Monday, 31 January 2011

Raw Pineapple-Macadamia Salad

This beautiful salad was my lunch today.  The recipe idea came from Dr. Douglas Graham and his 80/10/10 Diet Book. Dr. Douglas Graham, a lifetime athlete and raw fooder since 1978, is an advisor to world-class athletes and trainers from around the globe. I love how he likes to take some of the salad ingredients, blend them up and then use them as a dressing.  What a fantastic idea and so easy!!


 Raw Pineapple-Macadamia Salad
Printable Recipe
Serves 2

1 bunch of Romaine lettuce
2 vine-ripened tomatoes
1cup fresh chopped pineapple
8 raw macadamia nuts (reserve 2 for garnish)
(pineapple chunks to garnish salad)


1.) Chop both the Romaine lettuce and tomatoes.  Place in bowl. 

2.) Combine one cup of pineapple chunks and 6 macadamia nuts in blender until smooth. Place mixture on top of lettuce and tomatoes.  Garnish with a piece of larger pineapple right in the center.

3.) Before serving, toss salad mixture together, add additional chopped pineapple for garnish and sprinkle with two chopped macadamia nuts.

4.)  Enjoy this very satisfying salad!!

Common Neuropsychiatric Problems in Epilepsy

Epilepsy represents a complex neuropsychiatric condition with significant public health impact.  The prevalence estimates of active epilepsy range from about 1 to 4% of the general population.  Like other medical conditions, epilepsy appears to increase the risk for a variety of secondary (or cormorbidity problems).  Understanding these related risks can aid patients, families and clinicians in understanding symptoms, common presentation conundrums and best treatment approaches. A recent epidemiology survey published by Ottman and colleagues of a large sample of the general population in the U.S. provides insight into the range and relative risk for variety of disorders in those with epilepsy.  The key elements of this survey include the following key design items:
  • Data part of Epilepsy Comorbidity and Health (EPIC) Survey
  • Mail survey to random households in the United States
  • Case definition of epilepsy a yes response to the following question: “Have you ever been told you have a seizure disorder or epilepsy?”.
  • Those who reported being diagnosed with epilepsy (2.0% of those surveyed) were compared to those without a self-reported diagnosis
  • Surveyed other neuropsychiatric, pain and other medical conditions included: anxiety disorder, depression, bipolar affective disorder, ADHD, sleep disorder/apnea, tremor/movement disorder, migraine, fibromyalgia, chronic pain, neuropathic pain, asthma, diabetes, high blood pressure
  • Risk ratios controlled for a variety of potential confounding variables including: sex, age, income, population density,census region, prior head injury, and prior stroke
The comorbid conditions with the highest relative risks (that were statistically significant) are shown in the accompanying summary figure.   A prevalence ratio of 2.0 would mean those with epilepsy are twice as likely to have the diagnosis compared to controls without epilepsy. ADHD, bipolar disorder, movement disorder/tremor and fibromyalgia led the rank list of diagnoses.  A significant number of the disorders showed statistically significant associations between a risk of 1.0 to 2.0.   The only disorders that showed no link to a diagnosis of epilepsy were diabetes and high blood pressure.

The primary weaknesses of these types of studies is reliance on self-report diagnosis by a the respondents.  One way to exam the validity of diagnoses is to conduct more detailed direct interviews and examinations of a subset of study participants.  Also the rates of self-reported diagnoses can be compared to known direct interview studies.  Here are the rates of self-reported neuropsychiatric diagnoses in those without epilepsy in the current study: depression 25.6%, anxiety 13.9%, bipolar disorder 6.8%, ADHD 5.5%.   The bipolar disorder self-report rates seem unexpectedly high and the implications for the validity of this study is unclear.

The authors note their study demonstrating a lifetime self-report prevalence rate of 2.0% is consistent with previous other population-based surveys.  Neuropsychiatric comorbidities were common in those reporting epilepsy ranging from a low of 8.7% for neuropathic pain to 32.5% for depression.  The authors note this study will aid those caring for epilepsy and help target comprehensive assessment and managment.

Ottman R, Lipton RB, Ettinger AB, Cramer JA, Reed ML, Morrison A, & Wan GJ (2011). Comorbidities of epilepsy: Results from the Epilepsy Comorbidities and Health (EPIC) Survey. Epilepsia PMID: 21269285

Winter Asparagus-Fennel Soup

This is an incredibly good soup for preventing and fighting a flu or cold. It also tastes sooo....delicious. The detoxing effects of asparagus, the anti-septic & anti-bacterial effects of onion and fennel's ability to help with respiratory disorders such congestion, bronchitis and cough, make it a SUPER SOUP!! I added brown rice as an excellent source of all-around nutrition. If you have never tried fennel, it is delicious and has a very slight licorice aroma and taste.  The fronds look a lot like dill.

Asparagus has an abundance of an amino acid called asparagine, that helps to cleanse the body of waste material. As a result, some people have smelly urine after eating asparagus. Don't worry if this happens to you. Just be glad that your kidney's are functioning as they should. It is believed that most people produce the odorous compounds after eating asparagus, but only about 22% of the population have the genes required to smell them. Very interesting:) 

NOTE: According to the ancient Greek physician Hippocrates (460-377 BC), the founding father of natural medicine, the first and foremost principle of medicine must be to respect nature’s healing forces, which inhabit each living organism. Hippocrates considered illness a natural phenomenon that forced people to discover the imbalances in their health. He strongly believed in good food and related the course of any ailment to poor nutrition and bad eating habits. He stressed, "Let food be your medicine and medicine be your food"–advice that I believe in.

Fennel Bulb

Winter Asparagus-Fennel Soup
Printable Recipe

1 fennel bulb plant
1 bunch of asparagus
1 tsp. extra virgin olive oil
1 extra-large yellow onion
1/2 cup brown rice
4 cups (no salt added) vegetable broth
1 cup almond milk
2 tsp. sea salt or to taste (start with 1 tsp.)
freshly ground pepper, to taste.

1.)  Remove the fennel fronds from the bulb and stems.  Mince fronds to equal 1/2-3/4 cup.  Slice the fennel bulb and the stems into chunks.

2.) Cut 1 1/2 inches off the asparagus tips.  Cut remainder of asparagus into small chunks.

3.)  Slice onion into chunks.

4.)  Add 1 tsp. extra virgin olive oil to large soup pot.  Add in all vegetables and saute for 5 minutes.  Remove asparagus tips and set aside.

5.)  Add brown rice and broth to soup pot.  Cover and simmer over low for 30-40 minutes.

6.)  Puree small batches of soup in blender until very smooth.  Return to soup pot.

7.)  Add almond milk, asparagus tips and the fennel fronds to the soup.  Salt and pepper to taste. 

8.)  ENJOY good health!!

Sunday, 30 January 2011

Sleep Cycle: Review of iPhone Alarm App

I've spent the last week playing around with a 99 cent iPhone/i Pod Touch application called Sleep Cycle.  This is one of the innovate ways to incorporate the device accelerometer to monitor motion during sleep.  Motion during sleep is a proxy for sleep stage:  the more motion you are creating suggests being awake or in a light stage of sleep.  Deep sleep (or stage 3 or 4 sleep) typically involves limited movement.  REM (rapid eye movement) sleep that typically includes dream sleep also involves very limited physical body movement.  


Sleep cycle is a software app that uses movement during sleep to time your iPhone alarm.  It is designed to reduce the likelihood that your alarm will go off during a period of deep sleep or REM sleep.  If you have some movement around the time your alarm is set to go off, the alarm will be set off.  So say you want to wake up no later than 7 am.  Beginning at 630 am, sleep cycle with monitor physical movement.  If you begin to move during that 30 minute window, the alarm will sound.  I found the app easy to use and the primary function worked well--each time the alarm went off I was easily able to hear it and didn't feel like I had been awakened from a deep sleep or during dreaming.


But what I found even more fascinating than the alarm function with this app is the plot function that allows you to look at the entire night pattern of physical motion plotted to estimated sleep stage status.  The top screen shot shows a plot from my trial with the app.  It shows I fell asleep quickly to a deep sleep state.  I was awake at around 2 am for a brief period of time (elderly men will know what this was about) and then fell asleep with a gradual increase in sleep movement until being awakened by the alarm.  This pattern is pretty typical for normal patterns seen with more advanced sleep studies using EEG and polysomnograpy.
All right, so then last week I went on my annual ski trip to Lake Tahoe.  By history, I know that I sleep less well during travel and high altitude can influence sleep causing difficulty with onset insomnia and less deep sleep.  So I took the Sleep Cycle app along to Lake Tahoe and the figure at the left shows one of my night sleep plots.  I awoke in the morning with the alarm feeling like I had not slept well and that I had not had much good quality deep sleep.  The plot shows this to be the case.  I had 3 or 4 periods of being awake during the night.  One period of being awake around 430 am appeared to last at least 30 minutes.  There is less deep sleep and my total sleep time is less, as I was getting up earlier than my typical morning wake time.  


So this showed that Sleep Cycle was doing a reasonable assessment of my sleep pattern as the time in deep sleep approximated my sense of sleep quality.


So the next step in looking at Sleep Cycle was to see if it could monitor the potential therapeutic effect of taking a medication for sleep.  So after a night of poor sleep, I took a well-known sleep aid and started the Sleep Cycle app hoping for a good night's sleep and the sleep plot data to prove it.


The 27-28 January sleep plot shows the effect of the use of the sleeping pill.  There was a quick transition to a deep sleep that persisted through the first 6 hours of sleep.  After six hours of sleep there were two periods of being awake including one period shortly before the window for the alarm to sound went off.  


The sleep plot was consistent with what my subjective experience felt like.  I felt like I had slept well and in the morning I felt like I had a good night of sleep.  So the Sleep Cycle app confirmed my impression of the night.


Professional sleep study centers commonly use a technique called actigraphy.  Actigraphy typically involves wearing a motion sensing wrist watch like device.  It monitors activity through the night and estimates sleep based on the motion---very similar in principle to the Sleep Cycle app.  The Sleep Cycle app requires you to place your iPhone or i Pod Touch near your pillow.  I knocked if off the bed one night but other nights it was not a problem and seemed to do a good job monitoring sleep.


So I see the Sleep Cycle as the first iteration in the development of low-cost good quality actigraphy.  It seems to have excellent clinical potential.  For example, physicians might like to see 2 or 3 nights of Sleep Cycle data in the assessment of insomnia complaints.  They might also like to use it for monitoring response to treatment.  I certainly enjoyed this app and plan to continue to use it.  


Disclosure:  I have no financial interest in the Sleep Cycle app and have not been paid to write this review. 

Thursday, 27 January 2011

Weight Loss Summit

Heads up everyone.  I'll be speaking along with over a dozen others at a big online weight loss summit that you can sign up to listen to by clicking HERE

It starts in just a few days so get signed up soon.  It only takes a few seconds.  Should be a great interview.  I'll be talking about weight set point and the most likely ways it can be altered downward for the only type of fat loss that counts, lasts, and doesn't come with tons of collateral damage.

Eat the Food!   

Wednesday, 26 January 2011

Kids and Brain Injury: TED Talk of Dr. Kim Gorgens




  • I tend to be a worrier and after having a child I had more things to worry about
  • I study brain injury in children
  • Leading emergency room causes for head injury in children: cycling, football, skateboard/skating
  • A 58 g force can occur in boxing,  a 103 g force can occur football
  • Average concussion 95 g force
  • Concussion: change in consciousness--being unconscious not required
  • Risk for second concussion greater than first
  • NFL study confirms 3 or more concussions increases risk for dementia
  • How do we guarantee the safety of our kids? Shows a picture of child surrounded by bubble wrap
  • I am trying to decide on allowing my child to play football--I haven't made a decision but we can all do three things

Study Up:learn all you can
Heads Up CDC--A education and prevention focused site that includes:
Concussion in Sports--resources for athletes and coaches
Information on Brain Injury for Physicians--includes link to Acute Concussion Evaluation form (ACE), a guideline for assessment of the athlete
Facebook Page for CDC Heads UP: Provides ongoing education and discussion forum on brain injury awareness
cokidswithbraininjury.com A resource for parents of children with brain injury--particularly in Colorado

Speak Up: talk to coaching staff and state legislature regarding traumatic brain injury

Suit UP: wear a helmet--bike helmets reduce brain impact by 50%

The comment section following this TED presentation notes this presentation was short on research documentation supporting Dr. Gorgens main points.  I agree, and I was unable to find any research published by her in a Pub Med search.  Nevertheless, this presentation highlights an important public health issue and provides some information resources for parents and clinicians. 

Tuesday, 25 January 2011

Oxygen Debt

In 180 Degree Metabolism I recently added some new content about the importance of stressing exercise intensity more than duration for achieving metabolic adaptations that help with achieving a better ratio of body fat to lean body mass. Strictly from a body composition point of view that’s neato and all, but there’s strong evidence that doing short bursts of hard exercise has very unique, and potentially unmatched health benefits.
The first time I ever paid attention to the term “oxygen debt” was during my review of some of Scott Abel’s stuff. I didn’t count, but I’m pretty sure in his 5-Day MET DVD series he says “oxygen debt” while gasping for air in between sets at least 372 times. It seems kind of important to the guy, who I consider to be perhaps the world’s leading expert on exercise physiology due to his blend of personal experience, training experience, and extensive academic pursuits of the subject.

Another thing that jumped out at me was hearing some of the verbiage used by Vince DelMonte, including the term “oxygen debt.” DelMonte claims to have had minimal success with building muscle on various programs in the past, mentioning that he was referred to in his youth as “Skinny Vinny,” but that he finally found what works. And lo and behold DelMonte does a blend of functional training and weightlifting at maximum intensity to create an “oxygen debt.”

The theme is there again in Jon Gabriel’s work – the idea of doing very high bursts of exercise as if something is chasing you – and its striking ability to change the body’s metabolism to become less “thrifty,” making your body “want to be thin,” and lowering the weight set point for automatic, hunger and craving-free weight loss.

Clarence Bass, Rachel and Alwyn Cosgrove, Dr. Richard Bernstein, Sisson, DeVany, Big Chief – the list goes on and on. And now I’m talking about it too, as I have had substantial improvements in body composition since adopting Abel’s concept of doing what could only be called, confusingly, “functional, high-intensity, interval strength training.”

But my interest in the potential health benefits far exceeds my interest in using it as a tool to look like a man-beast when speaking on Metabolism at the 2011 Weston A. Price Foundation Wise Traditions Conference in Dallas this coming November (yes, you read that correctly). Perusing through the general concept of oxygen indebtedness is pretty exciting as it pertains to improving cardiovascular health, increasing functionality in old age, improving the stress response and adrenal health, lowering inflammation, improving asthma, and raising the metabolism overall.

I used to look at exercise like researcher Ray Peat looks at exercise – through a narrow and short-sighted mirror. Exercise = Stress = Bad, therefore, enjoy some nice walks and a little stretching and eat the food (ETF). While it’s true that in today’s day and age most exercise pursuits end in tragic failure due to poor information, poor accompanying nutrition, and extreme efforts in pursuit of unrealistic and more importantly, unnatural goals – that doesn’t mean that the right kind of exercise, done intelligently as part of a much broader set of healthy practices, attitudes, and nutrition, can’t be a powerful tool. It very well may be, and the oxygen debt, although it’s just one narrow element of the overall picture, could be the most important tool there is.

To begin with, let’s talk about ol’ Ray Peat since I brought him up. One of Peat’s primary platforms is the belief that maintaining the proper level of cellular respiration and oxygenation is one of the most important and vital elements of aging well and avoiding degenerative disease. This is done, according to Ray Peat’s research, by keeping thyroid activity up (this, in turn, makes sure there is adequate production of hormones like testosterone and progesterone which oppose estrogen, the ultimate anti-respiratory hormone in his view). To this I would agree.

But an interesting connection is that thyroid activity and oxygen consumption exist in tandem. As we age, thyroid activity usually falls and oxygen consumption falls with it. Interestingly, one reason this may take place is due to falling lung capacity. As we age, our lung capacity diminishes, and oxygen uptake falls substantially. The end result is reduced mitochondrial activity/cellular energy production and a much higher chance of getting cancer, stroke, heart disease, neurodegenerative diseases, and all our disease faves.

This general process can be reversed, and while a whole foods overfeeding attempt like RRARF may very well force the body to adapt by increasing cellular energy production and oxygenation via thyroid encouragement, there’s no doubt that the right kind of exercise can do it too.

As Al Sears writes in his 2010 book P.A.C.E.:

“Manfred von Ardenne discovered that your cells produce more energy when you practice short bursts of intense exertion – a capacity you build with my PACE program. This improves the way your organs use oxygen, keeping them younger longer. By keeping your routine focused on short, intense bursts… you send waves of life-giving oxygen through every cell in your body.”

Interestingly, Sears hints at what many of us have experienced firsthand, that endurance exercise has the opposite effect – giving up lung capacity and fast-twitch musculature for doing maximal effort work, and instead slowing down the metabolism as much as possible so that less oxygen is used performing the endurance task. These are horrible and highly unwanted adaptations akin to starving yourself. More from Weird Al Sears:

“Aerobics, jogging and marathon running are low-intensity, long-duration exercises. The Harvard study clearly shows that this kind of exercise increases your risk of heart disease and death.


And here’s why: When you exercise for long periods at a low to medium intensity, you train your heart and lungs to get smaller in order to conserve energy and increase efficiency at low intensity.”

So it’s kind of ironic that one could improve the oxygenation of their cells by striving to do exercise that’s hard enough to incur an oxygen debt (using more than you’re taking in and having to compensate for it later by panting hard or as Scott Abel says, “sucking in the room”), and lower overall stress hormone exposure by subjecting oneself to something that mimics a life-threatening emergency event and spikes stress hormones to the stratosphere.

But hey, just like forcing the body to adapt to burn more calories and expend less energy by stuffing your cakehole, short bursts of hard exercise (lasting 15 seconds to 4 minutes followed by recovery before you repeat) enough to make you really winded appears to induce some highly beneficial metabolic adaptations as well – with a huge cardiopulmonary bonus. It requires no equipment unless you want it to, workouts contain 7-20 minutes of total expenditure (not including rest time) in Sears’s program for example (done 3 times per week), and it’s much easier on your joints, tendons, and cardiovascular system than endurance exercise or weight training (although I do believe that weight training with lighter loads like that used by Scott Abel can easily be incorporated into the oxygen debt theme without too much collateral damage).

“Oxygen is the basic fuel your cells need to keep moving. When you’re jogging, your body can inhale enough oxygen to keep that activity going for quite a while. But when you’re sprinting fast, the demand for oxygen is so intense you can’t go for even a minute. As you approach maximal exertion, the amount of oxygen required to keep you going will exceed the amount you’re taking in – that’s the point when you begin accumulating an oxygen debt.


You may wonder why an oxygen debt is important. You might even think that pushing your body to that point is counter-intuitive. After all, why would you want to starve your body of oxygen?


The answer lies in your body’s ‘adaptive response.’


Think about what those words mean for a moment… an adaptive response is a change your body makes after confronting a challenge. If you don’t give your body new challenges, it won’t make these changes. In other words, you won’t grow or progress.


That’s one of the reasons why aerobics, cardio and long-distance running are not the best options for your long-term health. No progress will be made to build back lung capacity because you are not challenging your current lung capacity. In fact, because you are ‘preprogrammed’ to lose capacity with age, if you don’t train your body to make changes in response to challenges, you’ll actually start sliding backwards.


But when you give up these long, boring workouts, you can change your body’s experience with exertion.


When you achieve oxygen debt, your body responds. Plateaus are broken. Changes are made. First and foremost, your body reacts by increasing your lung volume and boosting your heart’s output.


By doing those kind of activities you actually ‘ask’ your body to make those changes. And in response, it does. You can train your body to make any kind of change you want. If you want small, tight lungs and decreased cardiac output, then keep jogging.”

To find out more about Sears and PACE, go the 180 Metabolism Blog and see a post and video on an experiment he did with two female identical twins. In the experiment one twin ran 50-yard sprints for 16 weeks and the other ran 10 miles for 16 weeks. Neither were asked to alter their diets. His experiment, as well as all the extensive data he’s compiled with his patients, thoroughly disproves all of the following myths:

1) You can’t build muscle and burn fat at the same time
2) You must lift weights to gain substantial amounts of muscle
3) Women can’t gain muscle easily
4) Women can’t achieve 10% body fat levels without counting calories
5) You must overeat to gain substantial amounts of muscle
6) You must restrict calories to lose substantial amounts of body fat
7) You must exercise more than 30 minutes per week to burn substantial amounts of body fat



Monday, 24 January 2011

Escitalopram for Hot Flashes

Hot flashes commonly occur in the course of menopause in healthy women.  Some women find their hot flashes to be very uncomfortable and distressing.  Hormone replacement can reduce the symptom severity of hot flashes, but recent research has underscored the potential risks associated with hormone replacement.  Therefore, there is increased interest in finding safer alternatives.

Freeman and colleagues recently published a randomized controlled trial of the selective serotonin reuptake inhibitor escitalopram (Lexapro) for hot flashes in healthy menopausal women.  The key research design features of this study were:
  • Patient selection: women between 40 and 62 with reduced or absent menses
  • Symptom severity: 28 or more hot flashes or night flashes rated bothersome or severe on at least 4 days per week
  • Exclusion: recent use of prescription or over the counter drugs for hot flashes, current hormone replacement therapy, current severe medical illness or mental disorder (major depression, bipolar disorder, suicide attempt, alcohol or drug abuse)
  • Drug regimen: escitalopram 10 mg per day versus placebo, if hot flashes not reduced by 50% at week 4 escitalopram was increased to 20 mg per day for 4 additional rates
  • Primary outcome measure: weekly hot flash frequency and severity (rated 1 to 3, mild, moderate, severe) 

Escitalopram proved superior to placebo in this study with hot flash frequency reduced from 9.9 per day on average to 4.3 at week 8 of the study.  Placebo treated women also had a decrease in hot flash frequency (reduced by 3.2 on average per day).   Hot flashes severity ratings were decreased from 2.17 (moderate to severe) to 1.63 at week 8 (mild to moderate).  After 8 weeks of treatment when escitalopram was discontinued, hot flash frequency and severity increased.  Interestingly the escitalopram group had no increased rate of side effect endorsement compared to placebo including no report of sexual side effects.

The majority of responders needed only the 10 mg dose of escitalopram.  About 20% of responders required going to the 20 mg dose.

This study confirms previous randomized control trials that suggest that antidepressant drugs may improve hot flashes for a significant number of women.  Other psychotropic drugs that have significant data for hot flashes include venlafaxine (Effexor XR) 75 mg, gabapentin 600 mg, and pregabalin 75 mg twice daily.  Although herbal remedies are promoted for hot flashes, a recent randomized controlled trial of black cohosh and red clover were no more effective than placebo.  For some women with severe hot flashes a period of hormonal treatment remains a common clinically used option.  

Photo of white pelicans courtesy of Yates Photography.

Freeman EW, Guthrie KA, Caan B, Sternfeld B, Cohen LS, Joffe H, Carpenter JS, Anderson GL, Larson JC, Ensrud KE, Reed SD, Newton KM, Sherman S, Sammel MD, & LaCroix AZ (2011). Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial. JAMA : the journal of the American Medical Association, 305 (3), 267-74 PMID: 21245182

Geller SE, Shulman LP, van Breemen RB, Banuvar S, Zhou Y, Epstein G, Hedayat S, Nikolic D, Krause EC, Piersen CE, Bolton JL, Pauli GF, & Farnsworth NR (2009). Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause (New York, N.Y.), 16 (6), 1156-66 PMID: 19609225

Friday, 21 January 2011

Low-dose Doxepin for Insomnia Treatment


Doxepin is a tricyclic antidepressant drug with significant sedative effect recently studied for use as a hypnotic in the treatment of insomnia.  Doxepin has strong antagonistic effects on several neurotransmitter receptors including the histamine (one and two), serotonin (two), alpha one adrenergic and muscarinic acetylcholinergic receptors.

Juliane Weber and colleagues recently reviewed clinical trial research related to doxepin and insomnia treatment.  For depression, doxepin typically requires 150 mg to 300 mg to achieve an antidepressant.  Many individuals are unable to tolerate this type of dose due to the sedative side effects.  Much lower doses (3 mg to 6 mg) have been investigated for effects on sleep.

A summary of the key points from their review:
  • Doxepin decreased time awake after onset of sleep by 40-46%
  • Total sleep time increased from 40 to 50 minutes per night
  • Proportion of sleep time in REM and slow wave sleep did not change
  • Elderly patients had similar effects with the lower 3 mg dosage
  • Effects were similar for patients with chronic or transient insomnia
  • In sleep lab testing doxepin reduced time to sleep onset from 35 minutes down to 20 minutes
A more recent study from Krystal and colleagues at Duke University looked at 1 mg and 3 mg doses of doxepin in elderly patients with chronic primary insomnia.  They found the 3 mg dose was effective in reducing wake time after sleep onset, total sleep time and overall sleep efficiency (percent of time asleep).

The duration of doxepin's effect has been studied for up to 12 weeks and there does not seem to be tolerance to the hypnotic effect over this duration.  At these low doses, doxepin appeared well-tolerated.  Longer term studies are needed to determine efficacy for periods of longer than 12 weeks.  One potential concern would be weight gain as the histamine and muscarinic receptors appear to be related to increased appetite and weight gain.

The FDA has approved doxepin 3 mg and 6 mg for insomnia treatment.  Typically, the lowest generic doses for this drug are 10 mg.  Three mg and 6 mg doses are available under the brand name Silenor.

This research suggests low-dose doxepin may be an alternative to hypnotics such as Ambien (zolpidem) for primary insomnia.  This research supports further study of current drugs for novel mechanisms and new indications.


Disclosure:  The author has no financial conflict of interest and has not received funding for research of this compound.

Image of chemical structure for two isomers of doxepin courtesy of Creative Commons authored by Ju.

Weber J, Siddiqui MA, Wagstaff AJ, & McCormack PL (2010). Low-dose doxepin: in the treatment of insomnia. CNS drugs, 24 (8), 713-20 PMID: 20658801

Krystal AD, Durrence HH, Scharf M, Jochelson P, Rogowski R, Ludington E, & Roth T (2010). Efficacy and Safety of Doxepin 1 mg and 3 mg in a 12-week Sleep Laboratory and Outpatient Trial of Elderly Subjects with Chronic Primary Insomnia. Sleep, 33 (11), 1553-61 PMID: 21102997

Thursday, 20 January 2011

Taco Salad with Homemade Tortilla Shells

This is an absolutely fabulous meal to make from  a lot of items you will already have in your kitchen.  With practice you can whip this meal up very quickly. I have recently made this meal several times in one week because we all loved it. I have also included a recipe for your own taco seasoning.  You only need one Tbsp. for this recipe, so don't add all 3 Tbsp-YIKES!!  Put homemade salsa on the side to dip your leftover tortilla shell in after finishing the salad portion.  Printable recipe link at bottom of post.

Start out by combining:
2 cups white whole wheat flour
1/2 tsp. sea salt
1 cup warm water
 Mix flour, salt and water together to make a soft dough. Spray ball of dough and surface with olive oil and knead until smooth. You want to have dough a little sticky, but not too sticky. Set the dough aside and cover with a warm damp cloth. Let the dough rest for at least 10 minutes or more.
Divide the dough into 8 equal parts.

Heat griddle on highest heat and turn oven to 425 degrees. Make smooth balls and press flat. Roll balls in flour and roll out until you have a 6 inch circle. If the dough sticks to the rolling pin or surface, dust very lightly with flour. (use just enough to help you roll out circle~too much flour will make your tortilla dry. I roll a few times, flip the tortilla over and dust lightly with flour, roll a few  more times and then flip again and until I have a 6 inch circle.  You might like this King Arthur Rolling Mat. I love this mat and use it to roll out dough for rolls, pizzas and tortillas. It has circles on it to help get your tortillas or pizza the perfect size you need.

Cook two tortillas on grill at a time.  When tortilla starts changing color and starts puffing, flip over.

Flip again after a few seconds. Take a flat spatula and press lightly on the puffed parts of the tortilla. This will help the tortilla to puff more. This is an important step to get your tortillas to be light and puffy.
Flip again. The tortilla should have light golden-brown spots on both sides. Do not cook very long because it will become hard. You need it to be soft and pliable. Keep tortillas stacked together on and under a cloth to keep from drying out.
Prepare tortillas for oven.

Rub 1/4 tsp. of olive oil on both the top and bottom of the tortilla and place on an upside down ,oven proof Ramekin. Click on Ramekin to see a picture of the one I have. This is the size you will need. 
Cook for about 6 minutes and remove to cool.

Next make your own homemade Taco Seasoning (this will make 3 recipes)

1 Tbsp. chili powder
1/4 tsp. garlic powder
1/4 tsp. onion powder
1/4 tsp. crushed red pepper flakes
1/4 tsp. paprika
1 1/2 tsp. cumin
1 tsp sea salt
1 tsp. black pepper

Mix all seasonings together. Use 1 Tbsp. of mixture and store the rest in a small glass container for later use.

In pan cook 1/2 tsp. olive oil, 1 cup chopped onion or green bell pepper & 1 crushed clove of garlic. Cook for 1 minute and then add  1 (15oz.) can drained and rinsed low sodium beans of your choice (I have used kidney and white beans). To this add 1/2 cup tomato sauce and 1 Tbsp. of the homemade taco seasoning.
Fill tortilla bowls with lots of fresh, organic spinach.
Add your favorite dressing on top of the spinach. Top each taco bowl with my Perfect Brown Rice. Pack rice in a small container and then dump on top of lettuce leaves.  This will keep your rice from going everywhere.  On top of the rice add your bean mixture (again pack in small container before dumping on top of rice). Garnish with a few sprigs of cilantro, a side cup of homemade salsa and fresh lime.
Makes 8 servings

Wednesday, 19 January 2011

Epigenetics

Since the early days I've been talking about many of the transgenerational phenomena when it comes to human health.  By transgenerational I'm talking about stuff that is not "genetic" (like how we are coded to have two eyes, two ears, and ten fingers), but outside dietary and lifestyle forces that affect our heredity - everything from fatty acid imbalances to heavy metal buildup to low nutrient levels to stressful events to the ability of your parents' weight loss attempts or stupid health ideas and how it can plop you into the world with a "thrifty metabolism."  The most thorough writing I did on it was in 180 Degree Diabetes in a chapter entitled "Nutritional History." 

Anyway, the following video passed along to me by frequent 180 Commentor Kash Money (warning, intentional cheese slinging coming up...) really rang my register.  I was like, Ka-Ching!  Put that in the bank and watch it make 2% while the price of everything goes up 20 times as much.  It's money baby! 

Sorry, too many hours at the beach and too many tangerines today (Florida).  Just trying to mimic the diet of JT's personal hero Clyde the Orangutan for a day (it's cool, he's mine too). 

Oh the video, yeah.  It's about Epigenetics and how the human body has developed an incredibly complex system of on and off switches in response to various environmental factors that help prepare the future offspring for the upcoming world it's about to enter into.  When you let the true significance of that set in you realize just how profound and mysterious and most of all - important epigenetics really is.  So much for low-carb Paleo diet theory, the last few generations probably have a lot more to do with our "blueprint" than the ancient one, and the low-carb adapted folk out there left the gene pool quite a while back (Except for Gary "Nanook" Taubes who was raised by Eskimos before becoming a journalist soldier in a vicious Macronutrient War against the invisible enemy Insulin Bin Laden). 

Anyway, it's worth a watch and will be a primer to some posts coming to a couple blogs near you in the future.  I'll be doing several posts indeed on the many epigenetic and perinatal connections to obesity and metabolic syndrome at the 180 Metabolism Blog, so be checking in.  I'm piling up all kinds of great, compelling content over there.   

Tuesday, 18 January 2011

The Brain and Musical Creativity: TED Talk of Charles Limb


Here are my notes from an intriguing TED presentation looking at musical creativity and functional MRI.

Charles Limb MD is a  surgeon who also studies creativity
A key research focus is to define the mechanisms of brain creativity
Work related to this production took place at Johns Hopkins and NIH

Musical creativity occurs across a variety of genre: ie. jazz musicians and rappers
Video is shown demonstrating creativity in a jazz pianist
How can the brain generate so much artist creativity?
Artistic creativity is a neurologic process that can be examined using rigorous scientific experiments

What do we understand about the science of innovation?  We are only beginning to understand the science of creativity.
There are many questions left unanswered
Functional MRI is used in his lab to study creativity
BOLD imaging--blood oxygen level dependent imaging a tool to study brain activation
More blood flow equals more activation

Video demonstrates musician playing keyboard while brain is imaged using fMRI
Experiment:  What happens in the brain in memorized versus improvised music production?
When you contrast improv with memorized jazz you find:
  • Medial prefrontal cortical activity increases
  • Lateral prefrontal cortical activity decreases
We think, to be creative you have to dissociate two areas of the frontal cortex--activating one and deactivating another

What happens when more than one musician work together in music improv?
Preliminary data (one case): Broca's area lights up with more than one musician
This area is key to communication suggesting a different area recruited in mutual improvisation

What about rap?
Rap has a function similar in many ways to jazz
A rap creativity experiment was designed similar to that of the jazz experiment
A memorized rap task was compared to an improvised rap task
Improvised rap requires activation of visual cortex and cerebellum of the brain
This pattern is different than the activation pattern in jazz
These experiments suggest multiple areas of brain involved in creativity depending on the type of output and whether on is working alone or with others

This is an exciting area where science is catching up to art.  Expect to see more research in this area.  Dr. Limb's research on jazz musicians is summarized in the Plos one research paper below.  The manuscript is free full text and includes some excellent graphics of the fMRI findings of the jazz experiment described in the video. 

Limb CJ, & Braun AR (2008). Neural substrates of spontaneous musical performance: an FMRI study of jazz improvisation. PloS one, 3 (2) PMID: 18301756

Monday, 17 January 2011

Eating Order

In a recent post I promised I would cease poking fun at various dietary cults out there (temporarily of course) and lay some firm ground rules in a post called “Eating Order.” I’ve spent an entire day laboriously chipping away at the idea, but unfortunately, my octopus-like mind has managed to outsmart itself.

Originally I had grand ideas – ideas like having a healthy relationship with food means making food choices based on what you know nourishes you. Sounds good right? I mean, if you know a certain food causes your body to react in a negative way, then eating it due to some social pressure or something like that is an unhealthy relationship with food, people, and yourself.

But how is one to really know such a thing? I mean, part of the philosophy here is that if Diet C or Food A makes X person healthy but gives you an allergic reaction or makes you a type 2 diabetic, the problem is not Food A or Diet C but YOU! Avoiding Food A or Diet C doesn’t do diddley squat to fix the root problem, which probably lies in the quantity or balance of corticosteroid hormones you produce due to a unique blend of hereditary, lifestyle, psychological, and dietary factors.

Another common “disorder” is believing that a certain food will harm you when in fact it won’t, and how is one to distinguish between myth and reality? It’s quite a gray area.  But there's no shortage of people that create self-fulfilling prophecies when it comes to certain no-no foods. Plus, a lot of people’s negative reactions to certain foods (like carbs let’s say) has to do with past diets (low-carb or low-calorie) and not some inherent genetic problem. Forcing yourself to eat the crap out of those pesky carbs that bloat you to high heaven, make your skin break out, leave you lethargic, send your appetite to the stratosphere, and pack on body fat is a great way to heal yourself.

Then there’s intuitive eating. If your circadian rhythms are all screwed up and you eat intuitively, you’ll have a half gallon of coffee and a doughnut from the time you wake up until 5pm, then you’ll ravage a normal dinner and eat 27 cookies until you pass out at 1am in the Lazy Boy, waking up a few hours later in a pile of crumbs with late night infomercials blaring (Tony Little’s Gazelle infomercial if you’re lucky).

Let your Autistic kid eat “intuitively” and you’ll most likely see the kid eating nothing but macaroni and cheese and cheese pizza washed down with anything that comes in Blue Raspberry flavor – eating, not so much out of biological wisdom, but out of opiate addiction.

So I don’t have all the answers (I never do but this time I’m actually admitting it, send Satan some hockey skates and a snowblower, he’ll need ‘em).

What I do know is that most who really do suffer from true “disordered eating,” or have in the past, did so because they came across some idea about diet out there, and got swept away by the thought of everlasting health Nirvana. Often a sudden weight loss with the dietary shift of several or more pounds, combined with reading a lot more of the materials put out by the allies of X dietary cult uninterrupted by contrary ideas was enough to take it from an interesting thought with a little promise into a full-on brainwashed eating regime in which “Charlie” became gluten, or animal products, or saturated fat, or the potato.

Others just took some zany idea about hard work and suffering leading to a better life and applied it to their physical bodies, going to war against their natural appetite and desire for rest and beating those urges “into submission” until they became very ill.

I don’t know. Be careful with what you buy into and do in the name of health.

Every dietary religion has crafted a story that “makes so much sense” when all you are exposed to is that line of thinking without counter viewpoints. I mean seriously, people actually delude themselves into believing that carbohydrates are fattening even when there are 4 billion living exceptions to some silly cultish proclamation, like Mark Sisson’s infamous claim that eating more than 150 grams of carbohydrates per day causes “insidious weight gain.” This is quite the fascinating proclamation when the prisoners at most concentration camps died of starvation on more than 150 grams of carbohydrates per day, or that roughly 99% of the couple billion lean males on earth eat closer to that amount every meal.

Even the stupidest diet on earth, Doug Graham’s 80-10-10 raw vegan diet, actually makes sense when you read the thing to some extent. I mean, all other primates eat a diet that is 100% raw with 70-90% of calories derived from carbohydrates. So why shouldn’t we? This definitely makes more sense to me than say, eating what a group of a few thousand isolated Eskimos ate when no other humans on the face of the globe ate that way. Of course, when you try his diet you lose weight! It’s the answer to all things!

I pity the fools.

I guess one rule of thumb, if I’ve ever found one, is that if you are SURE as to what the perfect diet or lifestyle or exercise program is for you or anyone else, you are SURE to be wrong, and your health will suffer eventually from being rigid. Mental rigidity, when it comes between your body and your plate or lifestyle habits, will always fail.

If you believe something strongly, don’t go out and find more like thinkers. That only makes it worse! Challenge those beliefs and find exceptions and find opposing viewpoints until you are confused. This is not just a rule for eating, but for life and strong thinking in general. In fact, the history of my life shows me that when I have “strong beliefs” about anything, I do so because I’m failing to see the big picture.

And together we’ll continue to learn and grow at 180, exploring the fascinating topic of human health, and doing what we do best – which is trying real hard to keep otherwise intelligent people from doing dumb shit in the name of health.

Yes you, I’m talking to you. Drop your utensil slowly, put your ice cold hands behind your balding head, and step away from the Tempeh.






P.S. - Although I wasn’t pleased where this was headed as I worked on it, I couldn’t help but at least include what I jotted down off the top of my head to start the Eating Order project. You may find something useful in it, so I hated not to at least put it up here somewhere…


Eating Order

In the last post I made lots of fun of the many modern day (and pretend Paleolithic era) forms of disordered eating. While that’s all well and good, unless we can define what ordered eating is, making fun of various dietary cults is purely entertainment.

Here, I hope to lay out some ground rules for ordered eating as well as address the many gray areas of what can be considered ordered and disordered eating. Ultimately, we’ll all have to make very personal decisions about our own relationships with food, but hopefully this will lay a foundation to help people build the right relationship, or rebuild a disordered one.

For starters, one thing that distinguishes the thinking at 180DegreeHealth from other health crusades out there is the belief that if person A eats X food or X diet and has great health and you eat X food or X diet and get fat or have an anaphylactic reaction, the problem is NOT X. The problem is YOU!

This might seem like common sense, but this is probably the most common mistake made in the entire field of nutrition. Nowhere is this one-dimensional way of thinking more prevalent than in the world of the food allergy alarmists. While food allergies are VERY real, and identifying and avoiding allergenic foods and substances can give people great short-term relief, it does absolutely nothing to address the real problem – which is the development of an allergic reaction to benign substances. And avoiding a long list of foods and eating some other foods instead usually leads to the development of allergy to many of the new food items until a person is backed so far into a corner that there is literally nothing he or she can eat without having an adverse reaction.

Rather, food allergy should be used as a diagnostic tool that points to shortage or imbalance of the production of the various anti-inflammatory and immune-modulating corticosteroid hormones. When this approach is taken, and one starts to understand what dietary, lifestyle, hereditary, and psychological factors have contributed to the unbalanced condition, then one can go about fixing the problem at the core instead of engaging in highly-restrictive, socially-crippling, and majorly disordered eating that is potentially a bigger health problem than a minor allergic reaction to a few foods in the first place.

Okay, that’s a separate and endless tangent, and elimination-type diets will always have at least some place in the world of health and nutrition, but you know what I mean.

And, more importantly, you can see from this line of thinking how many dietary cults form. When someone has an adverse reaction to a certain food, they go on to do some research on the evils of that food, and come up with no shortage of dirt on it (even though most of the dirt on it is taken completely out of context). Weight loss of as little as 10 pounds with the dietary restriction, with or without short-term health benefits, is often enough in this “ab-sessed” modern culture to turn someone into a total dietary Jihadist (myself included once upon a low-carb time, although I never got TOO ridiculous) saying truly dumb shit, like “grains will give you diabetes” or “egg yolks clog your arteries,” or “don’t eat nightshade vegetables man, they’re not meant for human consumption” or “don’t eat meat or you’ll get gout!” And this is just what is touted from a health perspective. The wannabe morally elite often get exponentially more ridiculous with their claims.

So I guess rule #1 of Eating Order is:

Major dietary restrictions should be a last resort, not a casual first line of defense.

More importantly, when you come across some kind of dietary ideology, instead of going out and reading more and more of the material put out by the same cult, you should actively seek out OPPOSING information so that you don’t lose your head over those ideas. Once you have educated yourself in a more balanced way, thought about how it all ties into your own personal observation and experience – or doesn’t, then you are slightly qualified to make a smart decision about tweaking your diet and lifestyle in some way in an attempt to improve your health.

But, keep in mind that whatever you decide, there is a more than 90% chance that it is WRONG. Also, your average health guru, although he or she may strongly feel that he or she possesses a level of health that it somehow superior than the rest of the population, and look the part, statistically-speaking the typical health guru has far worse health than the average person, and will die much younger than the average person – and it will be in large part attributable to their diet and lifestyle dogma beliefs and practices. No matter how seemingly-infallible, how attractive, how shapely, how fit, or how smart your favorite health “experts” are, there is absolutely nothing that guarantees they won’t go all Jim Fixx and die of a sudden heart attack tomorrow. Likewise, it’s awfully tough to prove that if they do live long and healthy lives, that their diet and lifestyle practices were responsible for it, or that you’ll have similar, much less identical results if you mimic their every move.

Rule #2 of Eating Order

Unless you are a health researcher or professional athlete, and even if you are a health researcher or a professional athlete, you shouldn’t spend much time thinking about your diet.

It seems like the people with the most disordered eating habits are those who spend way too much time thinking about macronutrient ratios, nutrients, calories, and other dietary elements. Discovery of all these food elements has been a tremendous disservice to the health neurotics of the world. While we try to foster an ongoing and interesting conversation about diet and health in general at 180, ultimately this should all be an act of intellectual curiosity on behalf of the participants here, and should not cloud your mind with health thoughts while you are chewing food (or inhaling it if that’s your style). Even as a health researcher dedicated to learning as much about the food-health relationship as possible in my lifetime, I too have to put in a conscious effort not to take it to the table with me, or let a new whimsical idea that popped into my head radically influence my dietary decisions. This brings us to the next rule…

Rule #3 of Eating Order

Do not “pinball” your diet (Scott Abel’s catch term).

This means bounce around from vegan to Paleo to a cleanse to dairy-free to low-fat to macrobiotic to Atkins (hardcore orthorexics often have the temptation to do all of the above at some point in any given month). Same goes for your sleep habits, exercise habits, and so forth. Once again, to take advantage of Abel’s great knowledge, “the body loves regularity.” It is probably much healthier to eat a #1 at McDonald’s for every meal than to swing back and forth between all these crazy forms of dietary extremism. Consistency and regularity with your eating patterns MOST of the time is a major health asset.

Since I can see 200 of you thinking busily about the exact meal that you are going to eat every single time you sit down to eat for the rest of your life, and getting out your stopwatch to time the hours, minutes, and seconds in between each feeding…

Rule #4 of Eating Order

Be flexible and relaxed about the composition of your meals, snacks, eating behavior, meal-timing and so forth.

While a little regularity is great and all, too much regularity, or limiting your food choices too much, or being overly aware of the macronutrient breakdown or calorie content of your meals is highly disordered.