Saturday 30 October 2010

Nori Edamame Salad With Ginger-Miso Dressing


I was inspired by the "The Plant Based Dietician" and her post for Nori Edamame Salad with Miso Sauce. I love Nori so I decided to create this beautiful salad.  I used bell peppers instead of cucumbers because I had forgotten to buy a cucumber.  Also, I think I went a little crazy with the Nori.  If you watch Julieanna's video, she didn't use as much as I did.  I also cut up little thin pieces of Nori and decorated the top of the salad. This was a really tasty dinner. She didn't include a specific sauce, but suggested some kind of miso dressing. You can buy one from your Health Food Store or make the Ginger-Miso dressing I have included.  Below is the recipe and ingredients I used.  Watch the video above with Julieanna ~The Plant Based Dietician" to help see how to assemble the salad. 
This was so quick and easy.  I also liked that I had virtually no mess in my kitchen to clean up.  YEAH!!


Nori Edamame Salad with Ginger-Miso Dressing
Printable Recipe
Serves 2-3

3 Nori large squares cut-up into rectangles. (I used 4 squares) (slice a few of the rectangles for topping)
1bunch of romaine lettuce
2 cups red cabbage (sliced)
1 cup carrots (match stick)
1 cup bell pepper (sliced)
1 cup frozen (thawed) Edamame
1/2 avocado (sliced)

Ginger-Miso Dressing
1 (2-inch) piece fresh ginger, coarsely chopped
2 tablespoons white miso
3 tablespoons tahini (sesame paste)
1/2 cup water
3 tablespoons fresh lemon juice

Mix together ingredients and pour over salad.

Assembling Salad:

Line salad bowl with Nori squares.  Mix together in separate bowl romaine lettuce, cabbage & bell peppers.  Pour mixture over Nori squares in bowl.  Add sliced avocado and edamame on top and garnish with additional thinly sliced nori.

Friday 29 October 2010

Does Alzheimer's Prevention Research Deserve More Funding?



Three separate items caught my eye recently related to the demographic challenge of aging and clinical neuroscience disorders of old age--primarily Alzheimer's disease and Parkinson's disease.

The first was the TED Talk of Gregory Petsko on the coming neurological epidemic. Here are my notes on the presentation--it is only about 4 minutes in lengh.

  • Next 40 years epidemic of neurological illness on global scale
  • Map of countries with >20% over 65 expanding
  • Lifespan doubled since 1940
  • Risk of Alzheimers increases exponentially after age 65
  • Alzheimers and Parkinsons Disease key disorders
  • Misfolding protein key to the development of Alzheimers
  • His research tries to develop drugs to inhibit this folding of tangling of brain proteins
  • Alzheimers disease linked to lower cancer risk
  • Current research funding by private entities
  • Government has dropped the ball
  • Caffeine protects against Parkinsons
  • Brain injury (concussion) is significant dementia risk factor
  • Chronic hypertension also raises risk
  • The clock is ticking for all of us
The second item was an editorial in October 27,2010 New York Times by Sandra Day O'Connor, Stanley Prusiner and Ken Dychtwald entitled "The Age of Alzheimer's". Key points in this editorial:
  • For every penny spent on research on Alzheimer's the U.S. spends $3.50 on treatment.
  • Yearly costs for the treatment of Alzheimer's estimated to increase from current $172 billion per year to $2 trillion in 2020 and $20 trillion in 2050.
  • When U.S. research efforts target key illness with sufficient funding results emerge.
  • A 10-year commitment to fight AIDS found effective treatments and added $1.4 trillion to U.S. economy. NIH spends about $3 billion per year on AIDS--there are five times as many
  • Alzheimer's disease patients and this disease only receives about $469 million per year in NIH research funds.
Congress has a bill to raise annual federal investment to $2 billion per year. The authors endorse pushing this investment through during the lame-duck session of Congress following next week's mid-term election.

The third item is the a scientific research summary manuscript entitled: Promising Strategies for the Prevention of Dementia. Middleton and Yaffe recently summarized the best research evidence for the most promising strategies for prevention of dementia. Although there is no universally endorsed prevention approaches in Alzheimer's disease, the authors note promise in the following areas:

Vascular Risk Factor Reduction:
  • Treat hypertension
  • Reduce high cholesterol
  • Identify and treat diabetes
  • Encourage reduction in smoking
  • Identify and treat metabolic syndrome (abdominal obesity, hypertriglyceridemia, low HDL cholesterol, hypertension and/or hyperglycemia) 
Cognitive Ability
  • Encourage people to get a college degree (or pursue highest level of education possible
  • Stay mentally active throughout adulthood 
Physical Activity
  • Reduces several vascular risk factors
  • Increase  brain neurotrophic factors 
Social Engagement
  • Develop and strong social network
  • Stay connected with friends and family members
  • Watch for the onset of social disengagement as it may be an early sign of dementia
Diet
  • No generally endorsed diet
  • Mediterranean diet (high in fruits, vegetables, fish, olive oil) may reduce dementia risk through reducing cardiovascular risk factors
Depression
  • Depression may be a early symptom or prodrome of dementia
  • Depression treatment (and seeking care) in elderly may lead to diagnosis of depression
  • Cognitive deficits may induce depressive symptoms
One promising prevention for dementia interfaces with prevention of brain trauma.  Funding brain trauma prevention is likely to also aid in reducing the risk of dementia in later life.

So the clock is ticking and like the national debt, the numbers are scary and growing daily. Promising prevention and treatment approaches are available. What will the research funding response be?

Middleton LE, & Yaffe K (2009). Promising strategies for the prevention of dementia. Archives of neurology, 66 (10), 1210-5 PMID: 19822776

Tuesday 26 October 2010

The Female Body Breakthrough

You know, I love doing book reviews and I hardly ever do ‘em. This is perfect seeing that my summer exploration into some of the popular bodybuilder and fitness enthusiast ideas regarding weight loss is coming to a close with a ceremonious “Eat the Food.” This is kind of like asking for a Woot Woot or an Amen. Here, I asketh upon the clergy, “Can I get an EAT THE FOOD-ah?!”

Actually, if we are going to go into full-blown cult status, we should call ourselves “Fuddhists” and worship Fuddha. Pronounced “Foodists” and “Foodha” of course.  Read the Fuddhist Bible HERE

So anyway, yeah, if I can stop thinking about food for a minute - like this GRILLED CHEESE maybe I could get going on this book review. Here goes.

The Female Body Breakthrough by Rachel Cosgrove is a book review that I issue to you ladies out there. A jam for the ladies and the superstars. My typical conversations about fitness can get a little Bro-ey, so hopefully this will even the score.

And when it comes to bro-ness, Cosgrove’s book is like the antithesis to all things male. Reading it felt like payback for all the times I made women in my life watch Predator, or Cabin Boy, or early-era Adam Sandler films – something that my willingness to watch that dance movie with Julia Stiles, that lame pairs figure skating movie, multiple viewings of A Walk to Remember, and even an at-the-movie viewing of Crossroads evidently didn’t make up for.

Although it would be an easy target for ridicule – I often found myself laughing while I was reading it due to her way over-the-top femaleness (B.I.T.C.H. – Be Inspiring Totally Confident and HOT!), we’re going to break this beauty down purely on substance and substance alone – because Cosgrove possesses some genius, and her message could very well be eclipsed by her She-Ra geekiness if it wasn’t for someone to translate what it is about her information that is a “Breakthrough.”

Cosgrove is the wife of Alwyn, and together they own a gym out in California where they “build butts.” Together, along with guys like Scott Abel, they are on the true cutting edge of exercise physiology. That cutting-edge understanding, although not elaborated upon much in the book itself, really comes through in the well-photographed and documented exercises as part of Cosgrove’s program.

Before we go any further, let me give you the basic premise of the book…

1) Cardio and aerobics and all that stuff stinks
2) If you want to look hotter, it requires having less body fat AND more muscle mass
3) The way to achieve that is to do a combination of metabolic exercise and strength training (which we’ll discuss), while eating a nutritious whole foods diet without obsessing over macronutrients, calories, etc.

Sounds reasonable. It is. In fact, although she didn’t quite go into such detail, you can basically categorize exercise into 2 categories…

1) Exercise that forces your body to do things more efficiently (burn less calories to do the same thing)
2) Exercise that forces your body to adapt by increasing its power capability, which, by definition, means becoming LESS efficient in a sense.

In other words, a performance athlete can generate huge amounts of power in a short period of time because their bodies are optimized for that type of activity. For endurance activity, muscle, particularly explosive fast twitch muscle is a huge burden – it burns way too many calories and will make you really tired if you tried to run 10 miles on legs constructed of fast twitch muscle fibers. Likewise, marathon runners are typically super weak, and cannot generate power.

Both adaptations are smart and appropriate adaptations to various forms of exercise. In fact, the body’s ability to make such adaptations is something to be marveled at really. But in a conversation strictly about cosmetic exercise, there is absolutely no doubt that fast twitch muscle-building and power-generating exercise is what yields superior results. But I guess it all depends on who you wanna impress. Once again we return to discussing Weird Al, who likes small butts and he cannot lie vs. Sir-Mix-A-Lot, who likes ‘em real thick and juicy.

But just to say “go lift weights” is incomplete. Cosgrove is a master of exercise physiology, and her workouts are designed to achieve something far beyond traveling around each exercise machine and making a few check marks on your clipboard.

Her workouts are a fine blend of asymmetrical movements, balance movements that activate what is called “proprioception” that Abel loves talking about, power moves that cause rapid muscle firing (like what you get from plyometrics), and some otherwise pretty badass stuff with an emphasis on overload (which is atypical for women-centered weightlifting which can be pretty light and fluffy). Overload means doing enough to force the muscle to adapt and increase its strength, size, and hardness. And it’s all done emphasizing full ranges of motion as well for full muscular development.

With Cosgrove, you’re not doing the typical bicep curls with 5 pounds dumbbells so fast and effortlessly that you are practically fanning yourself while you’re doing them. She’s more into classical strength training with heavier weights that you struggle to maybe, if you’re lucky, do 8 repetitions of. The result is that she and her clients are like superheroes, busting out chin-ups a half dozen at a time or more.



So you’re doing, not sissy stuff, but friggin’ one legged dumbbell deadlifts, super deep squats, front squats, and all that. Hence her claim that all of her clients have excellent butts that you can bounce a quarter off of.

These 3 times per week workouts are later punctuated by at least one “metabolic” workout per week. This is basically hardcore bodyweight exercises, plyometrics, rope-jumping, pushups, ab work, and all that blended into a high-intensity round patterned after high-intensity interval training (But I think Abel proves that this is unnecessary, and can very easily be worked into a strength training workout by doing the workout with very little rest in between sets. This is of course, the premise of his Metabolic Enhancement Training – combining what Cosgrove has made separate).

Anyway, her infatuation with postworkout protein shakes aside, Cosgrove’s book is a good primer into a result-generating fitness routine that many women could adopt into their own workouts. The name of her gym, “Results Fitness” is very appropriate. If I needed to pick up chicks I would definitely go there before going to a bar for that purpose, although protein-shake-swilling babes are not much sexier than the alcohol-swilling variety. Of course, 180 is not a fitness or exercise physiology palace by any means, but the book and the principles behind the exercises she highlights are worthy of mention – or worthy of recognition I should say.
I’m actually hoping to build my butt a little. I pretty much turned mine into a deflated balloon with years of hiking – an exercise done with very small ranges of motion that worked my quads and hamstrings like a champ, but left my ass hangin’.

So yeah, I’m looking to have a female body breakthrough in my butt. Shut up. I kill you.

The meat of the book is great. Illustrations are great. It’s not overly complex – even though I might have made it sound that way. All in all, for a woman who is really burning to build a “fit and fabulous” body, Cosgrove has created a pretty damn good roadmap. Treadmills, exercise bikes, Elliptical machines, and Stairmasters are forbidden. You gotta like that.  

The Gut as Man's Second Brain




Herbert Watzke recently presented a TED talk titled "The brain in your gut". Watzke is a food material scientist who has set up a department in this discipline at Nestle. This research focusses on how a multidisciplinary approach (chemistry, nutrition and neuroscience) can bring about ever better food sources (and maybe even better chocolate). His recent TED talk focussed on how we should see humans as benefiting as a species from the development of cooking and how our gut serves as a second brain. I have previously published a post looking the function of the brain insula--a region that appears to map for sensations from the gut and other body regions.  Here are my notes from his presentation that is just over 15 minutes if you have the interest and time.



We should call ourselves the coctivor rather than carnivore--we live to cook
Cooking was key to brain development in humans
Our brain growth has been key to our the development of our species

Food+Cooking=Energy
Cooking caused the brain to grow and the gut to decrease in size
Our stomachs are 60% of the size of the stomachs of similar sized primates
Cooking allowed the human species to migrate and colonize remote locations

Our gut has a silent voice

A tale of two brains---
Our gut has connection to the brain in decision making
A "gut feeling" influences our cognitive brain in decision making
Gut in innervated with complex nervous tissue

The gut is 40 feet long with 400 square feet of surface are it has 500 million nerve cells, 100 million neurons--around the size of a cat brain
  • 20 types of neurons with autonomic microcircuits
  • Senses both chemical and mechanical
  • Control muscle movement of gut
  • Controls the secretion of enzymes and hormones
How do these two brains work?
Gut lumen sends signals to the big brain for behavior integration
Gut lumen through chemical and mechanical sensing serves as a brain-in-gut digestion defense that sends hunger satiation signals to the big brain integration of behavior
The higher brain can interfere in the function of the gut-brain
Over-ride the hunger signal can result in anorexia nervosa

His research shows how food matrix breakdown occurs in ingested olive oil
How can we change cooking so that we have molecular language development in the gut?
Taste and Reward and Food Matrix can produce energy balance
Coquo Ergo Sum
I cook, therefore, I am

Thursday 21 October 2010

2 lb. Bag Chia Seed Giveaway!!

I am having a drawing for a 2 lb. bag of "Chia Seeds from ChiaSeedsDirect.com" Chia Seeds Direct has so kindly offered to give away these precious Chia Seeds to one of my readers in the US or Canada!! These seeds will be shipped directly to the winner by Chia Seeds Direct. I hope you will try out my two recipes below and the recipes on their website. Their Chia Seeds are of the very highest quality at a very low price~plus you get free shipping on all US orders. The Chia Seeds are a 90/10 mix of dark & light seeds.  All you need to do to be entered in the drawing is to leave a comment below so I can contact you if your name is drawn. The drawing will take place next Friday, October 29th in the afternoon. Check out all the great information on the Chia Seeds website.

     Christina Pirello, MFN, CCN one of America’s preeminent authorities on natural and whole foods, tells how to "Change Your Life With Chia."

Chia Seeds are a powerhouse nutritional food!

•Benefits superior to flax seeds.
•Naturally rich in antioxidants.
•Very mild flavor (no fishy taste like other foods high in Omega-3 acids).
•Extremely rich in Omega-3 acids.
•Very good source of fiber and magnesium.
•Raw, low in sodium and cholesterol-free.
•Organically grown without pesticides and cleaned without chemicals.
•Long shelf-life (up to 36 months)
•High in Protein (provides all of the eight essential amino acids).

You can download a free 16-page booklet on chia seeds, chia seeds benefits and chia seeds recipes.  Some of the recipes include Chia Lemonade and Almond Chia Maca Shake. The link to this free booklet is Chia Seeds: A Nutrition Powerhouse.

Health Seeker's Kitchen Recipes

Many of you have already heard about my Lemon Chia Fudge and my newest creation Raw Chia Smoothie Energizer. The Chia Smoothie Energizer will give you energy you didn't know you had:) Read more healthful information about Chia on my Lemon Chia Post.
Health Seeker's Kitchen
Lemon Chia Fudge
Printable Recipe

1 cup Vegan chocolate chips (melted)
3/4 cup organic raisins
1 tbsp. organic vanilla extract
2 tbsp. Chia seeds
1 lemon (juice only)
1/2 - 1 cup raw walnuts (chopped)

Melt chocolate chips in a saucepan on low. In small food processor or blender mix raisins, vanilla, chia seeds and lemon juice. Process until smooth. Pour in melted chocolate and mix well. Stir in walnuts and pour into small (very small 6" x 7" container). I used a small glass pyrex dish and used 3/4 of the dish by smoothing it to the size I liked. Also, smooth top of fudge so it looks perfect. Place in freezer and watch carefully for fudge to firm up, but not get too firm so you can slice easily. Slice into squares and either place back in freezer or leave at room temperature. ENJOY!

Health Seekers Kitchen
















 Raw Chia Smoothie Energizer
Printable Recipe
Serves 1

1 cup fresh squeezed apple juice
2 Tablespoons Chia Seeds
(Soak Chia seeds in apple juice for 30 minutes)

1 frozen banana
1 cup fresh spinach
2 sprigs parsley
1/2 lemon with rind cut away
4 ice cubes

After soaking Chia seeds put all ingredients in blender and process until smooth.  Poor into glass and garnish with slice of lemon.  Delicious!!  Enjoy the energy!!

Belly Fat, Cortisol, and 11Beta HSD

Oh yeah, nothing like some good old fashioned 11Beta Hydroxysteroid Dehydrogenase.  I know it was on everyone's mind lately, so I thought I'd bring it up.  Thanks to Shawn Talbott (shown left), author of The Cortisol Connection, as well as Jon Gabriel of the The Gabriel Method for turning me on to this intracellular enzyme that takes inactive corticoids and converts them into cortisol, our buddy and driving force of the creation of the infamous potbelly.

I do think 11Beta HSD is a huge game changer though.  Knowing the properties of cortisol, it seems increasingly obvious that it is the primary driver of insulin resistance, leptin resistance, obesity, metabolic syndrome, type 2 diabetes, and so on.  At least in theory it should be, due to its basic properties.  But in actuality, most people don't have high cortisol levels.  In fact, most people tend to have cortisol levels on the low side due to adrenal fatigue/hypoadrenia which we are bound to discuss in the near future.

But with 11Beta HSD, which is particularly active in liver and adipose tissue, particularly in the abdominal region, you don't have to have high cortisol levels to have high cortisol levels.  Does that make sense?  Anyway, watch the 2-part video and don't make fun of my hair or how I say "considerable" or I will freakin' cut your face man! 



Why Is Anorexia Nervosa Neglected for Drug Development?

Atypical Antipsychotic Olanzapine
Eating disorders have been a neglected area for high-quality psychopharmacologic research.  There are probably several reasons for this.  The classic eating disorder anorexia nervosa is relatively rare and identifying 500 to 1000 subjects for a clinical trial would likely be a significant (but not impossible) research challenge.   There are currently no FDA approved drugs indicated for the treatment of anorexia nervosa.

One drug in the U.S. has FDA approval for bulimia nervosa, the antidepressant fluoxetine.  But this approval occurred in the late 1980’s meaning we are approaching twenty-five years without a new drug approval for bulimia nervosa.  Pharmaceutical company interest in bulimia may be tempered somewhat by the experience of a trial using the drug bupropion.  Bupropion appeared effective in reducing binge eating in bulimia nervosa but a the clinical trial participants on bupropion had an increased risk of seizures during the trial.  The electrolyte disruption seen in bulimia (from bingeing and purging behaviors) may contribute to an increased risk of seizure—particularly for drugs with a known risk of reducing seizure thresholds.

So is anorexia nervosa neglected because there just are no potential candidates?  There is some evidence of the potential for the atypical antipsychotic medications in anorexia nervosa.  This evidence comes from outside the FDA approval process and typically involves small numbers of subjects.  McKnight and Park from the Department of Psychiatry at the University of Oxford recently summarized the research knowledge base in this area.

Why should atypical antipsychotics be considered for an eating disorder?  McKnight and Park propose three reasons:

  • Atypicals reduce agitation and anxiety—common hindrances in refeeding underweight patients with anorexia nervosa
  • Atypical often cause weight gain
  • Some features of anorexia nervosa resemble psychosis—persistent belief of being overweight despite starvation and weight loss
Only three double-blind trials have been published according to this review.  All involve olanzapine versus placebo.  Two of these studies found and increase in BMI (weight) with the drug.  All of the these studies found some favorable effect on anxiety, depression or eating disorder psychological symptoms.

One single blind study compared the atypical antipsychotic drug amisulpride to fluoxetine and placebo.  Amisulpride produced a significant weight gain compared to the other two treatment arms. 

Four open label non-blinded studies suggest the potential for quetiapine to have a favorable effect on weight gain and/or reduction in eating disorders psychological variables.

Evidence for the use of other atypical agents (i.e. risperidone, aripiprazole) is limited to a few case reports, but these have generally been favorable.  One case report noted development of hyperglycemia in adult with anorexia receiving 15 mg of olanzapine daily.

I searched the ClinicalTrials.gov website for anorexia nervosa and found only two active clinical trials recruiting subjects:

  • Olanzapine versus placebo for outpatients with anorexia nervosa (an NIMH-sponsored study) conducted by Cornell, University of Pittsburgh, Johns Hopkins and the University of Toronto with a targeted enrollment of 160
  • Aripiprazole versus placebo—a phase III study being conducted at the University of Barcelona in Spain with a targeted enrollment of 60
So the history of neglecting anorexia nervosa for drug development seems to be continuing.  What will it take for more research attention to this important disorder so that clinicians will have more to offer the patients and their families?

Image of Chemical Structure of Olanzapine provided in the public domain by author Ben Mills.

McKnight RF, & Park RJ (2010). Atypical antipsychotics and anorexia nervosa: a review. European eating disorders review : the journal of the Eating Disorders Association, 18 (1), 10-21 PMID: 20054875

Wednesday 20 October 2010

Google As a Medical Diagnostic Tool


My Google Reader accidentally picked up an intriguing abstract that examined a research study of resources that medical students use in solving diagnostic cases.  The abstract was picked up because it contained the word “exercise” that is one of my PubMed filter queries.  Although we often think that most diagnostic decision-making occurs from learned information stored in physician’s brains, information resources can be very helpful.  What information resources are medical students using to help them with the diagnostic process?

Graber and colleagues asked this question and designed a learning experiment.  One hundred and seventeen medical students were presented a challenging case and asked to provide their top three diagnoses as well as listing all the resources they used and the helpfulness of each resource.  This experiment occurred as part of a examination of the web-based decision support system known as Isabel.  The top six most used resources (and the percent of medical students who used the resource in the experiment) were:
  • Medical books (73%)
  • Google (70%)
  • Other students (69%)
  • Journals (49%)
  • Residents and attending (29%)
  • Isabel (28%)
 Of note, here were the students ratings of the top resources by usefulness (Likert Scale 1-not helpful to 5=extremely helpful:
  • eMedicine (4.0)
  • Medical books (3.9)
  • Up-to-Date (3.8)
  • Google (3.6)
  • Other students (3.5)
  • Journals (3.4)
  • Residents and attending (3.4)
So this group of medical students reported frequently using Google to assist in a diagnostic assignment and they rate it as extremely useful.  The students also endorsed eMedicine a web-based medical information resource and the Up-to-Date subscription medical information resource.  (Disclosure: I have written two chapters published by eMedicine).  It is not clear how the students defined using “journals” in this study.  I would have thought that PubMed would be a particularly good gateway for searching for diagnostic information by finding journals relevant to a specific clinical case presentation.

The use of Google for aiding in diagnosis is not limited to medical students and physicians.  Bouwman and colleagues describe two cases where parents were able to diagnose their child’s rare lysosomal storage disorder using Google.   Both cases had received extensive evaluation by medical personnel that did not result in a correct specific diagnosis.  Both child’s parents arrived at a correct diagnosis by using Google search.  In case one, the parents searched for “unexplained recurrent fever”, “pain in feet” and “skin rash” leading them to a site describing Fabry disease.   In the second case, parents typed in a sign their son exhibited “bowed fingers” and were led to a site for their son’s correct diagnosis of mucopolysaccharidosis.

Google can also provide false, irrelevant medical information when it comes to diagnosis.  Most clinicians have experienced patient’s making an incorrect self-diagnosis from information they obtained on the web.  It is best to use multiple sources of information when puzzled by a case presentation.  However, it appears that Google Search is playing an important role in how clinicians and the general public collect diagnostic information.  We need more research examining the potential power of this tool and the limitations.

Photo of Vijay Singh practicing putting at the 2010 PGA Championship courtesy of Yates Photography

Graber ML, Tompkins D, & Holland JJ (2009). Resources medical students use to derive a differential diagnosis. Medical teacher, 31 (6), 522-7 PMID: 19811168


Bouwman MG, Teunissen QG, Wijburg FA, & Linthorst GE (2010). 'Doctor Google' ending the diagnostic odyssey in lysosomal storage disorders: parents using internet search engines as an efficient diagnostic strategy in rare diseases. Archives of disease in childhood, 95 (8), 642-4 PMID: 20418338

Tuesday 19 October 2010

Spicy Black Bean Lettuce Wraps

I created these delicious lettuce wraps tonight and my 20 year old son ate them all. It was a good thing my husband was out of town because I would have had to come up with something else for dinner. I actually had a few of them and he ate the rest. We loved these.  Next time I am going to double the recipe.

Spicy Lettuce Wraps
Printable Recipe

Serves 4 as an appetizer, or 2 as a main dish:  Ready in 20 minutes

3 Tbsp. Nama Shoyu (Soy Sauce), or Bragg's Liquid Aminos
3 tsp. arrowroot Powder
2 tsp.  sweetener of choice
1 15 oz. can black beans drained
2 Tbsp. extra virgin olive oil
2 Tbsp. chopped fresh ginger
1 Tbsp. chopped garlic
1/2 cup chopped red bell pepper
1/2 tsp. crushed red pepper flakes
1/4 cup finely chopped green onion (about 2 stalks, chop entire piece)
3/4 cup chopped celery
1/4 cup chopped walnuts
3 Tbsp. chopped fresh cilantro
1 Tbsp. sesame oil
1 bunch butter lettuce
Cilantro sprigs and soy sauce, for garnish

1. Combine soy sauce, broth, arrowroot, and sweetener.  Stir until smooth.  Combine sauce with drained black beans and set aside. 

2.  Heat a large deep skillet or wok over medium high heat.  Add olive oil and swirl to coat pan.  Add ginger, garlic, and red bell pepper.  Cook, tossing often, until fragrant but not browned, about 1 minute.  Add chopped onion, sesame oil, cilantro, celery and walnuts. Toss well.

3.  To serve:  Arrange lettuce cups on a large serving platter and place a generous spoonful on each.  Garnish with cilantro sprigs and additional soy sauce to taste.

Enjoy!

Bupropion for the Treatment of Sexual Dysfunction

3D Model of Chemical Structure for Bupropion
Bupropion is a drug approved in the United States for the treatment of depression (Wellbutrin) and for smoking cessation (Zyban).  In contrast to the selective serotonin reuptake inhibitor (SSRI) class of drugs, i.e. Prozac, bupropion appears to have a predominant effect on blocking the reuptake of dopamine.  It appears to also be a nicotinic acetylcholine receptor antagonist possibly contributing to it’s effect on nicotine withdrawal symptoms.

Sexual dysfunction commonly presents as an adverse effect of the SSRIs and can be the reason for drug continuation in a significant minority of patients.  Some clinicians have used bupropion augmentation in an effort to reduce the sexual dysfunction associated with the SSRI drugs.  Many clinicians feel this is an effective approach despite limited research to support the strategy.   Now two randomized controlled clinical trials published from a research team in Iran provide more support for bupropion and it’s effects on sexual function in both men and women.

Safarinejad and colleagues conducted two independent studies.  In the first study, a series of women reporting distressing reduced sexual desire and activity were identified.   Three hundred and twenty three subjects were randomized to receive either bupropion SR 150 mg or placebo.   The study sample was limited to pre-menopausal women with regular menstrual cycles and no evidence of major depressive disorder.  The women on bupropion noted improvement in sexual function across a variety of psychometric domains.  Over 70% reported being definitely satisfied with treatment compared to less than 10% of those on placebo.   Bupropion was typically well-tolerated although rates of headache, insomnia, dry mouth, nausea and muscle aches were noted in between 5 and 10% of the bupropion group (statistically higher than the placebo group).

In the second study, 234 men being treated with an SSRI drug-related sexual dysfunction problem participated in a twelve week trial of bupropion SR 300 mg per day.  The types of sexual dysfunction included erectile dysfunction (73%), low sexual desire (66%), orgasm dysfunction (51%) and dissatisfaction with intercourse performance (50%).

Men assigned to the active bupropion treatment had significant reductions in the psychometric severity ratings in several domains.   Subjects reported reduced erectile dysfunction along with an increase their sexual desire.  The number of intercourse attempts increased from one to slightly more than two per week with bupropion while there was essentially no change in the placebo group.  Similar to the women’s study, men in the bupropion group had some increased endorsement of adverse effects including headache (8.5%), insomnia (6.8%), dry mouth (6.0%), nausea (5.1%), muscle aches (5.1%) and dizziness (5.1%).

The author notes that SSRI related sexual dysfunction is common in men and often not queried during medical visits.  Sildenafil (Viagra) also appears to be helpful for SSRI erectile dysfunction.  Given the research support for bupropion and sildenafil in ED associated with SSRIs, more clinicians should search for the problem and consider treatment options.  Neither drug has FDA approval for these indications, but clinical trials for these indications should be considered by their manufacturers.

3D model of the chemical structure of bupropion provided by the user:Sbrools under the Creative Commons Attribution-Share Alike 3.0 Unported license.

Safarinejad MR, Hosseini SY, Asgari MA, Dadkhah F, & Taghva A (2010). A randomized, double-blind, placebo-controlled study of the efficacy and safety of bupropion for treating hypoactive sexual desire disorder in ovulating women. BJU international, 106 (6), 832-9 PMID: 20151970


Safarinejad MR (2010). The effects of the adjunctive bupropion on male sexual dysfunction induced by a selective serotonin reuptake inhibitor: a double-blind placebo-controlled and randomized study. BJU international, 106 (6), 840-7 PMID: 20067456

Monday 18 October 2010

Understanding Belly Fat

“Those subjects who gained the most weight became concerned about their increasing sluggishness, general flabbiness, and the tendency of fat to accumulate in the abdomen and buttocks.”
-The Biology of Human Starvation… Response to the miraculous healing that took place during re-feeding after 24 weeks of calorie-restriction completely ruined the physical, mental, and emotional health of 32 young men.

Some mentions of belly fat came up in the comments section of a recent post. First of all, as a primer, belly fat – or visceral fat, is considered to be the most harmful type of fat. This type of fat is strongly correlated with insulin resistance, metabolic syndrome, and the escalating problem of impaired glucose metabolism on the way to an increased risk of heart disease, many cancers, obesity, and type 2 diabetes.

So what is it? Where does it come from? What encourages belly fat storage? What discourages belly fat storage?

As always, my response to these questions takes in a broader view than what is typically circulated throughout the health and nutrition world.

Once again we travel back to one of the most thorough and insightful studies done on real, live, human beings. Yes, a favorite of mine, and one that holds particular significance in my heart due to my personal experiences with starvation – The Biology of Human Starvation.

In the study, 32 men about my age, with an average height and weight of 5’10 and only a buck-fiddy on the scale (like 70-75 kg), had their average calorie intake of 3,500 calories per day cut approximately in half for 24 weeks. During the 24 weeks, they lost tons of body fat and became skeletonized by the low calorie intake. They lost all their belly fat too!

Hooray! The cure for belly fat! Just eat half the normal amount of calories that you normally eat! Word to yo mama!

Unfortunately, what this ignores, and why studies done on the subject and many related subjects are always incomplete, are the after effects.

The men were of course ravenous post-diet, just like any study subject of any calorie restriction trial regardless of weight when entering into the trial. Don’t think for a second that the fact that these men were lean going into calorie restriction makes any real difference when comparing them to overweight subjects. It doesn’t, as any of the leading obesity researchers will tell you.

And, these ravenous men ate their faces off obsessively, and promptly regained all the weight they had lost plus an extra 40%.

The men were split into 4 groups of 8, and each of the groups received a different re-feeding calorie level during the first 12 weeks of re-feeding. Only one group was allowed to eat as much as they wanted.

As you can see in the snapshot I took of the graph representing the weight gain of each group (click to enlarge it), and how that weight was redistributed, there was a disproportionally large increase in abdominal circumference compared to how weight was regained in the arms, legs, chest, total body fat, and so forth.

The “eat ad libitum” group (T) regained more than 100% of their abdominal circumference while only 60% of their body weight losses were restored at week 12. This means belly fat came first, long before muscle mass was fully restored. Or in Ancel’s precise words…

“Anthropometric data support this conclusion and indicate that during rehabilitation the adipose tissue increased in size more rapidly than the muscles. In the highest caloric group the circumferences of the upper arm, calf, and thigh showed an average recovery of 45, 46, and 54 per cent of the starvation decrement, whereas the abdominal circumference exhibited a recovery of 101 per cent [at week 12 of refeeding].”

In every group, abdominal fat accumulation outpaced fat and muscle deposition elsewhere. And this was just the first 12 weeks. If you are familiar with the other snapshot I took of a graph in the book, you can see that body fat levels didn’t peak in these men until 33 weeks post diet, at which point they had 40% more body fat than they did prior to the low-calorie period. Of course, at this point they not only had more total body fat, but the bulk of that fat was centered around the abdomen.

In other words, eating less food than you want to eat, followed by eating the amount of food you want to eat (or even less as was the case in the three groups NOT allowed to eat to appetite for the first 12 weeks), yields a nice rise in belly fat in proportion to other gains.

Wow. Now we have a real problem. We have “PROVEN” that cutting calories causes a loss of belly fat, and at the same time have shown that calorie restriction’s after effects cause a huge rise in belly fat compared to starting levels.

So does calorie restriction decrease belly fat, or increase belly fat? The correct answer, unless you omit the actual human experience of ravenous and uncontrollable hunger post diet, is that it increases belly fat. That’s what actually happens in REALITY, aside from what can be ascertained by nerding around in journals looking for answers to simple questions that lie right beneath your fricking nose.

“Oh but Matt, in laboratories calorie restriction seems to improve health and longevity in rodents, monkeys, and fruit flies.”

Well NEAT-O! In humans that are not locked in cages but are surrounded by a vast ocean of the most calorie dense and rapidly-absorbed foods man has ever devised, calorie restriction leads to out-of-control hunger, cravings, and a huge increase in belly fat depending on how many rounds you repeat the cycle of trying to achieve calorie deficit through restricting your food intake.

In real life, this doesn’t just happen with calorie restriction. Try carb restriction, which is INCREDIBLE for lowering belly fat! However, when followed by eating a bunch of carbs, which most people crave too strongly NOT to eat, while others are eventually forced to eat because of a long list of minor health problems like indigestion, anxiety, insomnia, constipation, cessation of menstruation, and so on developed due to long-term carbohydrate restriction…

Belly fat returns, and belly fat levels increase above and beyond where they ever existed prior. Hey, let’s not pick on low-carb. I got myself an excellent belly by overexercising for 5 months (great for reducing belly fat!), followed by a 2-week lowfat vegan diet (dropped even more belly fat!) followed by eating to appetite and packing on the most impressive midsection intertube of good lovin’ I’ve ever had the pleasure of carrying around (aided by beer, refined sugar, fruit, restaurant-fried food, and refined grain… none of which are part of the rehabilitative strategy that I have devised in THIS FREE EBOOK).

So the question becomes – does eating to appetite of a mixed diet with low to moderate exercise levels and plenty of good quality sleep and relaxation cause an increase in belly fat? Or is the increase in belly fat merely a RESPONSE to the stress you have subjected yourself to prior to actually eating and living granny-style?

If you are intellectually crippled with an aversion to real world observation and experience, or like to analyze diet and health in little fragments instead of seeing the whole picture, then low-fat vegan diets, low-carb diets, exercising like a fiend, and calorie restriction are all fantastic ways to reduce belly fat. It’s just a matter of picking the right guru to lead you to salvation.

More to come in the next post about whether or not the body chooses to store belly fat to completely sabotage your health and make your significant other lose interest in your physical appearance, or if, perhaps, by some far-fetched chance, gaining belly fat is an emergency rescue procedure performed by the body to protect you from the repeated deprivations and stresses it’s exposed to.

Seeking Depression Information on the Internet

The internet has grown as a source of health information for both clinicians and their patients.  Patients with mental disorders may be particularly drawn to using the internet for information due to the stigma associated with these disorders.  This makes it important for health educators to understand the demographic pattern of searches for health information including depression and other mental disorders.  A recent research study of those seeking information about depression provides some insight into the volume and pattern of web searches for "depression".  Fu et al conducted an interesting study that examined the number and pattern of internet searches for depression.  The authors used the following design in their study:
  • Query for all AOL users web searches between March and May 2006
  • Keyword depression with exclusion of obvious confounders, i.e. "great depression"
  • Limited to U.S. AOL users
  • Review of database of 21 million web queries.
The key results from their study included:
  • 3 of every 1000 internet searches sought depression-related information
  • 1.16 million search for "depression" estimated per month in the U.S.
  • The most common search areas related to depression were 1. general information 28%, 2. identification/managment 18%, 3. pharmaceutical company depression website 11%, 4. depression-related psychiatric comorbidities, i.e. anxiety disorder or bipolar disorder 7%, 5. female and pregnancy-related depression 5%, 6. teen depression 5%, 7. suicide 0.6%.
This study probably underestimates the volume of internet searches related to depression as some individual likely type in the name of a depression drug or other more specific information in their query.

The authors note the volume of public searches for depression should stimulate high-quality education for the disorder.  Health educators with high-quality, evidence-based information should also work to keep their information at the top of search engine queries.  There is a significant amount of misinformation about depression and mental disorders on the internet.  There needs to be an effort to make sure individuals searching "depression" get to sites that provide them the information they need to help them make good decisions about their symptoms and disorders.

Here are some of the web sites that I feel provide high-quality evidence-based information for the general public:

National Institute of Mental Health
Mayo Clinic
WebMD
Google Health
Drugs.com
National Association of Cognitive-Behavioral Therapists

If you have personal experience with sites that you would like to recommend, feel free to post your recommendations in the comments section.

Pricky Pear from Enchanted Rock State Natural Area in Texas courtesy of Yates Photography.

Fu KW, Wong PW, & Yip PS (2010). What do internet users seek to know about depression from web searches? A descriptive study of 21 million web queries. The Journal of clinical psychiatry, 71 (9), 1246-7 PMID: 20923627

Friday 15 October 2010

Podcast with Elizabeth Walling

Yesterday Elizabeth Walling interviewed me on The Nourished Life podcast.  We discussed mostly weight set point while diverging into a few side tangents such as exercise, the Paleo diet, and more.  You can listen to the podcast here...

The Nourished Life

I also regret my response to her last question, which was more or less "where does someone start?" when it comes to lowering the body weight set point.  I rambled a bit, and should have said something along the lines of...

"Wake up every day and try to set a new record for how well you nourish yourself that day with quality, unadulterated, nutritious food, a good night's sleep, plenty of pure water, and whatever else you find to be enjoyable and nourishing on a physical and emotional level." 

Thursday 14 October 2010

Brain Tutor HD iPad App Review

I have previously posted a review of the brain imaging applications Brain Tutor and 3D Brain.  My original review of the two applications for the iPhone and iPod Touch is located here and a review of the applications for the iPad are located here.

The original iPad review noted that the iPad versions of both applications were essentially the iPhone version with the common 2x modification that essential doubles the size of the image to accommodate the larger screen with the iPad.  There were no iPad specific changes in the original versions of these two popular and very useful applications.  That has now changed with Brain Tutor developing a new app specifically for the iPad called Brain Tutor HD. 

I have downloaded the new app and had the opportunity to spend some time with it.  I am very impressed because it provides two advantages over the iPhone version.  First, the resolution of the images in markedly improved and this improvement takes advantage of the iPad screen resolution.  Second, Brain Tutor HD adds new imaging modules include a both hemispheres view and a new set of images related to fMRI areas of research.

I have posted a comparison of a similar brain region from both the first version of Brain Tutor with the HD version for you comparision.  The top picture shows the frontal lobe using the early version with the second showing the HD version.  You can see the marked improvement in resolution with the new version.

The new both hemispheres view adds to the previous right and left hemisphere views in the previous version.  This is something the larger screen allows.  Like the previous version you can rotate in 3D and zoom images for more detail.

The fMRI module includes the following areas:
  • LOC-lateral occipital complex
  • hMT+/V5-occipital region responsive to direction and speed of moving stimuli
  • FFA-fusiform face area
  • PPA-parahippocampal place area
  • Hand somatosensory area
  • Hand motor area
  • SMA-supplemental motor area
  • PMA-premotor area
  • FEF-frontal eye field
  • STG-superior temporal gyrus
  • Broca’s area

 Each fMRI area is detailed in location and the method of functional localization.  The task that activates the area is described as well a relevant references related to area described.  Some of the areas lack relevant citations and some of the citations are somewhat dated in the application.

The only real down-side to the new HD version is that it is not free.  Previous versions were free applications and the current iTunes app store price is only $1.99.  This seems very reasonable for the remarkable graphics and the benefit this tool provides in learning brain anatomy.

More information about the Brain Tutor HD application can be found at the Brain Voyager website located here.

The next steps in brain imaging education advances will probably focus on true 3D imaging applications.  Brain Tutor and 3D Brain provide a 3D perspective using a two dimensional screen.  3D viewing applications (probably with new hardware) are likely to provide the next breakthough in understanding neuroanatomy.  Having a whole brain in your hand is a great way to learn but not practical for many.  The advantage of 3D teaching in brain anatomy has been recently demonstrated in a manuscript by Esteves at Boston University School of Medicine.  They found medical students learned better with using 3D modeling experiments to supplement two dimensional teaching methods.  Adding 3D to the iPad and web-based applications is likely to not be far off.

Brain Tutor and Brain Tutor HD screen shots courtesy of Yates Photograpy

Estevez ME, Lindgren KA, & Bergethon PR (2010). A novel three-dimensional tool for teaching human neuroanatomy. Anatomical sciences education PMID: 20939033