Kamis, 31 Maret 2011

Answering the Critics and Paleo 2.0

It may encourage you to know that I do have critics.  They don't typically show their faces on my blog itself (and I haven't moderated any comments away except some insane unrelated treatise on vaccines and when one single commenter was being a bit too enthusiastic about curcumin to the tune of 10 comments at a time, and all the viagra and birds nest soup spam ("Katherine Woo" and "alan," I'm looking at you)), but they do exist.

An early one had a review of my blog, here - his main critique is that paleolithic human's health is debatable.  Certainly their mental health is, but bones are bones, and metastasis and iron deficiency and whatnot are there for the discovering.  This critique falls into the general one that evolution isn't a good paradigm on which to base a lifelong health prescription.  To which I say - you haven't studied enough anthropology or evolution.  And I still contend that it is a very reasonable assumption that wild-type humans did not struggle with anxiety and depression and other major mental illness to the tune of 26% of the population per year.

Another critique is more generic and one I see on tweets on reddit (where the really cool people tweet rather indifferently) - that I am not proscriptive enough.  "That post was I guess kind of interesting but she didn't really say what to do."  Well, I've trained as a therapist, after all.  Any therapist who tells you exactly what to do is a fool.  If you follow my advice to the letter, you don't give yourself enough credit.  If you do the opposite in defiance, you don't give yourself enough credit. Either way you don't learn a damn thing.  (Little hint to newly minted therapists out there - never ever ever tell someone explicitly not to have an affair.) I'm interested in putting out the information.  It's your life, your body, your mind.  Do whatever you want.

Predictably, the other common critique is that I overreach (that I am perhaps too proscriptive).  An example is this doctor/farmer's tweet -  and that is the critique that I am perhaps most sensitive to.  The wisdom of alternative medicine has been undone by overreaching in the past.  I have no interest in repeating the meme of ridiculous alternative assertion and self-righteous conventional medicine refutation.  I hope I am careful not to overstate my case (as I was careful in the Wheat and Schizophrenia post the good doctor objected to).   Most of what I am interested in has not been properly studied.  But, of course, it ought to be :)

There have been other random and downright bizarre critiques along the way, but, for the most part, the internet reception has been quite positive.  Now that I have moved more mainstream with Psychology Today, I have encountered a bit of anti-psychiatry critique in general, and to be honest I'm not too interested in spending the time refuting it, but I guess I will do my best until it gets too boring.  The major issue I have is when someone assumes I know nothing about mental illness or the natural history of mental illness just because I also have experience with and utilize the medications in treating mental illness.  Yes, I know there are horrific side effects.  Yes, I know there is controversy.  There are even hopeful and Pollyanna ideas that psychosis is more appreciated and accepted in traditional cultures and that our modern ideas and lifestyle have falsely defined and pathologized psychosis.  Well, one of my professors in residency spent a lot of time in remote areas of Africa, and what he found was that the rare-ish person in a hunter gatherer population who is psychotic is either able to keep it together enough to be a bit of a shaman, or he or she is tied to a tree for most of his or her life.

I wish the Pollyanna version was true.  But I live in the real world, as do all of you.

Here is one of my favorite pieces of classical music (right click to open in new tab).  I'm positive I've linked it before, but there are a lot of new readers now, and it is apropos.  La Befana is harsh, and obnoxious, and wonderful, and fast, and celebrates life and humanity.  It is messy and offensive, but everything resolves into beauty at 3:06.  Hold out until 3:06.  In the last part of La Befana is encoded the secret of life and the universe, I promise.  La Befana is science, and surety, and slaughter.  Blood and celebration.  Roman orgies.  Sacrifice, and spring, and life.  Fires at sunset, and a smoky hung-over dawn.

Paleo 2.0 is a go.  (Well, I do take a little exception and think that early human migration patterns suggest that we did, indeed, eat an awful lot of marine animals for many many generations).  But, yeah, for the most part I am a Kurt Harris acolyte - all the more so because he would be uncomfortable with that term.  He is the lean paleo (as in archaic) wordsmith machine.  It's all right to admire.  We need a few touchstones in this post-modern industrial wasteland of human health advice.  What I don't need is some other self-important jerk with a pot belly and bedazzled glasses telling me to eat boneless skinless chicken breast and quinoa.

By all means, make it simple.  What is good for the body is good for the brain.  The neolithic agents of disease are wheat, excess fructose, and excess linoleic acid.  What goes without saying is the nonfood.  Don't eat it.  Oh, and be sensible otherwise.  For the most part, eat when hungry, and don't when you aren't.  Fast every once in a while to enjoy the full human experience of hunger and repletion (not to mention ketosis and autophagy).   Be strong.  Run around the yard and swim in the ocean and sprint up the street and hike up the hill.

What is in store for us?  Inflation?  Peak oil?  Epidemics?  Natural disaster?  Technology and brilliance and flourishing human populations?  Irregardless you will be flexible and physically and mentally healthy, as much as is practical and possible.

Or at least I hope that is so.  For me.  For my children.
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No Show at Clinic

So I refurbished another post:

Depression - Caused by Inflammation - Thus Like Other Diseases of Civilization

Such a staid title!  Oh well.  This is serious business.
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Selasa, 29 Maret 2011

What is patently obvious to anyone who has spent more than 10 minutes studying nutrition literature is that any truly effective nutritional intervention will have to be pleiotropic.  That is, muti-faceted.  Adding one isolated mineral or vitamin or spice or whatever on its own is rarely going to hold up to population-wide study, or, as Kurt Harris would say, "no magic foods."  The probable exceptions to this rule in mild conditions are fish oil and magnesium - but that is likely because they are so incredibly vital to health, and so horribly deficient in the SAD.  So I'll grant that a simple magnesium tablet (or hard water) will help cardiac function and anxiety when added to a diet of ho-hos and cheese curls and cola.

Anyway, very recently some psychologists in Christchurch, New Zealand put out this paper (tweeted by Jamie Scott), Effect of Micronutrients on Behavior and Mood in Adults with ADHD: Evidence From an 8-Week Open Label Trial With Natural Extension.  They did something rather sensible - they tested a multimineral/multivitamin.  Here is their perfectly sensible reasoning:  "this approach of using one ingredient at a time may be too simplistic, as interventions of single ingredients may actually upset nutritional balances, creating deficiencies of other nutrients�. therefore, a more effective nutritional intervention to evaluate for mental or physical health may be one containing a broad array of balanced nutrients."  Hallelujah.  I'm not sure how these psychologists keep getting research funding, seeing as how sensible they are, but we have this paper and let's run with it.  Of course, a natural foods nose to tail diet and swimming in the ocean and/or drinking mineral water will give us all the micronutrients we need.  But y'all know that already.

Another cool thing about this paper is that the researchers studied adults with ADHD.  And adults with ADHD tend to be complicated.  See, once you've managed to spend a majority of your life fighting inattention and hyperactivity when everyone else seems to be able to just sit down and do your taxes like you are supposed to, you are liable to be stuck with some ancillary depression or anxiety from the level of stress and frustration that develops from dealing with ADHD.  In fact, 75% of adults with ADHD have an additional psychiatric diagnosis.

In this open-label study, 14 medication-free adults with ADHD and mood issues (episodic symptoms of irritable, low, or elevated mood) were given a supplement called EMPowerplus.  Here's the ingredient list.  This multi is rather expensive (a two month supply at 8 capsules daily is about $75) and was studied previously in bipolar disorder.   In the ADHD study, the participants started of with 5 capsules daily (divided into three doses) and eventually increased to 15 capsules daily (which takes you to > $70 a month for the pills).  My grassfed beef + organ meat and tallow order is just a bit less than $100 a month for the whole family (including shipping), and I get lots of steak included.  Just sayin'.

The results of the trial were impressive.  After 8 weeks, there were significant improvements in all ratings (patient, clinician, and an observer) of mood instability, hyperactivity, quality of life, anger and aggression.  Inattentiveness (the primary ADHD symptom and the basic neurological issue) improved, but remained elevated compared to ratings of people without ADHD.  The study participants were told how to get the supplement, and 7 of the original bought EMPowerplus and kept taking it - after two months their measures continued to improve.  Those who came off the supplement either maintained their initial improvement, or began to regress.  2 participants on EMP+ were also able to quit smoking.  Intriguing!

Perhaps even more interesting is that two of the participants entered the trial with severe Obsessive Compulsive Disorder symptoms, and their OCD symptoms remitted by the end of the trial.  Anyone who treats OCD will understand that OCD is tough tough tough, and in general the gold standard is intensive behavioral therapy plus (typically) the highest available dose of an SSRI that won't take full effect for three months.  The fact that a (I'm hoping, considering the price) pharmaceutical grade multi could ameliorate OCD symptoms, even in a couple of case studies, is amazing.

The discussion in this paper is impressive, and once again far too sensible for standard academia.  Must be that grassfed meat they have available at the supermarket down in New Zealand.  The researchers suggest that neurotransmitter synthesis, second messenger signaling, and the efficiency of brain energetics could all be impacted by our crappy diets (hey, that's the whole thesis of my blog!).  There is evidence that nutrient content of the food supply has diminished over the past 50 years (which is why I subscribe to a summer CSA box from local  farmers who are Joel Salatin acolytes and add organic seashell mineral mush to the fertilizer.)  The researchers were also very fair about the limitations of the trial - it was exceedingly small and open-label with no control.  Basically a wee pilot study, proving nothing, but (hopefully) to be used evidence to apply for much larger (expensive) randomized controlled trials from which we could actually glean some sensible data.

As if that will ever happen.

In the mean time, I will go straight to the fallback of an evolutionary diet plus sensible additions such as dark chocolate.  Just as expensive, perhaps, but a lot tastier.
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Minggu, 27 Maret 2011

Another Refurbished Post and Song

Happy Sunday!  I uploaded/updated another post on Psychology Today.  And here's a song, too, by Nancy Sinatra.

Bang Bang

How Stress Makes You Sick and Sad  (literal titles work well)

Here's one more song, good for a Sunday.  Jeff Buckely Hallelujah.

And one more.  For good luck.  Mad World (the Donnie Darko remix)

Shucks.  Can't really link a Jeff Buckley song without linking his best one ever:  Lover, You Should've Come Over.
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Sabtu, 26 Maret 2011

Several folks (Julianne and Chris Kresser come to mind) tweeted about this new paper last week, and it really is a doozy.  "Exposure to a social stressor alters the structure of the intestinal microbiota:  Implications for stressor-induced immunomodulation."  The associated editorial is worth a read as well, if you have access.  Also, the journal it comes from, "Brain, Behavior, and Immunity" is very cool.  The entire journal is devoted to subjects of interest to any psychiatrist who looks into the inflammation/brain connection.  And if inflammation itself is truly behind the pathophysiology of psychiatric disorders, then somewhere in the archives or future of this publication will be the holy grail linking inflammation via diet and lifestyle to actual brain pathology.

This paper is a nice start.  First some fun facts.  The external surfaces of the body (that includes the gut, by the way, as we are a funny tube within a tube) are populated with microbes.  So populated, in fact, that 90% of the cells that make up the roving bacteria party + human host are the commensal microbiome.  Yup.  90% of you (by cell number) is them.  Most of these colonizers and symbiotes live in the intestine, especially the large intestine.  In the Matrix world of commensal species, the large intestine is Zion.

Here's the crazy thing - we know very little about these species.  Mostly because the vast majority seem to be absolutely dependent upon us (as we turn out to be symbiotically dependent on them).  They can't be cultured without the host in a lab.  They need a living working gut, where they flourish, but are difficult to study.   That means we didn't have the capability even to catalog the species of gut bacteria until we could practically and relatively cheaply sequence DNA in large amounts, so not until the last 7 years or so.

The beasties live in a "largely stable climax community" in our guts as the result of natural selection for species best adapted to our habits and personal nooks and crannies.  Fortunately, the beastie community is pretty resilient, but factors such as a change in diet and antibiotics will obviously transiently affect the population.  In addition, exposure to stress also changes the population of beasties, the details of which were more clearly elucidated by the work in this paper.

The beasties do all sorts of nice things for us, really.  They make vitamin K, several B vitamins, and eat up carcinogens and other nasties.  Their health and composition are definitely related to the pathology of obesity and of diabetes (at least in mice).  And, not surprisingly, these bacteria impact the immune system.

Germ-free animals raised in sterile environments without commensal microbiota have a different sort of intestinal immune system, with a lower amount of intestinal antibodies and fewer immune cells.  Colonizing these sterile mice will result in normalization of the gut immune system.  Alterations in the intestinal microbiota has been linked to asthma in animals and humans, suggesting that the beasties modulate adaptive and innate immunity.

Y'all might remember that some of those cytokines and immune system chemicals that are produced in the process of inflammation are known to be elevated in the case of depressive disorders.  Chemicals with names like IL-6, TNF alpha, and interferon gamma.  IFNgamma is known to actually cause depression.  Who cares?  Well, translocation of gut bacteria through the gut lining into the comparatively sterile body interior results in a systemic increase in IL-6 and the other cytokines.  We talked about that a little bit in relation to depression and chronic fatigue in posts a few weeks ago.  Psychological stress in humans, such as caring for a sick relative or chronic work stress, also is associated with elevated cytokines IL-6 and TNF alpha.  So the question asked by these researchers (and subsequently answered) is - does psychologic stress change the microbiota population, and is that related to a cytokine change within the body?

The experiment itself was complex and consisted of several different arms, and many mice made the ultimate sacrifice (along with their gazillion commensal microbiota).  In short, some mice were mostly left alone, others were given antibiotics and stress, others just exposed to mean "aggressive mice," others were restrained, and others given antibiotics and restrained...

So what happened to the microbiota and the levels of cytokines in these various experiments?  Well, the mice exposed to stress had definite changes in internal beastie populations.  In general,  exposure to stress (the mean mouse, or restraint) led to "a reduction in microbial diversity and richness."   In addition, exposure to the stressor led to a significant increase in IL-6 levels.  Interestingly, the specific genus of the population of microbiota were significantly related to the generation of IL-6.  TNF-alpha and INFgamma were also increased in stressed mice, but not significantly.

In the antibiotic-treated mice (with a pummeled microbiota), the IL-6 did not increase in response to stress.  Antibiotics reduced the amount of bacteria about 100-fold, so while it didn't eliminate the commensal bacteria by any extent, it made a good dent in the population.

Taken together, these results tell us that stress affects our gut bacteria, which affect our immune system and cytokines.  We know those increases are related to changes in psychological states.

The editorial quote of note:

The strength of implementing a truly integrative systems approach when studying stress physiology has never been clearer than in the work by Michael Bailey and his colleagues in this issue of the journal.  These scientists investigated the impact of stressor exposure on multiple physiologic symptoms, including the intestinal microbiota and the immune system.  These data reveal dynamic interaction between these systems when orchestrating the innate immunological stress response. 

So yes, they control your brain.  To some extent.  Best keep the beasties happy.  Kefir and sauerkraut anyone?
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Kamis, 24 Maret 2011

Dieting Can Make You Lose Your Mind

Refurbished Semi-Starvation post over at Psychology Today, with added squirrel:

Dieting Can Make you Lose Your Mind

As for this blog (which for the forseeable future will have the new cutting edge stuff), I have a big stack of papers to read, and some grouchy ipad posts to write for the weekend!
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Senin, 21 Maret 2011

I've combined three previous posts into a cogent and magnificent piece over on my blog at Psychology Today:

Low Cholesterol and Suicide


- Posted using BlogPress from my iPhone

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