Brain Posts Cracks Technorati Top Ten: Thanks!

I try to minimize self-promotion on this blog but today I'm going to do a little of that.  I started this blog nearly two years ago for personal motivation to stay current with research in the clinical neurosciences.  Blogging about recent research in clinical neuroscience kept me scanning PubMed abstracts directed to my Google Reader and kept me focused on succinctly summarizing work I felt was important.  Additionally, as I approach the end of my career, I felt a non-commercial blog might be a way give something back to my profession that has given so much to me.

Like many bloggers I follow my page views to see topics that might track more than typical interest.  I follow some of the blog ranking sites to gain perspective on Brain Posts.  This last week I was pleased to see that the Technorati algorithm ranked Brain Posts as the tenth ranked blog in the Family category and 40th in the Health category.  Technorati follows over 14,000 blogs in the Family category and over 15,000 blogs in the Health category.  I am very humbled and flattered by this recognition.

I don't understand the ranking algorithms (or their validity).  The numbers seem to jump around quickly and frequently.  But I do know that followers accessing the site and referencing the site play a key role in the rankings.  So this is really a post to thank those of you who have been visitors, commenters and post links to the site.

I plan to continue posting on clinical neuroscience research topics over the next year.  Additionally, I will be putting together some of the posts into electronic book formats.  This will involve selecting posts that might be of interest to specific reader groups.  Look for compilations of Brain Posts into eBooks formats under some of the following titles:

• Brain Science for Physicians
• Brain Science for Parents
• Brain Science for Teachers

Thanks again to all!

The 180 Healthy Eating Guide Part II – Information

In the last post we talked about the importance of intuition in choosing the foods that you eat. The bottom line is that if you are having a strong biological craving, you must fulfill it to the best of your ability. For young children intuitive eating is probably the most important guide. In an adult, especially one that spends a great deal of time lingering at food-centric health websites like this one, intuitive eating is often way too muddied up by intellectual interference.

Much of this intellectual interference comes from information. The rest comes from decades of accumulated baggage that comes in the form of conditioning – such as having your parents coerce you into believing that you don’t like vegetables and that cake and ice cream is a “treat” or a symbol of elated celebration. This is powerful psychological firepower for making someone a junkfood junkie with an aversion to anything considered health food (which can have deep-seated emotional ties to sacrifice, hard work, punishment, and mundaneness when parents and society interfere with their child’s natural intuition). Even parents with the best intentions often make eating healthy akin to “cleaning your room” and eating junk food one of the great joys and rewards of life. Oops.

While there is no doubt that we should all take strides to reboot our brains when it comes to various conditioning with food, and to some extent information, the thought that an educated nutrition geek could really move forward and leave all intellect out of the kitchen is simply a pipe dream. At this point, even though I’m thinking about what I’m eating a lot less than I once did, there’s really no way that I could just not think about what I’m eating completely. And maybe it’s okay that I can’t take it to that level. Information can and will always be one of the many important influences when it comes to healthy eating.

I give out information. And that information has helped thousands of people at this point to improve their health, and do so primarily with changes in nutrition and attitudes about eating. And as with any source of health information, this information has let thousands down as well, as many mis-interpreted this information, weren’t patient enough to follow through on the information, or simply invested too much into the information itself while not relying on other important aspects of healthy eating – intuition and investigation (which we will discuss in the final episode of this series). Information is limited in its scope and blind when intuition and investigation are left out of the picture.

With intuition and a good food supply without refined and processed modern foods, we probably wouldn’t need much information about eating. But there is such a glut of information out there in the world today that information is a powerful tool at combating other, less accurate information. Or not even inaccurate, but more like inflated, out-of-context, sensationalized, myopic dogma in need of a firm turkey tap (also known as a sack wack). That’s pretty much where I come in.

To keep mental interference out of the way and open up people to more freedom of exploration and self-experimentation (what I will refer to in the final episode as “investigation”), my information has become increasingly softer and less dogmatic over the years. I’ve found with any firm position there are always enough contradictions, exceptions, individual circumstances, and other factors that a firm position on things is unjustifiable. For some, even just being able to relax in a social setting with food and eat whatever is served is far more healthy than eating “the perfect diet,” whatever that is. I hope to continue my flexibility in thinking as 180 continues to move forward.

The firmest nutritional conclusions that I have come to thus far are:

1) One of the greatest assets in health preservation and disease resistance is the ability to produce cellular energy at a high rate – something I casually refer to as having a “high metabolism.” Carbohydrates and short-chain saturated fatty acids (in dairy fat and produced from the fermentation of fiber and resistant starch in the gut - of course, there can be individual circumstances when dairy and fiber are both ill-advised) are the most metabolically-stimulating foods, but only in the context of an otherwise sound diet (not completely vegan, not overly fat restricted, not calorie-restricted, mostly “food-based”).

2) Polyunsaturated fatty acids, because of their heat, light, and oxygen-sensitive nature – as well as their ability to suppress cellular energy production, will age you at a more rapid rate. Polyunsaturated fat is unavoidable in a normal, mixed diet – and some polyunsaturated fat consumption may be necessary or even optimal compared to extreme restriction, but there’s little question in my mind that consuming excesses of this type of fat is not optimal (especially in the form of vegetable oils that have had high heat exposure – as in fried foods like French fries, chips, etc.).

3) Eating below appetite reduces metabolic rate. Eating above appetite increases metabolic rate. Eating to appetite can either increase or decrease metabolic rate depending on what you are eating and a number of factors involved in metabolic rate such as type and duration of exercise, stress levels, sleep, sunlight exposure, nutritional status, and so on.

Of course there are dozens of other conclusions that I’ve come to, but none are as firm as these. Still, even with these conclusions, I’m not running around looking for supporting evidence but actively trying to seek out contradictory information to soften these dogmatic stances if warranted. In fact, I’ve received numerous reports of people reversing serious inflammatory disorders using moderate amounts of corn oil as their primary added fat. See enough of this over the summer as I shadow a practitioner using corn oil and claiming to get good results, and I will be more than happy to issue a challenge to the dozens of bloggers and authors entrenched in the belief that omega 6 polyunsaturated fat consumption is the primary driver of inflammation (a belief I currently hold as well, but which has lost a little steam as I have personally followed a very low omega 6 diet for 18 months with marginal improvements in outwardly signs of inflammation – and it requires more and more straining to chalk all problems and shortcoming up to it being "flushed" out of the system).

Stay tuned for the final and most important episode of the 180 Healthy Eating Guide – Investigation.

Vilazodone: A Novel Antidepressant

Vilazodone was approved by the Food and Drug Administration in the U.S. earlier this year, but is just now becoming available in pharmacies for prescription use.  The drug is marketed in the U.S. under the trade name Viibyd.  It is novel in that it the only antidepressant that combines two mechanisms that can increase serotonin in the brain cortex: selective serotonin reuptake inhibition and partial agonism of the 5HT1A receptor.  There are multiple selective serotonin reuptake inhibitors, i.e. fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro).  

There are also compounds that have an agonistic effect on the 5HT1A receptor.  These include:
Antidepressants: trazodone, nefazodone
Antianxiety drugs: buspirone
Atypical antipsyhotics: aripiprazole, ziprasidone, clozapine, asenapine
Illicit drugs/compounds: MDMA (ecstasy), LSD, psylocybin, cannabidiol (cannabis)
Antimigraine compounds: ergotamine
Other compounds: yohimbine

The combination of SSRI and 5HT1A agonist effect may synergistically increase serotonergic transmission.  

Two published clinical trials on vilazodone are available on PubMed.  The table below summarizes some of the key findings from the two published trials.

The dose of vilazodone studied was 40 mg in both studies.  Because of the common occurrence of gastrointestinal side effects, doses are typically initiated at a smaller level and increased to 40 mg over the first week or so.  The pattern and prevalence of gastrointestinal side effects with vilazodone appears similar to levels seen in previous SSRI trials.  Although headache was commonly reported with vilazodone, the rate did not differ from the rate endorsed by placebo.  Dizziness, dry mouth, insomnia and abnormal dreaming were endorsed at a higher level with vilazodone but by less than 10% of the subjects.

Although vilazodone was statistically superior to placebo on almost all depression measures, it was not statistically superior in remission rates in the Kahn study.  This finding along with the relatively low absolute response rate of 27.3% in the vilazodone group is a little disappointing.

The response and remission rates found in these two studies were similar to SSRIs.  Head to head comparison with an SSRI would be informative to see if vilazdone has any effectiveness or adverse event superiority.  Sexual side effects are common with the SSRIs and the two randomized vilazodone studies reported no difference in sexual side effects between vilazodone and placebo.  Additionally, the Rickels study showed some evidence for anxiety symptom reduction.  Clinical trials examining the effectiveness of vilazodone for anxiety disorders will likely be soon completed.

Disclosure:  The author has no stock in the parent company of vilazodone (Forest Labs).  Additionally no honoraria or research grant support has been received related to this drug.  The author received no reimbursement for writing this post and the comments are entirely those of the author.

Information on the agonists for the 5HT1A receptor obtained from Wikipedia.

Chemical molecular structure of vilazodone from Creative Commons file at Wikepedia by author Meodipt.

Rickels K, Athanasiou M, Robinson DS, Gibertini M, Whalen H, & Reed CR (2009). Evidence for efficacy and tolerability of vilazodone in the treatment of major depressive disorder: a randomized, double-blind, placebo-controlled trial. The Journal of clinical psychiatry, 70 (3), 326-33 PMID: 19284933


Khan A, Cutler AJ, Kajdasz DK, Gallipoli S, Athanasiou M, Robinson DS, Whalen H, & Reed CR (2011). A randomized, double-blind, placebo-controlled, 8-week study of vilazodone, a serotonergic agent for the treatment of major depressive disorder. The Journal of clinical psychiatry, 72 (4), 441-7 PMID: 21527122

Persistent Insomnia in Depression Responding to Antidepressants

Sleep problems commonly occur as part of a problem with mood disorders including depression.  Changes in sleep duration (insomnia or hypersomnia) are one of the criteria for the diagnosis of depression in the Diagnostic and Statistical Manual of Mental Disorders.  Although not absolutely required for the diagnosis, insomnia is a complaint in the the majority of subjects presenting for clinical trials in the treatment of depression.

The selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) have become one recommended strategy in the treatment of depression.  However, unlike other antidepressants, the SSRIs commonly do not have a sedative effect.  It is possible that when someone gets an antidepressant response to an SSRI, sleep disturbance also resolves.  However, in clinical practice, SSRIs commonly produce a partial remission of depression but fail to improve problems with insomnia.  So what does this type of response mean and what can be done for those with improvement in depression but residual sleep complaints.

Gulec and his research team from Turkey have some recent research on this topic posted online at the Journal of Affective Disorders.  They followed a group of adults with major depression treated naturalistically--i.e. treating psychiatrists could select the antidepressant drug although algorithms for dose and sequencing were followed.  Subjects were followed with research rating scales for a period of 52 weeks.  Some subjects responded and remained well.  Some subjects responded but had a recurrence of depression in the one year follow up period.  The key findings from the study:

• Persistent insomnia rates were high in those who had a recurrence of depression
• The recurrent groups showed the following rates of insomnia prior to recurrence: onset insomnia (difficult falling asleep) 58%, terminal insomnia (early morning awakening) 33% and middle of the night insomnia 8%.
• Only 26% of those subjects whose depression remained remitted throughout the 52 week follow up period endorsed any persistent insomnia complaint.

The authors note their study is consistent with other studies supporting insomnia as a marker for poor prognosis is depression.  Reynolds and colleagues found that subjects who remitted with an antidepressant drug (including improvement in subjective sleep) had had high rate of continued remission of depression with psychotherapy alone.  Those whose insomnia persisted were less likely to benefit from psychotherapy alone as a long term maintenance strategy.


So an important question is what to do when insomnia persists despite a general antidepressant response.  It appears this is a problem that is too important to ignore and hope it goes away.  Options appear to include adding a sedative antidepressant, switching to another antidepressant, adding a sedative hypnotic treatment for insomnia or adding cognitive behavioral treatment for insomnia.  Here there is little data to support one of these choices over the others.  A research study examining these types of options is needed to aid patients and their clinicians in the management of this common clinical situation.

Photo of Moth Hovering Over Flower Courtesy of Tim Yates

Gulec M, Selvi Y, Boysan M, Aydin A, Besiroglu L, & Agargun MY (2011). Ongoing or re-emerging subjective insomnia symptoms after full/partial remission or recovery of major depressive disorder mainly with the selective serotonin reuptake inhibitors and risk of relapse or recurrence: A 52-week follow-up study. Journal of affective disorders PMID: 21684011

Reynolds CF 3rd, Frank E, Houck PR, Mazumdar S, Dew MA, Cornes C, Buysse DJ, Begley A, & Kupfer DJ (1997). Which elderly patients with remitted depression remain well with continued interpersonal psychotherapy after discontinuation of antidepressant medication? The American journal of psychiatry, 154 (7), 958-62 PMID: 9210746

The 180 Healthy Eating Guide Part I - Intuition

It’s time to do a quick summary on what I’ve been thinking lately as it pertains to diet. Remember, this is just the eating component we’re talking about here, not the literally hundreds of other factors that go into achieving and maintaining good health. So don’t get overly wrapped up in it, or in eating in general. If anything, I look at eating as a tool to help combat the other stressors in life – a tool that can be used as an anti-stress, anti-inflammatory medication for the many other assaults placed upon us with modern life and mediocre heredity.

For the moment, it seems most appropriate that our individual diets are influenced by three main factors – the “3 In’s”:

1) Intuition
2) Information
3) Investigation

Today we’ll discuss the first – Intuition.

My intuition tells me that the Krispy Kreme doughnut, fast food French fries, Doritos, and chocolate milk are the best foods on earth. Okay okay, just making the most important point of this post – that each of these three categories, without the other, is limited and incomplete. Eating whatever you want or crave (loosely referred to as intuitive eating) is a tactic that works in some instances but can backfire in others.

Through many studies done on animal behavior, it has been found that when presented with supranormal stimuli – things that are bigger and better than is possible in nature, the supranormal stimuli beat nature every time. Birds will abandon their own small little eggs if you put an ostrich egg out there for them to sit on.

“Animals, humans included, seem to have a built-in preference for features larger than those that occur naturally. Ethologists, scientists who study animal behavior, have tried to understand the attraction of the ‘super-normal stimuli.’ Consider the oystercatcher, a shorebird with black-and-white plumage, a red bill, and brightly colored legs. Back in the 1950’s, Dutch ethologist Nikolaas Tinbergen conducted now-classic studies of the bird’s incubation behavior and discovered something astonishing: When presented with a choice between brooding its own small egg and the giant egg of a much larger bird, the oystercatcher invariably chose to sit on the giant one.”

-David Kessler; The End of Overeating

Men, even those like myself who truly prefer small-breasted women, still find it nearly impossible to keep our eyes off of a “tig-bittied,” surgically-enhanced bubble chest when she walks into the room. It’s as if there is something about them that has a higher power over a more primal region of our brains, and we stare at them like a Podling or Gelfling looking into the Dark Crystal.


And hyperpalatable, pornographic modern foods that are processed, extremely calorie dense, concentrated, scientifically-manipulated, cooked to perfection, laced with flavor enhancers, and served in a shiny package or in a fun and exciting restaurant beats out plain old natural food eaten in silence at your kitchen table in much the same way.

Plus, our eating preferences are largely formed by habit, conditioning, and various external stimuli too – not necessarily innate bodily needs. Man “stimuli” is a great word. Someone should get a tally going of how many times I use it in this one.

In other words, we come to like and prefer what we’ve grown accustomed to eating. Grow up eating junk food and you’ll intuitively prefer junk food over other things. Or even just look at orange juice. Raise any kid on earth on Minute Maid then give them a glass of freshly-squeezed orange juice that tastes ten times better. Every single kid will prefer the Minute Maid until they’ve had enough fresh juice to get used to the taste of fresh.

I too can attest to this as the more I eat something the more I grow to like it. When eating mostly oatmeal I came to really love oatmeal, and thought I’d never eat anything else for breakfast ever again. When eating a zero carb diet I thought slow-roasted ribeye was the best food on earth and felt like I could eat it every day for the rest of my life. In Nepal I really started to love the national dish – rice and lentils, meanwhile, my girlfriend at the time was in Costa Rica eating rice and beans every day and raving about how much she had grown to love it. And now, eating more than half of my calories as fruit, I’m convinced this time that fruit is the tastiest thing ever.

So what we think of as intuitive eating is very limited and highly malleable. But at the same time, our bodies have intelligence that comes out in subtle ways every single day that we don’t even take notice of.

Take for example getting thirsty after eating salty food. If you really think about how complex intra and extracellular water and electrolyte balance is – a complex process moderated by everything from our thyroid gland to our kidneys, you realize right away that this intuitive urge to dilute concentrated salt with water only minutes after ingestion is absolutely astounding. It’s a strong indication of just how fine-tuned our bodies are, and how masterful they are about controlling our involuntary urge to drink. This intelligence goes way beyond what we can do with information alone, which is always subject to human cognition error (throughout history, human cognition has been wrong about almost everything).

So, take intuition into account when you decide what to eat. The body knows when it needs carbohydrates for example – like after hard exercise or during stressful events. This often surfaces as a sudden craving or urge that is stronger than one of those desires to stimulate your bored self with the excitement of a Slim Jim.



Intuitive eating also eliminates the dead ends and dangers of overly restricted eating, as you’ll most likely crave carbohydrates if you’ve been eating too much meat or crave meat if you’ve been eating nothing but fruit and potatoes.

This is but one wing of healthy eating, but one that needs to be taken into account. Don’t take your body’s urges and needs out of the equation. It’s smart enough to keep you from starving to death or dying of dehydration, and it has needs that vary from hour to hour and from day to day that are never constant.

So a little flexibility is great to have, but is a fine line when our pleasure centers and preferences have been so tainted by supranormal stimuli (boom, said it again), the toys in our Happy Meals, the foods we were forced to eat to be able to eat ice cream when we were “good,” and other powerful psychosocial influences surrounding us in advertising and otherwise. In fact, our brains have a powerful mimicry program built into our hard drive, and even being around unhealthy people with unhealthy habits can have a really strong influence over our physiology. There are entire fields of study like “social endocrinology” and “psychoneuroimmunology” set up to study these and other very complex mental and social interactions that have a bearing on our health, habits, food preferences, and beyond.

But damn. If you are hungry, eat. If you are thirsty, drink. If you want something sweet, eat it. If you want some meat or fat, have some (and I’ll add non-eating intuition too… If you are sleepy, sleep. If you are tired, rest, and if you are stiff and restless, exercise). These are the most basic and important forms of intuitive eating. They’ve kept humans and all animals alive for millennia and have more than earned the right to influence our diets.

Pineapple

Recently a lot of people have reported to me that adding the good old-fashioned white powder to their diet has made them "feel like a new man (or woman)."  I'm talking about good old cane sugar of course.  Sucrose. 

We discussed the possibility that sucrose has special properties, with a tendency to increase carbohydrate oxidation more than other carbohydrates, and potentially raise carbon dioxide (an anti-stress substance) levels more than other carbohydrates.  Ray Peat who we overdosed on in May is certainly a big fan of it, and his support of it comes with tremendous academic backing.  Josh and Jeanne Rubin have shared many positive testimonials for the white powder as well. 

Yet, historically, white powders are on a short list of foods that displaced many calories in traditional diets, followed by a predictable decline in health in virtually every way.  While many modern humans seem to be better adapted to eating refined foods, it's still pretty hard to believe that sucrose could comprise a significant portion of the diet and not create some kind of nutritional sinkhole.  It is pretty much the only food on earth with no nutrient content.    And the nutrients that come packaged with other foods have been found relentlessly to be necessary for the proper metabolization and assimilation of those foods over the long haul.  The fact that Americans get nearly 1/4th of their calories from nutrient-free added sweeteners doesn't provide much comfort in the thought of eating a high refined-sugar diet.

So there's quite the cognitive dissonance going.  On one hand white sugar makes you feel great.  Warm, energetic, frisky, strong like bull.  On the other it seems like a fatal attraction.  It seems almost like the credit-driven economies of the world - providing a false sense of affluence while racking up a completely unpayable debt with inevitable consequence.  The illusion of wealth.

So I have no choice but to recommend sucrose-rich fruits instead - foods that are some of the most nutritionally-robust on earth packaged with this wonderful sucrose molecule.  They seem like a much better "investment."  To give you an idea of the nutritional superiority, if you were to eat 3,000 calories of white sugar, you would get 0% of your recommended allowance of vitamin C and zero grams of protein.  Eat 3,000 calories worth of pineapple and you are looking at 5,309% of the RDA in vitamin C and roughly 30 grams of protein (and 70-80 grams of fiber vs. 0 in the white sugar for those like myself that think fiber has unique metabolically-stimulating properties).  Foods like cantaloupe, clementines, peaches, and super-sweet Hawaiian Gold pineapples top the list of foods richest in sucrose (a generalization would be to say that citrus, stone fruits, and melons are highest in sucrose - you can see a list of foods highest in sucrose here).   

The focus of this post is pineapple.  I kind of turned on pineapple years ago after noticing that it pretty much brutalized my lips, tongue, and throat every time I ate it.  Pineapple is a very rich source of bromelain, which is a strong protease (a digestive enzyme that breaks down protein).  This seems to me to be the most reasonable explanation for this phenomenon.  While unripe pineapple might be great as a marinade for making meats more tender, it seems to be capable of tenderizing your mouth and throat when you eat it anywhere short of full ripeness.

So the following video shows some of the simple tricks I use for making sure my pineapples are very ripe before I cut them - as well as the technique that I find most efficient for cutting pineapples.  Sitting down and eating pineapple all by its lonesome to the point of complete satisfaction is an incredible, refreshing, invigorating snack that completely eliminates the need and desire for sweet junk foods like brownies, doughnuts, sodas, and candy.  For the $2.99 I pay for them, they are worth every penny. 

Frank Forencich

Not long ago I received three books in the mail from 180 follower Rob A. Rob and I have communicated closely for going on a couple of years now I think, and the arrival of these books – all of them written by exercise scholar Frank Forencich, was timely.


Every time summer rolls around I get the itch to spend a lot of time outdoors doing active things. My earliest dabblings with health came in my early 20’s when I realized that the more time I spent outside, the more my most pressing health problems at the time (mood swings, back pain, asthma, allergies) subsided. In fact, if I spent 24 hours per day in the outdoors backpacking around – on my feet most of the day and sleeping in the outdoors, those problems not only improved but completely disappeared until I returned to indoor living (and no, this is not confirmation per se that I was allergic to something in my home as I lived in nearly a dozen locations and noticed this effect every single time).

This is perfectly congruent with the beliefs of the early physiculturalists and the traditional naturopathic ideal – that clean air, clean water, proper rest, sound sleep, lots of sunshine, a peaceful, quiet environment, good food, and physical movement are the tools the body needs to recuperate from sickness. And when these are supplied in abundance, there are but a few maladies that the body cannot conquer.

While this is obviously overly idealistic, I do know that many with serious and minor health problems alike, if it were feasible to really “go native” like this, would truly witness superior results to that offered by the best that alternative and mainstream medicine offer combined.

I guess you probably have to truly experience what it feels like physically, mentally, and emotionally to truly untether yourself from electronics, the comfort of a bed, noise, news, and stale indoor air to really appreciate how powerful it can be. If you haven’t, you kinda have to take my word for it I guess. But there’s no doubt that my long-time romanticism of primitive and simple living is a contributor to the big stiffy I’ve always gotten over the diets and lifestyle of isolated peoples. I was like Rob Schneider’s character “orgasm guy” with every page I turned in Weston A. Price’s Nutrition and Physical Degeneration many years ago.

Anyway, I get from Frank Forencich’s books, that he feels much the same way. Frank is not into big muscles and cover model standards. He’s not into crash diets, treadmill cardio, and the latest list of “weird tips to blast belly fat.” Rather, he is into the enjoyment of play, the regenerative health benefits of exposing your physical body to new challenges, and the excitement of exercise as a form of adventure. Exercise is both a part of and a vehicle to living life at your greatest potential.

His books lack the kind of specific direction, hard-hitting medical claims, clear linear logic, and overhyped promises of results with pages of before and after testimonials like you see everywhere else in the fitness industry – which is precisely what makes them good reads. Instead, you come away with a feeling – a feeling that perhaps the entire way we view movement in the modern world and connect with our bodies is diseased. Even that the concept of reward and goals, when it comes to exercise or any health pursuit, is a part of the problem and not the solution – reinforcing that nothing is worth doing for the sheer inherent joy of doing it anymore, but is always just a means to an end.

And this concept, I get. In fact, my favorite forms of physical movement are precisely the things that I have done over the years that completely removed the element of competition or goal. I did them purely because they were enjoyable. Those things are hiking/backpacking, beach paddleball, snorkeling, and most recently Frisbee.

With hiking I used to just love being out there. At first I tried turning it into a competition where I tried to track mileage and make it to “x” number of mountain peaks or lakes. But I ended up ditching this mindset thankfully – for the first time I think since playing Wiffle Ball with my childhood buddies. In fact, when I realized just how powerful of a mindset change this was I really began to resent those that ventured into the Wilderness to accomplish a goal.

In Colorado, it is becoming increasingly trendy to climb all of the peaks in the state over 14,000 feet in elevation. These mountains are called the “Fourteeners.” I grew to really resent the people that came from all over the state (and the country), just to drop into one of my favorite local trails and ignore everything there while focusing myopically on “bagging” the peak. I came to refer to them as “Peak baggers,” a phrase I uttered as if they had said something bad about my mama.

If you think that sounds snooty, you should see the sacredness with which I hold what are perhaps the only games I’ve ever played without keeping score – paddleball and Frisbee. While paddleball may seem like a lame game, I can honestly say that the most enjoyable and childlike moments of my life came while playing beach paddleball – a game where you just hit a ball back and forth with another person or persons for the sheer enjoyment of it. And when I played with my stepmom and she drew up a court in the sand to keep score so that the game had some sort of “point” to it, I fantasized about ripping her head off with her spine coming with it, grabbed the ball, spiked it at her feet within the boundaries she had created, and said “1” to signify how not fun this game was going to be while keeping score. She walked away. It was one of the most dick things I’ve ever done. Nobody f%$#’s with my paddeball!

Anyway, Frank’s books aren't necessarily life-changing. Your life probably doesn't depend on rushing over to his site http://www.exuberantanimal.com/ to order his books immediately and absorb some incredible new information. To me his books were a reminder, a powerful one at that, of why I spend so much time with all this health crap. I do it because I freakin’ love it. I like how I feel when I eat mostly wholesome, carb-o-rific foods. I totally get off on simple physical pleasures like paddleball. Being outdoors in the sunshine and detached from comfort and climate-controlled environments is one of the most invigorating things I know. Learning about how the human body works, mine especially, and expressing my thoughts about it is totally mentally fulfilling to me.

So let it be a reminder to you too I guess. Health and physical movement are not something you need to justify based on results. They can be inherently enjoyable and enriching pursuits in and of themselves. It doesn’t matter whether you lose fat or build muscle from your health pursuits or whatever. Eating food that makes you feel good today isn’t a waste of time if you don’t live to 110 totally free of all illness and every ounce of body fat. Whatever nurtures you and makes you feel good mentally, physically, and emotionally is worth doing for the sheer enjoyment of it – no matter what that is, including giving the finger to health food so that you can relax and enjoy the company of friends and family without stressing over what type of oil was used in the preparation of that food. We all have our own unique paths to health.  Find it.  And go play if you can, your life might just "depend on it" according to Frank's first title. 

My notes from Frank’s books… He is obviously a very sharp guy…

Forencich, Frank. Play as if Your Life Depends on It. GoAnimal: Seattle, WA, 2003.
Forencich, Frank. Exuberant Animal. Author House: Bloomington, IN, 2006.
Forencich, Frank. Change Your Body, Change the World. Exuberant Animal: Seattle, WA,
2010.

PLAY AS IF YOUR LIFE DEPENDS ON IT…

p. 26

“The tissues of our musculoskeletal system – our muscles, tendons, ligaments and bones - cannot thrive in a state of suspended animation: They depend on gravitational, resistive and kinetic loads to maintain their integrity and health. When muscle tissue is challenged, it responds with growth and increased neural drive; it learns to generate stronger contractions. When connective tissue fibers are challenged with repeated contractions, they supercompensate by growing thicker at crucial junctions. When bones are loaded repeatedly, they increase their mineral density along the axes of greatest force. In this, stress is not the enemy at all; in fact, it is the primary somatic teacher that tells us where to grow, what to reinforce and how to heal.”

p. 35

“The April 2000 issue of Sports Medicine Digest suggested that, in terms of longevity, ‘it’s better to be fit than thin.’ Citing findings from the cooper Center for Aerobics Research, they reported that, in terms of general health as measured in death rates, being fit is far more important than being thin. For out-of-shape men, obesity was clearly associated with higher death rates, but among those who were in shape, body fat percentage was unrelated to mortality. In fact, men who are fit and fat have a death rate about one half that of unfit men in the normal weight range.”

p. 124

“… as our understanding of exercise becomes more sophisticated, we begin to see that it’s not pain that stimulates our bodies, but challenge. Now we say, ‘no challenge, no adaptation.’ In other words, if you don’t push your comfort zone a little, your body isn’t going to pay attention. It’s not the pain that makes the difference, it’s the push.”

p. 127

“When administered in an intelligent, oscillating pattern, we would be correct to describe exercise as ‘therapeutic trauma.’”

p. 221

“… just forget about numbers. Counting takes you out of your body. Instead, concentrate on the quality of your movement and pay attention to how your body feels as you become fatigued.”

EXUBERANT ANIMAL

p. 8

“We expect people to lay down their ideas in linear patterns with distinct rankings, hierarchy and above all, order. But, as we are beginning to discover, neither evolution nor good ideas work this way. Good ideas don’t proceed from point to point in sequential fashion; they split and splinter, branch and divide, just like species do. Simple ideas may sprout a few branches, but really good ideas become exceptionally bushy, generating thousands of conceptual sprouts that continue to grow as the discipline becomes ever richer.”

p. 149

“…modern health researchers have discovered clear evidence of destructive effects of noise on the human body. Exposure to high levels of auditory noise raises blood pressure, increases stress hormones, disrupts sleep and probably contributes to attention-deficit disorders, in both children and adults. And of course, noise also impacts our athletic performance.”

p. 300

“Every responsible physician, trainer and coach knows that speed fails. The only thing that really, truly works is frequent, vigorous movement combined with a sensible, food-based diet, sustained over years and decades.”

CHANGE YOUR BODY

p. 154

“Back at the dawn of the digital age, ‘visionaries’ claimed that the computer would be a highly effective labor-saving device that would free us from untold hours of drudgery. No longer would we be shackled to our desks, writing down numbers and words by hand until the middle of the night. We’d be granted a wide-open vista of easy living, free to pursue our favorite leisures, hobbies and fascinations. Boy, were they off the mark.”

p. 163

“… we now know that there’s one sure way to position yourself for a chronically activated stress response and that’s to adopt and hold tight to a single, static world view. The formula is simple: Develop a perspective on how the world works and stick to it. Then, when reality comes barging in with the inevitable counter-argument, you’re in for a case of cortisol poisoning and everything that goes with it, including damage to precious blood vessels and neurons.”

Brain Basis for Emotion Recognition Deficits in Depression

There is a emerging understanding of the role of social perception problems in depression and anxiety disorders.  Depression appears to effect the cognitive ability to judge the facial expression of others.  This impairment poses a challenge for interpersonal function and social relationships.  Research is now pinning down the neural basis for this deficit and to determine it’s persistence and the effect of depression remission on this social cognition function.

van Wingen and colleagues from the Netherlands recently published an fMRI study on this topic in Psychological Medicine.  The study had the following elements in research design:

• Subjects: Twenty case subjects with first episode of major depression (medication naive), Twenty one case subjects recovered from a first episode of depression and 30 healthy individuals without a history of depression
• f MRI Task: Visual recognition of anger or fearful face by semantic labelling or visual matching compared to a control task of matching facial orientation without attention to emotion
• Additional Neuropsychological Testing: Depression symptom level, anxiety (state and trait) symptom level, IQ, memory, visual learning, attention, psychomotor speed and executive function.

The depression case subjects were not different from recovered depressed subjects and controls on most of the tests of neuropsychological function.  As expected, they did have higher depression symptom severity scores (Hamilton Depression Scale average for the depressed group was 21.8) and higher anxiety symptom severity scores.

The depressed group performed as well as the remitted group on the control task and the visual emotion matching task.  However, they performed worse than both groups on the semantic matching task, i.e. selecting the correct word label for the emotion displayed visually.  

The brain regions that correlated (increased activation) with impaired semantic emotion labeling included three distinct regions:

• right amygdala
• left inferior frontal gyrus
• anterior cingulate cortex

The authors propose that one explanation for this finding in three distinct brain regions.

“The left inferior frontal gyrus is thought to integrate language with other information (Hagoort, 2005;Willems et al. 2007). Therefore, we suggest that the inferior frontal gyrus may integrate the semantic knowledge about the concepts of anger and fear with the emotional information conveyed by the faces by interacting with the amygdala. The concurrent activation of these systems may subsequently trigger automatic negative thoughts and stimulate task unrelated processes such as rumination (Siegle et al. 2002; Ray et al. 2005), and thereby hinder task appropriate behaviour.”

This explanation fits with the cognitive behavioral theory of depression.  The core concept being that depression is characterized by increased automatic negative thoughts about the self, the future and the environment.  The thoughts are generated by a maladaptive negative cognitive schema.  Activation of these automatic thoughts (i.e. by being shown negative facial emotions) produces distraction from tasks (i.e. correctly labelling these facial emotions). This process appears limited to when depression is present as the recovered depression group showed no deficit.

The authors also conclude the findings could be due to a compensatory mechanism for inadequate behavior or an altered coping mechanism for dealing with demanding situations. 

This study provides additional support that fMRI research may lead to advances in the treatment of depression by both psychotherapy and psychopharmacologic interventions.

Screen shot of 3D Brain showing the limbic system structures amygdala and cingulate cortex (along with the inferior frontal cortex) thought to be involved in impaired facial recogniton in depression.

van Wingen, G., van Eijndhoven, P., Tendolkar, I., Buitelaar, J., Verkes, R., & Fernández, G. (2010). Neural basis of emotion recognition deficits in first-episode major depression Psychological Medicine, 41 (07), 1397-1405 DOI: 10.1017/S0033291710002084

Dangers of Colorectal Cancer Screening

Last night, it was announced by my brother-in-law during dinner (ALWAYS while we are eating - is my family the only family like this?), that he will be going in for a colonoscopy later this week.  Then, to my horror, other family members chimed in and started talking about their colonoscopies.  I decided to eat in peace, and not get into it. 

With many things in mainstream medicine, people have begun systematically going in for routine check-ups on certain things as if it is some rite of passage somehow - like twice annual fluoride treatments.  This is good business, but going in for a colorectal screening is typically unnecessary, can be dangerous due to bowel injury (perforation), sedative side effects, and side effects from bowel preparation (with colonoscopy), and in the case of barium enemas and CT colonography, it exposes you to massive amounts of radiation.  And, at the end of the day, it doesn't do much for you even if they do find cancer while they're snooping around. 

Having perfect digestion is the best preventative step one can take to prevent colorectal cancer.  I would describe that as being able to eat a wide variety of foods without bloating, indigestion, painful or excessive gas, foul fecal odor, foul gas odor, hard stools, overly loose stools with the typical pain, burning, and discomfort of diarrhea, and little or no need for wiping.  Movements should come twice daily, be soft, and pass in seconds without straining.  Anything less than that and you should keep searching and experimenting for a way to achieve that.  That is how you prevent colon cancer.  Standard colorectal screening is not the answer, and can do tremendous collateral damage while giving you limited protection even if there is early detection. 

Just like many medical screenings, such as mammograms, colorectal cancer screening is a false safety net that is often served with a baked potato of radiation with all the fixins, and makes a lot more cents than sense.  It may come as a shock, but the American Cancer Society and the American College of Radiology endorse the kind of screening that gives you a massive dose of radiation!

Sure, if you are 73 years old, both parents died of colorectal cancer, you've had IBS your whole life, and your ass is now mysteriously bleeding - by all means go get screened.  But this is not some test that the mainstream public in the low-risk category, like my brother-in-law, needs to be getting routinely.   

Limiting Debt May Be Good For Your Mental Health

Article first published as Limiting Debt May Be Good For Your Mental Health on Technorati.

The relationship between financial status and risk for medical and mental disorders is complex. Premorbid functioning (level of function prior to the onset of a condition) may influence cognitive performance, motivation and the social interaction skills necessary for gaining employment and career success. Failure to obtain (or maintain) a rewarding job can contribute to increased stress and possible reduced access to treatment for medical or mental health conditions. Two recent studies examined the relationship between financial factors and risk for mental disorders. These studies provide potential strategies for the prevention of some common clinical neuroscience conditions.

Jenkins and colleagues in the United Kingdom studied the relationship between a variety of economic indicators and risk for presence of a mental disorder in over 8000 individuals in England, Scotland and Wales. The previous well-documented association between lower socioeconomic status and increased risk for mental disorders was found in this research study. Risk for any mental disorder (neurotic disorder, psychotic disorder, alcohol or drug use disorder) ranged from 24% of the highest earners to over 40% for lowest income group in men. For women the difference was 18% for the highest income group compared to 33% for the lowest income group.

Examining the relationship between income and risk for mental disorder in more detail in this sample produced an interesting finding. Income was strongly associated with the number of debts and the number of debts strongly correlated with rates of mental disorders. When the presence of personal debt (and other socioeconomic factors) was controlled, the association of income and mental illness vanished or was greater reduced. A small effect for income on rates of neurosis persisted after controlling for number of debts.

The authors of this study note that it was a cross-sectional study and there was no ability to examine the sequence of events. Perhaps the primary association is that those with a mental disorder are more likely to take on debt (whether out of necessity or perhaps because of impaired financial decision making associated with cognitive limitations). But the authors do note an important implication of their research. The role of personal debt and risk of mental disorder is rarely studied. Personal debt levels are increasing in many countries around the world. The role of debt in risk of (and management) of mental disorders is an emerging public health issue.

A second abstract that caught my attention in this topic area is a study by Lang and colleagues in the UK and the U.S. They noted that the prevalence of common mental disorders tends to rise up through midlife when a peak rate is reached. Their study found this effect occurred only in the lowest income group. Those in higher income groups appeared to be protected from this midlife prevalence rate increase. There was no mention of the potential role of debt in this common epidemiological finding.

These findings have influenced how I assess and manage patients. I tend to be more likely to ask about personal debt levels and the influence of debt (and intrusive debt collectors) in mood, anxiety levels and personal distress. Using debt counseling resources and encouraging the limitation of personal debt may become more common important components of clinical neuroscience.

Photo of credit card from Creative Commons file at Wikipedia.

Jenkins R, Bhugra D, Bebbington P, Brugha T, Farrell M, Coid J, Fryers T, Weich S, Singleton N, & Meltzer H (2008). Debt, income and mental disorder in the general population. Psychological medicine, 38 (10), 1485-93 PMID: 18184442

Lang, I., Llewellyn, D., Hubbard, R., Langa, K., & Melzer, D. (2010). Income and the midlife peak in common mental disorder prevalence Psychological Medicine, 41 (07), 1365-1372 DOI: 10.1017/S0033291710002060

How Fast Should You Lose Weight?

If you are reading this, then consider yourself lucky. I’m about to solve all of the world’s problems with this simple article. World peace. A cure for AIDS. Global warming. Tupac’s whereabouts. Where Bin Laden got his growth hormone injections. It’s all here.


Well okay, maybe not. But I do find that sometimes the very simple things that I take for granted often have the strongest impact on 180D readers. Today, we go with the simple of the simple. How fast should you lose weight?

My mom and I have been talking about this recently. I’m visiting her for several weeks in Nashville and it’s been on my mind, as my mom is a 96.3-degree 40-year dieter wanting to lose weight (and she gets that look of hopelessness when I tell her how long it will take to get a substantial amount of fat off of her body). Hence me writing about it. My mom repeated the standard mantra that most people hear – that “healthy” weight loss is about 2 pounds a week.

2 pounds a week? Holy Schnikies! That’s insane!

I actually like math, and we’ll use some math to scrutinize this…

A pound of fat is a storage depot of approximately 3,500 calories. So, to lose 2 pounds of fat in a week, you would need to have an energy deficit of 7,000 calories – which is 1,000 calories per day!!! Yikes! I virtually can guarantee that if you are running at a 1,000 calorie-per-day deficit you are going to be in for some real trouble, and a fierce activation of your famine response – not to mention running into some severe hunger and cravings. You might get away with this for a few weeks but there will be hell to pay unless you are an extreme rarity.

To run a calorie deficit that large, you are going to have to pursue the time-tested failed strategy of “intentional” weight loss. It’s certainly not going to be something that your body regulates and achieves spontaneously without physiological revolt or noticeable discomfort – something that I argue is the only way to lose weight sustainably and permanently.

To lose weight eating to appetite and doing reasonable quantities of physical activity, you are not going to run a deficit of more than a few hundred calories per day without noticing. Let’s say an absolute maximum of 500 calories per day. At a deficit like this, you are only losing a maximum of 1 pound per week of actual body fat.

Let’s not forget though that a quart/liter of water weighs a buttload (a frequently-referenced unit of measurement used here – get to know it). A change in water levels in the body by 4-5 pounds can happen in a matter of hours. In high school wrestling we would often shed 10 pounds of weight overnight by sweating like crazy and not eating or drinking anything. Mmmm, healthy.

Let’s also not forget that a pound of muscle only contains 600 calories, so a deficit of 600 calories is plenty to make you lose a pound – but you are losing muscle, not fat. This is hypothetical of course. The relative amounts of fat and muscle that you lose in any energy deficit depends highly on your age, gender, metabolic rate, type and quantity of physical activity, and more.

I think what is most common is that people induce a daily calorie deficit of 1,000 calories per day or so through diet, exercise, or a combination of the two. During the first week when metabolic rate is its highest, they lose the most total weight and the highest ratio of fat to muscle tissue. They lose 2-3 pounds and most of that is fat. As the weeks continue and metabolic rate starts to come to a screeching halt they being losing less fat, a little more muscle by percentages, and less overall weight. Eventually they lose no weight at all or even gain weight from increased water retention (water retention increases as metabolic rate falls).

So speaking strictly about fat loss, not “weight loss,” the absolute maximum rate of sustainable fat loss one can achieve without doing more than a few hours of exercise per week is only about one pound weekly. Of course, there have been many times in my life where I lost a pound of fat per day doing rigorous backpacking – sometimes over 20 miles per day carrying 50 pounds on my back. But that is quite a different scenario, and came with quick weight rebound and an overall worse body composition in my collective experiences with it.

This rate of fat loss is so slow that, if you are monitoring your weight on a scale, you are almost guaranteed to feel like it is taking too long. You will also be thrown off by subtle changes in water levels and muscle mass – perhaps thinking that you are not losing fat when indeed you are, or vice versa. In fact, it’s not uncommon at all for a male or female with a long dieting history to gain tremendous amounts of fat-free body mass while gaining no fat at all or even losing fat.

This is often welcomed by men, whose steroid-enhanced superstar physique idols weigh far more than an average male, but horrifying for women who may not understand that some of the world’s leanest women are, like very lean men – quite heavy for their height due to increased muscle mass. Take for instance Batty (left), who is a very lean and athletic real woman at 175 pounds who issues a formidable challenge to the currently idolized and out-of-reach-to-normal-women body image in her excellent WOMEN’S BODY IMAGE POST.

But know that men and women alike often gain weight while getting leaner as I did years ago with my first experiments with “ETF-ing” (eating the food). Most will find that their “ideal body weight,” from a health and metabolism perspective, is considerably higher than they’ve led themselves to believe. The good news I guess is that you may need to lose far less weight than you think to achieve your supposed ideal body composition.

So yeah, no major earth-shattering revelations here, but know that if you have more than 20 pounds of excess and unwanted fat on your body, plan on taking somewhere between 6-12 months or longer to get it off, with an absolute maximum rate of fat loss at about 50 pounds per year, if you hope to keep it off and not have your health and metabolism negatively impacted in the process. Throw away your scale. Scale weight is more or less irrelevant and the scale itself, if you weigh yourself more than once per month or so, can play some serious head games with you – such as getting irrationally emotional when you gain a pound one week, and drastically switching courses into the anorexic strategy for trimming off excess baggage.

All this equates to not realizing that you are dieting or losing weight because you experience no nagging hunger, no cravings, no freezing cold hands and feet and loss of sex drive, or any other negative symptoms. If you do, or if you catch yourself losing weight faster than 5 pounds per month, you need to eat more – perhaps even intentionally regain a couple pounds briefly before making even the slightest attempt at marching further, which is a strategy that has more or less become universal in the bodybuilding/fitness competitor world (and is gaining credibility amongst real obesity researchers as well, such as Amanda Sainsbury-Salis who I hope to write about soon).

With a process so comfortable and unnoticeable, it’s no different from living your normal life. You just happen to be losing fat as you do it at a pace that’s almost undetectable to anyone who sees you on a daily basis. Sure, dieting with hunger and lightheadedness and irritability and unwanted exercise is not something that you want to take a whole year. I can’t even make it for three weeks doing that. But when it’s unnoticeable, comfortable, and enjoyable – who cares how long it takes?

And as a last tidbit on the topic of the best rate of fat loss – as you approach a level that is very lean – lean enough to see your abdominal muscles for example, your ability to lose body fat without losing lean tissue and suffer adverse metabolic consequences becomes greatly diminished. Leanness gurus like Martin Berkhan and Clarence Bass both agree that the maximum rate of fat loss is no more than 2 pounds per month, and ideally even less than that, when trying to go from normal to freakishly lean. Something to keep in mind at least – that is, the less fat you carry the slower you need to lose it.

But in general, the harder you “try” to lose weight, the greater the magnitude of your failure to keep any fat that you lose off of your body. Sure, you can get some exercise, eat lots of low-calorie foods like fruits and vegetables, avoid intentionally overeating or eating when you are not hungry… but push too hard and you will experience an equal and opposite reaction from your body as a best case scenario.

More of this type of stuff to come over the summer, when losing fat is its easiest and most welcomed by your body.