Parental Education As Risk Factor For Eating Disorders

Genetic and environmental risk factors contribute to the risk for anorexia nervosa and other eating disorders.

Known risk factors for anorexia nervosa include female gender, young age, family member with anorexia nervosa, weight loss, and participation in weight sensitive sports or activities, i.e. gymnastics, dancing.

There has also been evidence that anorexia nervosa is more common in higher socioeconomic classes. This finding has made it one of the few brain disorders more common with this category.

A recent study using the Swedish medical registry sheds some light on increased risk related to socioeconomic status in anorexia and other eating disorders.

The Swedish medical registry used in this study contained over 2,000,000 records and from this group the research team were able to identify 15,474 girls and women (1.5%) with an inpatient eating disorder diagnosis along with 1051 boys and men (0.1%)

The key findings from the study included:

• Rates of eating disorder diagnosis increased with those born in 1982 and later
• Female eating disorder diagnosis rates were predicted by greater educational level in the father, mother and maternal grandparents
• Rates of anorexia nervosa and bulimia nervosa were nearly doubled in children of parents with post-graduate education compared to those without secondary education
• Parental social class and income were not linked to increased eating disorder risk

The authors note their study results finding links between eating disorders and socioeconomic status may be due to the higher education risk factor.

The authors also note the mechanism for this association is unclear. The speculate that high educational expectations for children may overlap with familial perfectionism, a trait known to increase eating disorder risk. Additionally, they note there is the potential for their study to be confounded by genetic factors.

This is an important study that will prompt further study of the link between parental education and eating disorder risk.

Readers with more interest in this topic can access the free full-text manuscript by clicking on the PMID link below.

Follow the author on Twitter @WRY999 

Photo of black bellied whistling duck is from the author's files.

Goodman A, Heshmati A, & Koupil I (2014). Family history of education predicts eating disorders across multiple generations among 2 million Swedish males and females. PloS one, 9 (8) PMID: 25162402

Smoking in Pregnancy and Child Brain Development

Smoking during pregnancy produces significant and diverse effects on prenatal development.

These adverse effects include dysfunction in prenatal and early childhood brain development.

Hanan El Marroun and colleagues from the Netherlands recently published an important childhood brain imaging study of smoking during pregnancy.

One hundred and thirteen children exposed to tobacco during pregnancy were compared to a control group of unexposed children.

Both groups of children between 6 and 8 years of age were compared on a variety of measures including:

• Nonverbal IQ
• Birth weight and gestational age
• Child Behavior Checklist scores
• Structural brain imaging measures using MRI structural brain imaging

The key findings from this study included the following:

• Birth weight: exposed infants had a significantly lower mean birth weight than non-smoking exposed infants 3194 grams vs 3475 grams (7.04 pounds vs 7.66 pounds)
• Total brain volumes: exposed children showed smaller total brain volumes and smaller brain white matter volumes
• Brain cortex measures: exposed children showed thinner brain cortex measures in multiple brain regions including frontal, temporal and parietal regions
• Behavioral and emotional problems: exposed children had higher measures of mood and anxiety problems at 6 to eight years

An additional important finding was a statistically significant correlation between mood symptoms and thinning of cortical thickness in the superior frontal cortex and the precentral cortex regions.

Children of women who stopped smoking immediately after learning of pregnancy displayed similar brain development as the non-exposed children.

Although key covariates were controlled in this study, the authors do note they cannot rule out a potential contribution of smoking epiphenomenon in their findings. Such potential epiphenomenon linked to the smoking group could include higher parental psychopathology, effect of other substances and differences in paternal nutritional profiles.

This study does support early pregnancy identification in smoking women and aggressive smoking cessation treatment efforts.

Readers with more interest in this study can access the free full-text manuscript by clicking on the PMID link below.

Photo of altamira oriole is from the author's files.

Follow the author on Twitter @WRY999

El Marroun H, Schmidt MN, Franken IH, Jaddoe VW, Hofman A, van der Lugt A, Verhulst FC, Tiemeier H, & White T (2014). Prenatal tobacco exposure and brain morphology: a prospective study in young children. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 39 (4), 792-800 PMID: 24096296

Prevent the Dreaded Afternoon Crash

We’ve all been there. You plowed through the morning, checking off all the items on your to-do list, sorting through your emails and, even, tackling that project you’ve been putting off for weeks.

Then, out of nowhere, it happens. You hit the proverbial wall. Your energy is zapped, and all you want to do is turn off the lights, hide under your desk and close your eyes for just a few minutes.

Don’t fear. You are perfectly normal. That tired, mid or late-afternoon feeling is your body’s response to its natural circadian rhythm — your internal clock that tells you when it’s time to wake up and go to bed — and the changes in blood-sugar levels that are largely dependent on what you eat.

Luckily, there are ways to fight the urge to curl up in your cubicle:

Eat Healthy

As if there weren’t enough reasons to watch what you eat, a healthy diet will help you stay focused throughout the day.

Many times, people will start to feel drowsy and rush to the vending machine for a candy bar or to the cafeteria to grab a piece of pizza or French fries. Rather than racing to sugary treats or fat-heavy foods that may provide a short high followed by a sugar crash, try eating a balanced lunch that includes protein and carbohydrates. The protein helps keep your blood sugar and energy at a good level, while the carbohydrates will keep you feeling full.

It’s also important you don’t skip the most important meal of the day. Yes, you know which one we’re talking about: breakfast. You’ve heard the old saying, eat breakfast like a king (or queen), lunch like a prince (or princess) and dinner like a pauper. Well, that’s because a nutritionally dense and filling breakfast will help sustain you during the times when your mental skills are in highest demand.

Paula S. Barry, MD

“Even if you don’t have time for a large meal each morning, try to include some protein and complex carbohydrates like fruits, vegetables and  whole grains into your daily routine, says  Paula S. Barry, MD, a primary care physician at Penn Family and Internal Medicine Longwood, in Chester County. “This will help to balance your glucose or sugar levels and keep you more focused throughout the day. By changing the food you eat for lunch you can obtain a more steady glucose level throughout the afternoon. Avoiding the peaks and troughs of fluctuating sugars may help you have a more energetic and productive day.”

Also try to watch  your alcohol or caffeine consumption throughout the week. If you simply can’t miss that office happy hour, limit yourself to a drink or two so that you don’t become fatigued later in the week.

Keep Active

One of the best ways to escape the tiredness is to hit the gym or go for a run on your lunch break. Unfortunately, many of us don’t have the time during work hours. If you’re unable to get away, there are things you can do in the office to boost productivity.

If you’re short on time and have just a few minutes between meetings, try some desk stretches to keep your muscles loose or consider a walking meeting. Not only will this provide a quick jolt of energy and inspire new ideas but it can also increase circulation to the brain and allow you to re-focus.

Pushing through the afternoon slump can be tough, but there are things you can do throughout the day to reach the finish line. Remember, there is no break from a healthy lifestyle.

“Always keep in mind that if you have severe or more prolonged symptoms, you should always check with your doctor to be sure you do not have diabetes or some other underlying medical condition,” suggests Dr. Barry.

Interested in other tips for office workouts? Check out Get Fit While at Work.

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Physical Exercise Effects on Brain EEG

There are a variety of methods to study the effects on exercise on brain function. 

Brain imaging techniques such as fMRI provides a new tool to search for regional effects of acute and chronic exercise.

Another tool that has received less attention is the electroencephalogram or EEG. One EEG measure of brain function is the individual alpha peak frequency or iAPF.

The iAPF is positively correlated with arousal, attention and speed of information processing. Higher iAPF is linked to faster speed of information processing.

Boris Gutmann and colleagues from the German Sport University Cologne recently published a study of the effects on acute and chronic exercise on iAPF.

Here are the key elements in the design of their study:

• Subjects: Ten males average age 22 who were regular participants in exercise but not highly trained endurance athletes
• Exercise: Time1- iAPF before and after exhaustive exercise and before and after steady state. Time2-iAPF before and after exhaustive exercise and before and after steady state. Time 1 and Time 2 exercise sessions were separated by four weeks that included steady state aerobic exercise training

The key findings from the study were:

• iAPF was increased after exhaustive exercise but not following steady state exercise
• This effect occurred both at time 1 and time 2 suggesting it was independent of training

The authors note the arousal effect of exhaustive exercise may be "mediatede by changes in neural activity in the reticular-activating system". 

I found it interesting that the effects of iAPF was limited to exhaustive exercise. In the exhaustive exercise protocol, subjects rode stationary bikes controlled by the researchers for intensity. Subjects started at 30 watts increased by 5 watts every 30 seconds until subjects reached exhaustion. The steady state exercise protocol was exercise on the bicycle for 30 minutes at 65-75% of maximal heart rate.

There appears to be some increasing research interest in the value of shorter periods of exhaustive exercise like that seen in interval training protocols. Increasing evidence supports the value of brief high intensity periods of exercise in promoting health benefits of exercise.

Using EEG markers may be helpful in examining the potential value of exercise in a variety of brain disorders, i.e. traumatic brain injury, attention deficit disorder, mood and anxiety disorders. 

Readers with more interest in this study can access the free full-text manuscript by clicking on the PMID link below.

Photo of Captiva, FL sunset is from the author's files.

Follow the author on Twitter: @WRY999

Gutmann B, Mierau A, Hülsdünker T, Hildebrand C, Przyklenk A, Hollmann W, & Strüder HK (2015). Effects of physical exercise on individual resting state EEG alpha peak frequency. Neural plasticity, 2015 PMID: 25759762

Ignoring Nature’s Call: What Are the Health Risks

Lori M. Noble, MD, a primary care physician at Spruce Internal Medicine, located at Penn Medicine Washington Square, discusses the health risks of ignoring nature’s call.

The long, grueling days of medical school and residency impart many lessons, far beyond those related to patient care. For instance, the mantra of my residency experience was "eat, sleep and pee when you can."

While I always made eating and sleeping a priority, urinating had a tendency to fall off my to-do list during a busy day.

I imagine this is not something unique to a career in medicine; I'm sure any woman who works in a demanding field can recall a time (or several) when she "held it in" a little longer than would have otherwise been comfortable. It's a pretty common sacrifice we make to get that one last thing done, typically without giving much thought to any potential consequence.

I recently came across an interesting article in a popular women's magazine that addressed the potential impact of holding it in and thought I'd share what I read and add my medical opinion.

Bladders are unique like fingerprints.
There is no real agreed upon amount of time that is considered okay to hold in urine. This is because every woman is different in terms of how hydrated she stays, how large her bladder is and how sensitive her bladder is to the stretch that happens as it fills with urine.

Bottom Line: The average woman will feel comfortable holding her urine for between three and six hours, but there's a lot of variability.

So Why Not Hold It In?

The authors downplay any consequence of holding in urine for a prolonged period of time, noting that the "worst case scenario" is a "bit more of a likelihood" of developing a urinary tract infection (UTI). As a physician and a woman, I take issue with this for a couple reasons:

1. UTIs can be dangerous. In some people, the infection can spread from the bladder up to the kidneys and even into the bloodstream if not treated quickly. Pregnant women and those with certain medical conditions that can affect bladder function (i.e., Multiple Sclerosis, Diabetes, etc.) are already at increased risk for UTIs, so they should be extra vigilant about emptying their bladders regularly to prevent infection.

2. Many women struggle as they get older with urinary incontinence (the loss of bladder control). Stress urinary incontinence is leakage when there is increased pressure applied to the bladder, like with coughing, laughing or jogging. Urge urinary incontinence is leakage because of an intense, involuntary contraction of the bladder, often described as the "I gotta go, I gotta go, I gotta go" feeling. Both can be made worse if the bladder fills up beyond a comfortable capacity.

Bottom Line: There are potential consequences of holding in urine for a prolonged period of time. Listen to your body and take time to go when you feel the urge.

Are There Benefits to Holding It In?

There is some evidence that holding urine can "train" the bladder to be less sensitive to the urge to go, and thus allow a woman to wait a bit longer between bathroom trips. In my opinion, the risks of holding it as outlined above, outweigh this potential benefit.

Bottom Line: When it comes to holding in urine, the risks of infection, leakage and pain outweigh the potential benefit of a modest increase in bladder capacity.

What About Men?

The authors didn't address this, likely because the article was in a woman's magazine. However, as men age, the prostate – an organ through which urine must travel to leave the body – tends to enlarge. This can lead to difficulty starting and stopping urination. As a result, the bladder may empty incompletely, putting these men at increased risk for urinary tract infection. So, in my opinion, older men in particular should also make every effort to get to the bathroom when the urge strikes.

Bottom Line: Men need to listen to their bodies urge to urinate, too, particularly as they get older.

So next time you feel the urge to go, try to fight the instinct to just cross your legs and hold it in for a bit longer – your bladder will thank you for it later!

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Your Pup May Be the Best Workout Buddy

Cynthia Otto, DVM, PhD, BS, discusses the importance of physical activity for you and your furry friends.

America’s obesity epidemic, tied largely to a sedentary lifestyle and lack of meal portion control, is not limited to humans – it’s also an issue for our dogs and cats.

Unfortunately, because the general public is so used to seeing overweight pets, dogs that are physically fit and at an appropriate weight tend to be seen as “too thin.” A healthy dog should have a defined doggy waistline and should have just slightly padded doggy ribs (the same goes for our feline friends).

Research has shown that dogs who are just 10 to 15 percent overweight shave up to two years off their lives. With an average life expectancy between eight and 18 years (depending on size and other genetic and external factors), a couple of years makes a big difference.

The Benefits of Working Out with Your Pet

Now, add the benefits of exercise to the health benefits of pet ownership.

Studies have shown that people who own pets have increased levels of physical fitness, as well as a decrease in loneliness, anxiety and depression. Spending quality time with your pet through exercise can help keep both you and your furry family member healthier by lowering blood pressure, reducing both the risk of obesity and heart disease, and ultimately, having a positive effect on mental wellbeing and connectedness through the human-animal bond.

Together, these things can impact the relationship with your pet by increasing oxytocin release in your brain and your pet’s. Oxytocin is a nurturing hormone that makes you feel good. Petting and playing with your pet can release the hormone. Plus, the interaction through play and physical activity helps dogs release energy, which helps them be better behaved in general.

Since they don’t have a job and can’t read or do Sudoku puzzles, pets rely heavily on you for physical and mental exercise.

Activities for You and Your Pooch

Struggling to come up with fun ways to keep you and Fido active for the recommended 150 minutes of aerobic exercise each week? Here are a few suggestions:

• Go for a couple long walks or jogs a few times a week
• Let your dog be your ball retriever during tennis practice
• Practice your Frisbee throw
• If your dog enjoys water, go for a swim together
• Include your pet in biking, hiking and trail running adventures 

Before embarking on any exercise program, it is always good to check in with your -- and your dog’s -- physician to ensure that everyone stays safe.

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Love Fed (Purely Decadent, Simply Raw, Plant-Based Desserts) Book Review & Recipe

I am very excited to be a part of the Love Fed Blog Tour by reviewing, Love Fed (Purely Decadent, Simply Raw, Plant-Based Desserts) by Christina Ross and published by BenBella Books.  Check out the links above for more exciting reviews and recipes during this awesome tour. 

Love Fed  is a beautifully illustrated book that can help you achieve better health. Christina has eliminated harmful sugars and refined ingredients to all her recipes.  I love that  they are also raw and full of flavor. Raw food is more "alive" and retains its enzymes, hormones, vitamins and minerals, that otherwise might be lost. Many dessert books claim to be healthy,  but what you are really getting is high fat, sugar loaded dessert bombs.  Not so with Love Fed! Christina's book has 80 delicious, easy recipes, without a touch of gluten, dairy, or refined sweeteners. Very little sweetener is added to her recipes. At first you may even think they need more sugar, but they don't.  It is just your taste buds that are use to very sweet treats. Sugar is an addiction that contributes to a huge collection of health problems. These health conditions are easily eliminated by just reducing or eliminating most of your sugar intake. A great goal to add to your New Years resolutions (2015)  is to eliminate these harmful sugars. Clean out your pantry and start today!!  A book like Love Fed can help all of us still enjoy treats, but achieve this goal.  

The recipe I decided to share with all of you is on page 117, Red Velvet Chia Parfait.  Doesn't that just sound scrumptious?  It was very light, delicious, satisfying and turned out beautiful (See my photo below)

Red Velvet Chia Parfait

Yield: 4 parfaits

Prep time: 15 minutes

PRINTABLE RECIPE

Parfaits provide a lot of payoff for very little effort—in 15 minutes you can have a beautiful, deliciously creamy dessert. This parfait is notable for the raw vegan cream cheese frosting on top. It’s wonderful spread on cakes and cupcakes, too. If you like a sweeter frosting, feel free to add 2 tbsp. of your favorite sweetener.

PARFAIT BASE

¼ c. chia seeds (black or white or a mix of the two)

1 tbsp. cacao powder

2 c. almond milk

2 tsp. beet juice or natural red food coloring

1 ½ tsp. coconut nectar

¼ tsp. vanilla bean powder or vanilla extract

“CREAM CHEESE” FROSTING

4 tbsp. melted coconut oil (see page 28)

2 c. chilled coconut cream

1 tbsp. Meyer lemon juice (regular lemon juice works, too)

1 tsp. vanilla extract

Chocolate curls or cacao powder, for garnish

To make the parfait base: Combine the chia seeds, cacao powder, almond milk, beet juice, coconut nectar, and vanilla bean powder in a medium bowl and whisk until well incorporated. Let the mixture sit for 10 minutes to thicken. Make the frosting.

To make the frosting: Place the melted coconut oil, coconut cream, lemon juice, and vanilla extract in the bowl of an electric mixer or a large bowl. Beat on medium speed or whisk by hand until the mixture is whipped and well incorporated. Don’t overmix or the frosting will be runny.

To assemble: Divide the chia mixture among 4 parfait glasses or bowls.

Place a frosting bag (or plastic bag) inside a glass, allowing the top of the bag to fold over the outside of the glass. This will allow you to scoop frosting into the bag without the risk of it leaking. Fill the bag with the frosting, then squeeze a dollop into each parfait glass on top of the chia mixture. Add the garnish and serve immediately, or store in the refrigerator for up to 3 days.