Saturday 30 July 2011

BBQ'd Mushroom and Spinach Salad

We got this recipe from Smoke and Spice: The Real Way to Barbecue by Cheryl and Bill Jamison. 


12 ounces portobello mushrooms
Coarse Kosher or sea salt


Dressing:
2 Roma or Italian plum tomatoes, seeded and chopped
1/3 cup extra-virgin olive oil
1 tablespoon balsamic vinegar
1 tablespoon chopped fresh basil
1 tablespoon minced fresh parsley
3 garlic cloves, minced
2 scallions, sliced
Salt and coarsely ground black pepper to taste


1 large bag of spinach, or equivalent
Crumbled feta cheese, optional
Sunflower seeds, optional


I've done this in my barbecue/smoker, but I guess you could use a covered grill using low, indirect heat.


Slice the mushrooms into large, bite-size pieces and salt them lightly. Arrange mushroom pieces on a small grill pan, rack, or a piece of heavy-duty aluminium foil.


Place in the barbecue and cook for 15 to 20 minutes, until they ooze liquid and are cooked through.


While the mushrooms are cooking, mix the dressing ingredients.


Add the cooked mushrooms and mix lightly. Can be served warm or chilled.


Place a layer of spinach on a serving platter. Spoon the dressing over the spinach. Garnish with feta cheese and sunflower seeds, if desired. Alternatively, serve the cheese and seeds separately and let folks add them if they'd like.

Friday 29 July 2011

Potluck options

Hard to believe that July is almost over. How's summer where you live? We're still looking forward to its arrival here in western Oregon ...

One challenge we frequently face is deciding what dish to take to a potluck (also known as a potluck supper, spread, Jacob's join, Jacob's supper, faith supper, coverd dish supper, bring and share, shared lunch, pitch-in, carry-in, bring-a-plate, smorgasbord, and dish-to-pass 1). We want to take something that we'll eat. That way, we know that there will be at least one item that fits our diet.This picture from the Wikipedia Potluck page is fairly typical, unless you're fortunate enough to be going to Grok potlucks. 
Carbfest, also known as a potluck (image from this site)

Carving station, complete with carbs! (source)
What kinds of dishes fit the paleo / primal / low carb philosophy, short of bringing a full carving station? Cost is an issue. Protein and fat are more expensive than carbohydrate. Breaking out the grass-fed ribeyes probably isn't practical. Prep time can be an issue, too. And sometimes it's best to avoid the whole diet / health / nutrition conversation. Mark Sisson's 80/20 Principle definately applies here. Some of these may not be your choices for everday fare, but they're far better than what we typically see at the potlucks we attend. So here's a list of the options we've come up with so far:

Pre-made party tray - I recently found these at our regional supermarket, composed of two kinds of lunch meat along with two kinds of cheese, already cut. Also included were a container of mixed olives and some packages of crackers. The price was reasonable.

Mixed nuts - Another buy-bring-open option. Pretty much self-explanitory.

Veggie tray - If you're certain that others will be providing animal protein and fat, you could opt for a plateful of plant parts. Obviously you could make this yourself or buy it pre-made.

 
Deviled eggs - These take a little time to prepare, but their cost can be quite reasonable. You don't have to use your locally-sourced pastured eggs.

 Pre-made meatballs and spaghetti sauce - This is a little more involved than the previous options, but not much. We buy a bag of frozen Italian meatballs at our supermarket, put them in the Grokpot and add a jar of the store's spaghetti sauce. Be sure to allow for enough time to thoroughly heat.

Beef sausage in BBQ sauce - Buy the beef sausage (like Hilshire Farms) when it's on sale, at this option becomes an even better deal. Slice the sausage into 1 - 1 1/2 inch pieces, put them in the Grokpot, and add a bottle of prepared BBQ sauce (Be careful with these sauces. They're typically loaded with various sweetners. But it's not like you're drinking the stuff. If you'd like, you could use your own. You can find my recipe here.)

Spinach salad with BBQ'd portobello mushrooms - I'll have to post the recipe for this, but we got it from Smoke and Spice: The Real Way to Barbecue by Cheryl and Bill Jamison.  [Update - the recipe is posted here.]

Nancy's all meat chili - Another recipe that I'll post soon.

Pulled pork - For extra-special occasions I've brought a Grokpot of my real pulled pork. I posted my recipes for the spice rub and BBQ sauce here.

I'd love to hear your suggestions.

References:
1 Wikipedia. Potluck. http://en.wikipedia.org/wiki/Potluck

Thursday 28 July 2011

Hoarding: Drug Treatment

This is the fourth post examining the problem of hoarding. In the first post, I reviewed some of the characteristics of people with animal hoarding behavior.  The second post examined some of the common co-occuring mental disorders in those with hoarding.   The third post looked at some evidence that the BDNF gene status may contribute to hoarding and also be linked in increased risk of obesity.


In this post, I will comment on the use of  pharmacotherapy as a part of a treatment program for hoarding.  Saxena recently published a review of the research literature of drug treatment of hoarding and also outlined results from a small open label study of the drug venlafaxine.  


Saxena reports that his group performed the only study specifically designed to assess the response of compulsive hoarding behaviors to a selective serotonin reuptake inhibitor (paroxetine) compared to a control group of individuals with OCD but no hoarding compulsions.


SSRI drugs have been the most promising group of agents for the treatment of OCD.  However, only about one third of those with OCD report a response approaching remission criteria when treated with an SSRI.  An additional third report partial improvement in symptoms while the remaining third appear to have no response to SSRIs.


There is some anecdotal reports claiming that hoarding symptoms in OCD predict a poorer response of OCD to SSRI therapy.  However, in the Saxena et al study of paroxetine for hoarding the following outcome was noted:
  • The OCD response rates were similar in the hoarding (28%) and the non-hoarding (32%) OCD groups
  • Hoarding symptoms were reduced by 24% with paroxetine (similar to response size in other OCD symptom clusters)
  • There was no finding of a correlation between the severity of hoarding symptoms and treatment response
  • A significant number of hoarders (and non-hoarders) were unable to tolerate the higher doses often needed in OCD populations
The Saxena review then summarizes an open-label trial of venlafaxine (Trade name Effexor in the U.S.) in thirteen hoarders.  Venlafaxine is a serotonin reuptake inhibitor as well as a norepinephrine reuptake inhibitor at higher doses.  Preliminary results in this sample suggest good response of hoarding behaviors in some individuals with a trend for greater reduction in hoarding symptoms compared to the paroxetine.

These manuscripts support consideration of use of an SSRI or venlafaxine type antidepressants in those with significant hoarding behaviors.  A comprehensive program that includes drug therapy, individual behavior therapy, family education and assistance with clutter clean up may be needed for the most severe cases of hoarding.


Molecular model of the antidepressant drug venlafaxine is in the public domain from Wikimedia Commons authored by Benjah-bmm27.


Saxena, S. (2011). Pharmacotherapy of compulsive hoarding Journal of Clinical Psychology, 67 (5), 477-484 DOI: 10.1002/jclp.20792


Wednesday 27 July 2011

Hoarding Linked to BDNF Gene in OCD

In two previous posts on hoarding, I have reviewed some the pathway and profile of animal hoarding as well as the common mental health problems found with hoarding.

Today I will review a study that provides some insight into potential genetic contributions to hoarding behavior.  Of interest, this genetic link also appears to carry some increased risk for obesity.

Timpano from the University of Miama along with colleagues at Florida State University and the National Institute of Mental Health Intramural programs have recently published a study of 301 subjects with obsessive compulsive disorder (OCD).

In previous posts it was noted that hoarding can occur in the context of OCD but that not all hoarders will meet criteria for OCD.  In the Timpano et al study, subjects started with a diagnosis of OCD and then were grouped into those with hoarding and those without hoarding behaviors.

The hoarding classification status was assigned based upon the subject response to two items found on the Yale Brown Obsessive Compulsive Scale (YBOCS).  One item queried about tending to save objects and second item queried about difficulty discarding objects.  Hoarding subjects were required to endorse both items.

The research team then looked at the subjects and the brain-derived neurotrophic factor (BDNF) status.  BDNF has been a genetic region of interest in a variety of clinical neuroscience conditions including schizophrenia, anxiety and aggression.  Additionally it appears to be involved in memory function and variants of BDNF have been linked to higher rates of obesity.

BDNF appears to serve a role as a central neurological system plasticity factor and modulates both serotonin and glutamatergic neurotransmitter systems.  The BDNF gene codes for a protein that can vary in an region in status of two amino acids valine and methionine.  At this regions, individuals can be assigned one of three genetic types: Val/val, val/met or met/met.

The Timpano et al team found the following key findings:
  • About 25% of those with OCD met criteria for being hoarders
  • The BDNF val/val genotype was found in 77% of the hoarding group versus only 60% of the non-hoarding OCD group
  • The BDNF val/val genotype correlated with increased hoarding symptom severity and BMI
  • 45% of the hoarding group met criteria for obesity (BMI >30) versus only 21% of the OCD only group
The authors note that there are animal models of hoarding where hoarding behaviors have been linked to dysregulation of feeding behaviors.  When humans begin to hoard objects, there may also be a overlapping drive to hoard (and consume) food.  The authors note there may be a complex gene mechanism whereby individuals display hoarding, increased body weight and psychopathology as evidence of a "thrifty gene" strategy that may have survival and evolutionary manifestations.

It would be informative to examine the BDNF gene status of hoarders without a diagnosis of OCD.  The authors note that interaction between BDNF and serotonergic function may partially explain some other the BDNF-hoarding-obesity triad.

There role of serotonin in OCD has received significant research attention. In the next post, I will look at the potential for selective serotonergic antidepressants pharmocotherapy in the treatment of hoarding behaviors.

The molecular model of BDNF above is in the public domain from a Creative Commons Attribution-ShareAlike 3.0 file (Wikepedia) authored by Microswitch.

Timpano, K., Schmidt, N., Wheaton, M., Wendland, J., & Murphy, D. (2011). Consideration of the BDNF gene in relation to two phenotypes: hoarding and obesity. Journal of Abnormal Psychology DOI: 10.1037/a0024159

Tuesday 26 July 2011

Hoarders: Mental Disorder Profiles

Hoarding is under increased scrutiny in both the public presence and clinical neuroscience research.  Some of this can be attributed to the television show Hoarders.  This show profiles a series of individuals with hoarding behaviors and the attempts made by professionals trying to help them.

If you have seen any of the shows you quickly realize that this problem is easy to assess but difficult to treat.   The effect on family members of hoarders is often extreme.  Family members commonly are driven from the hoarder's home due to increased clutter and concerns about sanitation.

Hoarding is being proposes as a new diagnosis under the fifth edition of the Diagnostic and Statistical Manual.  Clinicians who treat patients with obesessive compulsive disorder (OCD) are aware of hoarding phenomenology (symptoms) as some individuals with OCD will have hoarding behaviors.

Understanding hoarders requires assessment of co-occuring or comorbid mental disorders.  Frost et al have conducted a study of a comorbid disorders in a large series of over 200 individual hoarders and compared them to a group with OCD without problems with hoarding.

Obsessive compulsive disorder is a reasonable mental disorder to compare with hoarding.  Since some individuals (but not all) with OCD will have hoarding, it is helpful to use OCD as a psychiatric control group.  Such a strategy can aid with determining the boundaries (or discriminant validity) between similar conditions.

The authors used a rating scale that I have not heard of before--the Hoarding Rating Scale that rates three key components of hoarding:
  • Clutter in the living environment
  • Problems with discarding items
  • Excessive acquistion of physical objects
As expected the hoarder group had higher rates on all components of the Hoarding Rating Scale.  The two groups had some interesting differences in lifetime prevalence rates for mood, anxiety and ADHD diagnoses as summarized in the chart below:


Hoarders had higher rates of major depression and generalized anxiety disorder than those with OCD.  Additionally they demonstrated significant increase in rates of attention deficit hyperactivity disorder.  

When the two groups were compared on a variety of types of impulse control behaviors, hoarders were much more likely to endorse compulsive buying, a pathological drive to obtain free items and kleptomania.  They were not different than those with OCD in rates of pathological gambling or trichotillomania (a impulse to constant pull out ones own hair).

This study does lend some support for considering hoarding as a distinct disorder separate from OCD.   The high rates of ADHD in this hoarding sample support clinical consideration of this condition in hoarders.  I was surprised by the relatively low rate of substance abuse.

You will likely hear more about research examining those who have hoarding behaviors.  Family, twin and other genetic studies would helpful to tease out where this type of behavior differs for OCD and other mental disorders. Below is a three minute educational video on hoarding from the University of Michigan.



Chart is an original chart from the author adapted from data presented in the Frost et al manuscript listed below. 

Frost RO, Steketee G, & Tolin DF (2011). Comorbidity in Hoarding Disorder. Depression and anxiety PMID: 21770000


Monday 25 July 2011

Sleep Apnea: “Why am I so Tired?”


Sleep apnea, interrupted breathing while sleeping, has been linked to hypertension, heart disease, elevated blood sugar and stroke. There are a variety of diagnostic and treatment options available to treat sleep apnea and help sufferers regain a good night’s sleep. Penn is pioneering one of the latest options, which uses minimally invasive robotic surgery to treat sleep apnea patients who have problems with excess tissue at the base of the tongue.

Sleep apnea tends to be more common in men, and the bed partner often has sleep issues because of the snoring or gasping. In fact, it is often the wife who nudges her husband to seek treatment for this disorder, according to Ronald Barnett, MD, pulmonologist and sleep medicine specialist at Penn Medicine Valley Forge.

Grace Pien, MD, a specialist in women’s sleep issues, says a woman’s risk of developing sleep apnea increases after menopause. Dr. Pien is currently studying the role of estrogen and other reproductive hormones in protecting women from sleep apnea.

“Women appear to be protected from sleep apnea during their child-bearing years, but the risk increases once they enter perimenopause, and the risk for post-menopausal women is three times greater compared to premenopausal women,” said Dr. Pien.

A thorough sleep evaluation reviews all aspects of a person’s sleep habits, physical characteristics and associated medical conditions to help physicians make a diagnosis of sleep apnea. Usually, patients undergo an overnight sleep study, which can be performed in a sleep laboratory, or increasingly, in patients’ homes using home sleep monitors. About 80 percent of people tested are diagnosed with sleep apnea, according to Dr. Barnett.

Sleep studies are often recommended for patients who are overweight and have a history of hypertension and cardiac arrhythmias because of the link between sleep apnea and heart disease, according to Theodhor Diamanti, MD, Penn cardiologist. “Sleep apnea causes the oxygen levels to drop and low oxygen levels can lead to life-threatening cardiac arrhythmias,” said Dr. Diamanti.

Patients treated for sleep apnea are better rested, have higher oxygen levels, and are more active and able to live healthier lives.

The most common, and most successful treatment for sleep apnea is CPAP — continuous positive airway pressure. The positive airflow blows into the nose and/or mouth and keeps the airway open so that breathing is not interrupted. The treatment works for about 90 percent of patients.

Continuous positive airway pressure (CPAP) helps many patients who suffer from sleep apnea. But for those patients who can’t tolerate CPAP, surgery – including minimally invasive robotic surgery — may help break the sleep apnea cycle.

The muscles that hold the airway open relax during sleep. When the loose tissue vibrates, someone snores. If the tissue in the back of the throat collapses, it blocks the airway and results in sleep apnea. Uvulopalatopharyngoplasty is the most common procedure for removing the excess tissue in the throat.

“In surgical management of sleep apnea we can remove the tonsils and trim the uvula and palate,” said Erica Thaler, MD, Penn otorhinolaryngologist. “Now with the introduction of transoral robotic surgery (TORS) we can also help patients who have issues with the tissue at the base of the tongue.”

Dr. Thaler said about 20 patients have been treated for sleep apnea using TORS with good results. “This is a new procedure so we are continuing to follow these patients through sleep studies,” Dr. Thaler said, “but so far our outcomes have been positive.”

To learn more about transoral robotic surgery (TORS), visit the Department of Otorhinolaryngology-Head and Neck Surgery. To schedule an appointment, please call 800-789-PENN (7366).

RBTI Testimonial

I've made the point before and I'll make it even more emphatically here - there is only one person that has cracked the code of the RBTI.  His name is Challen Waychoff.  It has recently come to my attention that many people are hearing about RBTI here, googling it, and ending up on the forums of various jagoffs that have no idea what they are doing.  Fail. There is only one person in the world that has developed any degree of mastery using the Reams equation.  Accept no substitutes. 

For example, the most popular of the "RBTI" practitioners nearly killed the person that speaks in the following interview, by having her drink a bunch of water.  Water is like kryptonite to the hypoglycemic, and this is one of the worst cases of hypoglycemia imaginable - complete with daily blackouts prior to finding the really deally in Wheely. 

Anyway, Challen's program is a program designed to achieve remineralization.  And well, having a tooth start to regenerate and literally pop out a filling in only two weeks time is a pretty remarkable example of the amazing remineralizing potential of Waychoff's work.  Have a listen. 

Penn Develops Robotic Approaches for Treating Lung Disease


The thoracic surgeons at Penn Medicine are leaders in developing and applying minimally invasive surgical techniques to treat chest and lung diseases, including cancer.
Minimally invasive alternatives to traditional open-chest surgery, including robotic-assisted surgery, are used to treat many diseases in the chest and lungs, including lung cancer, thymic and mediastinal tumors, emphysema, hiatal hernias, fluid in the chest and chest infections, according to Taine Pechet, MD, Penn thoracic surgeon and vice chief of surgery at Penn Presbyterian Medical Center.
Lobectomy (removal of a section of the lung) is a common surgical treatment for lung cancer. Dr. Pechet said last year nearly half of all lobectomy surgeries were performed minimally invasively using video-assisted thorascopic surgery (VATs). With the recent addition of robotic-assisted thoracic surgery, Penn surgeons are extending the minimally invasive surgical options available to treat patients.
"Robotic-assisted thoracic surgery is relatively new in the U.S.," Dr. Pechet said. "Penn Medicine is an early innovator in the use of robotic-assisted surgery and is developing the techniques and strategies that will define the role of robotic-assisted surgery in the treatment of lung diseases."
For patients, the benefits of minimally invasive and robotic-assisted surgery may include:
  • Less early post-operative pain
  • Less risk of infection
  • Less anesthesia
  • Less blood loss
  • Less risk of abnormal heart rhythms
  • Better early lung function
  • Shorter hospital stay
  • Faster and more complete recovery
  • Quicker return to normal daily activities
For surgeons, the surgical robot's 3D visualization and added degree of movement allow increased control and precision, a key element in performing successful lung surgery. Dr. Pechet said Penn's thoracic surgeons are currently developing the best ways to apply this technology to chest surgery. As new technology and surgical techniques emerge, Penn's experienced surgeons are positioned to use the new techniques as soon as they become available.
Dr. Pechet sees patients and performs surgery at Penn Presbyterian Medical Center, and sees patients at The Penn Lung Center at Shore Memorial Hospital. For more information, visit the Penn Lung Center. Appointments can be made online or by calling 800-789-PENN (7366).

Animal Hoarders: Pathways and Profile

This week I will have four blog posts on the topic of hoarding.  This post will focus on the hoarding of animals, followed by posts on mental health disorders in hoarders, a review of manuscript looking a genetic factors in hoarding and then finishing with a review of pharmacotherapy treatment of hoarders.

Hoarding occurs in a variety of forms.  Some individuals with hoarding collect newspapers, clothes or other specific items such as dolls.

One group of hoarders appear vulnerable to collecting animals.  As with all hoarding types, eventually the hoarding gets out of control leading to unsanitary conditions and disruption of interpersonal relationships.

With hoarding of animals, conditions can deteriorate to the point of significant animal malnutrition as owners have escalating costs to feed and provide veterinary care to their animals.  Most complaints to animal welfare agencies about hoarders center around animal health or sanitation associated with the behavior.

Steketee and colleague recently published a description of sixteen individuals with a problem with animal hoarding in the Review of General Psychology.    Although not a large number, it is one of the largest descriptions to data and provides some insight into the pathway and profile of animal hoarders.

For their control group, they interviewed a series of individuals who owned many animals but had no trouble with caring for them.  The animal hoarding case group had all been identified by referral from an animal protection agency that had investigated the hoarding household following a public complaint.

The study used a combined qualitative and quantitative approach with the key findings from the study showing the hoarders:

  • Reported poor childhood attachment to their families
  • Endorsed a chaotic childhood environment
  • Endorsed human characteristics to animals
  • Experienced extreme emotional reactions to animal deaths
  • Distrusted authority
  • Exhibited impaired adult functioning in home maintenance and work performance
  • Endorsed more dysfunctional adult human relationships

The authors note their study supports the three pare theoretical model proposed by Patronek and Nathanson for animal hoarding:

  1. Failure to development secure human attachments during childhood
  2. Poor adult functioning leading to social and work problems with few friends and supportive family members
  3. Development of a reliance on animals for emotional comfort

Some similar developmental abnormalities may be found in other hoarder subgroups. Substitution of interpersonal relationships with preoccupation with objects or animals seems to be a common theme.

Photo of young Canadian gosling walking across drive way with worm/grub in mouth courtesy of the author's private files.

Steketee, G., Gibson, A., Frost, R., Alabiso, J., Arluke, A., & Patronek, G. (2011). Characteristics and antecedents of people who hoard animals: An exploratory comparative interview study. Review of General Psychology, 15 (2), 114-124 DOI: 10.1037/a0023484

Patronek GJ, & Nathanson JN (2009). A theoretical perspective to inform assessment and treatment strategies for animal hoarders. Clinical psychology review, 29 (3), 274-81 PMID: 19254818

Sunday 24 July 2011

Smoky Tempeh Panini on Sprouted Wheat Bread

Panini Grills do something so... yummy to your sandwiches. It takes an ordinary sandwich and makes it special!  For this recipe I used Sprouted 100% Whole Grain Bread-Ezekiel 4:9 by Food for Life.  Different from most breads today, this unique bread is made from freshly sprouted live grains and contains no flour.  Sprouting the bread releases all of the vital nutrients stored in whole grains.  It not only significantly increases vitamins, but also causes a natural change that allows the protein and carbohydrates to be assimilated by the body more efficiently.  I also used some organic smoky fermented tempeh strips "fakin bakin" by Lightlife. ($1.00 off coupon below).  The 2 bread slices give you 8 grams of protein, the 1 1/2 pieces of tempeh strips give you 4 grams and the 2 tablespoons of hummus give you 1 for a total of 13 grams of protein. I spread each piece of bread with 1 tablespoon of jalapeno flavored hummus, added 1 1/2 slices of smoked tempeh strips, sliced tomatoes, fresh basil, mushrooms, fresh jalapenos and after grilling added romaine lettuce.  YUMMY!   The paninis will cook in a matter of minutes, so watch them carefully.
$1.00 of Smoky Tempeh Strips
Smoky Tempeh Panini on Sprouted Wheat Bread
2 sandwiches

3 pieces of organic smoky tempeh strips (fakin' Bacon)-cooked & cut into 6 pieces
4 tablespoons Smoked Jalapeno &  Garlic Hummus or your favorite hummus
8 slices of tomato
6 sliced mushrooms
2" piece of jalapeno sliced
8 medium size pieces of basil
4 romaine leaves sliced

1.) Cook smoky tempeh strips in pan until lightly crispy. 

2.)  Heat panini grill. 

3.)  Cut the 3 long pieces of tempeh in half to equal 6 slices.  You will use 3 of these slices for each of your sandwiches.

4.)  Spread each piece of bread with 1 tablespoon hummus.  Add 3 slices of smoky tempeh to one piece of bread, then 4 slices of tomato, followed by mushrooms, jalapeno & basil.  Put the other slice of bread on top of vegetables.  Repeat with other sandwich.

5.)  Place sandwiches in panini grill and cook for just a few minutes on medium high.  Watch carefully. 

6.)  After removing panini add fresh romaine lettuce and cut in half.  Serve with a big salad or soup.

Saturday 23 July 2011

Armi Legge

This work with Challen is heating up and getting more and more interesting every day.  I'm away from my beloved Wheeling at the moment, but used one of the simple rules of RBTI today to prevent someone going into a seizure.  In fact, the person was so disoriented that she thought she had had a seizure and rushed to the bathroom mirror to look for bite marks on her tongue.  But there were no bite marks because the vast majority of seizures are incredibly easy to prevent when you know what Challen refers to as, "The rules of the sugar."  In fact, not only was this person's seizure prevented, but ten minutes later the splitting headache was gone, there was no sign of disorientation or loss of coordination, and she was talking 90 miles per hour, smiling, and in a good mood.   

And that's just how RBTI is.  It's impossibly simple, quick, and easy.  So much so that no one believes it.   

Anyway, got a good interview coming up on Monday with a person who was bedridden with a side of thyroid cancer six months ago and is in great health today after following the guidance of Challen Waychoff.  Thought I would torture all you first with something not pertaining to RBTI...

Here is a month-old interview I did with Armi Legge - a pretty remarkable young triathlete, blogger, and podcaster who is only 16 frickin' years old!!!  Way ahead of his time this one.  Thanks to Armi for doing it.  I owe him and arm and a leg.  Haha, ya get it?!!!  Bet he hasn't heard that one before.          

Friday 22 July 2011

Dairy-Free Whipped Topping Berry Dessert

Oh my goodness.....this is the best tasting whipped topping dessert!!!  The deliciousness is all about the whipped up pears, cashews and vanilla.  I have been experimenting and looking for a good whipped topping for a long time and was so excited to see this on Julianna Hever (The Plant-Based Dietitian's) blog.  Chef AJ created this with Julianna and I decided to give it a try.  I am so glad I did, because this is amazing. I have made this for many people and they all loved it, including two cooking/nutrition classes I just taught. I added a little lady bug at the top with some dairy-free mini chocolate chips for some extra cuteness. You have to give this dessert a try. Julianna also just published her book "The Complete Idiot's Guide to Plant-Based Nutrition available on Amazon August 2, 2011.

Dairy-Free Whipped Topping Berry Dessert
Printable Recipe
Serves 4

Ingredients:
8 cups sliced berries
mini vegan chocolate chips

Pear-Cashew Cream
1 (28 oz.)  jar of pears in own juice (drained)
1/3 cup raw cashews
1 tablespoon vanilla
1 tsp. xanthum gum

Directions:
1.)  Make cashew cream by blending drained pears, cashews, vanilla and xanthum gum in blender until smooth. 

2.)  Place 2 cups of sliced berries in 4 serving dishes.  Cover with cashew/pear cream and sprinkle with mini chocolate chips.  Add a lady bug by add 1/2 red grape to skewer, followed by a strawberry (cut small wings out by making thin sliced on each side of strawberry).  Finish lady bug by adding some mini chocolate chips for spots.  Display on top of cashew/pear Cream.

Thursday 21 July 2011

Bachmann, Migraine and Work Impairment

There has been recent interest in the issue of migraine and work impairment related to Michele Bachmann, a candidate for the Republican Party in the 2012 presidential election.  Bachmann has acknowledged that she suffers from migraine headaches.  The attending physician to Congress released a letter stating representative Bachmann's migraine headaches are infrequent, related to known triggers and managed on as needed medications including sumatriptan and ondansetron.

This issue prompts a review of some the key elements in the epidemiology of migraine.  Migraine is a common disorder with prevalence rate estimates of 18% in women and 6% in men.  The female predominance is noted beginning in adolescence.  Prior to puberty, boys and girls have equal prevalence rates.

Below is a chart that examines the prevalence rates for migraine across the life cycle.  The rates suggest a significant decrease in prevalence after age 50.  If you are going to make the claim migraine excludes someone from taking on important roles, you will be excluding many individuals, the majority being women during their key ages of work productivity.

Triggers for migraine headaches include:
  • Change in sleep pattern (reduced or increased sleep time)
  • Weather/weather changes/temperature changes
  • Menstrual cycle phase or hormonal issue
  • Alcohol (beer and red wine)
  • Psychological stress
  • Sensory stimuli (noises/lights)
  • Foods including MSG, aged cheeses and chocolate
  • Caffeine or caffeine withdrawal
The level of work impairment is attributed to migraine will be dependent on the frequency and the severity of the each migraine headache.  There is a great deal of variability in the frequency and severity of migraine headaches.  Studies estimate that up to 60% of individuals with migraine experience one or fewer attacks per month.  An additional 15% report two to three migraines per month with the remainder (25%) experiencing four or more attacks monthly.

Whether experiencing few or many attacks, the majority of individuals with migraine report some or significant headache-related impairment.  It is not uncommon for individuals with migraine to require a period of rest in a dark environment while medications are used to abort the attack.

Medication treatment options typically focus on attack treatment or prevention (or reducing the frequency) of migraine attacks.  Preventive treatment strategies typically are commended for those with more frequent and more severe attacks.  Representative Bachmann's medication fall in the attack treatment category.

Although individuals with migraine may require temporary work restrictions, they can be awakened if sleeping and make decisions.  This is pretty analogous to people without migraine who are required to be awakened to make urgent decisions during the course of sleep.

Successful women who have migraine have demonstrated their ability to succeed in the face of the condition.  There is no research evidence to support migraine as a contraindication to pursuing or performing important leadership roles. 

Listing of triggers for migraine from the Mayo Clinic website.

Figure is author original generated from data provided in the Buse et al manuscript.

Disclosure:  The author of this post has contributed small donations to presidential election campaigns of Barack Obama, Mitt Romney and Michele Bachmann.

Bigal, M., & Lipton, R. (2009). The Epidemiology, Burden, and Comorbidities of Migraine Neurologic Clinics, 27 (2), 321-334 DOI: 10.1016/j.ncl.2008.11.011

Buse, D., Rupnow, M., & Lipton, R. (2009). Assessing and Managing All Aspects of Migraine: Migraine Attacks, Migraine-Related Functional Impairment, Common Comorbidities, and Quality of Life Mayo Clinic Proceedings, 84 (5), 422-435 DOI: 10.4065/84.5.422

Wednesday 20 July 2011

Nuts, Booze, Soy and Cardiovascular Mortality

I have previously published several posts related to diet, cardiovascular mortality and cognitive function.  A recent post looked at the relationship of fiber intake and mortality.  Another post examined adherence to a Mediterranean style diet with reduced risk of cognitive decline.  Now there is another important study published examining diet and risk of cardiovascular mortality and all-cause mortality. 

Cardiovascular disease and mortality are important issues for many of the clinical neuroscience diseases.  Heart disease is often the first issue that comes to mind when thinking about cardiovascular disease.  However, here is just a partial list of clinical neuroscience disorders linked to vascular function and health:
  • Stroke
  • Vascular and Alzheimer's dementia
  • Transient ischemic attacks
  • Vascular neuropathy
A study Akbaraly et al published in The American Journal of Clinical Nutriton examined dietary history and mortality in those participating in the Whitehall II epidemiologic study.  The Whitehall II study is a study of Londoners who worked in one of 20 civil service occupations.  The baseline data was first collected in 1985 through 1988 (when subjects were 35 to 55 years old) but nutritional information was not collected until 1991-1993.  At that time subjects were scored on a composite index of healthy eating called the Alternative Healthy Eating Index (AHEI) composed of the following subscale categories:
  • Vegetables
  • Fruits
  • Nuts and soy
  • Ratio of white meat to red meat
  • Total fiber
  • Trans fat
  • Ratio of unsaturated fats to saturated fats
  • Duration of multivitamin use
  • Alcohol intake
A composite score is calculated from this index with higher scores indicating presumed healthier diet.  The study subjects were grouped in three groups--low AHEI , intermediate AHEI and high AHEI each group representing a third of the sample.  


After 18 years of follow up, approximately 10% of the low AHEI subjects had died compared to 7% of the high AHEI subjects.  Cardiovascular mortality was 42% less for those in the high AHEI group.  All estimates were made after controlling for a variety of potential confounding sociodemographic variables, i.e. gender, BMI, smoking status).


There were two findings that caught my attention from this study.  One was some of the inflammatory and clinical differences in the groups.  The high AHEI group:
  • Had lower serum levels of inflammatory markers C-reactive protein (CRP) and interleukin-6 (IL-6)
  • Had lower levels of dyslipidemias (elevated cholesterol or triglycerides)
  • Had no lower risk of having hypertension or diabetes
A second finding in the study was the examination of the contribution of individual categories to correlation with lower cardiovascular mortality risk.  Only two of the categories correlated with reduced cardiovascular death rates: nuts and soy AHEI scale score and alcohol intake scale score.  Total fiber intake had the next largest individual contribution but failed to be statistically correlate with reduced mortality.


Maximum scores in the nuts and soy category were reached with only one serving per day.  Maximum scores in the alcohol intake category were reached with two drinks per day for men and one drink per day for women. 


This study adds impetus to further study of what are the most important contributing factors of a "healthy diet" when health is measured as reduce risk of mortality from cardiovascular disease and all other causes.


Photo of Carlos Zambrano pitching for the Chicago Cubs courtesy of Yates Photography.
  
Akbaraly TN, Ferrie JE, Berr C, Brunner EJ, Head J, Marmot MG, Singh-Manoux A, Ritchie K, Shipley MJ, & Kivimaki M (2011). Alternative Healthy Eating Index and mortality over 18 y of follow-up: results from the Whitehall II cohort. The American journal of clinical nutrition, 94 (1), 247-53 PMID: 21613557

Tuesday 19 July 2011

Autism and MRI Physical Biomarkers

Minor physical anomalies (MPAs) commonly occur in those with autism.  I have previously published a post on a study outlining the type and prevalence of these anomalies in a series of case of autism and austim spectrum disorder.

One of the MPAs noted in the 1970s in autism spectrum disorder is an increased intraorbital distance (distance between the eyes).   This abnormality also noted as hypertelorism has been noted in a variety of brain developmental abnormalities as well as in some normal individuals.

The brain developmental correlates of hypertelorism have not been studied extensively.  It is possible that developmental hypertelorism may reflect brain developmental variations linked to clinical disorders.

Cheung et al and colleagues from the University of Hong Kong and Harvard School of Dental Medicine recently published a brain MRI study of intraorbital distance in autism spectrum disorder in PloS One.  This study examined the correlation of intraorbital distance with a variety of brain structural measurements.

Thirty six children between the ages of 7 and 16 years with autism spectrum disorder were compared to a group of 55 developmentally normal children matched by age and gender.  The two groups were in the normal intelligence range with the verbal IQ of the autism spectrum group 112 compared to a verbal IQ of 117 in the control group.

Magnetic resonance imaging scans were used to accurately measure the intraorbital distance.  This measurement was then compared with brain structure volumes.

Intraorbital distance correlated with several brain regions volumes in the autism spectrum group but not in the control group.  The areas with increased volume correlating with intraorbital distance in the autism spectrum group included:
  • Bilateral amygdala
  • Bilateral medial temporal lobe regions
  • Left inferior frontal cortex lobes
Amygdala developmental abnormalities have previously been noted in studies of autism.  The medial lobe appears to be important in social and language skills developments.

The authors note the possible relationship between intraorbital distance and brain development in this statement from the manuscript discussion section: 

     "The inference is that in this group, the growth of midline bony and brain regions are tightly linked; that is, regions involved in the regulation of socialization, emotion and memory appear to enlarge with the visual system".

These finding suggest that MRI intraorbital distance may be a potential biomarker for autism spectrum disorders.   Additional longitudinal studies of intraorbital distance and brain development in children may provide additional support for the findings in this cross-sectional studies.

Image of intraorbital distance measurement in autism from Cheung et al distributed under the terms of Creative Commons Attributions License which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 

Cheung C, McAlonan GM, Fung YY, Fung G, Yu KK, Tai KS, Sham PC, & Chua SE (2011). MRI study of minor physical anomaly in childhood autism implicates aberrant neurodevelopment in infancy. PloS one, 6 (6) PMID: 21687660

Monday 18 July 2011

Hypoglycemia – It’s Not All in Your Head, It’s All in Your Urine

While I of course am still very unsure of what to make of my RBTI adventure overall (it’s only been a week, and it is quite a shocking mind funk), I feel comfortable saying that there is at least something of value going on here. How much value? I don’t know. It remains to be seen. I have no doubt that some seriously undesirable body chemistries can be greatly improved, and from the improvement many health problems of all kinds can be improved along with it. This is obviously a very familiar concept here and in the world of nutrition and natural health to begin with.

While I am most skeptical that the ideal urine and saliva pH is 6.4, what I am becoming increasingly certain about is the absolute awesomeness of the tool used in RBTI known as the refractometer. The refractometer is a simple agricultural tool that measures the degree of refraction as light passes through a liquid. The result is a number representing the total amount of dissolved carbohydrate in the liquid (I thought this number was the “Brix” number, but was corrected by DML on that – thanks dude).

What’s so cool about it is that it really is the best measurement of your true sugar levels. The mainstream thinks it’s all about the blood sugar level, and this can be revelatory, but often the carbohydrate levels in the urine and the blood move in completely opposite directions. This is particularly true as it pertains to what people casually refer to as “hypoglycemia.”

Hypoglycemia is a term that drives many in Western Medicine berserk. They go nutty nuts (a technical term used by Martin Short in his role as Clifford – one of the most monumental and inspiring motion pictures in the history of film) because actually having blood sugar levels in the range of hypoglycemia (below 65 mg/dl) is very rare - and you can go below that and sometimes feel just fine, with no signs of an adrenaline surge.



In fact, if most people were to test their blood sugar when feeling that shaky, irritable, lethargic, headachy, mid-afternoon “hypoglycemic" dip, they would find that their blood sugar is actually elevated. And this is where the confusion over what is really physiologically taking place in a person’s body stems from. It is most certainly hypoglycemia, but because the blood sugar is fine or even elevated, in the medical world this is not hypoglycemia but just some psychosomatic crapola. The refractometer settles this.

I’ll explain in a moment. First, let’s look at the “hypoglycemia” experienced by one of the people who turned me onto Challen and the RBTI in the first place.

I had a very difficult time helping this person to rehabilitate herself from a high-protein/low-carb distance running combo that left her completely unable to metabolize food and hospitalized for months. She was a wreck. When carbohydrate was freely available to her system she actually felt pretty good. When it wasn’t, she would tremble and shake, vomit, lay awake sleepless, and deteriorate rapidly. We tried again and again to tweak macronutrient ratios and things like that, but still she would experience these crushing hypoglycemic blows.

What she was experiencing, without a doubt, was the symptoms of her adrenal glands kicking into hyperdrive in order to elevate sugar levels in the body. That’s where the shaking, psychological and mood disturbances, cold hands and feet, and so forth stem from. Not exactly rocket science.

And she was at her worst early in the morning. 4am is a very common time of day to enter into a hypoglycemic state and it progresses throughout the early dawn hours if no food is ingested. This person had a glucose meter, so she tested. During this hardcore (and I mean hardcore) hypoglycemic episode, her blood sugar levels would soar to 130 mg/dl (technically hyperglycemia!) – a diabetic fasting level. But this person was definitely no diabetic. In fact, eating would immediately make her feel better and send the blood sugar plummeting to 75-ish.

What’s going on here is that the adrenals keep blood sugar elevated – trying to deliver sugar to the system somehow, and when food is ingested insulin rises, shuts down the adrenal glands, and stops the release of glycogen coming from the muscles and liver (which is the source of the hyperglycemia during fasting).

There is always a push-pull going on between the primary sugar raising and sugar lowering forces in the body. In the most simplistic sense, activation of the sympathetic nervous system causes the body to release sugar from within, and when food is ingested the body switches into a parasympathetic state that allows the sugar to be stored and stops the release of sugar from within.

In someone with hypoglycemic tendencies, the sympathetic nervous system goes wild to continually try to make carbohydrate available.

You may be a little confused at this point. Is hypoglycemia really hyperglycemia and how can I call someone with hyperglycemia (blood glucose 130mg/dl) “in a hypoglycemic state?”

The almighty refractometer tells the real story. If you want a tool that will tell you whether you lack carbohydrate or have too much, blood sugar testing ain’t gonna do it for you. The refractometer, however, is extremely reliable from what I’ve seen thus far. During those hypoglycemic dips, so common in the wee hours of the morning and in the early afternoon, the refractometer reading of the urine will tell you all you need to know.

Now, when this person tests the sugar levels of her urine, it will confirm if she is hypoglycemic or not (but of course, by now, she knows exactly what it feels like to have the sugar level dipping too low – hypoglycemic symptoms emerge like clockwork). The reading will be 1.2 or less, and in her case, with a severe problem, it is often much lower (like 0.5). Yet, her blood sugar often moves in the exact opposite direction.

Part of the RBTI program is keeping the sugar levels stable in a small range instead of a large, chaotic roller coaster range. And many years ago, when I first ate to keep my sugar levels as stable as possible by eating precise amounts of carbohydrates at precise and consistent meal times, I no doubt experienced the benefits.

If you know, even after doing RRARF (which can increase your glycogen storage capacity, improve glucose clearance, and other things that are helpful in keeping sugar levels stable), that you still have some lingering sugar swings that are causing you problems with energy, sleep, mood, focus, appetite and cravings, and more – there’s no question that using a refractometer and figuring out the precise times of day, number of minutes after meals, and so forth that your sugar levels tend to tank could be a huge game changer. Then, by simply eating a piece of fruit or two during that time, you may in turn be able to keep your sugar stable enough to reap the many potential rewards of keeping this stable (and keeping the stress response dormant).

From what I have gathered so far, Challen’s rules regarding hypoglycemia couldn’t be simpler. Whenever sugar levels are below 1.5 on the refractometer, eat a piece of fruit or have a sip of juice (and get to know at about what time that is going to happen). If you have sugar crashes in the wee hours of the morning, make sure not to eat heavy in the evening and keep an apple or glass of juice by your bedside. That’s it. Complicated stuff I know.

But seriously, Challen strongly thinks that the refractomer alone would be enough to really improve people’s health. I tend to agree. For self-care and dietary fine-tuning, it shows a lot of potential. Seeing how unstable some people’s sugar levels are with the use of the refractometer, more medical folk would really understand hypoglycemia, and realize that the problems are not just all in people’s head when the problem doesn’t show up in the unreliable glucose tolerance test.

Granted, this article is really an oversimplification of the whole picture of sugar regulation and how sugar levels interact with the pH and salt levels.  But like I said, I do suspect that the refractometer does have a medical value aside from the strict practicing of the full RBTI program.  I can't wait to get one and play with it.