Sunday, January 23, 2011

The History of Tai Chi and Health-Part III: Tai Chi’s Use for Health Promotion

When Mao Zedong took power of China in 1949, he outlawed all traditional practices, including TCM, Tai Chi, and Qigong, and viewed them as superstitious (Chen, 2004). However, during health reforms Mao and his advisors began to see Traditional Chinese Medicine, including Tai Chi and Qigong, as an opportunity to aid in primary healthcare (Xu, 2010). Mao saw individual physical fitness as a sign of a strong nation. Qigong and Tai Chi fit into his vision of active masses, and his efforts in primary care inspired much of the Alma Ata conference in 1978 (Janes, 1999; Xu, 2010). Because Mao was a modernist who believed in science, a tremendous research effort began to explore Tai Chi and Qigong. Thus, Tai Chi and Qigong had to prove not to be merely a mystical superstition through using tools of scientific observation, which at that time were mainly large case studies (Kaptchuk, 2000; Xu, 2010).

Today in North America, Tai Chi has a variable and intense research history. It has been used and studied as an intervention on AIDS patients, haemophiliacs and just about every type of disease imaginable. One search on Google Scholar using the search term “Tai Chi” yielded 24,700 hits, and a search of the Cochrane Library website brought up reviews on Tai Chi and hypertension, headaches, depression, rheumatoid arthritis, fall reduction, and dementia.

One of the first influential studies on Tai Chi in the US was in 1996, when a team of researchers received funding from the National Institutes of Health to study Tai Chi and fall reduction (Wolf et al., 1996). There have been many studies replicating its efficacy in fall reduction, and it is included in many recommended guidelines for that purpose, including those issued by the Canadian Society of Exercise Physiology (CSEP, 2008), the US Department of Health and Human Services (US DHHS, 2008) and the American Physical Therapy Association (APTA, 1999).

Not many studies have been conducted on exploring its potential use in primary prevention, meaning preventing disease before people get a disease. I think this lack of research has to do with many preconceived notions people have linking Tai Chi with elderly people or because it is slow. Also, there is some controversy in exercise science fields as to how much of a role VO2max plays in prevention of cardiovascular disease. Recently, there has been some research that suggests musculo-skeletal strength plays a larger role than previously thought. If that is the case Tai Chi can maybe a good exercise for the primary prevention of cardiovascular disease.

Next The History of Tai Chi and Health-Part IV: Tai Chi and Chronic Disease

Thursday, January 20, 2011

The History of Tai Chi and Health-Part II: The origin of Tai Chi

The origins of Tai Chi are rooted in mythical Chinese culture. The Chinese credit the celebrated hero Zhang San Feng with the creation of Tai Chi. Legend has it that he observed a hawk attacking a snake. As the battle between the two animals ensued, the snake repeatedly used relaxed evasive movements to elude the aggressive attacks of the hawk. Finally, the exhausted and frustrated hawk flew away. There are several versions, using different birds, but this is the basic myth (Frank, 2003). However, the true origins of Tai Chi are in dispute. The first historical record shows Tai Chi was developed in the 17th century in Chen Village (Yang, 2010). Later, Tai Chi was passed on to Yang Lu Chan, who developed the Yang style, which is now the most popular and most researched.

Yang Lu Chan’s grandson Yang Cheng Fu became the inheritor of the Yang tradition. He defined Tai Chi as “the art of concealing hardness within softness, like a needle in cotton” and asserted that “its technique, physiology, and mechanics all involve considerable philosophic principles” (Wile, 1983, p.3). He popularized Tai Chi for the masses and distinguished two levels, the civil and the martial (Wile, 1983). The civil is the “essence” and can be used for development of health, which is referred to as a type of gong, or practice or skill. In this way it falls under the umbrella of Qigong, a type of Qi-based exercise that literally means the practice (gong) of moving life’s vital energy (Qi) (Cohen, 1997). The martial is the “function,” which has the civil in mind but can be used for self-defense (Wile, 1983). Traditionally, Tai Chi is often taught in this martial manner, in which learning the form is not an end unto itself but a first step in which the basics are internalized. Then, after a year or so, the student learns push hands and sword practice. Thus, Tai Chi is a martial art that contains within it self-healing principles intertwined in martial movements.

As Tai Chi has developed through the centuries and through various schools of practice, it has become not one specific set of movements but can be practiced in different forms. Empty hand forms are usually the main focus of most Tai Chi classes. “Long forms” contain many more movements than “short forms,” which are not traditional but are modified to ease the learning curve. Different traditional styles are descended from the Chen but have evolved as various families transformed them, including the Yang, Wu, Sun, and Li styles. The variability of forms and intensities of physical activity among them is one of the challenges in understanding Tai Chi.

This infusion of healing movements with martial movements signifies Tai Chi as a unique exercise. Many people compare it to Yoga but it is quite different because of this martial aspect. I know of many people who study Tai Chi solely for martial practices but predominantly Tai Chi is a healing exercise. This is especially the case in the US, where so many combative styles are promoted. Tai Chi has a comparative advantage in that it offers a mindfulness Qi-based exercise.

The next post will explore Tai Chi’s involvement in Health Promotion

Monday, January 17, 2011

The History of Tai Chi and Health-Part I: Tai Chi and Traditional Chinese Medicine

This series of blog posts will be in 5 parts. Hopefully providing a broad and in-depth picture of Tai Chi. For the first installment of The History of Tai Chi, we must explore its connection to traditional Chinese medicine or TCM.

Tai Chi is part of traditional Chinese medicine (TCM), both of which are indigenous practices from China. Because these holistic approaches are rooted in a time when doctors did not have today’s powerful medical and technological tools at their disposal, physicians tended to treat the whole person and the environment around them (Cohen, 1997; Kaptchuk, 2000). TCM, born thousands of years ago, epitomizes this approach (Hong, 2004; Kaptchuk, 2000). Health systems of that era were radically different from today, with no medical technology to speak of; secondary and tertiary prevention was not as efficient or effective. Consequently, people who lived prior to the advent of modern medicine had to be resourceful and devise systems of primary prevention, which were essential for survival.

At the basis of the TCM system stands Qi, which is often translated as a fundamental form of vital energy that animates all living things (Yang, 2009). Some scholars explain Qi’s place in Chinese thought as “a formless ‘reality,’ which, though not graspable by the senses, is immanent in all things” (Xu, 2010, p. 967). This belief in Qi is also essential to Tai Chi, which shares many principles with TCM and has been integrated into the TCM system.

Both Tai Chi and TCM are rooted in the Chinese philosophy called Taoism, which is based on intense observations of patterns in nature, such as the movement of water, wind, and rocks. Early Taoists developed treatises on longevity, hygiene, and immortality, and these ideas fuel much of Chinese culture. Feng Shui, dietetics, martial arts, painting, and TCM all use the same paradigm or explanatory model of how the universe works (Kaptchuk, 2000; Kohn, 1993; March, 1968). The individual is but a microcosm of the universe, and to achieve harmony or happiness, one should align himself or herself with Qi to stay in harmony with the melding of energy and matter (Kaptchuk, 2000). If an individual becomes un-aligned or a blockage occurs, then disharmony can fester and “dis-ease” or disease will result (Yang, 2009).

Taoism is represented graphically by the icon known in the west as the “yin-yang” symbol, which illustrates a balanced interrelationship of opposites—for example, night and day, and hot and cold, etc. (Frank, 2003; Kaptchuk, 2000). Embedded in its Taoist roots, Tai Chi literally means “grand ultimate point,” (Yang, 2008) the point of balance in the yin-yang. The oldest known writing that discusses yin-yang theory is the “I Ching,” or “The Book of Changes,” which describes the natural ebb and flow of energy in the universe and how that effects change, written during the Bronze Age, 1100 B.C. (Hong, 2004) (Yang, 2010). Tai Chi’s main aim, to harmonize or align oneself with Qi, was summed up by the Taoist sage Chuang Tzu in the 4th century B.C.: “Set your body straight, see everything as one, and natural harmony will be with you“ (Lan, 2002, p.217).

Next post will explore the beginnings of Tai Chi.

Thursday, January 13, 2011

Alton Brown and the Science Behind Salt

For a few years in late 1990’s, I worked in a kitchen gadget store in Seattle. We made many product recommendations to our customers, and of all the celebrity chefs we touted, Alton Brown received the highest ratings. Unfortunately, he chose to use his celebrity status and reputation against the public health campaign for salt reduction.

Alton Brown is a successful author, television show chef, and TV show presenter who writes and produces many cooking shows on the Food Network. Brown’s main show, “Good Eats,” presents him as a culinary expert, and his television work has made him a very influential person in the food industry. That is why I was shocked and disappointed to see Brown adding his unique touch of comedy and science to the promotion of salt, sponsored by Cargill, a multinational corporation that produces salt and other food products. Cargill and many others in the processed food industry have been battling public health and its salt reduction campaigns since the 1970’s

Cargill’s latest crusade to promote salt includes an interactive website dedicated to Brown’s pitch: The website features Brown as a tour guide/lecturer at Salt 101 Labs. In an extremely formal environment that screams power, he spouts about 10 facts about salt, such as “salt is goood!” “salt is a necessary component to the natural functioning of cells,” “sodium chloride, NaCl, is a compound all humans need to survive,” and “whoever controls salt is in power, and in my home it is me; I control the salt.” The message is clear, salt is not only tasty, but it is also good for you, life sustaining, and powerful. There are also interactive games where, for example, you can move Brown’s arm to season a meal with salt.

After viewing the intro, the user can click to enter the “lab” or the “kitchen.” Both links present authoritative information about salt with a bias towards using more. Brown is in his element explaining technical details to viewers. He excels at explaining the science of food, such as human taste, the chemical make-up of salt, and why it is so effective at enhancing flavor. The scientific facts sound reasonable and non-controversial, and it is unlikely there are factual errors in the science Brown presents. The real problem with the videos is not inaccuracies in scientific reporting but what information is omitted. In fact, there is only one potentially negative comment about salt: putting salt on snails will kill them because they are mostly made of water.

The one potentially redeemable aspect of the video is that they do recommend sea salt—Diamond Crystal sea salt to be precise—because sea salt has less sodium than regular salt. But this is still without much value because of the excessive promotion of adding salt to food.

While it is true that salt is necessary for sustaining life, the missing pieces of information are that humans only need a tiny amount (1,200 to 1,500 milligrams per day) and that excess salt consumption (above 2,300 mg per day) is strongly associated with serious health risks like hypertension, cardiovascular disease (CVD), and stomach cancer Cardiovascular disease is the number-one killer globally, and hypertension is one of the strongest predictors of CVD mortality. Brown’s salt industry presentation does damage to the health initiatives trying to reduce mortality.

There is no doubt that we as humans have cultivated a salt craving. Much of the world’s population consumes salt in quantities of greater than 6,000 milligrams per day, with Eastern European and Asian countries averaging higher than 12,000 milligrams per day. In 2004, the average Canadian daily salt consumption was 7,800 milligrams. Observational studies going back to the 60’s, conducted on indigenous peoples where salt consumption is low have shown that hypertension, the leading cause of CVD mortality, is extremely low there as well, making them a low-risk population. These groups of people had salt intake levels hovering around 1,000 milligrams per day.

Companies like Cargill make their money by “adding value” to food, which means they process it for the consumer. Processed foods account for 70% of the salt in the Canadian diet. For example, the label on a pack of Oreo cookies states that one serving (three cookies) has 160mg of sodium, which is 1/14th of the maximum recommended amount. To further encourage people to put additional salt on chocolate covered cookies and ice cream—a recipe proposed by Brown in the video--is nothing short of dangerous to public health.

Such companies have an incentive to promote salt content in foods, and consumers have built a taste for it. The taste for salt can be reduced, but it can be difficult to change, so any doubt cast on the evidence or authoritative messages proclaiming that salt sustains life make it that much harder for public health practitioners to protect consumers.

The exact pathogenesis of salt is not known, and that leads to the doubt exploited by industry. That is why an etiological understanding of salt’s effect in humans is an important step in regulating the processed food industry. Thus far, the most accepted explanation is that excess sodium in the human system can lead to decreased sodium excretion and water retention. This increases plasma volume and increases vascular tone and contractility, which increases blood pressure, resulting in hypertension.

The Salt 101 video portrays salt as healthful, nourishing, and empowering. By combining Brown’s comedic genius with the persuasive potential of social media, Cargill seduces viewers to ignore those charged with protecting the public health.

(References available upon request)