getting serious about it again. A woman I paddled closely with, was 72. The swells and breaking waves were making her nervous so she and I and the instructor rafted up for a few minutes to talk about it. We find out she'd gone skydiving with her son the month before...he gave her a tandem jump as a birthday present. I suddenly felt really old.
She loved it and all she can think about is "doing it again." Another woman I met had been an x-ray tech, then became a health educator, then an RN...and just kept changing her jobs as she realize what she wanted to do. The other women were the same. They all reinvented themselves....from a divorce mother of two teens, to a high school Spanish teacher....I was so impressed.
Maybe I've been going to all the wrong places to meet people because these women weren't complaining, they were exploring! Just because they had one career, they weren't afraid to seek out another. They liked kayaking and camping and trying new things. And we're in our 50's, 60's and 70's. It's never too late to find something you love, or rediscover a new love. I came home inspired to lose weight and get in shape so I can continue to paddle. Maybe taking up an old sport isn't reinventing myself, but losing weight, risking new friendships, new experiences and embracing a different lifestyle is.
Don't wait to do, try or learn something new. One day you'll wake up and there won't be time to do what you want to do.
Source: https://www.linkedin.com/pulse/reinventing-yourself-becky-blanton?trk=eml-b2_content_ecosystem_digest-network_publishes-265-null&midToken=AQGg9tVGdAEiDA&fromEmail=fromEmail&ut=0DSYx_cdv9JSQ1
Weaning Off Prescription Meds
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Sunday, July 26, 2015
Is it time to move on?
The first step to getting anywhere is deciding you're no longer willing to stay where you are. -Unknown
MS'er Gardens all around Victoria
This man .focuses on his present moments by trimming shrubs and trees around his city, Victoria, B.C., Canada.
Source http://vancouverisland.ctvnews.ca/video?clipId=664928&binId=1.1180928&playlistPageNum=1
Fecal transplant, not just for C. difficile, it could cure various diseases.
In a study published in January in the New England Journal of Medicine,
a Dutch team found that these transplants (using the real stuff, not synthetic)
cured 15 of 16 people with recurring C. diff.
Antibiotics cured three of 13, and four of 13, in two separate groups.
Fecal transplant was “significantly more effective” than the use of v
ancomycin, the study concluded
“It’s a proof of principle that restoring a normal intestinal ecosystem
can cure an important disease,” says Dr. Martin Blaser, an infectious
diseases specialist at New York University’s Langone Medical Center, who
was not involved in that study.
“It suggests that if the microbial ecosystem is disturbed, and you
can [fix] it, you could cure various diseases.” In other words,
not just C. difficile.
a Dutch team found that these transplants (using the real stuff, not synthetic)
cured 15 of 16 people with recurring C. diff.
Antibiotics cured three of 13, and four of 13, in two separate groups.
Fecal transplant was “significantly more effective” than the use of v
ancomycin, the study concluded
“It’s a proof of principle that restoring a normal intestinal ecosystem
can cure an important disease,” says Dr. Martin Blaser, an infectious
diseases specialist at New York University’s Langone Medical Center, who
was not involved in that study.
“It suggests that if the microbial ecosystem is disturbed, and you
can [fix] it, you could cure various diseases.” In other words,
not just C. difficile.
Fecal transplant, which has been practised for centuries
(taken through the mouth, it was called “yellow soup” in
traditional Chinese medicine), gives scientists a window
into the ecosystems of bacteria that inhabit our bodies:
a vast, interconnected web called the human microbiome,
which remains terra incognita—and our next medical frontier.
(taken through the mouth, it was called “yellow soup” in
traditional Chinese medicine), gives scientists a window
into the ecosystems of bacteria that inhabit our bodies:
a vast, interconnected web called the human microbiome,
which remains terra incognita—and our next medical frontier.
A miracle cure, not for the squeamish
Are fecal transplants the next treatment for
heart disease, Crohn’s and even autism?
Are fecal transplants the next treatment for
heart disease, Crohn’s and even autism?
Cynthia Morgan-Robson always prided herself on her independence.
She raised four kids (her husband died of cancer 45 years ago),
including a daughter with Down’s syndrome. She lived on her
own in Port Hope, Ont., well into her senior years, and every
Sunday night, she’d drop into daughter Linda Harness’s house
for dinner. In 2009, following a string of hospital
visits related to knee-replacement surgery,
Morgan-Robson acquired a vicious
Clostridium difficile (C. diff) infection.
Laid low by crippling diarrhea, she could no longer care
for herself. At times, she was incoherent.
Vancomycin, a powerful antibiotic prescribed for C. diff,
seemed to help, but as soon as she went off the drug,
her symptoms returned.
She raised four kids (her husband died of cancer 45 years ago),
including a daughter with Down’s syndrome. She lived on her
own in Port Hope, Ont., well into her senior years, and every
Sunday night, she’d drop into daughter Linda Harness’s house
for dinner. In 2009, following a string of hospital
visits related to knee-replacement surgery,
Morgan-Robson acquired a vicious
Clostridium difficile (C. diff) infection.
Laid low by crippling diarrhea, she could no longer care
for herself. At times, she was incoherent.
Vancomycin, a powerful antibiotic prescribed for C. diff,
seemed to help, but as soon as she went off the drug,
her symptoms returned.
Harness moved her mother, now 75, into a nursing home in
early 2012. “Her cognition was completely gone,” says Harness,
a nurse. “She couldn’t eat, couldn’t use the toilet, couldn’t walk.”
A doctor at the nursing home referred her to infectious diseases
specialist Dr. Elaine Petrof, who works with C. diff patients at
the Kingston General Hospital. Petrof suggested a fecal
transplant—transferring a donor’s stool, by colonoscopy or
enema, into the patient’s colon.
early 2012. “Her cognition was completely gone,” says Harness,
a nurse. “She couldn’t eat, couldn’t use the toilet, couldn’t walk.”
A doctor at the nursing home referred her to infectious diseases
specialist Dr. Elaine Petrof, who works with C. diff patients at
the Kingston General Hospital. Petrof suggested a fecal
transplant—transferring a donor’s stool, by colonoscopy or
enema, into the patient’s colon.
Harness, who was tapped to supply her mother’s dose, was
initially horrified. “Dr. Petrof said, ‘Go buy a Magic Bullet [blender].
You’re only going to use it once, and it’s not going to be for
a drink,” she says. The idea of fecal transplant is that “good”
bacteria from healthy stool move in and take up residence,
crowding out “bad” bacteria such as C. diff. The donor (typically
a patient’s family member) is screened for conditions that could
disqualify her, including hidden disease or parasites. She’s
instructed to produce a sample at home, put it on ice and
take it to hospital for the procedure. “I almost broke into
hysterics,” Harness continues. “Even as a nurse, I’d never heard
of this.”
initially horrified. “Dr. Petrof said, ‘Go buy a Magic Bullet [blender].
You’re only going to use it once, and it’s not going to be for
a drink,” she says. The idea of fecal transplant is that “good”
bacteria from healthy stool move in and take up residence,
crowding out “bad” bacteria such as C. diff. The donor (typically
a patient’s family member) is screened for conditions that could
disqualify her, including hidden disease or parasites. She’s
instructed to produce a sample at home, put it on ice and
take it to hospital for the procedure. “I almost broke into
hysterics,” Harness continues. “Even as a nurse, I’d never heard
of this.”
The Magic Bullet was spared. Instead of calling for Harness’s
sample, Petrof recruited Morgan-Robson into a clinical study
using synthetic feces—the first of its kind—produced with the
help of the “robo-gut” at the University of Guelph, a bioreactor
that approximates the human colon. “Elaine contacted me because
she knew I could culture a lot of the bugs found in the human
gut,” says Guelph microbiologist Emma Allen-Vercoe. They found
a donor who’d rarely taken antibiotics and was thought to have
a healthy, diverse communty of gut bacteria, then seeded the
robo-gut with the donor’s fecal sample. The scientists chose
33 strains of bacteria they knew could be knocked out with
antibiotics (so there would be an “antidote” if anything went
wrong), and added them to a saline solution. The synthetic
stool, called “Repoopulate,” is “way less gross” than the real
thing, says Allen-Vercoe, who adds that it looks a bit like a
vanilla milkshake.
sample, Petrof recruited Morgan-Robson into a clinical study
using synthetic feces—the first of its kind—produced with the
help of the “robo-gut” at the University of Guelph, a bioreactor
that approximates the human colon. “Elaine contacted me because
she knew I could culture a lot of the bugs found in the human
gut,” says Guelph microbiologist Emma Allen-Vercoe. They found
a donor who’d rarely taken antibiotics and was thought to have
a healthy, diverse communty of gut bacteria, then seeded the
robo-gut with the donor’s fecal sample. The scientists chose
33 strains of bacteria they knew could be knocked out with
antibiotics (so there would be an “antidote” if anything went
wrong), and added them to a saline solution. The synthetic
stool, called “Repoopulate,” is “way less gross” than the real
thing, says Allen-Vercoe, who adds that it looks a bit like a
vanilla milkshake.
Amazingly, it seems to have cured Morgan-Robson and the other C. diff patient who was treated as part of the study. Both received
Repoopulate by colonoscopy at Kingston General in May 2012;
since then, their symptoms have disappeared. Morgan-Robson,
who remains in the nursing home, has returned to her former
self. After the treatment, she was able to recognize Harness’s
three daughters again. “We were amazed,” Harness says.
“She’s back.”
Repoopulate by colonoscopy at Kingston General in May 2012;
since then, their symptoms have disappeared. Morgan-Robson,
who remains in the nursing home, has returned to her former
self. After the treatment, she was able to recognize Harness’s
three daughters again. “We were amazed,” Harness says.
“She’s back.”
Canada has become a hotbed for C. difficile infection, which
can be fatal: Between 1997 and 2005, hospitals saw an almost
fourfold increase in associated deaths, according to the Public
Health Agency of Canada, partly due to the spread of a more
dangerous strain of the bug. Those at risk aren’t just the elderly
and hospital-bound. Increasingly, “community-acquired cases”
are being reported among young and otherwise healthy people,
Petrof says, such as women who’ve received antibiotics prior
to Caesarean sections, or patients who get antibiotics from
their family doctors for sinus infections. “I have Queen’s University
students in my clinic,”
says Petrof, who is also an associate professor there. “I see
people in their twenties. I’ve been contacted about children
[with C. diff].”
can be fatal: Between 1997 and 2005, hospitals saw an almost
fourfold increase in associated deaths, according to the Public
Health Agency of Canada, partly due to the spread of a more
dangerous strain of the bug. Those at risk aren’t just the elderly
and hospital-bound. Increasingly, “community-acquired cases”
are being reported among young and otherwise healthy people,
Petrof says, such as women who’ve received antibiotics prior
to Caesarean sections, or patients who get antibiotics from
their family doctors for sinus infections. “I have Queen’s University
students in my clinic,”
says Petrof, who is also an associate professor there. “I see
people in their twenties. I’ve been contacted about children
[with C. diff].”
Fecal transplant appears to be a powerful way to treat them,
maybe even more effective than antibiotics. Emerging evidence
suggests many of the illnesses that plague us today, including
asthma, heart disease, diabetes, allergies and even autism,
could be related to the billions of bacteria in, on, and around
us—and the success of fecal transplant in combatting C. diff
hints at potential fixes for a range of conditions.
maybe even more effective than antibiotics. Emerging evidence
suggests many of the illnesses that plague us today, including
asthma, heart disease, diabetes, allergies and even autism,
could be related to the billions of bacteria in, on, and around
us—and the success of fecal transplant in combatting C. diff
hints at potential fixes for a range of conditions.
In a study published in January in the New England Journal
of Medicine, a Dutch team found that these transplants
(using the real stuff, not synthetic) cured 15 of 16 people with
recurring C. diff. Antibiotics cured three of 13, and four of 13,
in two separate groups. Fecal transplant was “significantly more
effective” than the use of vancomycin, the study concluded. “It’s
a proof of principle that restoring a normal intestinal ecosystem can
cure an important disease,” says Dr. Martin Blaser, an infectious
diseases specialist at New York University’s Langone Medical Center,
who was not involved in that study. “It suggests that if the
microbial ecosystem is disturbed, and you can [fix] it, you could
cure various diseases.” In other words, not just C. difficile.
of Medicine, a Dutch team found that these transplants
(using the real stuff, not synthetic) cured 15 of 16 people with
recurring C. diff. Antibiotics cured three of 13, and four of 13,
in two separate groups. Fecal transplant was “significantly more
effective” than the use of vancomycin, the study concluded. “It’s
a proof of principle that restoring a normal intestinal ecosystem can
cure an important disease,” says Dr. Martin Blaser, an infectious
diseases specialist at New York University’s Langone Medical Center,
who was not involved in that study. “It suggests that if the
microbial ecosystem is disturbed, and you can [fix] it, you could
cure various diseases.” In other words, not just C. difficile.
The world of medicine is always looking for the next high-tech
cure: stem cells, mind-controlled prosthetics, a brand-new wonder
drug. Yet one of the most talked-about treatments today is
extraordinarily primitive. Fecal transplant, which has been practised
for centuries (taken through the mouth, it was called “yellow soup”
in traditional Chinese medicine), gives scientists a window into
the ecosystems of bacteria that inhabit our bodies: a vast,
interconnected web called the human microbiome, which
remains terra incognita—and our next medical frontier.
cure: stem cells, mind-controlled prosthetics, a brand-new wonder
drug. Yet one of the most talked-about treatments today is
extraordinarily primitive. Fecal transplant, which has been practised
for centuries (taken through the mouth, it was called “yellow soup”
in traditional Chinese medicine), gives scientists a window into
the ecosystems of bacteria that inhabit our bodies: a vast,
interconnected web called the human microbiome, which
remains terra incognita—and our next medical frontier.
Judging from the hand sanitizers, antibacterial soaps and
other germ-fighting products that have now become standard
nearly everywhere, many people think of all bacteria as
pathogens—invisible organisms that cause disease. In fact,
even the healthiest among us carry far more bacterial cells than
human ones: They outnumber us 10 to one. As Julian Davies,
a reknowned microbiologist at the University of British Columbia
(now emeritus) puts it, “We are only 10 per cent human and the
rest of us is microbes.” That population of microbes is established
early in life—starting with a baby’s voyage through the birth canal,
when he’s doused in his mother’s bacteria—and remains as unique
as a fingerprint. In the gut, microbes extract nutrients from
food; they synthesize vitamins, fight off infection and reduce
inflammation, to name just a few of their roles.
other germ-fighting products that have now become standard
nearly everywhere, many people think of all bacteria as
pathogens—invisible organisms that cause disease. In fact,
even the healthiest among us carry far more bacterial cells than
human ones: They outnumber us 10 to one. As Julian Davies,
a reknowned microbiologist at the University of British Columbia
(now emeritus) puts it, “We are only 10 per cent human and the
rest of us is microbes.” That population of microbes is established
early in life—starting with a baby’s voyage through the birth canal,
when he’s doused in his mother’s bacteria—and remains as unique
as a fingerprint. In the gut, microbes extract nutrients from
food; they synthesize vitamins, fight off infection and reduce
inflammation, to name just a few of their roles.
Our modern microbiomes are thought to look quite different
than those of our ancestors. A 2012 study of 1,000-year-old
human fecal samples (collected from three archaeological digs
in the Americas) shows that ancient-human gut microbiomes
looked more like those of non-human primates and rural,
non-Western communities than the average Canadian or
American, concluding that the last century has seen a seismic
shift in our gut bacteria populations, at least in Western cities.
than those of our ancestors. A 2012 study of 1,000-year-old
human fecal samples (collected from three archaeological digs
in the Americas) shows that ancient-human gut microbiomes
looked more like those of non-human primates and rural,
non-Western communities than the average Canadian or
American, concluding that the last century has seen a seismic
shift in our gut bacteria populations, at least in Western cities.
Scientists believe it’s no coincidence that, since the advent
of antibiotics, conditions such as inflammatory bowel disease,
Celiac disease, childhood asthma and allergies, heart disease,
obesity and autism, to name a few, have been on the rise. And
while no one doubts the importance of antibiotics in fighting
infectious disease, we’re exposed to a lot of them these days.
Kids receive 17 courses of antibiotics, on average, before their
twentieth birthdays, according to Blaser, who notes that
antibiotics are also fed at low levels to the farm animals we
eat, to promote growth.
of antibiotics, conditions such as inflammatory bowel disease,
Celiac disease, childhood asthma and allergies, heart disease,
obesity and autism, to name a few, have been on the rise. And
while no one doubts the importance of antibiotics in fighting
infectious disease, we’re exposed to a lot of them these days.
Kids receive 17 courses of antibiotics, on average, before their
twentieth birthdays, according to Blaser, who notes that
antibiotics are also fed at low levels to the farm animals we
eat, to promote growth.
Antibiotics don’t just attack pathogens; they can take out
beneficial bacteria, too. That’s why patients with C. diff tend
to relapse once they stop taking vancomycin, a powerful antibiotic
that wipes out good bugs and bad. Like seeds, C. difficile produces
spores. To cause a full-blown infection, these spores must take root
and germinate in the gut, which is much more easily accomplished
when the microbial ecosystem is diminished—such as after
a course of drugs like vancomycin. Allen-Vercoe compares the gut
to a rainforest.
“If it’s nice and healthy, with lots of different plants and animals,
that ecosystem will be resistant to disease.” But if loggers clear-cut
the trees, the ecosystem collapses, creating an opportunity for
pathogens to take root.
beneficial bacteria, too. That’s why patients with C. diff tend
to relapse once they stop taking vancomycin, a powerful antibiotic
that wipes out good bugs and bad. Like seeds, C. difficile produces
spores. To cause a full-blown infection, these spores must take root
and germinate in the gut, which is much more easily accomplished
when the microbial ecosystem is diminished—such as after
a course of drugs like vancomycin. Allen-Vercoe compares the gut
to a rainforest.
“If it’s nice and healthy, with lots of different plants and animals,
that ecosystem will be resistant to disease.” But if loggers clear-cut
the trees, the ecosystem collapses, creating an opportunity for
pathogens to take root.
Antibiotics aren’t the only culprit. In developed countries, more
babies than ever are born by Caesarean section (in Canada,
it’s about 25 per cent), and a recent study in the Canadian Medical Association Journal found that babies born by C-section lacked
a type of gut bacteria found in those delivered vaginally, even
if they were breastfed. Infants who received formula (and no
breast milk) showed big differences in their gut bacteria, too.
A baby’s gut microbiota composition is linked to his or her growth
rate, noted a recent Norwegian study that examined fecal samples
from 218 newborns.
babies than ever are born by Caesarean section (in Canada,
it’s about 25 per cent), and a recent study in the Canadian Medical Association Journal found that babies born by C-section lacked
a type of gut bacteria found in those delivered vaginally, even
if they were breastfed. Infants who received formula (and no
breast milk) showed big differences in their gut bacteria, too.
A baby’s gut microbiota composition is linked to his or her growth
rate, noted a recent Norwegian study that examined fecal samples
from 218 newborns.
Disorderly microbiomes are being linked to a range of conditions,
including obesity. Dr. Jeffrey Gordon of the Washington University
school of medicine has shown that obese people and thin people
have different microbial populations in their guts. If fat people
diet and become thin, their bacterial makeup changes. After
transplanting the gut bacteria of an obese person into a
germ-free mouse, that mouse becomes overweight; the same
thing happens (in reverse) with bacteria from a malnourished
subject, producing a malnourished mouse. One of Allen-Vercoe’s
projects, with the B.C. Cancer Agency, looks at colorectal cancer.
In certain patients, it seems that a bug normally found in the
mouth lives instead in the gut, causing problems we don’t yet
understand.
including obesity. Dr. Jeffrey Gordon of the Washington University
school of medicine has shown that obese people and thin people
have different microbial populations in their guts. If fat people
diet and become thin, their bacterial makeup changes. After
transplanting the gut bacteria of an obese person into a
germ-free mouse, that mouse becomes overweight; the same
thing happens (in reverse) with bacteria from a malnourished
subject, producing a malnourished mouse. One of Allen-Vercoe’s
projects, with the B.C. Cancer Agency, looks at colorectal cancer.
In certain patients, it seems that a bug normally found in the
mouth lives instead in the gut, causing problems we don’t yet
understand.
One of the biggest surprises has been a potential link between
the microbiome and autism. “It’s a disease thought of as behavioural,”
says Dr. Derrick MacFabe, director of the Kilee Patchell-Evans Autism
Research Group at the University of Western Ontario in London, Ont.
But it looks as though metabolic and immune changes could be
at least partly responsible for the behaviours involved.
MacFabe has found that certain gut bacteria associated with
autism spectrum disorders (ASD) produce a waste product,
called propionic acid, after eating the carbohydrates we consume,
foods that many autistics crave. When lab rats were given this
same substance, they started showing behavioural and brain
changes seen in ASD, such as repetitive behaviour, decreased
social interaction and seizures.
the microbiome and autism. “It’s a disease thought of as behavioural,”
says Dr. Derrick MacFabe, director of the Kilee Patchell-Evans Autism
Research Group at the University of Western Ontario in London, Ont.
But it looks as though metabolic and immune changes could be
at least partly responsible for the behaviours involved.
MacFabe has found that certain gut bacteria associated with
autism spectrum disorders (ASD) produce a waste product,
called propionic acid, after eating the carbohydrates we consume,
foods that many autistics crave. When lab rats were given this
same substance, they started showing behavioural and brain
changes seen in ASD, such as repetitive behaviour, decreased
social interaction and seizures.
MacFabe is co-author of a recent study that screened 213 kids
with ASD. It found that 17 per cent of them had blood metabolic
markers predicted by the lab-rat model. At the same time,
his team looked for genetic changes in these children, but
none was found, suggesting environmental causes, possibly
from the gut. He says long-term antibiotic use in mothers or
their kids, which alters the microbiome, is “a potential risk factor
for autism.” MacFabe believes
a product such as Repoopulate could one day help certain autistic
patients, although no trials have yet been done.
with ASD. It found that 17 per cent of them had blood metabolic
markers predicted by the lab-rat model. At the same time,
his team looked for genetic changes in these children, but
none was found, suggesting environmental causes, possibly
from the gut. He says long-term antibiotic use in mothers or
their kids, which alters the microbiome, is “a potential risk factor
for autism.” MacFabe believes
a product such as Repoopulate could one day help certain autistic
patients, although no trials have yet been done.
Allen-Vercoe is working with MacFabe to sample the gut microbes
of autistic patients, She’s also studying fecal samples from autistic
kids inside the robo-gut, which mimics the distal colon, the end
point of our digestive tract and where the greatest diversity of bugs
can be found. “We can add vancomycin,” she says, or alter what
sort of diet goes into the robo-gut—limiting carbohydrates, casein
or gluten, which some parents believe helps their kids’ symptoms
—to see how the autism-associated bacteria respond. She’s
also using the robo-gut to build microbial ecosystems such as
those found in patients with Crohn’s disease or ulcerative colitis,
where, as she puts it, the “ecosystem is really out of whack.”
Working with McMaster University, she plans to transfer different
ecosystems into germ-free mice, creating a model to study
each disease.
of autistic patients, She’s also studying fecal samples from autistic
kids inside the robo-gut, which mimics the distal colon, the end
point of our digestive tract and where the greatest diversity of bugs
can be found. “We can add vancomycin,” she says, or alter what
sort of diet goes into the robo-gut—limiting carbohydrates, casein
or gluten, which some parents believe helps their kids’ symptoms
—to see how the autism-associated bacteria respond. She’s
also using the robo-gut to build microbial ecosystems such as
those found in patients with Crohn’s disease or ulcerative colitis,
where, as she puts it, the “ecosystem is really out of whack.”
Working with McMaster University, she plans to transfer different
ecosystems into germ-free mice, creating a model to study
each disease.
Beyond these conditions, gut bacteria have even been implicated
in heart disease. A recent study from a group led by Dr. Stanley
Hazen of Cleveland Clinic’s Lerner Research Institute found that
when bacteria in our digestive tracts metabolize a compound
called carnitine (abundant in red meat), they make a byproduct
called trimethylamine N-oxide, TMAO for short, which is linked to
atherosclerosis. The more carnitine we consume, the more
these bacteria thrive. Following 4,000 patients over three years,
Hazen’s team found that higher blood levels of TMAO were
associated with higher risk of death, as well as non-fatal
heart attack or stroke.
in heart disease. A recent study from a group led by Dr. Stanley
Hazen of Cleveland Clinic’s Lerner Research Institute found that
when bacteria in our digestive tracts metabolize a compound
called carnitine (abundant in red meat), they make a byproduct
called trimethylamine N-oxide, TMAO for short, which is linked to
atherosclerosis. The more carnitine we consume, the more
these bacteria thrive. Following 4,000 patients over three years,
Hazen’s team found that higher blood levels of TMAO were
associated with higher risk of death, as well as non-fatal
heart attack or stroke.
“Microbes only know how to eat and replicate,” Hazen says.
However, as their by-products are pumped through the
bloodstream, influencing our bodies in various ways, “they are
functioning as hormones,” he continues. “Our gut microbiome
is really our largest endocrine organ.” But it’s a flexible one,
he notes, because what it’s “fed” can influence over time what
this microbiome becomes. “In our future, we will drug the microbiome,”
Hazen predicts. “We will give it drugs to treat diseases, like
cardiac disease or diabetes or obesity. We just have to work
out what the language [the bacteria] are speaking—the chemical
Braille.” Then it becomes a druggable target.
“That’s our long-term future; it’s so much easier to take a pill.
Nobody wants to do a fecal transplant to treat their diabetes.”
However, as their by-products are pumped through the
bloodstream, influencing our bodies in various ways, “they are
functioning as hormones,” he continues. “Our gut microbiome
is really our largest endocrine organ.” But it’s a flexible one,
he notes, because what it’s “fed” can influence over time what
this microbiome becomes. “In our future, we will drug the microbiome,”
Hazen predicts. “We will give it drugs to treat diseases, like
cardiac disease or diabetes or obesity. We just have to work
out what the language [the bacteria] are speaking—the chemical
Braille.” Then it becomes a druggable target.
“That’s our long-term future; it’s so much easier to take a pill.
Nobody wants to do a fecal transplant to treat their diabetes.”
Repoopulate represents the future of medicine, one in which the
patient’s own microbiome is manipulated to cure or prevent disease.
Until we understand and master those techniques, our body’s
crudest waste product—which teems with literally millions
of bacteria, representing hundreds of different species, many of
which are still barely known to science—is gaining recognition
as a wonder drug, but one that’s still considered experimental.
There’s a powerful “ick” factor associated with working with raw
feces, even among doctors and nurses. The ones who do perform
the procedure typically find themselves resorting to it when
confronted with patients who might not have any other choice.
patient’s own microbiome is manipulated to cure or prevent disease.
Until we understand and master those techniques, our body’s
crudest waste product—which teems with literally millions
of bacteria, representing hundreds of different species, many of
which are still barely known to science—is gaining recognition
as a wonder drug, but one that’s still considered experimental.
There’s a powerful “ick” factor associated with working with raw
feces, even among doctors and nurses. The ones who do perform
the procedure typically find themselves resorting to it when
confronted with patients who might not have any other choice.
Dr. Elaine Petrof performed her first fecal transplant only four
years ago. Her elderly patient “had an unrelated infection and
then got C. diff. She was maxed out; I couldn’t put her on any
more antibiotics.” Her desperate family kept coming to the
hospital with a “pot of poop” and asking Petrof to try a fecal
transplant. “I finally thought, ‘Why not? She’ll die otherwise,’ ”
she says. Within three days, the patient dropped from 20 bowel
movements to two. She was soon able to return home. Petrof
says she performed several more fecal transplants before Health
Canada tightened its restrictions in 2011.
years ago. Her elderly patient “had an unrelated infection and
then got C. diff. She was maxed out; I couldn’t put her on any
more antibiotics.” Her desperate family kept coming to the
hospital with a “pot of poop” and asking Petrof to try a fecal
transplant. “I finally thought, ‘Why not? She’ll die otherwise,’ ”
she says. Within three days, the patient dropped from 20 bowel
movements to two. She was soon able to return home. Petrof
says she performed several more fecal transplants before Health
Canada tightened its restrictions in 2011.
Today, Health Canada considers the use of fecal transplant
to be “investigational,” meaning it can only be conducted within
a clinical trial. (Kingston General partnered with McMaster and
continues to perform fecal transplants under the umbrella of a
clinical trial.) In mid-June, the U.S. Food and Drug Administration (FDA) changed its stance slightly on fecal transplant. The FDA
had formerly required an “investigational new drug application”
whenever the treatment was used; following an outcry from
doctors and patients, who found this to be burdensome, the FDA
promised it would use its discretion in enforcement. (Patients
must, at minimum, give informed consent and be told the
treatment is “investigational.”)
to be “investigational,” meaning it can only be conducted within
a clinical trial. (Kingston General partnered with McMaster and
continues to perform fecal transplants under the umbrella of a
clinical trial.) In mid-June, the U.S. Food and Drug Administration (FDA) changed its stance slightly on fecal transplant. The FDA
had formerly required an “investigational new drug application”
whenever the treatment was used; following an outcry from
doctors and patients, who found this to be burdensome, the FDA
promised it would use its discretion in enforcement. (Patients
must, at minimum, give informed consent and be told the
treatment is “investigational.”)
Some patients who can’t find a doctor to perform a fecal transplant
will take the drastic step of doing it themselves. Jim Hughes,
59, was one of them. About four years ago, after taking antibiotics
to fight a sinus infection, he contracted C. diff; Hughes, who is
five feet, eight inches tall, dropped from 160 to 145 lb. He took
vancomycin for about a year, but whenever the doctor tried to
taper his dose, “the symptoms came roaring back.” Three years
ago, Hughes’s doctor put him in touch with Dr. Michael Silverman,
an infectious diseases specialist and assistant professor at
the University of Toronto, who published a paper describing
DIY fecal transplants. “He said, ‘If you’re willing, here’s
something,’ ” Hughes says. “I said, ‘Sign me up.’ ”
will take the drastic step of doing it themselves. Jim Hughes,
59, was one of them. About four years ago, after taking antibiotics
to fight a sinus infection, he contracted C. diff; Hughes, who is
five feet, eight inches tall, dropped from 160 to 145 lb. He took
vancomycin for about a year, but whenever the doctor tried to
taper his dose, “the symptoms came roaring back.” Three years
ago, Hughes’s doctor put him in touch with Dr. Michael Silverman,
an infectious diseases specialist and assistant professor at
the University of Toronto, who published a paper describing
DIY fecal transplants. “He said, ‘If you’re willing, here’s
something,’ ” Hughes says. “I said, ‘Sign me up.’ ”
Hughes’s two daughters and daughter-in-law were screened as
potential donors. (Silverman insists on this step before self-
administering a fecal transplant, which he says is done with
a home enema kit.) Hughes’s daughter-in-law ended up providing
the sample. It took three attempts to complete the procedure,
but eventually, it worked. Within a day or so, Hughes’s symptoms
started to disappear. “Within a week, it was fine,” and he
remains healthy today. Patients considering DIY transplants
must talk to their doctors first, says Silverman, who believes
that at-home transplants can “fill a gap” for patients when local
health care providers won’t do it.
potential donors. (Silverman insists on this step before self-
administering a fecal transplant, which he says is done with
a home enema kit.) Hughes’s daughter-in-law ended up providing
the sample. It took three attempts to complete the procedure,
but eventually, it worked. Within a day or so, Hughes’s symptoms
started to disappear. “Within a week, it was fine,” and he
remains healthy today. Patients considering DIY transplants
must talk to their doctors first, says Silverman, who believes
that at-home transplants can “fill a gap” for patients when local
health care providers won’t do it.
Dr. Colleen Kelly, a gastroenterologist with the Women’s
Medicine Collaborative in Providence, R.I., cautions
against DIY fecal transplants due to the risk of infection.
Still, she’s frustrated more doctors
won’t perform the procedure. “I was getting annoyed because
[patients] were coming from really far away,” Kelly says. “
One from North Carolina had to fly to Rhode Island with their
donor. I had an 88-year-old drive down from New Hampshire.”
She surveyed other doctors about why they weren’t doing fecal
transplants and many told her it was because safety and efficacy
data were lacking. As a result, she’s leading the first randomized
controlled clinical trial of fecal transplant to treat C. diff in
the U.S., with funding from the National Institutes of Health.
One of several Canadian trials, at St. Joseph’s Healthcare Hamilton,
is looking at whether frozen stool works as well as fresh, which
could allow for anonymous donor banks. (It would also eliminate
the problem of stage fright, when a donor can’t perform the
morning of the procedure.)
Medicine Collaborative in Providence, R.I., cautions
against DIY fecal transplants due to the risk of infection.
Still, she’s frustrated more doctors
won’t perform the procedure. “I was getting annoyed because
[patients] were coming from really far away,” Kelly says. “
One from North Carolina had to fly to Rhode Island with their
donor. I had an 88-year-old drive down from New Hampshire.”
She surveyed other doctors about why they weren’t doing fecal
transplants and many told her it was because safety and efficacy
data were lacking. As a result, she’s leading the first randomized
controlled clinical trial of fecal transplant to treat C. diff in
the U.S., with funding from the National Institutes of Health.
One of several Canadian trials, at St. Joseph’s Healthcare Hamilton,
is looking at whether frozen stool works as well as fresh, which
could allow for anonymous donor banks. (It would also eliminate
the problem of stage fright, when a donor can’t perform the
morning of the procedure.)
Now that fecal transplant is increasingly accepted to treat
C. diff, severe inflammatory bowel disease, including ulcerative
colitis, is a candidate to come next, according to Dr. Ciaran Kelly,
a professor of medicine at Harvard Medical School. As our
understanding of the human microbiome continues to grow,
one day maybe hospitals everywhere will have a bioreactor such
as the robo-gut, churning out powerful “super-probiotics” to treat
a range of diseases. For doctors and patients, it can’t come
fast enough.
C. diff, severe inflammatory bowel disease, including ulcerative
colitis, is a candidate to come next, according to Dr. Ciaran Kelly,
a professor of medicine at Harvard Medical School. As our
understanding of the human microbiome continues to grow,
one day maybe hospitals everywhere will have a bioreactor such
as the robo-gut, churning out powerful “super-probiotics” to treat
a range of diseases. For doctors and patients, it can’t come
fast enough.
Source:
Psychobiotics for the treatment of anxiety, depression and other mood disorders
Mental Health May Depend on Creatures in the Gut
The microbiome may yield a new class of psychobiotics for the treatment of anxiety, depression and other mood disorders
Jessica Fortner
The notion that the state of our gut governs our state of mind dates back more than 100 years. Many 19th- and early 20th-century scientists believed that accumulating wastes in the colon triggered a state of “auto-intoxication,” whereby poisons emanating from the gut produced infections that were in turn linked with depression, anxiety and psychosis. Patients were treated with colonic purges and even bowel surgeries until these practices were dismissed as quackery.
The ongoing exploration of the human microbiome promises to bring the link between the gut and the brain into clearer focus. Scientists are increasingly convinced that the vast assemblage of microfauna in our intestines may have a major impact on our state of mind. The gut-brain axis seems to be bidirectional—the brain acts on gastrointestinal and immune functions that help to shape the gut's microbial makeup, and gut microbes make neuroactive compounds, including neurotransmitters and metabolites that also act on the brain. These interactions could occur in various ways: microbial compounds communicate via the vagus nerve, which connects the brain and the digestive tract, and microbially derived metabolites interact with the immune system, which maintains its own communication with the brain. Sven Pettersson, a microbiologist at the Karolinska Institute in Stockholm, has recently shown that gut microbes help to control leakage through both the intestinal lining and the blood-brain barrier, which ordinarily protects the brain from potentially harmful agents.
Microbes may have their own evolutionary reasons for communicating with the brain. They need us to be social, says John Cryan, a neuroscientist at University College Cork in Ireland, so that they can spread through the human population. Cryan's research shows that when bred in sterile conditions, germ-free mice lacking in intestinal microbes also lack an ability to recognize other mice with whom they interact. In other studies, disruptions of the microbiome induced mice behavior that mimics human anxiety, depression and even autism. In some cases, scientists restored more normal behavior by treating their test subjects with certain strains of benign bacteria. Nearly all the data so far are limited to mice, but Cryan believes the findings provide fertile ground for developing analogous compounds, which he calls psychobiotics, for humans. “That dietary treatments could be used as either adjunct or sole therapy for mood disorders is not beyond the realm of possibility,” he says.
Personality shifts
Scientists use germ-free mice to study how the lack of a microbiome—or selective dosing with particular bacteria—alters behavior and brain function, “which is something we could never do in people,” Cryan says. Entire colonies of germ-free mice are bred and kept in isolation chambers, and the technicians who handle them wear full bodysuits, as if they were in a biohazard facility. As with all mice research, extrapolating results to humans is a big step. That is especially true with germ-free mice because their brains and immune systems are underdeveloped, and they tend to be more hyperactive and daring than normal mice.
Scientists use germ-free mice to study how the lack of a microbiome—or selective dosing with particular bacteria—alters behavior and brain function, “which is something we could never do in people,” Cryan says. Entire colonies of germ-free mice are bred and kept in isolation chambers, and the technicians who handle them wear full bodysuits, as if they were in a biohazard facility. As with all mice research, extrapolating results to humans is a big step. That is especially true with germ-free mice because their brains and immune systems are underdeveloped, and they tend to be more hyperactive and daring than normal mice.
A decade ago a research team led by Nobuyuki Sudo, now a professor of internal medicine at Kyushu University in Japan, restrained germ-free mice in a narrow tube for up to an hour and then measured their stress hormone output. The amounts detected in the germ-free animals were far higher than those measured in normal control mice exposed to the same restraint. These hormones are released by the hypothalamic-pituitary-adrenal axis, which in the germ-free mice was clearly dysfunctional. But more important, the scientists also found they could induce more normal hormonal responses simply by pretreating the animals with a single microbe: a bacterium called Bifidobacterium infantis. This finding showed for the first time that intestinal microbes could influence stress responses in the brain and hinted at the possibility of using probiotic treatments to affect brain function in beneficial ways. “It really got the field off the ground,” says Emeran Mayer, a gastroenterologist and director of the Center for Neurobiology of Stress at the University of California, Los Angeles.
Meanwhile a research team at McMaster University in Ontario led by microbiologist Premsyl Bercik and gastroenterologist Stephen Collins discovered that if they colonized the intestines of one strain of germ-free mice with bacteria taken from the intestines of another mouse strain, the recipient animals would take on aspects of the donor's personality. Naturally timid mice would become more exploratory, whereas more daring mice would become apprehensive and shy. These tendencies suggested that microbial interactions with the brain could induce anxiety and mood disorders.
Bercik and Collins segued into gut-brain research from their initial focus on how the microbiome influences intestinal illnesses. People who suffer from these conditions often have co-occurring psychiatric problems such as anxiety and depression that cannot be fully explained as an emotional reaction to being sick. By colonizing germ-free mice with the bowel contents of people with irritable bowel syndrome, which induces constipation, diarrhea, pain and low-grade inflammation but has no known cause, the McMaster's team reproduced many of the same gastrointestinal symptoms. The animals developed leaky intestines, their immune systems activated, and they produced a barrage of pro-inflammatory metabolites, many with known nervous system effects. Moreover, the mice also displayed anxious behavior, as indicated in a test of their willingness to step down from a short raised platform.
SEE ALSO:
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- Evolution: Dolphins "Shout" to Be Heard over Boat Noise |
- Health: The Conflicted History of Alcohol in Western Civilization |
- Space: Europa's "Brown Gunk" Suggests a Briny Sea |
- Technology: Timeline: The Amazing Multimillion-Year History of Processed Food |
- More Science: The Flavor Connection
Autism connection?
Scientists have also begun to explore the microbiome's potential role in autism. In 2007 the late Paul Patterson, a neuroscientist and developmental biologist at the California Institute of Technology, was intrigued by epidemiological data showing that women who suffer from a high, prolonged fever during pregnancy are up to seven times more likely to have a child with autism. These data suggested an alternative cause for autism besides genetics. To investigate, Patterson induced flulike symptoms in pregnant mice with a viral mimic: an immunostimulant called polyinosinic:polycytidylic acid, or poly(I:C). He called this the maternal immune activation (MIA) model.
Scientists have also begun to explore the microbiome's potential role in autism. In 2007 the late Paul Patterson, a neuroscientist and developmental biologist at the California Institute of Technology, was intrigued by epidemiological data showing that women who suffer from a high, prolonged fever during pregnancy are up to seven times more likely to have a child with autism. These data suggested an alternative cause for autism besides genetics. To investigate, Patterson induced flulike symptoms in pregnant mice with a viral mimic: an immunostimulant called polyinosinic:polycytidylic acid, or poly(I:C). He called this the maternal immune activation (MIA) model.
The offspring of Patterson's MIA mice displayed all three of the core features of human autism: limited social interactions, a tendency toward repetitive behavior and reduced communication, which he assessed by using a special microphone to measure the length and duration of their ultrasonic vocalizations. In addition, the mice had leaky intestines, which was important because anywhere from 40 to 90 percent of all children with autism suffer from gastrointestinal symptoms.
Then Caltech microbiologist Sarkis Mazmanian and his doctoral student Elaine Hsiao discovered that MIA mice also have abnormal microbiomes. Specifically, two bacterial classes—Clostridia and Bacteroidia—were far more abundant in the MIA offspring than in normal mice. Mazmanian acknowledges that these imbalances may not be the same as those in humans with autism. But the finding was compelling, he says, because it suggested that the behavioral state of the MIA mice—and perhaps by extension autistic behavior in humans—might be rooted in the gut rather than the brain. “That raised a provocative question,” Mazmanian says. “If we treated gastrointestinal symptoms in the mice, would we see changes in their behavior?”
Mazmanian and Hsiao investigated by dosing the animals with a microbe known for its anti-inflammatory properties, Bacteroides fragilis, which also protects mice from experimentally induced colitis. Results showed that the treatment fixed intestinal leaks and restored a more normal microbiota. It also mitigated the tendency toward repetitive behavior and reduced communication. Mazmanian subsequently found that B. fragilis reverses MIA deficits even in adult mice. “So, at least in this mouse model, it suggests features of autism aren't hardwired—they're reversible—and that's a huge advance,” he says.
Limits of research
The human gut microbiome evolved to help us in myriad ways: Gut microbes make vitamins, break dietary fiber into digestible short-chain fatty acids and govern normal functions in the immune system. Probiotic treatments such as yogurt supplemented with beneficial strains of bacteria are already being used to help treat some gastrointestinal disorders, such as antibiotic-induced diarrhea. But there are little data about probiotic effects on the human brain.
The human gut microbiome evolved to help us in myriad ways: Gut microbes make vitamins, break dietary fiber into digestible short-chain fatty acids and govern normal functions in the immune system. Probiotic treatments such as yogurt supplemented with beneficial strains of bacteria are already being used to help treat some gastrointestinal disorders, such as antibiotic-induced diarrhea. But there are little data about probiotic effects on the human brain.
In a proof-of-concept study Mayer and his colleagues at U.C.L.A. uncovered the first evidence that probiotics ingested in food can alter human brain function. The researchers gave healthy women yogurt twice a day for a month. Then brain scans using functional magnetic resonance imaging were taken as the women were shown pictures of actors with frightened or angry facial expressions. Normally, such images trigger increased activity in emotion-processing areas of the brain that leap into action when someone is in a state of heightened alert. Anxious people may be uniquely sensitive to these visceral reactions. But the women on the yogurt diet exhibited a less “reflexive” response, “which shows that bacteria in our intestines really do affect how we interpret the world,” says gastroenterologist Kirsten Tillisch, the study's principal investigator. Mayer cautions that the results are rudimentary. “We simply don't know yet if probiotics will help with human anxiety,” he says. “But our research is moving in that direction.”
Strains of Bifidobacterium, which is common in the gut flora of many mammals, including humans, have generated the best results so far. Cryan recently published a study in which two varieties of Bifidobacterium produced by his lab were more effective than escitalopram (Lexapro) at treating anxious and depressive behavior in a lab mouse strain known for pathological anxiety. Although Cryan is optimistic that such findings may point the way to the development of psychobiotics, he is wary of hype. “We still need a lot more research into the mechanisms by which gut bacteria interact with the brain,” he says.
Lymph System In Brain
Lymph system "accidentally" found in brain while researchers were trying to study immune cells in the meneges. #MS http://www.macleans.ca/society/science/are-we-on-the-cusp-of-a-revolution-on-how-we-understand-the-brain/ …
Gut: An international peer-reviewed journal for health professionals and researchers in gastroenterology and hepatology
Gut is a leading international journal in gastroenterology and has an established reputation for publishing first class clinical research of the alimentary tract, the liver, biliary tree and pancreas.Gut delivers up-to-date, authoritative, clinically oriented coverage of all areas in gastroenterology. Regular features include articles by leading authorities, reports on the latest treatments for diseases, reviews and commentaries. Gut is an official journal of the British Society of Gastroenterology, subscribers to Gut also receive Frontline Gastroenterology .
Link: http://gut.bmj.com/
Friday, July 24, 2015
Clues To Understanding Your Brain By Neurologist V.S. Ramachandran
Vilayanur Ramachandran tells us what brain damage can reveal about the connection between celebral tissue and the mind, using three startling delusions as examples.
V.S. Ramachandran is Director of the Center for Brain and Cognition
Link: http://cbc.ucsd.edu/index.html
Wiki: https://en.wikipedia.org/wiki/Vilayanur_S._Ramachandran
Source: http://www.ted.com/speakers/vilayanur_ramachandran
Neurologist V.S. Ramachandran looks deep into the brain’s most basic mechanisms. By working with those who have very specific mental disabilities caused by brain injury or stroke, he can map functions of the mind to physical structures of the brain.
Why you should listen
V.S. Ramachandran is a mesmerizing speaker, able to concretely and simply describe the most complicated inner workings of the brain. His investigations into phantom limb pain, synesthesia and other brain disorders allow him to explore (and begin to answer) the most basic philosophical questions about the nature of self and human consciousness.
Ramachandran is the director of the Center for Brain and Cognition at the University of California, San Diego, and an adjunct professor at the Salk Institute. He is the author of Phantoms in the Brain (the basis for a Nova special), A Brief Tour of Human Consciousness and The Man with the Phantom Twin: Adventures in the Neuroscience of the Human Brain.
What others say
“Ramachandran is a latter-day Marco Polo, journeying the silk road of science to strange and exotic Cathays of the mind. He returns laden with phenomenological treasures...which, in his subtle and expert telling, yield more satisfying riches of scientific understanding.” — Richard Dawkins
Link: http://cbc.ucsd.edu/index.html
Wiki: https://en.wikipedia.org/wiki/Vilayanur_S._Ramachandran
Source: http://www.ted.com/speakers/vilayanur_ramachandran
Introduction to MS Aquatic Fitness
Uploaded on Apr 2, 2015
Aquatic exercise provides a comfortable option for people with multiple sclerosis (MS) due to its supportive, reduced-impact environment. This instructional video demonstrates a wide variety of shallow-water exercises designed specifically for the MS community, addressing areas of balance, strength, range of motion, mobility, and aerobic endurance. Activities are performed at various impact levels, offering options to personalize the workout. Following the 30-minute demonstration, the program concludes with a sample workout routine that runs through all of the exercise activities and their variations.
For information on MSAA's Swim for MS online Aquatic Center, visit:
* http://aquatics.mymsaa.org to learn more about Aquatic Exercise and MS
* http://SwimForMS.org to learn about all things Swim for MS, including how you can conduct your own Swim for MS fundraiser - any pool, any time!
00:00:00 - Introduction/Warm Up
00:06:07 - Aerobic Training
00:15:40 - Balance Coordination and Lower-Body Resistance
00:24:06 - Upper-Body Resistance
00:26:54 - Stretching Exercises
00:29:37 - Sample Workout
For information on MSAA's Swim for MS online Aquatic Center, visit:
* http://aquatics.mymsaa.org to learn more about Aquatic Exercise and MS
* http://SwimForMS.org to learn about all things Swim for MS, including how you can conduct your own Swim for MS fundraiser - any pool, any time!
00:00:00 - Introduction/Warm Up
00:06:07 - Aerobic Training
00:15:40 - Balance Coordination and Lower-Body Resistance
00:24:06 - Upper-Body Resistance
00:26:54 - Stretching Exercises
00:29:37 - Sample Workout
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