Wednesday, 23 March 2011

Cognitive Biomarkers in Eating Disorders


I previously posted on a review of the neuropsychological domain of set-shifting as a possible biomarker for eating disorders.  In that post, set shifting as measured by the Wisconsin Card Sort tests was impaired in those with an anorexia nervosa and continued impaired despite weight restoration.  Additionally, sisters of those with an eating disorder, also showed some impairment on this measure even when they had no eating disorder problem.  This supports a potential role for set shifting as a potential biomarker for eating disorders.

Now an additional study of neuropsychological performance in women with eating disorders and their healthy sisters has been published in the journal Comprehensive Psychiatry.  In this study, the authors examine two computerized tasks tapping the symmetry of performance of the brain’s left and right hemisphere.   

The test of right hemisphere function involved a two-bar visual bar graph stimulus.   Participants were asked to identify the presentation as odd or even dependent on the location of an indicator arrow.  In the test of left hemispheric function task, four letter strings were presented and participants were asked to identify the words as real work or a pseudoword.

The subjects with eating disorders included young women with anorexia nervosa, restricting subtype, anorexia nervosa, binge-purge subtype and bulimia nervosa.  The neuropsychological tests were assessed for accuracy and speed of response.  The key finding from the study were:
  • Patients with eating disorders showed higher error rates and slower response times on tests of both the right and left hemisphere
  • Anorexia nervosa, restricting subtype tended to be associated with the greatest level of impaired functioning
  • Sisters of the eating disorder subjects also showed impairment despite scores similar to controls on measures of depression, impulse control, obsessional thinking and eating disorder symptoms
The authors note that there results support “general individual differences in cognitive processes that may run in families, irrespective of the eating disorder condition of the family member”.    The authors also note that their findings support the continuum model of eating disorders proposed by Michael Strober.  This model proposes that anorexia nervosa, restricting subtype is the most severe category of the eating disorders with bulimia nervosa being the least severe (on a general basis, it is possible for some individuals with bulimia nervosa to have a more severe eating disorder than some individuals with anorexia nervosa, restricting subtype).   The data from this study indicate the anorexia nervosa restricting subtype demonstrated the most severe neurocognitive impairment with bulimia nervosa the least impairment.

Look for more studies examining neurocognitive function in those with eating disorders.  Strategies that combine neuropsychological assessment with fMRI and genetic data may be the most powerful strategy for research in these disorders.  


Photo of rescued sea turtle from the Loggerhead Marine Center in Juno Beach, Florida courtesy of Yates photography

Rozenstein MH, Latzer Y, Stein D, & Eviatar Z (2011). Neuropsychological psychopathology measures in women with eating disorders, their healthy sisters, and nonrelated healthy controls. Comprehensive psychiatry PMID: 21397219

Tuesday, 22 March 2011

Chick'n Chili Verde Soup

 You are all going to love my latest soup creation "Chick'n Chili Verde Soup".  It is absolutely delicious and can be served with some homemade wholegrain breadsticks (shown above), or some healthy tortilla chips crushed into the soup.  Also, don't forget your raw organic greens on the side.  I started this soup creation by using one piece (2.5 oz.) from the product Gardein Chick'n Scallopini. This is a plant-based product that you can find in the frozen section of your health food store. One piece has 2 grams of fat ,14 grams of protein, 30% of your iron needs and 2 grams of fiber. It was a very nice addition to this soup and adds some extra nutrition. I know you and your family are going to love this soup.

Chick'n Chili Verde Soup
Serves 4

1 Gardein Chick'n Scallopini Piece (chopped into cubes)
1 tsp. olive oil
1 clove garlic (minced)
1 yellow onion (diced)
1 extra large or 2 smaller tomatillos
1/2 jalapeno pepper (chopped finely)
1/2 red bell pepper (diced)
1 Anaheim pepper (diced)
1 1/2 cups corn (fresh or frozen)
6 cups salt-free vegetable broth (Rapunzel salt-free bouillon)
2 small juiced limes or 1 large lemon
1/2 tsp. coriander
1/4 tsp. cayenne pepper
2 tsp. chili powder
1 tsp. cumin
2 tsp. sea salt
1 Tbsp. agave nectar
2 Tbsp. arrowroot powder (mix with small amount of cold water, then add some hot soup mixture, then add to soup.

1.)  Cut Chick'n piece into small squares.  Put 1 tsp. olive oil in soup pot and cook Chick'n pieces until slightly browned.  Add minced garlic, chopped onion, tomato and peppers.  Cook for 2 minutes stirring carefully.  Add in corn, 6 cups vegetable broth, agave and seasonings.  Bring to a boil and then reduce to simmer.  Mix 2 Tbsp. arrowroot powder with a little cold water.  Then add some hot soup mixture to the arrowroot powder before adding the entire mix to soup.  This will help to thicken the soup a bit. 

2.)  Enjoy with homemade bread sticks or crunchy tortilla strips.

Emotional Processing Bias in Depression

Clinicians and individuals with depression understand the tendency for depression to be associated with over-interpretation of negative cues in the environment.  Depression seems to heighten perception of negative environmental cues including interpersonal (or social) cues.   The cognitive behavioral model of depression emphasizes the cognitive triad—a negative bias (view) of the self, the environment and the future.

Functional magnetic resonance imaging is providing a model to study emotional processing and better understand how this processing may be disturbed in depression.  When shown brief images of emotion-laden faces, subjects suffering from depression show exaggerated responses.  Depressed or angry faces produce heighted amygdala responses in those with depression.  Happy faces produce a blunted amygdala response. 

Teresa Victor and colleagues recently published a study in the American Journal of Psychiatry providing additional information about this emotional processing bias.  (Disclosure:  Dr. Victor is now a neuroscientist with the Laureate Brain Institute-my employer).   She summarized her findings in a recent journal club.  Here are the key findings from her recent research:
  • The amygdala response to facial images occurs even with brief subliminal (unconscious) presentations
  • Sad facial images activate the amygdala in depressed subjects (compared to controls) in both those with active and remitted depression
  • Happy facial images activate the amygdala in controls more than depressed subjects
  • Eight weeks of selective serotonin reuptake inhibitor therapy (sertraline) reverse  (normalize) the amygdala response to facial emotion cues

 The authors summarize their findings “These data demonstrate that negative emotional-processing biases occur automatically, below the level of conscious awareness, in unmedicated, currently depressed people…”.  “This nonconscious processing of emotional stimuli is consistent with evidence that the amygdala contains cells that are tuned selectively to specific stimulus characteristics, facilitating early detection of biologically salient information”.

The findings from this research suggest exaggerated amygdala responses to sad faces may be a trait marker and not just due to the presence of active depression.  This might allow this trait to be studied as an endophenotype (or potential genetic marker for depression).    Normalization of this exaggerated response with selective serotoning reuptake inhibitors may provide an additional paradigm for studying the effect of new novel antidepressants.

From the clinical standpoint, this study suggests that negative emotional cues may occur below the level of consciousness in the daily lives of those with depression.  It supports clinical experience that some dysphoria may occur in response to environmental cues patients do not remember (or recognize at the time of the cue).   Further study of emotional processing is likely to advance both the research and clinical understanding of depression and other mood disorders. 


Photo of sea gull over beach at Jupiter Island, Florida courtesy of Yates Photography.

Victor TA, Furey ML, Fromm SJ, Ohman A, & Drevets WC (2010). Relationship between amygdala responses to masked faces and mood state and treatment in major depressive disorder. Archives of general psychiatry, 67 (11), 1128-38 PMID: 21041614

Monday, 21 March 2011

Conversation with East West Healing

Tomorrow's the big day.  As some of us are delving into this strange new world of eating MORE, not less simple sugar instead of being devout starchatarians, I thought it would be great to have a conversation with Josh and Jeanne Rubin of East West Healing and Performance.  The Rubin's are very well-versed in the use of not just sugar, but also gelatin as a non-inflammatory source of protein added to the diet in signficant quantities (another recent tangent). 

While in the past they've leaned towards metabolic typing and Paleo-ish diets, they have been having great success by following Ray Peat's ideas on fats, protein, and carbohydrates with real people in the real world.  Their results have been fantastic, and I knew it was time to get them on the phone and make them spill the beans as to what exactly they are seeing and why. 

So please join us tomorrow at 1pm Pacific/4pm Eastern for what should be a great, casual conversation between us, and hopefully Josh and Jeanne will open up the lines for many of you to call in and ask questions, share your concerns and personal experiences, and use Karate Kid aliases as was done during my interview with Sean Croxton. 

If you are new to 180, familiarize yourself with THIS FREE EBOOK to understand what a radical idea it is for me to consider sugar as helpful with a long list of health problems when used in the right context. 

The interview with Josh and Jeanne can be found by clicking HERE
The call will be recorded so if you can't tune in for it live you can still listen to it later. 

To get a taste of what's to come, watch Josh's recent video on sugar.  Please do not attempt to take your head off, bite it, and put it back on. 

Saturday, 19 March 2011

How to Cook Dark Leafy Greens

Just a quick little weekend blurb here...

This is very simple but for some reason, maybe due to my inner Cracker Barrel, I just really love it.  You couldn't pay me to a eat a salad if these greens were sitting next to it. 

To make them all I do is add a couple cups of water to a pot, 1 sliced onion per pound of dark greens (turnip greens are the best - hellfire that's what they serve at Cracker Barrel, but this works well for collard greens and various types of kale as well as mustard greens and others), plenty of the infamous MONEY SPICE, and cook them for at least an hour at a very low simmer, if not a hair longer.  This was filmed a couple of months ago and now I'm cooking them even longer! 

I consume all of the greens as well as the broth which is tasty and full of minerals which I'm all about.  In fact, next time I make these I'm considering using a little chicken stock instead of water and/or adding a couple ounces of powdered gelatin at the end - stirring it in until it is dissolved but not boiling the hell out of it.  It could be part of my gelatinophilia experimentation.  For you real rednecks (Johnny Lawrence), throw a frickin' hambone or a couple pig's feet up in there.  Mercy.   

Thursday, 17 March 2011

Exercise May Reduce Appetite But Increases Calorie Consumption

The relationship between exercise, appetite and food intake is a complex relationship.  Aerobic exercise has been touted as a way to reduce appetite potentially increasing weight loss.  This effect has been termed the anorexia of exercise.  The effect appears to be commonly found after exercising at greater than 60% of maximum oxygen consumption.  This decreased appetite after exercise has been  possibly due to the redistribution of blood flow from the gastrointestinal tract to the peripheral muscles.   However, a temporary reduction in appetite following exercise may not actually correlate with a reduced caloric consumption over a more extended period of time.

Derek Laan and colleagues from Purdue University and the University of Missouri recently published a further look at the relationship between exercise, appetite and caloric intake.  In addition to aerobic exercise, they examined the effect of resistance exercise on appetite and calorie consumption.  The key issues in the design of this study included:

  • Subjects: Male and female from the Purdue community, ages 18 to 29, BMI between 18 and 29 (normal weight to overweight but obesity excluded), percent body fat less than 20% for men and less than 35% for women, not currently dieting with no recent weight loss/gain, nonsmokers, nondiabetic and exercising at least twice per week for 30 minutes in each of aerobic and resistance categories.
  • Experimental Design: Three sessions: 1.) one aerobic session of 35 minutes cycling at 70% maximum heart rate, 2.) one resistance training session of 35 minutes including 3 sets of 5 weight lifting exercising at 75% maximum, 3.)  a control session of no exercise
  • Appetite and Calorie Consumption:  1.) Perceived appetite rated before and after exercise using 13 point scale with 1=not at all hungry and 13=extremely hungry, 2.) Thirty minutes after exercise subjects were given 30 minutes to consume a pasta salad meal with instructions to eat as much or as little as desired until feeling comfortably full.
The key results of the research included:

  • Aerobic exercise but not resistance exercise reduced hunger ratings 10 minutes after exercise.  The effect lasted about 30 minutes when hunger ratings returned to levels experience by resistance exercise and controls
  • Mean caloric meal intake was 897 calories for aerobic exercise group, 924 calories for the resistance exercise group and 784 calories for the control group (both exercise groups consumed more than controls—14 to 18% more, a statistically significant amount
The authors concluded that in healthy adults, aerobic exercise does temporarily reduce hunger ratings but the effect is small, transient and not related to reduced calorie consumption in an unrestricted meal setting.  A similar study would be interesting in a group of patients with anorexia nervosa who commonly exercise to excess in an attempt to lose weight and maintain weight below medically healthy levels.   Additionally, similar studies in obese subjects might be helpful in prescribing the best exercise and diet regimens for weight loss.   This study suggests resistance training alone may increase caloric intake more than the calories expended in resistance exercise.   The increase caloric consumption with aerobic exercise probably contributes to the limited weight loss found in starting an aerobic exercise program.

Photo of March 2011 sunrise at Juno Beach, Florida courtesy of Yates Photography.

Laan DJ, Leidy HJ, Lim E, & Campbell WW (2010). Effects and reproducibility of aerobic and resistance exercise on appetite and energy intake in young, physically active adults. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 35 (6), 842-7 PMID: 21164556

Val Kilmer McCully


Okay, his first name is not Val. I added that. Whatever I can do to squeeze in an 80’s movie photo, damnit I’m willing to do it!  He was a "real genius." 

Let’s focus more on McCully. It’s an Irish name. It’s St. Patrick’s Day. Pretty awesome huh? Yeah I know.

What’s the difference between Mick Jagger and an Irish farmer? Mick Jagger says “Hey you, get off of my cloud.” An Irish farmer says, “Hey McCloud, get offa my ewe!”

Okay, serious faces now everyone. Thinking caps…

Kilmer McCully was one of “those” good scientists who challenged the status quo about heart disease. Instead of merely looking at the hypothesis that saturated fat raises cholesterol and then cholesterol jumps into coronary arteries because it has nothing better to do – meanwhile nodding his head, repeating the word “statin” in a catatonic state, and drooling all over his desk…

…Kilmer McCully did what a real scientist does, which is challenge a theory with more loopholes and contradictions than one can even begin to imagine (and was of course ostracized and cast into scientist purgatory for his heretical findings). Contradictions like, I don’t know, the fact that Australian Aboriginal men have low cholesterol (average less than 190 mg/dl), perfect blood pressure (average 125/77), a BMI of 23.2, and 5,000% more heart disease than butter-lovin’ and higher cholesterol-havin’ French women (that’s 50 times more for you non-mathorexics).

McCully noticed that there was no connection between cholesterol and heart disease, so he actually did do some real scientific work and found something that did play a role in heart disease – elevated levels of homocysteine.

Homocysteine is a type of cysteine found in milk. But not just any milk. Specifically, Harvey Milk. It’s a joke, relax. I’m not going to eat junk food and start shooting people. I’m very sensitive to the gay community. I cried watching Milk and cried even harder watching Brokeback Mountain while the guy in front of me laughed and said “anus” every time they said the name “Ennis.”

Homocysteine is a by-product of methionine metabolism. The amino acid methionine is supposed to be converted to homocysteine and then into cysteine. However, this conversion requires an abundance of three key nutrients: folic acid, B6, and B12 – as well as adequate thyroid. Without those factors, homocysteine levels rise, predispose one to heart disease, cause inflammation, and accelerate the aging process.

But McCully was a real scientist with the ability to think intelligently, so I’m sure he didn’t realize the role of thyroid in any of this…

“For many years deficiency of thyroid hormone secretion has been known to predispose to arteriosclerotic heart disease. In persons with a serious deficiency of thyroid hormone, the ability of the cells of the body to use oxygen is impaired. The basal metabolic rate is slowed in hypothyroidism, and the liver begins to make increased quantities of cholesterol and triglycerides. As a result the cholesterol and lipoprotein levels become elevated, and the risk of coronary heart disease increases… Subtle or marginal deficiencies of thyroid hormone, detected by measuring basal metabolic rate, are found to be widespread in populations with a high risk of arteriosclerotic heart disease.”

Hmmm, sound familiar?  You can read about the importance of thyroid and metabolism in health and disease in THIS FREE EBOOK

But the important lesson here from a dietary perspective is pretty simple, and something that many would agree upon to at least some degree. And that would be that eating a diet with an excess of methionine and a bunch of B-vitamin depleted foods with it is a bad combination. This basic idea is not something new. Researchers noted long before the discovery of homocysteine that food is not metabolized correctly when B-vitamin intake is inadequate…

Robert McCarrison, while studying deficiency of various B-vitamins noted…

“…in the absence of vitamins or in their inadequate supply, neither proteins nor fats nor carbohydrates nor [minerals] are properly utilized; some are largely wasted, while others yield products harmful to the organism.”

While Roger J. Williams pointed towards a similar conclusion. This pretty much says it all…

“A large amount of information, based upon carefully controlled scientific experiments, indicated very strongly that vitamin B6 is another key nutrient which is often present in inadequate amounts in the cellular environment of those whose arteriosclerosis is extreme. Experiments with monkeys have yielded clear-cut results. When they are rendered vitamin B6 deficient, they develop arteriosclerosis rapidly. When monkeys are fed diets supplemented with vitamin B6, they have much lower levels of cholesterol in the blood than when these diets are not supplemented. The animals on the supplemented diet eat much more food than the others, and since their diet contains cholesterol, they get far more cholesterol into their bodies. This does not matter, however; the extra vitamin B6 they get allows them to dispose of the surplus, with the result that their cholesterol blood levels are not as high as in those animals that consume less cholesterol.”


And…


“High or low amounts of fats or carbohydrates are not atherogenic providing supportive nutrients, specifically pyridoxine (vitamin B6), are present. But if pyridoxine is not adequately provided, regardless of the relative amounts of fat or carbohydrate, the diet will be atherogenic.”

Of course the joker in all of this is that just eating nutritious foods rich in say, B-12, isn’t necessarily going to give you high levels of vitamin B-12. The human body unfortunately is much more complex. But it certainly won’t hurt to eat vitamin-rich foods in preference to white stuff – especially white sugar and high-fructose corn syrup which, unlike fortified flour and “enriched” rice, contains absolutely no nutrients whatsoever – real or synthetic.

But the concept is simple nonetheless. In the straightforward words of McCully…

“The dietary factors that determine whether blood homocysteine levels are elevated are the total methionine content of the dietary protein and the content of vitamins B6, B12 and folic acid in the diet.”

McCully isn’t a big fan of fats either really, as they do nothing to offset the methionine content of the typical Western diet because they contain virtually no B-vitamins just like refined carbohydrates. Of course, I’ve pointed out many times that your typical American eats up to 50% of calories from refined carbohydrates and another 35% or so from fats, leaving little room for food containing water soluble vitamins.

One solution to this is of course to, as a general rule, consume less methionine-rich animal protein. Methionine restriction in mice, not surprisingly, has shown tremendous life extension. Ray Peat, another real scientist, has postulated that many of the longevity-enhancing effects of calorie restriction have nothing to do with the amount of energy ingested, but more to do with the total quantity of methionine and other amino acids in a similar pro-aging class. And as I’ve argued before over the controversial findings in The China Study in the past, it should be no surprise that animal protein increases health risks when added to the diet of people eating more than half of their calories from refined carbohydrates like rice and noodles.

Methionine is needed in substantial quantities during the growth period of life when we are adding lots of new lean tissue. Perhaps this is why methionine content is so high in say, eggs. Methionine all goes to the muscles and organs where it is concentrated. So, as a general rule, eating muscles and organs naturally lends itself towards a much higher total methionine intake, although not all meats are created equal.

But, as we reach adulthood and no longer have such a high requirement for total protein or methionine, in a conversation about a general “ideal” diet (and such generalizations should never be made for something so individual as a person’s immediate nutritional needs – a major mistake the government makes is not just their dietary recommendations alone, but the fact that they MAKE BROAD, SWEEPING DIETARY RECOMMENDATIONS in the first place), there would be no harm in eating “mostly plants” with plenty of methionine-free gelatin-rich broths in lieu of giant T-bones or perpetuating the newfound American infatuation with lean chicken breast.

There’s no reason to fear methionine of course. You need some, and when you are going to eat some animal foods it’s probably best to get after the most nutritious of the bunch, such as B-vitamin superhero organ meats (I have pate in my fridge, which also protects against nitrate deficiency!), whole eggs, shellfish, and dairy products – particularly cheese which contains a lower concentration of the “bad” amino acids… that part is in the whey that bodybuilders and Mercola are consuming in outrageous quantities.  Same thing with egg whites vs. the yolks. 

And well, you already know how I feel about eating a lot of refined carbohydrates. What I like about McCully’s theory is that it is much more congruent with the observation in all cultures of a widespread health demise occurring when each society was introduced to refined carbohydrates for the first time, with or without other dietary and lifestyle factors.

Anyway I'm outta here.  All this health food talk on St. Patty's Day is filling my mind with visions of ice-cold Guinness.  Here are some other McCully quotes to make your head hurt. No wonder so few people caught on to his theory. He wrote it in language that only a PHD already tied to the cholesterol theory could possibly understand. The final quote about unifying the respiratory, oncogene, and genetic theories of cancer is particularly painful, but interesting nonetheless…

“Current thinking about how homocysteine causes plaques in the arteries theorizes that a buildup of homocycsteine in the body leads to overproduction of a highly reactive form of homocysteine that causes LDL to become aggregated. This reactive form, homocysteine thiolactone, is made from methionine in the liver by an enzyme that participates in the protein formation and by other less well-understood processes. The LDL-homocysteine thiolactone aggregates are released into the blood from the liver. Then these aggregates are taken up by macrophages of the artery wall, many of which are derived from wandering monocytes of blood, to form foam cells of early arteriosclerotic plaques. These foam cells degrade the LDL-homocysteine thiolactone aggregates and release fat and cholesterol into developing plaques. The foam cells also release homocycsteine thiolactone into surrounding cells of the artery wall, affecting the way cells handle oxygen. As a result, highly reactive oxygen radicals accumulate within cells, damaging the lining cells of arteries, promoting blood clot formation and stimulating growth of arterial muscle cells which form fibrous tissue, mucoid matrix and degenerative elastic tissue.

The homocysteine theory explains why populations that consume foods of animal origin with abundant methionine and foods that are highly processed, refined and preserved with depletion of B vitamins are susceptible to arteriosclerosis.”

p. 86

“Another very interesting feature observed in cell cultures from children with homocystinuria is the distinctive pattern of growth, which resembles the pattern of growth of cancer cells in culture. Furthermore, the muscle cells of arteries grow in a similar pattern in early arteriosclerotic plaques. As explained in Chapter 2, the 19th century German pathologist Rudolf Virchow likened the increased numbers of muscle cells in atheromas to tumors of the blood vessels. In some way, abnormal homocysteine productions induces cells to lose control of growth processes, causing growth of muscle cells in arteriosclerotic plaques. Recent experiments have shown that homocysteine damages cultured endothelial cells and increases the growth of smooth muscle cells. These effects on the cells of artery walls explain in a general way the early phases of production of arteriosclerotic plaques.”

p. 96

“The origin of arteriosclerosis is now understood to be a toxic effect of a by-product of protein breakdown, the amino acid homocysteine. The importance of fats and sugars in the genesis of the disease is now understood to be related to loss of vitamins B6 and folic acid through processing, refining and preservation of foods, creating an imbalance between the abundant methionine of foods of animal origin and the amount of these essential vitamins necessary to prevent a buildup of homocysteine in the body.”

p. 213

“In summary, the discoveries of the role of homocysteine thiolactone, thioretinamide, thioretinaco and thioco in malignant cells offer a new way to unite the respiration, genetic and oncogene theories of the induction of cancer. The loss of thioretinaco ozonide from cell membranes leads to the abnormal respiration of mitochondria in malignant cells, with secondary accumulation of reactive oxygen radicals. The loss of thioretinaco also allows excessive synthesis of homocysteine thiolactone from the methionine, causing aggregation and altered activation of nucleoproteins, abnormalities of cellular membranes, altered immunological recognition and increased growth potential through increased activation of oncogenes and increased formation of thioco.”