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Yoga

Members of Gentle Strength Yoga studio relax during a class. Photo from Christne Cirolli

kevin@tbrnewsmedia.com

In 2014, Andrea Petterson was in a dark place. The Sound Beach resident had recently left her job as a landscape manager at Stony Brook University, just months after she accused her supervisor of sexual harassment and discrimination. At the time, she was in the beginning stages of filing a lawsuit against the school.

“I was at my lowest,” Petterson said, looking back. “That job was my life, my identity and everything I was. Suddenly, I felt very unsafe.”

Andrea Petterson with one of the ornaments she made and sold. Photo from Christne Cirolli

That was, she said, until she found herself inside Gentle Strength Yoga studio, after a friend suggested she try and heal herself there. Owned and operated by John T. Mather Memorial Hospital nurse Christine Cirolli, the yoga studio opened in Mount Sinai in 2013, and moved permanently to Route 25A in Rocky Point in 2016.

Aside from offering regular classes, acupunctures and massages, the studio was designed to be a community-oriented refuge where “people can band together to help each other,” according to Cirolli.

“The second I stepped in, it just felt like home,” said Petterson, who was a student for two years before graduating from Long Island Yoga School in Great Neck and eventually becoming an instructor at the studio. “Christine really gave me an opportunity here to learn more about myself. She was the one that told me that ‘helping heals’ and that has stuck with me.”

This past Christmas, Petterson raised close to $3,400 by making and selling holiday ornaments in the studio, and then donated the funds to several families in need. She routinely teaches classes at Joseph A. Edgar Immediate School in Rocky Point and within Shoreham-Wading River school district.

She also said the studio has motivated her to start an organization that helps to empower young women.

Melissa McMullan, a longtime regular at the studio and a teacher in the Comsewogue School District, said the holiday fundraiser at the studio helped provide a happy holiday for one of her students, whose family lives in poverty. She referred to the studio as “a special place.”

“Christine really gave me an opportunity here to learn more about myself.”

— Andrea Petterson

“It’s the kind of place where people can come in and talk about what’s going on physically or mentally and everybody sort of works together to help each other,” she said. “At the studio, we learn that yoga is really the beginning of a lifelong practice of being connected with, and kind to members of our community.”

Cirolli, a Queens native and Suffolk Community College graduate, said she has been practicing yoga on and off since she was in high school, and always aimed for her studio to be inclusive for everybody.

“I feel blessed that people would trust me, that they are here in a place of caring and love,” Cirolli said.

She added that Gentle Strength hosts a free 12-step recovery yoga program for those affected by alcohol addiction.

“It’s just providing people with another tool to help in their recovery,” she said of the program. “It doesn’t require anyone to sign up or register, either, so if they wanted to come here and be completely anonymous, they can. I thought that was a really nice way to try and welcome people in here who might otherwise be steered away.”

Are we over- or undertreating?

By David Dunaief, M.D.

Dr. David Dunaief

How do we protect one of our most valued assets, our infrastructure? Not roads and bridges, but our bones. When we think of bone fractures as a child or young adult, we think of short-term pain and inconvenience, but usually we recover without long-term consequences.

However, as we get older, fractures can be a lot more significant, with potentially life-altering or life-ending consequences. Osteoporosis is a silent disease that affects millions of patients, most commonly, but by no means exclusively, postmenopausal women. The trend is for low bone mass and osteoporosis diagnoses to increase by 29 percent from 2010 to 2030.

Osteoporosis is where there is bone loss, weakening of the bones and small deleterious changes in the architecture of the bone over time that may result in fractures with serious consequences (1).

One way to measure osteoporosis is with a dual-energy X-ray absorptiometry (DXA) scan for bone mineral density. Osteopenia is a slightly milder form that may be a precursor to osteoporosis. However, we should not rely on the DXA scan alone; risk factors are important, such as a family or personal history of fractures as we age. The Fracture Risk Assessment Tool (FRAX) is more thorough for determining the 10-year fracture risk. Those who have a risk of fracture that is 3 percent or more should consider treatment with medications. A link to the FRAX tool can be found at www.shef.ac.uk/FRAX.

Most of us have been told since we were young that we need more calcium to make sure we have strong bones. In fact, the National Osteoporosis Foundation recommends that we get 1,000 to 1,200 mg per day of calcium if we are over 50 years old (2). Recommendations vary by sex and age. This would be mostly from diet but also from supplements. However, the latest research suggests that calcium for osteoporosis prevention may not be as helpful as we thought.

The under/overmedication treatment paradox

Depending on the population, we could be overtreating or undertreating osteoporosis. In the elderly population that has been diagnosed with osteoporosis, there is undertreatment. One study showed that only 28 percent of patients who are candidates for osteoporosis drugs are taking the medication within the first year of diagnosis (3). The reason most were reluctant was that they had experienced a recent gastrointestinal event and did not want to induce another with osteoporosis medications, such as bisphosphonates. The data were taken from Medicare records of patients who were at least 66 years old.

On the other hand, as many as 66 percent of the women receiving osteoporosis medications may not have needed it, according to a retrospective study (4). This is the overtreatment population, with half these patients younger, between the ages of 40 and 64, and without any risk factors to indicate the need for a DXA scan. This younger population included many who had osteopenia, not osteoporosis.

Also, the DXA scan may have shown osteoporosis at what the researchers described as nonmain sites in one-third of patients diagnosed with the disease. Main sites, according to the International Society for Clinical Densitometry recommendations, would be the anterior-posterior spine, hip and femoral neck. A nonmain site in this review was the lateral lumbar spine. Before you get a DXA scan, make sure you have sufficient risk factors, such as family or personal history of fracture, age and smoking history. When the DXA scan is done, make sure it is interpreted at the main sites. If you are not sure, have another physician consult on the results.

We all need calcium to prevent osteoporosis, right?

Calcium has always been the forefront of prevention and treatment of osteoporosis. However, two studies would have us question this approach. Results of one meta-analysis of a group of 59 randomized controlled trials showed that dietary calcium and calcium supplements with or without vitamin D did increase the bone density significantly in most places in the body, including the femoral neck, spine and hip (5). Yet the changes were so small that they would not have much clinical benefit in terms of fracture prevention.

Another meta-analysis of a group of 44 observational dietary trials and 26 randomized controlled trials did not show a benefit with dietary or supplemental calcium with or without vitamin D (6). There was a slight reduction in nonsignificant vertebral fractures, but not in other places, such as the hip and forearm. Dietary calcium and supplements disappointed in these two trials.

Does this mean calcium is not useful? Not so fast!

In some individual studies that were part of the meta-analyses, the researchers mentioned that dairy, specifically milk, was the dietary source on record, and we know milk is not necessarily good for bones. But in many of the studies, the researcher did not differentiate between the sources of dietary calcium. This is a very important nuance. Calcium from animal products may increase inflammation and the acidity of the body and may actually leach calcium from the bone, while calcium from vegetable-rich, nutrient-dense sources may be better absorbed, providing more of an alkaline and anti-inflammatory approach. This would be a good follow-up study, comparing the effects of calcium from animal and plant-based dietary sources.

What can be done to improve the situation?

Studies have shown that yoga can help prevent osteoporosis by improving mobility, posture and strength.

Yoga used to be on the fringe of society. Now, it has become more prevalent and part of mainstream exercise. This is a good trend since this type of exercise may have a big impact on prevention and treatment of osteoporosis. In a small pilot study, the results showed that those who practiced yoga had an increase in their spine and hip bone density compared to those who did not (7). There were 18 participants in this trial.

The researchers were encouraged by these results, so they increased the number of participants in another study. The results showed that 12 minutes of yoga daily or every other day significantly increased the bone density from the start of the study in both the spine and femur, the thigh bone (8). There was also an increase in hip bone density, but this was not significant. The strength of the study includes its 10-year duration. However, one weakness was that this trial did not include a control group.

Another was that 741 participants started the trial, but only 227 finished, less than one-third. Of those, 202 were women. Significantly, prior to the study there were 109 fractures in the participants, most of whom had osteoporosis or osteopenia, but none had yoga-related fractures by the end of the trial. The “side effects” of yoga include improved mobility, posture, strength and a reduction in anxiety. The researchers gave a nice road map of specific beneficial poses. Before starting a program, consult your doctor.

The moral of the story is that exercise is beneficial. Yoga may be another simple addition to this exercise regimen. Calcium may be good or bad, depending on its dietary source. Be cautious with supplemental calcium; it does have side effects, including kidney stones, cardiovascular events and gastrointestinal symptoms, and consult with your doctor to assess whether you might be in an overtreatment or undertreatment group when it comes to medication.

References: (1) uptodate.com. (2) nof.org. (3) Clin Interv Aging. 2015;10:1813-1824. (4) JAMA Intern Med. online Jan. 4, 2016. (5) BMJ 2015; 351:h4183. (6) BMJ 2015; 351:h4580. (7) Top Geriatr Rehabil. 2009; 25(3); 244-250. (8) Top Geriatr Rehabil. 2016; 32(2); 81-87.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Jeff Nilssen trains inside a gym in Thailand. Photo from Jeff Nilssen

By Colm Ashe

In Thailand, 27-year-old Jeff Nilssen marveled from the sidelines as one of his trainers, Jom, unleashed a fury of vicious leg kicks. It wasn’t long before Jom dislocated his opponent’s knee.

According to Nilssen, Jom is “the nicest guy in the world, 120 pounds and can literally kick your leg off if he wants to.”

The next day, Jom was laughing and hanging out with everyone at one of the many camps Nilssen stayed at during his trip to Thailand.

In America, fighting with your peers can be a recipe for disaster, but Nilssen is well acquainted with the type of brotherhood that forms from muay thai, Thailand’s national sport, also known as the “art of eight limbs,” because it utilizes the fists, elbows, knees and shins to physically enhance a full-contact fighter.

Nilssen has been training as a martial artist and kickboxer since he was 14 years old, but used his trip to gain a “deeper understanding for the different styles of Muay Thai and refine my technique in the sport’s country of origin.”

 Jeff Nilssen knocks around a punching bag in Thailand. Photo from Jeff Nilssen
Jeff Nilssen knocks around a punching bag in Thailand. Photo from Jeff Nilssen

For the last five years, Nilssen has been studying the combat sport. He took what he learned from his trip in January and broke ground with his newfound knowledge at Fusion MMM & Kickboxing, a gym in Port Jefferson Station, where he trains clients.

Although Thailand’s national sport is a deadly style of combat, Nilssen infused the various moves he learned, along with the discipline, to create his own personal style.

Most of the Muay Thai instructors at Fusion have a background in the Dutch style of fighting. With his knowledge of traditional Thai style, the gym’s repertoire has never been more expansive, giving a deeper meaning to the name “Fusion.” The best MMA fighters tend to adopt a style that blends multiple disciplines.

In the words of Bruce Lee, the trainers at Fusion “take what is useful, and discard what is not,” combining a medley of fighting styles from Brazilian jiujitsu, wrestling and karate, to taekwondo, chute boxing and western boxing. All together, the team has created an innovative and creative form of MMA.

It’s the environment seen in Thailand that Nilssen tries to emulate. In the country, the dominant religion is Buddhism. The combination of disciplined exercise and mindfulness fostered an environment in which Nilssen witnessed next to no “street” violence during his four-month stay, he said. The trainer described the Thais as “incredibly friendly and helpful people, but all warriors at heart.”

The fights he did see were organized events that “exemplified the duality of this warrior culture” and expressed how gracefully the Thais balance opposing poles of aggression and respect.

Each fight began with a dance called the wai kru, which demonstrates the fighter’s respect for his or her own gym as well as the physicality they possess, and ends with both fighters bowing to show respect for the opposing side.

Since the sport is so widely practiced, it was common for Nilssen to see kids as young as 10 participating.

Jeff Nilssen outside the Wat Chalong temple in Phuket. Photo from Jeff Nilssen
Jeff Nilssen outside the Wat Chalong temple in Phuket. Photo from Jeff Nilssen

“As a Westerner, this might sound outrageous, but it is their culture, not ours, and as an avid student of combat sports, I can see how the effect of this ripples through their culture,” Nilssen said. “It is an honor for the kids to represent their family and their gym. I know how influential competing has been on my life, so I can understand and respect this practice. The kids fought incredibly hard and with pride.”

Not only did Nilssen have a deep respect for the traditions he was exposed to, he understood them on a core level.

Nilssen returned to Port Jefferson Station in May in great shape, with a fresh new perspective and a diverse array of fighting techniques to implement into his classes following the life-changing experience.

Nilssen’s trainer at Fusion, George Lederer, said he wishes he could have “22 Jeffs at the gym to train with.” Lederer said he respects Nilssen, not only as a student, but as a training partner. Even when no one else shows up, the Fusion trainer is consistently there and ready to work.

Nilssen’s clients say they love that their trainer thinks outside the box, and has tremendous knowledge about how the body works and moves, to keep them safe but also push them to work hard.

“Jeff is a really knowledgeable, caring, and intense trainer,” Brianna O’ Neill said. “He knows how to push you out of your comfort zone and teach you amazing techniques. I have grown so much since I started training with him — both in my Muay Thai technique and my overall fitness level. He makes sure to tailor our sessions to my martial arts and fitness goals. I owe so much of where I am to him.”

Fusion also offers fitness programs for those uninterested in combat, hosting yoga and kickboxing.

For more information about Fusion, visit www.fusionkickboxing.com.

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