Intelligence Intact

I had to dig into an old eZine I had written two years ago this morning, fetching a recipe that will be part of the RBTI Intro Package due for release next weekend.  And while I was digging, I took a moment to read one of the articles I had written on the importance of critical thinking - and of constantly seeking out opposing viewpoints to your sacred conclusions instead of banding together with like-thinkers and drifting away to crazy town.  Anyway, it made me smile in a nostalgic kind of way, especially in light of the strange new world of the surprisingly-effective RBTI that I have openly immersed myself in over the past three months.  Guess I was born to be a guinea pig, cuz I really love this wild world of health and nutrition.  So full of surprises.  Okay, here it is... 

One of the most difficult challenges I’ve ever come across in pursuing health understanding is keeping my own intelligence intact. I have common sense, and I have come across some of the greatest material ever written on the subject of health. That information and common sense combined have shown me, proven to me beyond any doubt, certain fundamental truths. These truths are very basic, such as carbohydrates are not bad. Saturated fat is not bad. Cholesterol in egg yolk doesn’t contribute to heart attacks. Fiber does not cause digestive illness. Strict vegan diets suck. It is unsafe to build a diet around non-nutritive white powders. Cutting calories and over-exercising to lose weight is a futile strategy.


But time and time again, before these fundamentals really became concrete, it was all too easy to get swept away with the latest intriguing theory. I don’t regret pursuing all kinds of ideas, from being a vegetarian for years in my early 20’s, to eating a bunch of gnarly raw foods – from whole heads of cabbage to raw chicken hearts. It was all an adventure. Each brought forth its very own insight, and gave me a rich experience from which to draw upon.

Much of this was done in the spirit of exploration. For many others, it is a very different situation in which they are drawn into the realms of narrow-minded dogma.

Like Lierre Keith, recent disgruntled author of The Vegetarian Myth.  Keith followed a strict vegan diet for something like 20 years. Oopsies! An assortment of health problems later and Keith’s vegan education was complete. Vegan score appointed by Keith… F.

Others hear the preacher behind the low-carb pulpit talking up a complicated-sounding storm about how there is insulin and leptin and lipolysis and metabolic syndrome – and if you eat carbohydrates you’re just going to magically accumulate fat because of all that insulin you’re secreting. Sounds good. The theory makes sense. Carbs raise insulin. Insulin stores fat. Therefore carbohydrates make you fat. I mean come on! They feed corn and grain to pigs and that’s what makes them fat. Everybody knows starch is fattening! (or so they claim).

I’ve even had the luxury of dealing with some of the most insane and one-sided folks of all, the raw Primal/Paleo type folks. I’ve been accused of treason for condoning the consumption of “mind-altering cooked foods!” For that special someone, mind alteration could be just the ticket to bring them back to sanity. Yes, there are nutrition cults out there eating massive amounts of feces, drinking their own urine, and using human semen for skin health. A little research and the voice of someone who overcame a serious illness or two is all it takes to get a massive and devout gang of followers.

I guess all I’m saying is that even I, with a great and diverse wealth of knowledge and experience, still get curious. I want to know what people are experiencing on their health escapades. The conclusions that people have come to in their own explorations are always of profound interest to me. I can’t get enough of it, and my mind remains eternally open to new ideas. I cover all my bases to the best of my ability, hoping that nothing goes overlooked, and that I haven’t missed some great discovery that someone else has made. And in doing so, I drift a little in that direction to really give it a fair shot. I allow myself to buy into the ideas and believe, even if for only a moment, that I might have made a tragic mistake in my own health conclusions.

We all will do this, not just in the arena of health, but in all avenues of life. But without checks and balances to keep us from straying into a realm of the totally illogical, it is easy to get lost and do ourselves some harm.

Whatever your beliefs are about health or otherwise, it is important to repeatedly challenge yourself on those ideas. If you think you have all the answers, take your ideas to a place where they will be met with stiff opposition. It is there that you will find good arguments that you will have difficulty explaining away. It is in the face of this challenge and conflict that you will develop a more complex and deeper understanding of the issues you had thought were solved. It’s here that you’ll find what you thought was a neat and impenetrable theory to be, in actuality, painfully oversimplified and blind.

If I’ve found any theme amongst all the health cults that have come to downright retarded conclusions, from vegans to raw chicken-eating carnivores, it is that they are terribly opposed to having their theories challenged and tested. Anyone who doesn’t agree is an idiot or has scandalous motives. Some vegans call the Weston A. Price Foundation “factory farming propaganda.” I kid you not. That’s like calling a group of protesting anti-abortionists “baby killers.”

I comment at blogs and websites preaching all kinds of health sermons, and I typically go to these sites and directly square off with their conclusions. The result is that I get banned. I’m told that I don’t “support their community’s objectives” and need to get lost. They are not interested in conversations. They are not interested in answers or advancing their knowledge because they already have all the answers. They are inflexible. They are blind. They are drifting off into space, becoming ever more isolated and ever more defensive as they collectively fall off the deep end of reality.

So the tidbit of advice I have to give is one that has served me incredibly well, and will no doubt serve me in the future – keeping me constantly honing in on better and more sophisticated answers. That is simply to be a critical thinker. Challenge yourself and others and revel in their assaults on your own conclusions. This is helpful. This is part of the natural feedback mechanisms that are established for every aspect of our existence. We need this. We need both support and challenge to have fuller, more comprehensive perspectives in our many endeavors – be it in health, in religion, in finance, and in relationships. This is what keeps our intelligence intact, and from drifting into deep space where we get lost and find ourselves gasping for oxygen by the time it’s all said and done.

Improving Dementia Diagnosis With a Sleep Marker

Dementia presents a growing challenge for clinicians both in the assessment as well as treatment domains.  Autopsy remains the only definitive diagnostic intervention that can confirm Alzheimer's disease and the other forms of senile dementia including vascular dementia, dementia with Lewy bodies, frontotemporal dementia and other dementia variants.

Since autopsy studies do not provide clinicians or their patients any direct benefits during the patient's lifetime, better diagnostic tests and clinical predictors are needed.

A recent study from a team of neurologists, psychiatrists, sleep medicine specialists and pathologists from the Mayo Clinic supports the potential of a sleep disorder to aid in the diagnosis of dementia with Lewy bodies.  Lewy bodies are distinct accumulations of proteins found in the brains of individuals with parkinsonism and Lewy body dementia.  They are identified at autopsy by special stains viewed under a microscope.

Dementia with Lewy bodies is often considered the second most common type of dementia.  The clinical diagnostic criteria were revised in 2005 and include core and suggestive features.  The core features include: fluctuations in cognitive abilities, parkinsonism and visual hallucinations.  The suggestive features include: sensitivity to antipsychotic drugs, reduced brain dopamine uptake on functional brain imaging and presence of the sleep disorder known as REM sleep behavior disorder (RBD).

The 2005 diagnostic guidelines for dementia with Lewy bodies can be made when patients have two of the core criteria or one of the core criteria and at least one suggestive criteria.

REM sleep behavior disorder (RBD) is a sleep disorder characterized by violent (or other dangerous) behavior during the REM or dream or nightmare phase of sleep.  This behavior can include punching, kicking, yelling, jumping out of bed often in response to specific content of the dream that is being experienced.  Individuals with RBD can physically injure themselves or their bed partners with their violent behaviors.

In normal individuals, REM sleep includes temporary muscle paralysis preventing individuals from physically responding to dreams or nightmares.  Loss of this REM sleep paralysis can lead to development of RBD.  RBD is felt to indicate disregulation of several brain neurotransmitter systems including dopamine, serotonin and acetylcholine.  This dysregulation may explain extreme sensitivity of patients with RBD to adverse effects of a variety of psychotropic drugs including antidepressants and antipsychotics.

The Mayo Clinic study included a prospective longitudinal study of a group of patients with dementia who were seen four times per year until their deaths.  Postmortem autopsies were conducted on 234 patients.  Seventy seven (33%) of the sample met pathological criteria for diffuse Lewy body disease.

The authors looked specifically at RBD as a predictor of true diagnosis of dementia with Lewy body disease.  They found that RBD was three times more powerful as a predictor of Lewy body dementia than any of the the core criteria of Lewy body dementia.

This study confirms the value of RBD in diagnosing Lewy body dementia--in fact it supports moving RBD up to a core feature rather than a suggestive feature.  A second multicenter study by Bliwise and colleagues has confirmed the high rates of RBD in Lewy body dementia compared to those with Alzheimer's disease.

These findings should encourage clinicians to aggressively look for RBD in patients with dementia to aid differential diagnosis and the treatment planning in this challenging population.

Photo of typical Santa Fe home architecture taken during sunset in Santa Fe, New Mexico from the author's collection.

Ferman TJ, Boeve BF, Smith GE, Lin SC, Silber MH, Pedraza O, Wszolek Z, Graff-Radford NR, Uitti R, Van Gerpen J, Pao W, Knopman D, Pankratz VS, Kantarci K, Boot B, Parisi JE, Dugger BN, Fujishiro H, Petersen RC, & Dickson DW (2011). Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. Neurology, 77 (9), 875-82 PMID: 21849645

Bliwise, D., Mercaldo, N., Avidan, A., Boeve, B., Greer, S., & Kukull, W. (2011). Sleep Disturbance in Dementia with Lewy Bodies and Alzheimer’s Disease: A Multicenter Analysis Dementia and Geriatric Cognitive Disorders, 31 (3), 239-246 DOI: 10.1159/000326238

The Holy Grail of Weight Loss III

...CONTINUED FROM THE LAST POST

ME: This ties in to one of my strongest philosophies on money - it's better to make a little bit of money doing what you love than making a ton of money doing what you hate. The same could be said of living a "healthy lifestyle." A pound lost doing something enjoyable is worth more than 10 pounds lost doing something excruciatingly difficult - like starving yourself or doing unwanted exercise. The word 'sustainable' is sheer poetry - up there with 'unprocessed.' And this concept is really important when you consider the fact that you have been losing weight consistently for almost 2 years steady. Who could do unwanted exercise and deprive themselves of food for 2 years? Not me. And as you know, the metabolic consequences of doing so can be quite severe.


Now I'm sure everyone is curious... Could you tell us what kind of foods that you enjoy and were able to eat? What did a typical day of eating look like for you?

SASHA:  You are absolutely right. Chronic dieters have this imaginary wagon or track that they like to talk about being on and there are always a myriad of reasons for them to "fall off the wagon" or "go off-track." I've seen a lot of this in the past two years of associating with people who diet, which to me is very different from people who heal their bodies. A lot of this has to do with food. I love talking about the way I eat because I love food and both my husband and I love cooking and looking for new sources of whole food. At first it was difficult, we had to spend a little time and research to suss out our sources for the right kinds of foods. I wanted to stay away from grocery store foods for the bulk of our shopping, so this meant the local farmer's market, local produce sellers, people who sell pastured chickens and eggs, etc. We found a couple of butchers, and while the price is going to be a little higher, it’s worthwhile to have local product. We even managed to find a fish monger where we buy our seafood. We taste the difference and the nutrient value is also a plus.

Surprisingly we've done this all on a budget with a few extravagances like buying ghee and coconut oil from our local health food store. We just stay away from the processed "health" foods and expensive organic produce. If my produce is a little damaged but in season and comes from a local source who raises smaller crops organically, this is going to be cheaper than a large chain like Whole Foods. Learn how to shop locally and according to season for the best prices.

Typically we favor yogurt and in season fruit for our breakfasts or pastured eggs. We normally eat a second large meal but not a third, skipping dinner. We favor beef and game meats, our butcher carries a large selection of meats; fowl, buffalo, elk, sausages made in house. We're especially fond of braising meats because there are so many ways of braising and the "low and slow" method in the BBQ during the summer. Legumes, sweet potatoes, squash, locally-grown corn, chard, greens, whatever is in season, with plenty of butter. A little fruit but not too much. We live where berries are plentiful and we incorporate these into our diet when they're in season. We make our own pizzas and ice cream so we can control what goes in them, but again, this is not to make food necessarily less fatty but to avoid processed foods. The bottom line is, we keep things very simple and basic.

I talked about the lack of quality product coming out of fast food restaurants and chain/corporate restaurants. Our bodies need nutrient dense, fatty foods but we eat bad quality foods that are doctored up with a lot of sodium and HFCS. How do you think a place like Red Lobster is able to afford to sell you lobster for $9.99? Bad quality food and bad nutrition leaves your body lacking and still craving so you eat more bad food and so forth. Obviously I have a vendetta against these types of restaurants but I'm so well fed and satiated, there's no danger that I'll binge on packages of diet cookies because of uncontrollable cravings. There's no imaginary wagon or track for me to fall of off. Not once in two years have I ever thought of my weight loss in those terms.

I just want people to know that this is real and I'm not crazy. I really do EAT.

ME:  You say that you weren't eating dinner. Was this something you did all along or started up recently with all the talk about eating light in the evening? Did you eat anything at dinner at all? And how long did it take for your body to adjust to this eating schedule where you really weren't hungry in the evening? I'm very curious about this because it could be a pivotal maneuver in your weight loss, AND I'm even thinking about re-working RRARF to advise overfeeding until 2pm and then coasting into the evening with a very light meal - to reap the same rewards, but make weight gain a less frequent occurrence. Do tell…

SASHA:  To be honest, the meal schedule wasn't deliberate at all but rather accidental. It started a little over a year ago mostly due to my husband's weird schedule and also because we had become used to eating when we were hungry and noticing that our hunger was greatest after 11 and before 2 in the afternoon. We thought it was because we would cycle, hike or run in the mid-mornings, but regardless of what we do or don't do, this eating pattern simply seems natural. I imagine that people who eat a lot of "lite" processed diet foods and non-fat foods are constantly fighting their appetites (and probably why they just give up on losing weight). The more you get into the habit of eating whole foods and nutrient dense meals, the less time the body begs to be fed constantly. At first you may overeat and gain weight but eventually your body's mechanism gets the signal that it is being fed. My personal experience has told me that obeying my body and appetite should be a priority. If I seem to gain a couple of pounds one week because I was hungrier a couple of days and ate more, the weight comes back off the next week then drops even further. The weight doesn't stay on a logical schedule which I know makes a lot of people crazy, but it will continue a downward trend.

Any eating after 2 is very light and this schedule seems to give my body a chance to catch up and rest during the evening hours and overnight. Some days, if there's a need or desire, I can switch things up and have a heavier dinner if I eat lighter during the day, but I don't do this often, probably once or twice a month at the most. I've learned to be flexible.

ME:  Amen on not being hungry when you have nourished yourself properly earlier in the day. My most recent studies have highlighted just how truly natural this eating pattern is. And I do believe it's a useful tool for weight loss - not starving yourself at night that is, but eating enough early to naturally be satisfied in the afternoon and evening. Once again, the focus is on eating more at the right time, and allowing the "eating less" part to occur spontaneously.

Anyway, this is exactly what I have sought after all along - trying to get people to ignore everything and focus on nourishing themselves, answering the physiological call of their hunger with quality nourishment, and letting things fall where they may. If anything, you seem to have succeeded because you are even MORE dedicated to that self-commitment than others. It's amazing to see the trust that you've developed for your body, nourishing it and letting it sort things out on its own. I think a lot of people, by the time they get near 400 pounds, have an extreme DISTRUST for themselves and a strong love-hate relationship with food. Congrats to you and your husband for overcoming such barriers. Very few people at your former weight and age ever have the kind of success that you have had. But I hope this interview will lead to many more light bulbs going off, and more people will have the courage to do what you've done, and display the kind of patience you've displayed. Thank you so much for taking the time to do this Sasha. Can't wait to see where you are in another 2 years.

The Holy Grail of Weight Loss II

Interview continued from yesterday's post...

ME:  Beautiful... And I'm glad that whatever you managed to squeeze out of my materials worked out for you. As you know, not everyone loses weight when they go all 180D. In fact, many gain weight - at least for the first few months as their metabolism comes up towards normal.

What did you do that you suspect is different from others who haven't had such results? If you could give them advice, or share how you did things specifically, what would you say?

In other words what I'm asking is, what makes you so damn special!!??

SASHA:  180DegreeHealth often hurts my head (in a good way of course!) but I understood enough that I knew I was finding answers to my questions. There are reasons for the massive allure and subsequent failure inherent in the diet culture. I needed to know why and how I was going to do things differently. I think if people really want to succeed at fixing their metabolism using this method, above all they need to be persistent and consistent. Fixing your metabolism and eliminating cravings happens, but it takes time. It took me about three months to eliminate cravings and about two more months before my metabolism kicked in and I started losing the bulk of the weight. Many people don't have the patience for this, which is why fad diets are so popular. A lack of patience and a lack of food and body knowledge is how people end up as lifelong dieters who never reach a goal.

But I'm not special or even particularly intelligent or well-disciplined. I believe anyone can do this. Personally, I think it's most beneficial to restrict yourself to whole, traditional foods. Absolutely no fast food and no processed foods. I even go so far as to not eat breakfast cereals, I don't care how natural they claim to be, they're still processed and in a cardboard box and most taste like the box. One big mistake I see people make is that they fail to see the problem with eating at corporate/chain restaurants. You can't go to an Olive Garden and eat healthy. How do these restaurants maintain consistency from restaurant to restaurant? Much of their food is heat n’ serve. Obviously these types of restaurants are one of my pet peeves. I'm married to a professional chef who's worked in every type of restaurant imaginable and we avoid these restaurants for the plague they are.

Eat fat. When I tell my friends that I just ate a gorgeous piece of fatty grassfed ribeye or pork belly then lost a few pounds the same week, they think it's a joke. It's no joke. I'm proof of that. My body tells me when I need to eat more or eat fat and I listen. People don't listen to their bodies anymore. Train yourself to listen to your body and it will tell you everything you need to know.

Retrain your palate. On a regular basis I complain about how people have trashed their palates with processed foods. Source the grassfed beef, butter, pastured chickens and eggs. Cook with lots of ghee and coconut oil, buy vegetables in season, learn how to cook. After you learn to eat at home you'll find you're going to make better choices when you eat out. I've lost count of the number of people who are trying to lose weight that can't maintain any kind of consistency in how they eat. They're either eating some nasty chicken breast with lettuce and lite dressing at home or gorging out on really bad food at Applebee's or Chili's. The quality of your product at home should be consistent with the quality of product when you eat out.

Be physically active but don't exercise. I know that makes no sense but I hate exercise. I've only been to a gym once several months ago when my husband and I got a free one-month trial. It was dull, boring, my muscles were uncomfortably sore all the time and I stopped losing weight. We never went back. My advice to people is to find a few fun activities you like to do and enjoy. Bicycle, hike, run, kayak, do yoga, whatever you enjoy. Avoid massive amounts of useless cardio, overtraining with weights and silly fads (Zumba, yuck). I do a lot of bicycling, hiking and yoga but not to the point that it becomes loathsome.

(This is right in line with this conversation on exercise from early this year....)


Once your body finds its rhythm and your metabolism mends, the body's weight finds its own level, like water. I'm amazed at how almost effortless the weight loss has become. I say "almost" because sometimes I get thrown off balance, but the correction is always pretty simple. Every individual is different but what works for me has had an equal and amazing affect on my husband who has lost 88 pounds along with my 127 pounds. He ended up coming along for the ride, so to speak, when I started my new way of eating and understanding food and my body and he has reaped the benefits too.

ME:  Great answer - and I knew you were going to say something about retraining your palate and being really committed to eating unprocessed foods. My research has led me increasingly in that direction. I've found that there is a huge difference between a mostly unprocessed food diet and a 100% unprocessed food diet. And it has everything to do with retraining the palate.

You mention not doing exercise but being physically active. How much of a role did exercise play in you and your husband's weight loss? Were you really making a point to move your body more? If you had to estimate, what percentage of the weight loss do you think was attributable to getting more activity, and how much was the diet? Or do you really think it requires both to realistically succeed?

SASHA:  I like this question best because I think the distinction I made is important and deserves some clarification. Just like appetite, a morbidly obese person loses the ability to gage what is a normal activity level so we wind up terribly underactive while still thinking of ourselves as fairly active. How many times have you been told by a morbidly obese person, "Well, I'm pretty active for a big guy/lady, but I don't seem to lose the weight". It isn't because this is true, but because our perception of what normal activity is, is warped. I know my judgment of what it's like to be hugely overweight seems insulting, but it really is like being myopic in a fishbowl. You lose sight of so much.

At my heaviest when I started losing weight, I knew I needed to move more, but because I feel about the same toward the exercise/fitness business as I do about the diet/weight loss business, I wanted to do things opposite of what the mainstream would tell me to do. My plan, pick activities that I imagine myself doing at any weight and for reasons other than weight loss. Make sure it's something I enjoy and something that I can see myself doing for many years to come. This, for me, started with walking and evolved into hiking. I live in the Pacific Northwest so this was a natural evolution. Last winter I started running, then trail running and eventually I bought my bicycle. Every activity I've picked has evolved in some way, either in intensity or mileage, and this is important, because as your body fixes and repairs itself due to the obesity, your body will naturally want to move more.

So, my way of eating and losing weight and my physical activity are not mutually exclusive of one another. When you eat to appetite and eat what your body craves, your physical activity will naturally feel inclined to match that by either doing something more intense, less intense or by wanting more sleep. It's an almost 50/50% relationship between the two and I can't imagine one without the other. It is important to understand what kind of energy your body is "into". I'm more of a slow steady burn with more endurance while my husband has become inclined toward shorter, high energy bursts, which is probably why he enjoys mountain biking and running. Whatever it is, you're going to want to be active.

I know some people would argue that you can lose the weight without any of this, but how long will that last? I've seen enough people go the wrong route in both directions so it's easy to know what to avoid. I see the people who do nothing or very little, lose a few pounds or more, but beyond that not much changes for them physically. I have also seen people engage in frantic and large amounts of cardio, losing large amounts of weight quickly after which they burn out, gain some back and struggle, never to find that momentum again. I guess the bottom line is sustainability. What are you going to eat or do that will become a natural part of your life from here on out? I approach both my food and my physical activity with this in mind.

Continue to PART III...

Topiramate Augmentation in Major Depression

Molecular Model of the Drug Topiramate

Currently available antidepressants provide significant relief from major depression in many patients.  However, a significant number of patients receive little or limited relief following an initial trial of a standard first-line drug from the selective serotonin re-uptake inhibitor class of agents.


A common clinical strategy after initial drug non-response and non-remission is to consider pharmacological augmentation.  Augmentation options for clinicians include lithium carbonate, triiodthyronine (thyroid hormone), a second antidepressant, an atypical antipsychotic or adding psychotherapy if it is not already being provided.


Despite the number and range of augmentation options, additional options need to be explored given the persistence of depressive symptoms in many individuals.  A small study from Iran suggests one alternative to consider may be the drug topiramate.


Topiramate is a drug approved by the FDA for the treatment of epilepsy and migraine headaches  in the United States.  It is not approved for the treatment of any primary psychiatric disorder.  The exact mechanism of action for topiramate is unknown although it is known to have effects on the sodium channel, gamma-amino butyric acid (GABA) receptors, glutamate receptors and act as a carbonic anhydrase inhibitor.


Mowla and Kardeh have published a small study of 42 subjects randomized to topiramate or placebo.  The key elements of the study include:

• Subjects: Adults with DSM-IV major depressive disorder who had failed to respond to eight weeks of treatment with an SSRI drug (fluoxetine, citalopram or sertraline)
• Drug: Topiramate 25 mg per day increased by 25 mg per week throughout the trial (mean dosage 175 mg/day) or placebo
• Clinical trial design: Double-blind, randomized controlled trial with primary outcome measure the Hamilton Depression Rating scale (HAM-D) administered by a psychologist not involved in treatment

Fifty three subjects started the study with 11 dropouts (six in the topiramate group and five in the placebo group).  HAM-D scores statistically decreased more in the topiramate group (21.6 at baseline to 14.7 at 8 weeks) than in the placebo group (21.9 at baseline to 20.8 at 8 weeks).


Since a score of seven or more is considered remission in MDD, the mean score of 14.7 in the topiramate groups suggests significant residual symptomatology.  The authors do not provide the number of subjects meeting remission criteria in the topiramate and placebo groups by 8 weeks.


Nevertheless, topiramate has some potential significant advantages in the treatment-resistant major depression population.  First, it is a generic drug and would have some cost advantages in comparison to some of the other options.  Second, topiramate it typically weight neutral or produces a slight weight reduction.  Most antidepressants increase weight over time so this might be an important advantage.  Third, topiramate might hold an advantage in treatment of MDD populations with migraine or epilepsy--disorders with an indication for the drug.


This study is too small to change clinical practice patterns or guidelines.  Additional larger replication studies need to be considered.  

Molecular model of the drug topiramate from Wikipedia Creative Commons file released to the public domain.  Author of the model is: Fvansconsellos

Mowla A, & Kardeh E (2011). Topiramate augmentation in patients with resistant major depressive disorder: a double-blind placebo-controlled clinical trial. Progress in neuro-psychopharmacology & biological psychiatry, 35 (4), 970-3 PMID: 21291943

Spicy Roasted Red Pepper & Hummus Sandwich with Portabello

This is an amazing sandwich that I know you will love. I used a crusty artisan bread and made my own spicy hummus sandwich spread.  After spreading on my hummus, I added sliced apples, tomatoes, grilled portabello mushrooms, Mezzetta roasted red peppers, Mezzetta jalapeno stuffed olives, basil leaves & romaine lettuce. Talk about flavor plus in a sandwich!!  You could also grill this or put it in your panini maker, just add the lettuce after your sandwich is done cooking. See picture below for this same sandwich panini style. I hope you will give this sandwich a try because I know you and your family with love it.

Spicy Roasted Red Pepper & Hummus Sandwich with Portabello
Serves 2-4
Printable Recipe

4 slices of Artisan Bread
8 tbsp. homemade spicy hummus (see recipe below)
4 apple slices
4 tomato slices
8 sliced pieces of a large portabello mushroom
1 tsp. olive oil
3 tbsp water
½ cup Mezzetta Roasted Red Peppers
8 Mezzetta Jalapeno Stuffed Olives (sliced)
8 medium size pieces of basil
Romaine lettuce leaves

1.) Grill 8 long slices of a large portabello mushroom in 1 tsp. olive oil. Lightly salt and pepper and cook for 2 minutes. Add 3 tbsp of water all at once and continue to cook 2 additional minutes. Remove from heat.

2.) Spread all 4 pieces of artisan bread with 2 tablespoons each of hummus. Slice apples and tomatoes into ¼ inch thick round pieces. To one side of each sandwich add 4 portabello mushroom slices, 2 slices of apple, 2 slices of tomato, ¼ cup roasted red peppers, 4 sliced olives, 4 basil leaves and romaine lettuce. Put the other slice of bread without the vegetables on top to make a finished sandwich.

Spicy Hummus
1 (16 oz.) can low sodium garbanzo beans/chick peas
1/4 cup Mezzetta Roasted Red Peppers
3 tbsp liquid from Mezzetta Roasted Red Peppers jar
3 tbsp water
1 clove fresh garlic
½ tsp maple syrup or agave
¼ tsp ground cumin
¼ tsp ground cayenne pepper
½ tsp paprika
1 tsp dried onion flakes
½ tsp sea salt

Directions:
Put all ingredients in food processor or higher powered blender and blend until smooth. Stop and scrape sides of blender several times.




Spicy Roasted Red Pepper & Hummus Sandwich with Portabello

 

Fitness, Hippocampus and Forgetting

Hippocampus in Green from 3D Brain iPad App

Cardiorespiratory fitness appears to be associated with a variety of benefits in cognitive functioning.  The mechanisms for this benefit are unclear.  Association studies do not provide evidence for the pathways between related variables.  For understanding pathways, clinical trials, longitudinal studies and multivariate approaches are more powerful approaches.

Amanda Szabo and colleagues at the University of Illinois at Urbana-Champaign recently published a multivariate study looking at fitness, hippocampus and forgetting in a group of elderly adults in the journal Neuropsychology.  The hippocampus is a brain region known to crucial to working memory.  Changes in hippocampal volume have been linked to age-related cognitive decline and the development of Alzheimer's disease.

The key elements of design in this study included:
Subjects: 158 older adults with a mean age of 66.5 years
Variables: Fitness level as measured by VO2 estimate from a graded exercise test, brain hippocampal volume from a brain 3T MRI scan, spatial working memory task, subjective rating of forgetfulness (Frequency of Forgetting Questionnaire)
Statistics: Path analysis examining direct and indirect effects of fitness on hippocampal volume, working memory test performance and subject rating of forgetfulness using the comparative fit index (CFI)

The authors started with a presumed pathway model for the mechanism of the relationship between fitness and forgetfulness in the following pathway:

• fitness levels predict hippocampal volume
• hippocampal volumes predicts working memory function performance
• working memory performance predicts subjective forgetfulness

Fitness levels were associated with a variety of sociodemographic and medical variables at baseline including: self-reported physical activity, presence of hypertension, cardiovascular disease, body mass index, education level, gender and age.  These baseline variables were evaluated and controlled in the final pathway analysis.

The authors found their predicted model held up in the analysis: "cardiorespiratory fitness is associated with the frequency of forgetting indirectly through its influence on hippocampal volume and, in turn, spatial working memory".

The study noted fitness level is not the sole determinant of hippocampal atrophy.  Age alone is an independent contributor of hippocampal atrophy.  Fitness may reduce the effects of age-related hippocampal atrophy and forgetfulness but it is unable to reverse the effect.

So fitness is not a panacea but it appears to be an important factor in maintaining cognitive function in later life.  Now, I just wonder if my wife can help me find my running shoes?

3D Brain image of the hippocampus in green screen shot from the author's collection.

Szabo, A., McAuley, E., Erickson, K., Voss, M., Prakash, R., Mailey, E., Wójcicki, T., White, S., Gothe, N., Olson, E., & Kramer, A. (2011). Cardiorespiratory fitness, hippocampal volume, and frequency of forgetting in older adults. Neuropsychology, 25 (5), 545-553 DOI: 10.1037/a0022733