Richard G. Petty, MD

Integrated Medicine with Heart Surgery

The movement to treat the whole person is a lot more developed in Europe than tit is in the United States. So it is always gratifying to see research on integrated medicine on this side of the pond. Even if there are critics who call anything holistic “woo woo,” the fact is that patients like the approach, and there is a developing research base.

A new study from the Mayo Clinic indicates that massage therapy decreases pain levels for patients after heart surgery. During a five-month period in 2005, 58 patients undergoing surgery participated in a pilot study to examine the effect of massage on pain after surgery. Of the 30 who received massage, the mean pain scores were less than 1 on a scale of 1 to 10, with 10 as the most painful.

Before the massage therapy, these patients rated their pain at an average of 3 on a 10-point scale. In the control group of 28, pain levels remained the same over the same period, according to findings published in the current issue of Complementary Therapies in Clinical Practice. 

As a result of the pilot study, Mayo now has a full-time massage therapist available for patients after heart surgery, and a larger, randomized study is under way.

The reason for the study was that patients often report that tension, stress, pain and anxiety get in the way of their recovery after cardiac surgery. Therefore apart from massage, the researchers are also exploring the use of stress management, music therapy and guided imagery as adjuncts to the best of modern medicine.

This makes good sense, and I shall keep you posted as more information is published.

Rewiring the Dyslexic Brain

Dyslexia can be a real difficulty for many children, although for many it has been a gift: they have succeeded very well in life by mobilizing other psychological and neurological resources. Sir Richard Branson, the founder of Virgin Enterprises, Thomas Edison and Albert Einstein are all said to have had dyslexia.

There are many types of dyslexia, but in the most common - developmental dyslexia – children confuse letters and syllables when they read.

It now appears that some children with dyslexia struggle to read because their brains are not correctly wired to process fast-changing sounds, according to a study published this month in the journal Restorative Neurology and Neuroscience.   

However sound training using computer exercises was able to rewire children's brains, correcting the sound processing problem and improving reading.

More than 30 years ago Paula Tallal of Rutgers University proposed that children with dyslexia might have an underlying problem processing sound, but it has never been tested using brain imaging. The researchers used functional MRI imaging (fMRI) to examine how the brains of twenty two 9- to 12-year old children with developmental dyslexia, and normal readers, responded to sounds, both before and after using educational software called Fast ForWord Language.

The first test involved measuring how the children's brains responded to either fast-changing or slow-changing sounds that resembled speech. The fast-changing sounds altered in pitch or other acoustic qualities quickly. In just tens of milliseconds, as occurs in normal speech. The slow-changing sounds changed over only hundreds of milliseconds.

In normal readers, 11 brain areas became more active when the children listened to fast changing, compared to slow changing, sounds. In dyslexic children, the fast-changing sounds did not stimulate high levels of activity in these regions of the brain. Instead, dyslexic children processed the fast-changing sounds as if they were slow changing. They used the same regions of the brain but at lower intensity.

We know that infants must correctly process fast-changing sounds as they learn language. They use sound processing to create a sound map of their native language. If they are unable to analyze fast-changing sounds, their sound map may become confused. The idea is that they run into trouble when they first see printed letters because the children's brains now try to match their internal sound map to letters that they see on the page. Linking normal letters to confused sounds may lead to syllable-confused reading.

But the brains of the children with dyslexia changed after completing exercises in a computer program known as

The Fast ForWord Language program does not involve reading at all, but only listening to sounds, starting with simple, changing noises, like chirps that swooped up in pitch. The children then have to respond with a clicker when the chirp's pitch goes up or down. At first the sounds are played slowly, but they gradually speed up, becoming more challenging for dyslexic children. The exercises are then repeated with increasingly complex sounds: syllables, words, and finally, sentences.

The fMRI study showed that these repetitive exercises appeared to rewire the dyslexic children's brains: after eight weeks of daily sessions - about 60 hours in total - their brains responded more like the brains of typical readers when they were processing fast-changing sounds, and at the same time their reading improved.

It is still early days for this research, and we do not yet know whether the improvements in reading and in the brain will be sustained.

This research may make it possible to identify children at risk of dyslexia even before they start learning to read. It is also possible that other approaches to learning sounds, such as learning to sing or play an instrument may be effective, since most of us learn music with gradual, repetitive, and intense listening and move up to faster changing sounds.

Decision Making and Internal Balance

Many of us run into problems when we try to make decisions. In a special section in the October 26 issue of the journal Science, Martin Paulus who is a professor in the Department of Psychiatry at the University of California in San Diego, has marshaled a growing body of evidence that human decision-making is inextricably linked to an individuals' need to maintain a homeostatic balance.

He goes on to suggest that psychiatrists may need to approach the treatment of psychiatric patients from a new direction: by understanding that such individuals' behavior and decision-making are based on an attempt to reach an inner equilibrium, in the same way that we try to being our temperature or blood pressure back to a set point. And if the thermostat is broken we may see mental illness and substance abuse.

This makes good sense: in the past decision-making process as a considered series of options and values, but that is not what we see in the clinic. People with addictions and some mental illnesses keep making bad choices, despite being intelligent and insightful.

Recent neuroimaging research shows strong support for the homeostatic nature of decision-making:
The insula is involved in processing interoceptive information: the body's internal state or sense of balance
Damage to the insula stops addiction to cigarettes
Some of the same brain structures implicated in the urge to take drugs are involved in other biological urges

The question addressed in part by this paper are whether changes in decision-making behavior and associated brain functions are a result of pre-existing characteristics - which may predispose individuals to use drugs - or occur as a consequence of long-term use. 

This is certainly an interesting idea, and we shall have to see how it fits as we collect further data.

“The quality of a decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.”
--Sun Tzu (Chinese Military Strategist and Author of the “Art of War”, c.400-c.430 B.C.E.)

“The risk of a wrong decision is preferable to the terror of indecision.”
--Maimonides (a.k.a. Rabbi Moses ben Maimon, Spanish-born Jewish Philosopher and Physician, 1135-1204)

“All you have to decide is what to do with the time that is given you.”
--J.R.R. Tolkien (South African-born English Writer, Linguist, Oxford Don and a Member of C.S. Lewis’ Literary Group, “The Inklings,” 1892-1973)

“Decisions are doorway to change and change starts from a moment of decision. One decision can change your life forever!”
--Tony Robbins (American Motivational Speaker and Writer, 1960-)

“Nothing is more difficult, and therefore more precious, than to be able to decide.”
--Napoleon Bonaparte (Corsican-born French Military Strategist, General and, from 1804-1814, Emperor of the French, 1769-1821)

He That Enjoys His Portion

Having grown up at a time and in a culture where it was expected that everyone would finish every morsel of food on his plate, it was quite a shock to come to the United States and to be confronted by mountains of food. During my first few months I dutifully consumed everything on my plate and soon noticed the effect on my waistline. But it brought home to me the power of social and cultural factors in eating.

Though each of us is responsible for how much we eat, research suggests that cultural and social norms can make it hard for us to choose appropriate portion sizes. The November 2007 issue of Harvard Women's Health Watch has published an interesting article about the way in which misperceptions about portions can affect calorie intake.

A first point is that many of us tend to treat portions as equivalent to nutritional servings. A serving is a specific quantity of food designated on the basis of nutritional need. However, a portion--the amount you actually get on your plate, in the package, or at the counter--is often much larger. Many of us do not always read the Nutrition Facts label, and may find ourselves eating two or three servings' worth. Studies suggest that we might be satisfied with smaller portions if larger ones were not so easily available. Other research has shown that the more plentiful the food, the more we eat. I know form my own experience that both of those are true.

The Harvard Women's Health Watch offers some advice for “keeping portions in proportion:”

• Train your eye: Measure out servings - not portions - of the food you commonly eat so you know what a single serving looks like
• Change your tableware: Use a smaller bowl or a mug for cereal and a smaller plate at dinner
• Control portions at home: To discourage second helpings, serve food in the kitchen and take it to the table on plates
• Eat at regular intervals throughout the day: Do not wait until you are hungry, since you are then more likely to overindulge at the next meal
• Control portions while eating out: Avoid buffets and salad bars. Instead of a dinner, order a low-fat appetizer and a large salad with dressing on the side

These are all simple and straightforward pieces of advice that will be familiar to anyone working in the weight and metabolism field.

On another occasion I shall give you a few more of my own tips, including “Perimeter shopping”

Folic Acid: Too Much of a Good Thing?

If you believe everything that your read in the media or hear on those infomercials, you would think that you should spend all day munching pounds of fruits and vegetables while taking megadoses supplements chasers.

While that may sound good in theory, in practice things are not so simple and this approach may actually do you harm.

A good example has just come to light in a report from the Institute of Food Research in the United Kingdom that has just been published in the British Journal of Nutrition.

We have talked before about the potential value of fortifying food with folic acid. Apart from reducing the risk of neural tube defects in babies, it may also reduce the risk of depression.

The new report suggests that fortifying flour with folic acid may lead to a range of health problems.

Folic acid is a synthetic form of folate, a B vitamin found in a wide variety of foods including liver and leafy green vegetables. Folates are metabolized in the intestine, whereas folic acid is metabolized in the liver. The liver is an easily saturated system, and at doses of half the amount being proposed for fortification that could lead to significant unmetabolized folic acid entering the blood stream.

This excess folic acid could cause a number of problems:
It may interfere with some treatments for leukemia and arthritis
Women being treated for ectopic pregnancies
Men with a family history of colon cancer
People with blocked arteries being treated with a stent 
In women undergoing in-vitro fertilization, it may increase the likelihood of conceiving multiple embryos
Unmetabolized folic acid accelerates cognitive decline in the elderly with low levels of vitamin B12 (If they have normal levels of B12, folic acid may slow brain aging)
While dietary folates have a protective effect against some cancers, folic acid supplementation may increase the incidence of colon cancer
Folic acid may increase the incidence of breast cancer in postmenopausal women, though other studies have shown the opposite

The trouble is that it could take 10-20 years for any potential harmful effects of unmetabolized folic acid to become apparent.

The latest study follows a letter to the Food Standards Agency from Sir Liam Donaldson, the Chief Medical Officer of England, requesting further expert consideration of two recent studies linking folic acid to bowel cancer before the government gives the final go-ahead for mandatory fortification of food with folic acid. However the Food Standards Agency has stuck to its position that fortification is safe. Mandatory fortification has already been introduced in the US, where it has been required since 1998, Canada and Chile, where it has cut neural tube defect rates by up to half.

Professor Nicholas Wald, director of the Wolfson Institute of Preventive Medicine, said:

“Fortification would prevent many cases of spina bifida and would also benefit the health of the country as a whole. Further delay in this public health measure will result in hundreds more babies being disabled by this serious disorder, or pregnancies being needlessly terminated due to a neural tube defect."

When it comes to analyzing risks and benefits, one of the most important things is to realize that more is not necessarily better, and that folate and folic acid are not the same thing at all.

Second is the point that we discussed before: some people have the right genes to be able to metabolize folic acid with impunity, while others may get a range of problems from taking it.

Optimism and the Brain

Humans have a wonderful ability to expect positive events in the future, even when there is no shred of evidence to support them. One of the key components of resilience is optimism. Though there is data to show that there is a genetic contribution to optimism, it is also a psychological attribute that can flow from life experiences as well as attitude that can be developed. Though the motivational coaches who tell us that putting on a happy face will make you happy and optimistic are probably overstating the truth! A lack of optimism is often a sign of clinical depression so learning more about it, is not just an academic exercise.

New research just published in the journal Nature indicates that there are two regions of the brain linked to optimism.

The team from New York University and University College, London, says that the act of imagining a positive future event, for example winning an award or receiving a large sum of money, activates two brain areas: the amygdala and the rostral anterior cingulated cortex (rACC). The finding ties in with earlier studies that suggested that these brain regions malfunction in depression. (1,2)

The investigators first measured how optimistic 15 volunteers were using a standard questionnaire. They were then scanned using functional magnetic resonance imaging (fMRI) while reflecting on one of a number of potential scenarios.

In one part of the trial, subjects followed specific instructions to recall a negative event in the past, such a funeral that they had attended in the past five years. In another experiment they had to imagine what it would be like to be involved in a car crash in the near future. At other points in the study subjects had to reflect on positive events such as winning an award in the past or receiving a large sum of money in the future.

Reflecting on both past and future events activated the amygdala and the rACC regions of the brain. However, positive events, and particularly those imagined in the future, generated a significantly larger response in these regions than reflecting on negative events.

When imagining happy events, the more pessimistic subjects in the trial had less activation of these brain areas than their optimistic counterparts when imagining happy events.

For some time now, many researchers have assumed that the amygdala and rACC are only involved in negative thoughts and negative reactions, but this research indicates that they have an important role in signaling cheerful thoughts. And, what is more, these are also regions of the brain that have been implicated in depression. Previous research has suggested that patients with depression have decreased nerve signaling and fewer cells in the rACC and amygdala.

Is this why people with depression find it so hard to generate positive thoughts?

This is important work that will likely have a great many practical applications.

“Children are born optimists and we slowly educate them out of their heresy.”
--Louise Imogen Guiney (American-born English Poet, 1861-1920)

“Although the world is full of suffering, it is full also of the overcoming of it.”
--Helen Keller (American Blind and Deaf Swedenborgian Philosopher, 1880-1968)

“No man is so old as not to think he can live one year more.”
--Marcus Tullius Cicero (Roman Political Figure and Orator, c.106-43 B.C.E.)

"The way to become happy
Is to think

And to feel

That the very best is yet to come.”
--Sri Chinmoy (a.k.a. Chinmoy Kumar Ghose, Indian Philosopher and Spiritual Teacher, 1931-2007)

The Neurology of Fibromyalgia

Fibromyalgia can be a particularly nasty illness, not least because people who suffer from it have often been misdiagnosed and occasionally even accused of malingering. But the pain can be very real and very severe. There are some very good reasons for believing that it is a neurological problem involving regions of the brain and spinal cord that are involved in modulating pain.

A new study from the University of Bath and Royal National Hospital for Rheumatic Diseases in England has raised some intriguing possibilities for treatment. A year ago, researchers from the same institution reported that there is a reorganization of the sensory regions of the brain n people with chronic pain.

In this new study, researchers asked patients to look at a reflection of one arm while moving their other arm in a different direction that was hidden behind a mirror positioned in front of them at a right angle. So one limb was obscured from view behind the mirror while they could clearly see the other limb and its reflection.

This simple experiment created a mismatch between what the brain sees from sensory input and what it feels through the motor system that controls movement.

Of the 29 fibromyalgia patients involved in the study, 26 reported feeling a transient increase in pain, temperature change or heaviness in their hidden limb - all symptoms of a flare up of their condition.

This suggests that a mismatch between sensory and motor neurons could be at the root of the fibromyalgia.

This study adds to the growing body of evidence that many of the symptoms of fibromyalgia may be triggered or perpetuated by a sensory-motor conflict.

That opens up all kinds of new possibilities for treatment.

Television and High Blood Pressure in Overweight Children

After learning that watching too much television may cause behavior problems in children, a new report in the American Journal of Preventive Medicine indicates that watching too much television may push up a child’s blood pressure, but only if he or she is overweight.

Researchers from the University of California, San Diego; the Rady Children's Hospital - San Diego; the University of California, San Francisco; and the University of South Alabama collected data on 546 young people, aged 4 to 17 years, who were evaluated for obesity at pediatric subspecialty weight management clinics in San Diego, San Francisco and Dayton, Ohio, from 2003 to 2005. Children and their parent(s) were given a written questionnaire, which was used to estimate the average daily time spent watching TV, and then a physician verbally reviewed and confirmed the time estimate. The height and weight of the children were measured to determine a Body Mass Index and their blood pressures were recorded.

The investigators found that TV time was positively correlated with the severity of obesity. After controlling for race, site, and BMI score, both the severity of obesity and daily TV time were significant independent predictors of the presence of hypertension. Children watching 2 to 4 hours of TV had 2.5 times the odds of hypertension compared with children watching 0 to 2 hours. The odds of hypertension for children watching 4 or more hours of TV were 3.3 times greater than for children watching less than 2 hours of TV.

Yet more evidence that as wonderful as the television can be, too much of anything is not a good idea.

Well, almost anything...

“I find television very educating. Every time somebody turns on the set I go into the other room and read a book.”
--Groucho Marx (American Comedian, 1890-1977)

Sleep Deprivation and Emotional Instability

Most of the time we are in control of our moods, rather than our moods being in control of us. One of the main things that we learn as we get older is not simply to damp down our emotional reactions, but to make them “contextually relevant:” we produce the right emotional response for the right situation. Yet we also know that there are exceptions: times when our emotions over-run any attempts at our control.

Second, we all know that sleep deprivation can be a Bad Thing. It is known to impair a range of mental and physical activities, including immune function, metabolic control and many cognitive processes, including learning and memory.

It has long been suspected that sleep deprivation can have significant effect on mood. Many of us feel irritable and distractible if we haven’t slept enough, and you may have had the experience of being up all night and feeling a little bit “high” in the morning. It has also been known for centuries that mood disorders are very commonly associated with sleep disturbances, and sleep disturbance is often the first sign that someone with mood problems is running into trouble. So mood and sleep must be linked in some way.

Despite these common observations, there has never been that much empirical evidence for the impact of sleep deprivation on mood, and in particular the effects of sleep deprivation on the brain.

An important new study by researchers from Harvard Medical School and the University of California at Berkeley has just been published in the journal Current Biology, and it is beginning to fill in some of the gaps in our knowledge.

The amygdala is known to be involved in processing of emotionally salient information, particularly unpleasant or aversive stimuli. In mature individuals, the emotional centers of the brain are usually controlled and modulated by an array of connected systems, mainly in the frontal regions of the brain. One particularly important part of the frontal lobes that is involved in controlling the amygdala is the medial-prefrontal cortex (MPFC). Under normal conditions the MPFC is supposed to exert an inhibitory, top-down control of the amygdala, so that we only generate appropriate emotional responses.

The scientists worked with 35 volunteers who were deprived of sleep for 35 hours. Blood flow can be used to deduce which specific regions of the brain are active. The researchers used functional magnetic resonance imaging (fMRI) to examine the blood flow – and therefore activity - in the brains of the volunteers in real time, both during and after sleep deprivation.

After going without sleep, the participants were asked to look at images that were designed to trigger angry or sad emotional responses. The investigators discovered that the amygdala showed 60% higher reactions to the images compared with people who are not sleep-deprived.

This is an extraordinarily large effect and implies that sleep deprivation knocks out the normal control mechanisms in the frontal lobes so that the sleep-deprived brain reverts to a more primitive pattern of activity. As a result we become unable to put emotional experiences into context and produce controlled, appropriate responses.

If we needed any more reasons to get a good night’s sleep, this one is very powerful. It also re-iterates something very important: if you or a loved one have had problems with mood, anger or anxiety, it is essential to watch your sleep pattern. Any change may be a harbinger or trouble, and is an excellent early warning that you or they need a hand to make sure that things stay on an even keel.

"Your brain shall be your servant instead of your master, you will rule it instead of allowing it to rule you.”
--Charles E. Popplestone (American Author of Every Man a Winner, 1936)

“Control your emotions or they will control you”
--Chinese Proverb

“For the uncontrolled there is no wisdom, nor for the uncontrolled is there the power of concentration; and for him without concentration there is no peace. And for the unpeaceful, how can there be happiness?”
--Bhagavad Gita (Ancient and Sacred Sanskrit Poem Incorporated into the Mahabharata)

“He who controls others may be powerful, but he who has mastered himself is mightier still.”
--Lao Tzu (Obscure Chinese Philosopher, Founder of Taoism and Alleged Author of the Tao-Te Ching, c. 604-c. 531 B.C.E.)

“ . . . let every man be swift to hear, slow to speak, slow to wrath.”
--The Bible, James 1:19

“When angry, count ten before you speak; if very angry, a hundred.”
--Thomas Jefferson (American Writer, Philosopher, Politician and, from 1801-1809, 3rd President of the United States, 1743-1826)

The Neurology of Eating

Any attempt at weight management that fails to address the whole person is doomed to failure.

It is not enough to diet and exercise, and whatever the truth of manifesting, you cannot think yourself thin. Success demands an approach that integrates every system of your body, mind, social and subtle systems. For many people there is even an important role for integrating their spirituality into a plan for healthy living.

So we need to learn as much as we can about each component. Some fascinating new research has added some important pieces to the puzzle.

Writing in the journal Nature a group of scientists from University College London and King's College London used peptide YY (PYY), a naturally occurring hormone that regulates appetite, to investigate which areas of the brain are involved in controlling food intake.

PYY is released into the bloodstream from the intestine after we eat something. In animals PYY signals the appetite control centers in the hypothalamus and brainstem that food has been eaten. Injections of this hormone have been shown to decrease food intake both in healthy volunteers and in people with obesity.

The hypothalamus and brainstem are ancient regions of the brain involved I te most basic functions. But humans have complex, highly developed brains, and the question was to discover how PYY regulates eating in humans.

The study involved eight normal weight men in a double blind placebo-controlled study. After 14 hours without food the subjects were given an intravenous infusion of either PYY or placebo for 100 minutes. During all this their brains were scanned continuously using functional Magnetic Resonance Imaging (fMRI). Thirty minutes later they were offered an unlimited meal. Each subject was tested twice one week apart, once with PYY and once with the placebo. PYY infusion reduced food consumption in all 8 subjects and on average caused a 25% reduction in the calories eaten.

Now it gets interesting. The fMRI scans showed that PYY not only targets the primitive parts of our brain that control feeding but it also acts in the corticolimbic brain regions that are involved in the rewarding and pleasurable aspects of eating.

The greatest change in brain activity in response to PYY was within the orbitofrontal cortex (OFC), a region that acts as an integrative center in the brain and is also implicated in reward processing. The change in OFC activity predicted how much food the volunteers subsequently ate. The greater the activation, the less people.

When we are hungry, brain activity within the hypothalamus predicts how much food we should eat. However an infusion of PYY tricks the brain into thinking that it has eaten, and switches on the circuits that control eating. The activity in the orbitofrontal cortex now predicts how much people will eat in the future.

If you have not eaten for a long time, you get full very quickly. It is not that your stomach has shrunk; it is that the production of hormones like PYY has been turned down. When you eat, they are over-produced and switch off more eating. When someone has gastric bypass surgery, their levels of PYY go up and stay up. 

An important aspect of weight management is to retrain and reprogram the mind and body.

This research helps to show us how the approach works.

Broccoli and Skin Cancer

This one is going to launch a thousand gags on the late night talk shows, but it is actually quite serious.

Despite what you hear on some of those infomercials, there is a strong link between ultraviolet radiation (UVR) and many kinds of skin cancer. You can even use ultraviolet radiation to induce cancerous change in cells cultures in a Petri dish.

In an article from Johns Hopkins University published in the Proceedings of the National Academy of Sciences damaging effects of UVR can be significantly reduced by the topical application of a broccoli extract called sulforaphane that comes from broccoli sprouts. Sulforaphane was first identified over 15 years ago, and it has been shown to play a role in preventing the development of several types of tumors that can be induced by cancer-causing chemicals. It may also have a role in fighting some established tumors.

The research involved both animal and human studies, and showed that the level of erythema (skin reddening) caused by UVR is substantially reduced when this extract is applied to the skin.

The broccoli extract is not acting like a sunscreen; it does not absorb the UVR, neither does it stop it from entering the skin. Instead it enters the cells and switches on the production of several enzymes that protect cells from UV damage. The result is that the protective effect is sustained for days after the extract has been removed.

The advantage of this is that it is much longer-lasting than any sunscreen - several days, in fact. The scientists said the protection is still there when no extract is present on/in the skin.

The researchers first tested sulforaphane on mouse models of skin cancer, and then on six healthy human volunteers.

Each of the volunteers had small patch of skin exposed to a pulse of UVR. Some of the patches were treated with the broccoli extract while others were not.

At the highest UVR dosages, UVR-induced redness and inflammation was on average 37% lower when the extract had been applied, and the protection was sustained for at least three days. They also found that protection varied greatly depending on the person - protection ranged from 8% to 78%.

These variation may be due to the volunteers' different skin types, dietary habits and genetic differences.

In these trials, the conventional sunscreens did not provide significant protection.

This research is important for several reasons:

• The research re-emphasizes the importance of recognizing inter-individual differences. An approach that works for one person may not help another
• There are many times in life when we cannot do much to prevent something bad happening to us: radiation, stress or somebody being mean. The new approach s not just to prevent exposure, but also to work on resilience: how can we stop ourselves from having a bad reaction? The whole of us, from our cells to our soul?
• It is inevitable that people will start telling you that broccoli is the way to protect yourself against skin cancer, and I am just waiting for the advertisements to start coming in. Do not be fooled! This research involves a specific extract applied to a precise area of skin. As far as we know, it does not apply to eating broccoli

The Evolving Obesity Pandemic

Here is something that is not too much of a shock. At least it isn’t until you look at the numbers.

People are getting heavier throughout the world, with the possible exception of south and east Asia. These are the conclusions of a one-day global “snapshot:” a single day in 2006 when doctors and nurses in 63 countries across five continents - not even including the United States – found that between half and two-thirds of men and women in were overweight or obese.

The study is being published in the journal Circulation and included 168,159 people. The initial results were published http://eurheartjsupp.oxfordjournals.org/cgi/content/abstract/8/suppl_B/B26 last year in the European Heart Journal, but this new report puts more “flesh” on the original report.

The International Day for the Evaluation of Obesity (IDEA) study looked at two measures of fatness - waist circumference and body mass index or BMI.

A BMI (weight in kg divided by square of height in meters) of 18.5 to 25 is considered healthy. A BMI over 25 is considered overweight and greater than 30 is obese. I shall have something to say about BMI in a moment.

In Eastern Asia 7% were obese, compared with:

• 36% of people in Canada
• 38% of women in Middle Eastern countries
• 40% in South Africa

Canada and South Africa led in the percentage of overweight people, with an average BMI of 29 among both men and women in Canada and 29 among South African women.

In Northern Europe men had an average BMI of 27 and women 26. In other words they were just into the overweight “category.” In southern Europe, the average BMI was 28. In Australia BMI for men was 28 and 27.5 for women. In Latin America the average BMI was just under 28.

Waist circumference was also high - 56% of men and 71% of women carried too much weight around their middle.

The overall frequency of heart disease was 16% in men and 13% in women. In Eastern European men, many of whom still smoke, the rates of heart disease, 27%, and women, 24%. By comparison in Canada the rate of heart disease in women was 8%, and in men 16%.

The rates of diabetes varied across regions. Overall, 13% of men and 11% of women were diagnosed with diabetes.

This means that the rest of the world is catching up with the United States, long considered the country with the worst weight problem.

An estimated two-thirds of Americans are overweight and a third of these are obese. In the US, the lifetime risk of developing diabetes, is also high - 33% for men and 38% for women.

In studies like these, a BMI over 25 is considered to be overweight and greater than 30 is obese. I have commented before about the limitations of using BMI, but it remains a way of getting an overall picture of what is happening in the body.

The findings are deeply worrying.

It is well known that increasing weight, particularly the amount of fat carried inside the abdomen – not the “lovers’ handles!” - increase the risk of coronary artery disease, Type II diabetes and other diseases including some cancers. That point about the “intra-abdominal” fat I all important. For years we have been told that even small increases in weight can do us harm, but that is not completely accurate. It is where the fat is deposited, not only how much we have. It is only when people become extremely obese all over that the risks of many diseases begin to climb.

The moral of the story?

Watch you the size of your abdomen, and stay tuned as I give you more advice about the Whole Person ways to control you weight.

Emotion and Cancer Survival

There is some research coming out in the December issue of the journal Cancer from some researchers at the University of Pennsylvania School of Medicine and other colleagues. The results surprised me, particular since I know some of the authors, and they are first rate investigators.

For over thirty years, most research studies have claimed to find an association between emotions, attitudes and beliefs, and the chance of survival form several types of cancer. Entire psychological wellness and psychotherapy programs have been designed around that premise.

The study suggests that emotional wellbeing has no effect on the chances of surviving head and neck cancer. People with negative emotions had the same survival rate as people with positive emotions.

Patients from two Radiation Therapy Oncology Group clinical trials completed a quality of life questionnaire known as the Functional Assessment of Cancer Therapy-General (FACT-G) at the start of the trials. So these assessments were added on to studies of different cancer treatments. One trial was looking at what is known as “dose fractionation strategies” and the other was looking at combined chemotherapy and radiation treatments.

The FACT-G questionnaire included a collection of items called the Emotional Wellbeing Scale. This was assessed against overall survival.

There were 1,093 at the start of the trials, of whom 646 died during the period of the study. One of the reasons for trusting the data is that this large sample together with the consistency in the treatment the patients received have made this study one of the most statistically robust ever conducted.

Emotional state did not predict survival, and the results did not change when the researchers took into account possible effects such as interactions between emotional wellbeing and the methods of the study, gender, the primary site of the cancer, or the stage of the cancer.

There are several important points:

• The study only included head and neck cancer patients. These are often very traumatic cancers, but they do not usually involve the endocrine system. Some of the best data on emotions and survival come from studies of breast cancer, which often involves disturbances of hormones that may themselves have an impact on mood and survival. And mood can have a big impact on hormones
• The patients in the study had to keep coming to appointments, and to follow instructions, so they may not be representative of all people with head and neck cancer

But the most important thing is this: before critics jump off the deep end, let’s be very clear.

The study is not saying that having an optimistic or positive emotional outlook does not bring benefits to cancer patients. All it is saying is there is no evidence that it prolongs life.

Psychotherapy, art therapy, bibliotherapy and many others can all provide a great many emotional and social benefits.

They may not add anything to the years that a persons lives, but they may add greatly to the life in those years.

Chocolate, Comfort Foods and Depression

Most people have done a bit of comfort eating from time to time: candies and chocolates are usually the favorites. That’s not a coincidence. Not only do they taste good, but chocolate also contains chemicals that may improve mood, and sugar can have an indirect impact on the uptake of specific amino acids into the brain, where they go on to form the chemical neurotransmitters involved in inter-cellular communication and learning.

On the more serious side, some types of mood disorders, particularly seasonal affective disorder, premenstrual syndrome and the so-called “atypical depression” are often associated with quite sever cravings for chocolate.

So I was very interested to see a paper from colleagues in Australia in this month’s issue of the British Journal of Psychiatry.

Gordon Parker and Joanna Crawford examined links between chocolate craving in people who are depressed and both personality style and atypical depressive symptoms, with a web-based questionnaire completed by nearly 3000 individuals reporting clinical depression.

People accessing a mood disorder consumer information website (http://www.blackdoginstitute.org.au) were invited to participate in an online survey of lifetime treatments for a depressive episode, together with some interesting evaluation tools.

Half of the respondents said that they craved chocolate, and the number was slightly higher in women. They said that they felt that chocolate helped with depression, anxiety and irritability. The ones who said that chocolate helped were more likely to score higher on a “neuroticism” scale, particularly irritability and rejection sensitivity.

Five years ago the same team found that atypical depression was associated with a personality that was especially sensitive to rejection, and also tended to be linked with several symptoms - including food cravings – that tie in with behaviors aimed to try and make us feel better and to maintain internal balance.

The results suggest that people with certain personality styles derive personal benefit from comfort eating. Some research has linked carbohydrate craving to the opioid system in the brain, and it is possible that munching on chocolate may be an example of genuine self-medication. People eat to chocolate to calm down their ability to feel emotional distress.

The trouble is, of course, that although chocolate is yummy and may even be therapeutic, too much can be a bad thing. Weight problems are common in people with chronic depression, especially the “atypical” type.



“Chocolate causes certain endocrine glands to secrete hormones that affect your feelings and behavior by making you happy. Therefore, it counteracts depression, in turn reducing the stress of depression. Your stress-free life helps you maintain a youthful disposition, both physically and mentally. So, eat lots of chocolate!”
--Elaine Sherman (American Culinary Expert, Teacher and Writer, 1938-2001)

"Look, there’s no metaphysics on earth like chocolates.”
--Fernando Pessoa (Portuguese Poet, 1888-1935)

Height and Quality of Life

It’s difficult to guess it from that mug shot over on the left, but your humble reporter is six foot four, or, for our more metrically inclined friends, 193 centimeters. Believe it or not, on my mother’s side of the family, that would have made me one of the shortest. Over the years I have heard all the arguments about boys getting their height form their mothers, height being correlated with various maladies, and the old chestnut about tall people being more successful. Something that clearly escaped Alexander the Great, Napoleon Bonaparte and Adolph Hitler.

Nonetheless, some interesting correlations between height and psychological measures have begun to emerge in recent years.

Regular readers may recall the work from the West of England that has found some association between growth hormone and intelligence.

A new study in the journal Clinical Endocrinology indicates that your height in adult life significantly affects your quality of life, with shorter people reporting worse physical and mental health than people of “average” height. Shorter people judge their state of health to be significantly lower than their “normal” height peers do. I put quotes around words like “average” and “normal, since they have particular scientific rather than personal connotations.

The data for this study came from 14,416 people enrolled in the 2003 Health Survey for England, carried out by the UK Department of Health. In this survey, participants filled out a health-related quality of life (HRQoL) questionnaire and a nurse measured their height. A person's health-related quality of life refers to their perceived physical and mental health over time rather than a measure of his or her actual health.

People in the shortest height category (men shorter than 162 cm {5 foot four inches} and women shorter than 151 cm {4foot eleven inches}) reported they experience significantly lower HRQoL than people of “normal” height. The effect size is more pronounced the shorter a person is. This means that a small increase in height has a much larger positive effect on a short person than it does on a person of “normal” height.

One of the reasons for doing this study, which was supported by Novo Nordisk, is that there are some uncommon problems such as growth hormone deficiency or Turner syndrome in which people have short stature. The argument is that if their height causes psychological distress, there is a greater justification for treatment with growth hormone, which can increase their final adult height by approximately 4-10 cm (1.5 to 4 inches) depending on the underlying cause.

There is also another point. Some people already have a shorter stature, and most are perfectly well adapted. But it is important to be aware that some may be suffering in silence, and it is so important to ensure that they get the help that they need.

We cannot cure everything problem in the world, but we should be able to treat anything.

Finding Your Ancestors

I think that most of us have at least a little bit of curiosity about our ancestry. Growing up in Europe, most people have quite a good idea where they came from. It is very different in the “New World.”

People here often have deeply personal reasons for wanting to know their ancestry. Some hope to validate genealogical records or fill in gaps in family histories. Others are searching for a connection to specific groups or places in Eurasia or Africa. Many African Americans hope to trace ancestral links lost during the slave trade. Other hope to obtaining Native American tribal affiliation or to challenge tribal membership decisions.

Hence the proliferation of services offering genetic analyses to individuals. And it has become big business.

A quick search on Google just found least two dozen companies who market genetic ancestry tests to help people discover the origins of their ancestors. The tests typically cost between $100 and $900, and in the United States alone it is said that more than 460,000 people have purchased the tests during the past six years.

But there have been lingering doubts about the value and accuracy of the tests.

In "The Science and Business of Genetic Ancestry Testing," which appears in the today’s issue of the journal Science Deborah Bolnick, assistant professor of anthropology at The University of Texas at Austin and 13 researchers from universities across the country call upon the scientific community to educate the public about the limitations of the tests, and also urge consumers to approach the tests with caution.

The writers argue that the assumptions and limitations of the tests make them less informative than many people realize. Secondly, the rapid commercialization of the tests may have led to misleading practices that reinforce misconceptions.

They make several important points:

• Most tests trace only a few of your ancestors
• Most only test a small portion of your DNA
• Tests are not likely to identify all of the groups or locations around the world where a test-taker's relatives are found
• When we do genetic research we spend a great deal of time checking and re-checking the accuracy of the tests. But commercial tests may report false negatives or false positives
• Limited sample databases mean test results are subject to misinterpretation
• There is no clear connection between DNA and racial/ethnic identity: the similarities between the races are far greater than the differences
• Tests cannot determine exactly where ancestors lived or what ethnic identity they held

There is also an excellent feature story, entitled "Deep Roots," that may interest you.

Caveat emptor!

An Extraordinary Memoir

Regular readers will know that I am very interested in helping people with posttraumatic stress disorder (PTSD), and you will find a number of articles here.

The problem is growing as more people are returning from the conflicts overseas. But it is also important to return to another point: the difference between categorical and dimensional diagnosis. Few problems fit into neat little boxes. Instead they tend to lie on spectra. At one end you have people who have never had a day’s trouble in their lives, at the other you will find people who have been incapacitated by the most terrible things that have happened to them.

And in between is a huge number of people who do not fit any diagnostic criteria, but nonetheless suffer from many of the signs and symptoms of illness. How many people suffer from some of the symptoms of PTSD because they found a dead relative? Or had an important relationship that went terribly wrong?

They do not, of course, have diagnosable PTSD, but it can sometimes be helpful to reframe their suffering as a reaction to trauma.

I have just reviewed a book on the Amazon website that I hope is read very widely.

The book is called The Dancer Returns: From Victim to Victory, by Susan Lee Titus.

It tells an extraordinary true story about a young businesswoman who is brutally assaulted. She suffered from such severe PTSD that she actually needed to be admitted to hospital for a short time.

She transcends the terrible experience, and she is herself transformed by compassion and forgiveness. She moves on to teach dance to incarcerated women, each of whom carries her own scars.

The book is short but profoundly moving and can be life-changing.

If you have any interest in PTSD in all its manifestations, and also if you are interested in alternative ways of living with and transcending distress, I strongly recommend the book.

Dopamine, Drugs and Diabetes

We recently talked about the increasing evidence that insulin has many extremely important roles in the brain.

New research by investigators at the Center for Molecular Neuroscience and the Institute of Imaging Science at Vanderbilt University Medical Center researchers, working with colleagues in Texas, has found that insulin levels affect the brain's dopamine systems. These systems are involved in motivation, reward, salience, movement and emotional processing. Disturbances in dopamine pathways have been implicated in substance abuse, as well as schizophrenia, bipolar disorder and attention deficit hyperactivity disorder (ADHD). Drugs that interfere with the dopamine pathways may produce Parkinsonism as well as elevations of the hormone prolactin.

The psychostimulant drugs amphetamine and cocaine, as well as related medications for ADHD, block the reuptake of the neurotransmitter dopamine by dopamine transporters (DATs) thereby increasing the level of dopamine signaling. Some of these compounds also cause a massive surge of dopamine through DATs, resulting in high levels of synaptic dopamine that alter attention, increases motor activity and plays an important role in the addictive properties of psychostimulants.

The reason for examining a possible relationship between dopamine and insulin goes back to the 1970s, when it was reported that amphetamine had no effect on diabetic animals and in the 1980s it was shown that diabetic rats did not show the usual stereotyped behaviors when given amphetamine. There were also odd reports about disturbances in the enzyme dopamine-beta-hydroxylase in experimental diabetes and changes in dopamine D1 receptors in the brains of rats with induced diabetes.

These observations lead to this new research into a possible link between insulin signaling and amphetamine action.

They used a standard a rat model of type 1 diabetes in which insulin levels are massively depleted, and then assessed the function of the dopaminergic pathway in the striatum, an area of the brain rich in dopamine.

In the absence of insulin, amphetamine-induced dopamine signaling was disrupted: dopamine release in the striatum was severely impaired and expression of DAT on the surface of the nerve terminal was significantly reduced.

The lack of the DAT protein on the plasma membrane prevents the amphetamine-induced increase in extracellular dopamine, and in turn, amphetamine fails to activate the dopamine pathways that stimulate reward, attention and movement.

The researchers then gave insulin into the brains of the diabetic animals and found that the system returns to normal, indicating that the lack of insulin in the striatum directly affected amphetamine action.

They also developed a probe for brain DAT activity using functional magnetic resonance imaging (fMRI). In normal, healthy rats with plenty of insulin, amphetamine increased neural activity in the striatum. But in diabetic animals, activity in the striatum was suppressed.

So there is a powerful interplay between dopamine neurotransmitter systems and insulin signaling mechanisms. The results are some of the first to link insulin levels and dopamine function in the brain and hold several implications for human health and disease.

We need to have another look at the effect of diabetes on the brain. We have known that people with diabetes are at increased risk of cognitive impairment and depression, and we had assumed that it was because of hypoglycemia and vascular disease. Those assumptions may have been wrong.

The findings may also be important for diseases with altered dopamine signaling, such as schizophrenia and ADHD. Insulin may have something to do with the underlying brain disturbances in ADHD. Then control of insulin levels and neuronal responses to the hormone may help determine the efficacy of psychostimulants in people with ADHD.

Every now and then you see people on psychostimulant medications who need huge doses. Perhaps their problem lies with insulin rather than dopamine.

Stretching and Exercise

I think that most of us have been told that it is really important to stretch before we hit the gym, and do it again after we have finished. It is said to improve performance as well as reducing the risk of injury and post-exercise stiffness. It is one of those things that has just entered mass consciousness.

However a new study using the Cochrane database shows that stretching before or after exercise has little or no effect on muscle soreness between half a day and three days later.

Two researchers identified 10 relevant trials, each of which involved between 10 and 30 people. Nine of the studies had been carried out in laboratory situations and people stretched for everything from 40 seconds to 10 minutes.

The investigators used a 100-point scale to assess stiffness after exercise. The results showed that the effects of stretching were extremely small. Stretching reduced soreness by less than 1 point on the 100-point scale. The size of the effect was similar if stretching was performed before or after activity. 

The authors point out that there is still a need to see whether stretching can have an effect on people in the community who have reduced levels of flexibility.

“A great man can bend and stretch.”
--Chinese proverb

“The simple exercise of stretching helps to counter the congestions, compressions, and adhesions which obstruct the flow of the vital force through the spinal column with its sixty-two branching nerves and thus to regain energy. This truth of the need of spine-loosening movement is instinctively known by every dog and cat, every lion and tiger, for they apply it immediately after awakening from sleep. The back, the legs, and even paws are bent and stretched and even rolled by them in this natural exercise.”
--Paul Brunton (a.k.a. Raphael Hurst, English Philosopher, Traveler, Spiritual Teacher and Author, 1898-1981)

“Dachshunds are ideal dogs for small children, as they are already stretched and pulled to such a length that the child cannot do much harm one way or the other.”
--Robert Benchley (American Writer, Actor and Critic, 1899-1945)

Relationships, Conflict and Heart Disease

Robust, dynamic and balanced relationships can be the source of untold support and happiness in our lives. They can also provide us with the scaffolding on which to structure and maintain the health and meaning of our existence.

On the other hand, precisely because positive relationships can be such powerful forces for good, toxic, fractured and unbalanced interactions can create physical, emotional, social and spiritual havoc. Most of the evidence about the physical impact of negative relationships has concerned heart disease and disturbances of the immune system.

An article in this week’s issue of the Archives of Internal Medicine continues to flesh out the interaction between dysfunctional relationships and heart disease, suggesting that If you are in stuck in a close relationship with many negative characteristics, for instance conflict, you may well have a raised risk of heart disease, compared with somebody whose close relationship is more positive overall.

Roberto De Vogli and his colleagues from University College, London, looked at 9,011 British civil servants who filled in a questionnaire about negative aspects of their close relationships during two periods: 1989-1990 and 1985-1988. The main focus was on couples and participants also outlined how much regular emotional and practical support they received from their partners. They were followed up twelve years later to find out whether they had had a fatal or non-fatal coronary event, including chest pain of cardiac origin or a full-blown heart attack.

Of 8,499 people who were followed up and had provided enough information at the start of the study, quite a high number - 589 - had sustained a coronary heart disease event, although none of them had obvious coronary heart disease at the beginning of the study. The analysis took account of multiple potentially confounding risk factors including socioeconomic status and health habits. When they had all been stripped away, the researchers found that there was a 1.34 higher risk of coronary heart disease events among those who experienced a high level of negativity in their close relationships. This link was found in both men and women and in each social class. It could not be explained by depression or negative personality traits: it seemed to be the negative relationships itself that was to blame.

We already know that negative marital interactions are associated with depression, often in combination with reduced self-esteem and higher levels of anger. These are all emotions that can have both acute and chronic effects on the coronary arteries, through alterations in the normal balance of the autonomic nervous system, neuroendocrine changes, disturbances in coagulation and inflammatory and immune responses.

Many people are sensitive to any kind of negative interactions in the people around them, but the effects are particularly toxic if they involve the people closest to us. They are more likely to elicit strong emotions such as worry and anxiety that are the most likely to induce effects on our bodies.

Staying in a chronic negative relationship may be more than just masochistic.

It could kill you.

“Tenderness emerges from the fact that the two persons, longing, as all individuals do, to overcome the separateness and isolation to which we are all heir because we are individuals, can participate in a relationship that, for the moment, is not of two isolated selves but a union.”
--Rollo May (American Existential Psychologist, 1909-1994)

“Whenever you're in conflict with someone, there is one factor that can make the difference between damaging your relationship and deepening it. That factor is attitude.”
--Timothy Bentley (Canadian Family Therapist)

“Today the network of relationships linking the human race to itself and to the rest of the biosphere is so complex that all aspects affect all others to an extraordinary degree. Someone should be studying the whole system, however crudely that has to be done, because no gluing together of partial studies of a complex nonlinear system can give a good idea of the behavior of the whole.”
--Murray Gell-Mann American Physicist Noted for his Concept of Strangeness and the Discovery of Quarks, and, in 1969, Winner of the Nobel prize in Physics, 1929-

“We shield our heart with an armor woven out of very old habits of pushing away pain and grasping at pleasure. When we begin to breathe in the pain instead of pushing it away, we begin to open our hearts to what’s unwanted. When we relate directly in this way to the unwanted areas of our lives, the airless room of ego begins to be ventilated.”
--Pema Chodron (Formerly Deirdre Blomfield-Brown, American Buddhist Nun, 1936-)

Overcoming Rejection

I am sure that most of us have faced some form of rejection at some time or other in our lives. People with high self-esteem seem better able to take rejection in their stride, but usually only if it is “earned.” Simply trying artificially to build your self-esteem rather than having built it on a platform of past achievement, will probably not work very well.

New research in the journal Psychological Science from UC Berkeley indicates that this does not mean that people with low self-esteem are doomed to respond defensively to criticism and rejection. The key seems to be that people who are better at controlling their impulses are less vulnerable to rejection. 

There were 38 female and 29 male participants in the study. The first completed the Rosenberg self-esteem scale, one of the most widely used self-esteem measure in the social sciences. They then completed a questionnaire on their ability to focus on tasks at hand without distraction. The subjects were arranged into two groups - low self-esteem and normal-to-high self-esteem – based on their scores on the Rosenberg scale.

Each of the volunteers then viewed images showing positive, neutral, negative and rejection themes while being subjected to sporadic loud noises. A startle probe measured the force of their eye-blinks in response to the abrupt sounds. Eye blinks are a good measure of the startle response and correlate fairly well with the activation of the “fight or flight” reaction.

As anticipated, all the participants blinked more strongly when the loud noise was paired to such negative images as dead animals or mutilated bodies. However, the people with low self-esteem blinked more forcefully in response to pictures portraying themes of rejection loneliness and alienation. Paintings with negative themes or acceptance themes, such as lovers embracing, did not elicit the same response in low self-esteem people.

In other words the powerful was in which rejection activates the threat system in people with low self-esteem suggests that their fear of rejection runs extremely deep and engages neurological systems involved in reacting to a threat.

On the other hand, those with low self-esteem who scored higher for attention control, which included the ability to focus, were able to modulate their immediate reactions to rejection. 

Some previous work has suggested that self-esteem is part of a primitive emotional warning system that warns us if we are in danger of being socially excluded. While the evolutionary function of this detection system was originally intended to motivate people to stay socially connected, the constant anticipation of rejection can create problems, with the system being triggered by the merest whiff of rejection. They may become hypersensitive and have a brain that generates a cascade of defensive reactions if they sense any kind of disapproval.

Although this is a small study, the evidence is that rather than teaching self-esteem skills, the solution for them might be to improve their abilities to focus, concentrate and regulate their internal states.

In other words develop some specific forms of self-control and resilience.

For many people this may be the most effective way of helping them to cope with disappointment and maintain close relationships.




“No man is free who is not master of himself.”
--Epictetus (Phrygian-born Greek Stoic Philosopher, c.A.D.55- c.A.D.135

“It is not the mountain we conquer but ourselves.”
--Sir Edmund Hillary (New Zealand Mountaineer and Explorer, 1919-

“Mind control is not one's birthright. The successful few owe their success to their perseverance.”
--Ramana Maharshi (Indian Hindu Mystic and Spiritual Teacher, 1879-1950

“The cyclone derives its powers from a calm center. So does a person.”
--Norman Vincent Peale (American Cleric, Writer and Self-Help Expert, 1898-1993)

Sri Chinmoy Has Moved On

I just heard that Sri Chinmoy has died, or as many would say, entered Maha Samadhi.

I was never one of his followers, but I was impressed by some of the things that he achieved in his efforts to ground spirituality in the “external” world.

He was born Chinmoy Kumar Ghose in a small village named Shakpura in what is now Bangladesh. At the age of 12, after the death of his parents, entered the Sri Aurobindo Ashram, a spiritual community near Pondicherry in South India.

He spent the next 20 years there engaged in spiritual practices, including meditation, writing poetry, essays and spiritual songs.

He moved to New York City in 1964 to work as a clerk at the Indian Consulate, and to teach Western spiritual seekers.

He used some unorthodox methods: he spread his philosophy through his own way of life, exercising and creating art and music. He drew attention by breaking weight lifting records and stunts like power-lifting pickup trucks and public figures like Muhammad Ali and Sting.

He claimed to sleep for only 90 minutes a day and when he was not traveling to perform in concerts and spread his message, spent the rest of the time meditating, playing music, exercising and making art.

Sri Chinmoy drew upon Hindu principles to advocate a spiritual path to God through love and devotion, prayer and meditation. But he was one of the first to publicize the idea that meditation does not necessarily mean sitting quietly. Instead he recommended that his disciples develop their spirituality by transcending seemingly impossible physical challenges.

At one time or other he was the guru of many people including Carl Lewis, Carlos Santana, John McLaughlin, Roberta Flack and Clarence Clemons.

As with so many teachers, there were plenty of allegations of impropriety, but I have never seen any credible evidence to support them.

Many years ago he wrote his own epitaph:
“Before the final curtain goes down

On my life, 

I shall say to my Mother-Earth,
“My gratitude-heart is all for you, 
All for you.”

Here are some of my favorite poems and quotations that he wrote over the years. I do hope that you find some of them as helpful, enlightening and inspirational as I have.

“You hate someone whom you really wish to love, but whom you cannot love. Perhaps he himself prevents you. That is a disguised form of love.”

“Do not try to approach God with your thinking mind. It may only stimulate your intellectual ideas, activities, and beliefs. Try to approach God with your crying heart. It will awaken your soulful, spiritual consciousness.”

“If we know the divine art of concentration, if we know the divine art of meditation, if we know the divine art of contemplation, easily and consciously we can unite the inner world and the outer world.”

“By hating that person, you have lost something very sweet in yourself.”

“Be universal in your love. You will see the universe to be the picture of your own being.”

“If we call ourselves children of God, then others are also children of God.”

“Love is the only wealth that man absolutely needs.
Love is the only wealth that God precisely is.”

“You can only hate someone whom you have the capacity to love, because if you are really indifferent, you cannot even get up the enough energy to hate him.”

“Whether you accept or reject it, God's Love for you is permanent.”

“Let us not worry
About the future.
Let us only do the right thing
Today,
At this moment,
Here and now.
Let the future take care of itself.”

“There comes a time in the seeker's life when he discovers that he is at once the lover and the beloved.”

“Listen to the inner light;
It will guide you.
Listen to the inner Peace;
It will feed you.
Listen to the inner Love;
It will transform you,
It will divinize you,
It will immortalize you.”

“Love is not a thing to understand.
Love is not a thing to feel.
Love is not a thing to give and receive.
Love is a thing only to become
And eternally be.

“I shall love the whole world,
But I shall control
Only myself.

“The aspiring soul which he embodies is the lover in him. And the transcendental Self which he reveals from within is his Beloved.”

“Complete and total perfection will come about only when we feel that our perfection is no perfections as long as the rest of humanity remains imperfect.”

“He who loves, never grows old. God it a shining example.”

“The very nature of kindness
Is to spread.
If you are kind to others,
Today they will be kind to you,
And tomorrow to somebody else.”

“When we have
A childlike state of mind,
It becomes extremely easy to find God
Here, there and everywhere.”

“Of all the medicines
In the inner life,
A smile is by far
The best medicine.”

“Meditation is the only way to overcome fear. There is no other way. Why does meditation help us overcome fear? In meditation we identify ourselves with the vast, with the Absolute. When we are afraid of someone or something, it is because we do not feel that particular person or thing is a part of us. When we have established conscious oneness with the Absolute, with the Infinite Vast, then everything there is part of us. And how can we be afraid of ourselves?”

“For a genuine seeker,
The inner world
Is infinitely more real
Than the outer world.”

“My Lord does not want to know what I have done for Him. He just wants to know how I am. If he hears from me that I am happy, then he himself becomes exceedingly happy. In unmistakable terms He tells me that my happiness is His real and only Satisfaction.”

“Today I must dive deep within
And know what I come
To this earth-stage for.”

“Smile, smile, smile
At your mind
As often as possible.
Your smiling will considerably reduce
Your mind's tearing tension.”

“Your self-transcendence-goal
Is not something
That you have to achieve.
It was already given to you long ago
By your Beloved Supreme.
You have only to believe it.
You have only to receive it.”

“You follow
Your heart's love.
Your life's happiness
Will follow you.”

“God’s foremost treasure on earth
Is my ever-blossoming
Gratitude-heart.”

“Yes, I can!
I certainly can!
I can have
A gratitude-flower-heart
That shall remain open
At all hours.”

“If you give God your heart’s
Dearest treasure, surrender,
Then God will grant you
His Vision’s Dearest treasure, peace.

“Instead of telling the world
What it is supposed to do,
Why don’t you immediately do it yourself ?
In this way, I assure you,
Your happiness will be surprisingly multiplied.”

“Once you have established
Your inner contact
With your inner Pilot,
Your life's transformation-victory
Will not remain a far cry.”

“O kindle the fire of happiness!
Therein I shall see
The door of friendliness,
The room of greatness
And the palace of goodness.
I shall see, I shall see.”

“If your Lord Supreme requests you to do something, rest assured he has already given you the capacity – even more than necessary – long before you actually need it.”

“If you are already an awakened soul,
Then you must realize
That God has already given you
A supreme task to perform:
He wants you to work
For His Vision’s world-blossoms.”

“My service to humanity
Is my real opportunity
To prove my genuine love
For God and God alone.”

“Enthusiasm
Rules his inner world.
Determination
Rules his outer world.
Therefore
Happiness has become
His real name.”

“Of all the gifts
You have offered to God,
Your happiness-gift
He treasures most.”

“If you want to remain always happy,
Always perfect and always fulfilled,
Then always keep inside your heart
A pocketful of sweet dreams.”

“To my extreme happiness,
My Lord has come to tell me
That from now on
I must stand apart from my actions,
Divine and undivine.
He alone is the Doer;
I am a mere observer.”

“Be in love with your heart-life.
There, only there,
Is the flood of happiness.”

“God loves only one philosophy,
And that is the Do-it-here-now philosophy.”

“Every morning and evening I am
Determined to sing and dance
On the highest peak
Of my sun-flooded
Aspiration-mountain.”

“At last
He is healed of his self-doubt.
Now what is happening ?
He is awakening
To his souls ecstasy-sun.”

“Every second a seeker can start over,
For his life’s mistakes
Are initial drafts
And not the final version.

“We must see that God operates not only in us but in others as well. God also operates in our so-called enemies. But these are not our real enemies. Our real enemies are doubt, fear, anxiety and worry. When we do not cry to perfect others, but only try to perfect our own lives, then we will have joy.”

“A sincere seeker knows what his goal is: the highest Truth. He will not delay his journey.  In the spiritual life we aspire for the highest Truth, for God, and for nothing else.”

“Precious and spacious      
The aspiring heart has to remain    
Always.”

“I am not even six feet tall. Yet I am praying to the Absolute Supreme to reach His infinite Height, which is far beyond even my imagination's flight. For me to long to grow into that Height — is this not a miracle?"      

"I am mortal. My thoughts, my deeds, my experiences — everything that I have and everything that I am — represent mortality. Yet despite everything that I have and everything that I am, I am longing for Immortality. Is this not a miracle?”

“There is only one immediate question:      
Where is God?    
The immediate answer is:    
God is where    
My heart's love-breath is.”

“Ingratitude is as old      
As man himself.    
Gratitude is a child    
Of yesterday.”

“The supreme secrets of a peaceful life:      
Expect not; just give.    
Delegate not; just start and continue.    
Retire not; just aspire for    
self-transcendence.”

“In the spiritual life the easiest way to conquer ego is to offer gratitude to God for five minutes daily. If you cannot offer gratitude for five minutes, then utter it for one minute. Offer your gratitude to God. Then you will feel that inside you a sweet, fragrant and beautiful flower is growing. That is the flower of humility.”

“In our spiritual life very often we get fascinating experiences and then we don't want to aspire anymore. It is true that experiences can give us encouragement, but very often when we get too many experiences we enter into the vital world. Suppose you are walking along a street toward your goal. If you see beautiful trees, ponds and flowers alongside the street, what happens? The scenery is so beautiful that you take a rest. You say, "Let me stay here and enjoy this," and then you stop and enjoy it. But your destination remains a far cry.”

“The problem with fault-finding
Is that he who finds fault with others
Is in no way a happy person
Even after he has successfully
Accomplished his task.”

“True inner joy is self-created
It does not rely on any outer circumstances
A river is flowing in and through you carrying the message of joy.
This divine joy is the sole purpose of life.”

“Meditation is not an escape. Meditation is the acceptance of life in its totality, with a view to transforming it for the highest manifestation of the divine Truth here on earth.”

“When we meditate soulfully, devotedly, we have to accept humanity as our very own. We have to know that humanity as it stands is far, far, from perfection, but we are also members of humanity. We have to take it with us. If we are in a position to inspire others, if we are one step ahead, naturally we have the opportunity to serve the divinity in the ones who are following us. We have to transform the face of the world on the strength of our dedication to the divinity in humanity.”

“God-realization, or Siddhi means Self-discovery in the highest sense of the term. One consciously realizes his oneness with God. As long as the seeker remains in ignorance, he will feel that God is somebody else who has infinite Power, while he, the seeker, is the feeblest person on earth. But the moment he realizes God, he comes to know that he and God are absolutely one in both the inner and the outer life. God-realization means one’s identification with one’s absolute highest Self.”

“What we call our joy, God calls our perfection. Each human being has come into the world with the message of perfection. Each human being will one day realize the highest Truth. Each human being is destined to be fulfilled. It is the birthright of our soul.”

“Not one      
But twenty-four self-giving-hours    
Every day I have    
For my use.”

“At the end of all the roads      
There is only a sound-life    
That does everything,    
And a silence-life    
That becomes everything.”

“True spirituality is the acceptance of earth-life. A true seeker is he who accepts life, transforms life and perfects life so that the earth-life can become a conscious instrument of God.”

“When I was an animal I evolved through selfishness.
Now that I am a man my evolution can be achieved only through self-sacrifice.”

“How can one know who his spiritual teacher is?...His heart looks at the spiritual Masters and makes the choice. When the heart sees a spiritual Master, if it is overwhelmed with joy, then there is every probability that that spiritual Master is the right one for the seeker.”

“The joy of a self-giving life      
Can neither be measured    
Nor be expounded.”

“God is not a thing to be achieved, but a thing to be.”

“You may not know,
But it is absolutely true:
With each heartbeat
Your heart is calling: “God, God!” 
You may not hear it,
But God Himself definitely hears
Your heart’s cry.”

“The moment we use the term 'help', a kind of egocentric idea enters into us. If we help someone, that means we are in a superior position. When we help, we feel that we are one step ahead or one step higher than the ones that we are helping. But if we serve someone, then we offer our capacity with humility, on the strength of our loving concern and oneness. So let us use the proper term, 'service'.”

“A moment of
self-giving life
can conquer the sorrows
of many long years.”

“Forgive, you will have happiness.
Forget, you will have satisfaction.
Forgive and forget,
You will have everlasting peace
Within and without.”

“Imagination plays a most significant role in the spiritual life. Suppose you are not having good meditations, but six months ago you had a very good, powerful, high meditation. What you can do is try to imagine that powerful meditation. Then your imagination will become reality. After fifteen minutes or half an hour, you will get a good meditation. Vivekananda was such a great spiritual figure, yet sometimes for six months at a time he did not have a good meditation. What did he do? He used to imagine a time when he did have a good meditation, and inside his imagination was aspiration. So imagination is very good.”

“Our goal is not to have      
A problem-free life.    
But to conquer all the problems
As they appear    
Along our life-road.”

“Let us serve the world soulfully. The pay we will receive for our service will be in the currency of gratitude, God's gratitude, God the only gratitude.”

“Each human being can at once be a fighter and forgiver. When self-doubt tortures him, he must play the role of a fighter. And when his own ignorance humiliates him, he must play the role of a forgiver.”

“A spiritual man should be a normal man, a sound man. God Himself is normal; He is not insane. In order to reach God, a spiritual person has to be divinely practical in his day-to-day activities. Spirituality does not negate the outer life. But we have to know that the outer life does not mean the animal life. The outer life should be the manifestation of the divine life within us.”

“Either by silencing the mind or by opening the heart, today's man can become tomorrow's God, tomorrow's Divinity. And embodied Divinity soon becomes revealed Immortality.”

“If we believe in our own      
Self-transcendence-task    
Then there can be    
No unreachable goal.”

“Love of the limited self, the very limited self, is another name for human love. Love of the entire world is another name for divine love.”

“Silence tells the seeker in us to love, to love himself. It tells us it is wrong to hate ourselves because of our imperfections. When the seeker loves himself, loves the Divine within himself, he eventually realizes the Ultimate Truth."

“Inner silence is not just the absence of thoughts. No! Silence is the blossoming of our indomitable inner will. Silence is our inner wisdom-light. "

“The way to become happy
Is to think
And to feel
That the very best is yet to come.”

“Failure 
Is not falling down.   
Failure   
Is desiring to live
Where I have fallen.”

“There is no greater miracle
Than our conscious efforts
To become good human beings.”

“Meditation is man's self-awakening and God's Self-Offering.
When man's self-awakening and God's Self-Offering meet together
man becomes immortal in the inner world
and God becomes fulfilled in the outer world.”

“You have no idea
How much you do for mankind
When you love God unconditionally
Even for a fleeting moment.”

“My soul reminds me
Again and again
That I am not the doer.
I am only a witness-
God-existence-life.”

“Allow everything else to vanish
Save and except your cherished dreams,
For your cherished dreams
Are treasured sleeplessly
By God Himself.”

“World-harmony
Should be taken
As a world-prayer
On a daily basis.”

“Just start your inner race without waiting to see
Who else is ready to run with you.
When others see you have reached your goal,
They will also be inspired to run.”

“Keep an open heart
To allow the world
Lovingly and faithfully
To come in.”

“Although it is extremely difficult
We must realize
That we came into the world
Not to destroy but to illumine
Our enemies.”

“Human love wants to possess and be possessed by the world. Divine love wants to establish its inseparable oneness with the world and then it wants to divinely enjoy this oneness. Supreme Love transforms human love into divine love and blesses divine love with boundless joy and divine pride."

“Each devoted moment
Prepares a beautiful sunrise
And a fruitful sunset.”

“A genius is he
Who ends rules and regulations.
A genius is he
Who is nothing but a powerful drop
In the ocean of cosmic life-energy.”

“When you consciously use time
To do something Divine,
You enter into timeless Time.

When you are consciously thinking
Of something divine, eternal Life come
And shakes hands with you.”

“The heart of every human being
Can leave behind a legacy
Of world-illumining compassion.”

“To inspire others
Is to be immediately rich
In the inner world.”

"What is joy? It is a bird That we all want to catch. It is the same bird That we all love to see flying.”

“When you talk and God listens, it is Prayer. When you listen and God talks, it is Meditation.”

“The moment you want to make progress is the moment you become an eternal beginner. The dawn is the beginning of a new day: it symbolizes hope, illumination and perfection. Every day the dawn begins its journey in the infinite sun. If you can feel that your whole being - your body, vitality, mind and soul - represents the ever-blossoming dawn, then you will always remain an eternal beginner.”

“Do not allow yourself
To be rued by dark doubts.
Make friends with bright hopes
At every moment
To change your own world
And the world around you.”

“Peace will come when we replace the love of power with the power of love.”

“God hears
The soulful prayers of a seeker
Not only with great readiness
But also with immediate
Oneness.”

“In tomorrow’s world
Many things will enlighten humanity.
But the thing that will enlighten
Humanity’s inner and outer life most
Is the transcendental temple
Of universal silence.”

Memory and Emotion

Your humble reporter has had more than his fair share of major life events. As a sixteen year old I was a passenger in car that had a meeting with another vehicle driving down the wrong side of the road. This was in England, where folk always do drive on the “wrong” side, but the fellow who was kind enough to arrange the collision could never explain why he was driving on the “American” side.

The interesting thing is that the memory of the crash is seared into my memory: I can remember the license plate of the vehicle that hit us. Some people call that a “flashbulb memory.”

If you live in the United States you probably have clear and fairly accurate memories of where you were and what you were doing on September 11th 2001.

This kind of experience is not uncommon: most of us have noticed that events that occur during heightened states of emotional arousal, such as fear, anger, happiness and sex are far more memorable than less dramatic occurrences. The emotional “load” of an event is a key factor in remembering it. Previous studies have confirmed that heightened states of emotion can facilitate learning and memory.

This makes good evolutionary sense: emotionally charged events are likely to be the ones that we need to remember. From an evolutionary perspective, it is more important to remember where Mr. Saber-tooth Tiger lives, rather than the names of the Kings and Queens of England.

Therefore the regions of the brain that are responsible for the storage of memories need to distinguish between important experiences and those that less significant for survival. The brain must have some mechanisms for giving priority to emotionally charged memories, so that they are converted and stored in long-term memory.

The downside is that in some situations, for instance posttraumatic stress disorder (PTSD), this process can become pathological and people can be tormented by persistent vivid memories of traumatic events.

Writing in the journal Cell, researchers from Johns Hopkins University and their collaborators at Cold Spring Harbor Laboratory and New York University may have identified the biological basis for this phenomenon. Memories in the brain are held in neurological circuits and each new experience creates a new circuit. The investigators have found that the hormone norepinephrine, which is released during emotional arousal, serves to "prime" nerve cells to remember events. They do this by increasing the neurons’ chemical sensitivity at the precise sites where nerves rewire to form new memory circuits.

Norepinephrine is often described as one of the "fight or flight" hormones and it is likely also involved in the third type of response to a threat, which is “freeze.” In the brain norepinephrine energizes the circuit-building process by adding phosphate molecules to a nerve cell receptor called GluR1. The phosphates help guide the receptors to insert themselves next to a synapse.

So when the emotionally-charged brain needs to form a memory, the nerves have plenty of available receptors to quickly adjust the strength of the connection and lock that memory into place.

The researchers targeted the GluR1 receptor after discovering that if it is disrupted in mice, the little creatures develop spatial memory defects. They tested the idea by either injecting healthy mice with adrenaline or exposing them to fox urine, both of which increase norepinephrine levels in the brain.

They then analyzed the brains of the mice and found increased phosphates on the GluR1 receptors and an increased ability of these receptors to be recruited to synapses.

When the researchers put mice in a cage, gave a mild shock, took them out of that cage and put them back in it the next day, mice who had received adrenaline or fox urine were likely to "freeze" in fear, compared with mice who had not been exposed to the adrenaline or fox pee. This implies an enhancement of their memory of the cage and its unpleasant associations.

In a similar experiment with mice genetically engineered to have a defective GluR1 receptor, adrenaline injections had no effect on mouse memory. So this provides us with further evidence of the "priming" effect of norepinephrine on the receptor.

There has been a lot of recent interest in using medications like beta-adrenoreceptor blocker propranolol – which prevents some of the actions of norepinephrine -  to prevent the development of PTSD in people who have been exposed to extreme trauma, and this research may provide the scientific basis for this kind of therapy.

On the other hand, this research leads me to predict that people with overactive GluR1 receptors may be constantly curious about their environment, but also likely to be chronically anxious and more likely to develop PTSD.

We have known for years that propranolol and other beta-blockers may attenuate some of the physical symptoms associated with anxiety. Most people had assumed that the medicine worked by reducing heart rate, shaking and sweating. But experienced clinicians usually find that beta blockers that cross the blood/brain barrier work best, and it may well be that these drugs also have direct actions in the brain itself.

“Recollection is the only paradise from which we cannot be turned out.”
--John Paul (a.k.a. Johann Paul Friedrich Richter, German Novelist and Humorist, 1763-1825)

“The existence of forgetting has never been proved:  We only know that some things don't come to mind when we want them.”
--Friedrich Wilhelm Nietzsche (German Philosopher, 1844-1900)

“The moment we find the reason behind an emotion … the wall is breached, and the positive memories it has kept from us return too. That's why it pays to ask those painful questions. The answers can set you free.”
--Gloria Steinem (American Feminist, Political Activist and Editor, 1934-)

A New Treatment for Alcohol Dependence?

Several news outlets have today picked up on an apparently odd report: topiramate, a medicine used for migraine and seizures, may also help some people who are alcohol dependent.

A 14-week multicenter clinical trial was orchestrated by researchers at the University of Virginia, and published today in the Journal of the American Medical Association.

371 male and female alcoholics, all of whom were drinking heavily at the time of entering the trial, were randomly selected to take topiramate (up to 300 mg/day) or placebo. All of them had a weekly 15-minute intervention with a trained nurse to enhance adherence to the medication and treatment regimen.

Trials of people with substance abuse are always complicated by high non-compliance rates. Some studies skew their results by making the questionable assumption that if someone doesn’t show up, then they must be cured! This study was structured more realistically: dropouts were assumed to have relapsed to their baseline drinking level.

Even when the dropouts were included, topiramate lowered the percentage of heavy drinking days (the number of days in which men consumed ≥5 drinks/day and women drank ≥4 drinks/day, divided by the number of study days) by a mean of 8.44% more than placebo. The topiramate group showed a reduction from 82% to a mean of 44% heavy drinking days during the 14 weeks, while the placebo group had a reduction from 82% to a mean of 52% heavy drinking days.

In a second analysis that tested the study hypothesis for all randomized participants who took at least one study medication dose and had at least one double-blind site visit, topiramate was much more efficacious than placebo, lowering the percentage of heavy drinking days by a mean of 16.19% more than placebo.

Topiramate was more efficacious than placebo, on measures of self-reported drinking and the liver enzyme gamma-glutamyltransferase, which is a sensitive marker of alcohol consumption.

There are some good reasons why topiramate may be helpful: it acts on gamma-aminobutyric acid receptors in the brain, which have been implicated in some addictive behaviors, including over-eating.

A few years ago topiramate was being examined as a possible weight loss agent, since it has effects on feeding and on metabolism.

The trials have been suspended in  North America, primarily because of one of the main side effects of topiramate: it may cause cognitive dulling and word finding difficulties in some people. Those side effects sometimes take a few weeks to develop.

A second point is that when it is used for weight management, some people quickly develop tolerance to its effects.

This new study is interesting and may turn out to be very important. We shall have to see whether the effect on alcoholics is robust and sustained over time.

“All excess is ill, but drunkenness is of the worst sort. It spoils health, dismounts the mind, and unmans men. It reveals secrets, is quarrelsome, lascivious, impudent, dangerous and bad.”
--William Penn (English Quaker, Colonizer in America and Founder of Pennsylvania, 1644-1718)

“One reason I don’t drink is that I want to know when I am having a good time.”
--Nancy Lady Astor (American-born British Politician, 1879-1964)

“Hide our ignorance as we will, an evening of wine soon reveals it.”
--Heraclitus (Greek Philosopher, c.540-480 B.C.E.)

“Where the drink goes in, there the wit goes out.”
--George Herbert (English Religious Poet, 1593-1633)

Meditation, Stress and Self-Regulation

There is progressively more evidence that meditation can have measurable effects on behavior and the brain. The trouble is that some of the results have conflicted, mainly because of the different types of meditation and different measurement protocols. So I was very interested to see some new research in this week’s issue of the Proceedings of the National Academy of Sciences, by a team of researchers from China collaborating with renowned experts at the University of Oregon, who have developed an approach for neuroscientists to study how very brief meditation training might improve a person's attention and response to stress.

The study itself was done with undergraduate students in China. The experimental group received five days of meditation training using a technique called integrative body-mind training (IBMT), which was developed in China n the early 1990s.

IBMT is a rapid mental training method that aims at inducing a state of alert restfulness using breathing and guided imagery.

The control group received five days of relaxation training. Before and after training both groups took tests involving attention and reaction to mental stress.

The experimental group showed greater improvement a test of attention that was designed to measure peoples’ ability to resolve conflict among stimuli. Subjects were stressed by doing mental arithmetic.

At the beginning of the experiment both groups showed an elevated release of cortisol following the mathematical task, but after training the experimental group showed less cortisol release. This probably indicates an improvement in stress regulation. The experimental group also showed lower levels of anxiety, depression, anger and fatigue than the control group.

The next stage in the research will involve direct measurements of brain function.

Although IBMT is described as a form of meditation, it may be inducing something slightly different from, say, Zen meditation. The important point is that it is possible to produce measurable physiological changes in just five days, and this will make it much easier to examine the dynamic effects of hypnosis, relaxation and this technique on brain function.

I would also be grateful for any readers who have more information abut the precise details of IBMT, and whether training in the precise techniques is available outside China.

I shall keep you posted as new data emerge.

“Peace can be reached through meditation on the knowledge which dreams can give. Peace can also be reached through concentration upon that which is dearest to the heart.”
--Patanjali (Indian Philosopher said to be the Compiler of the Yoga Sutras, Dates Unknown)

“Through meditation and by giving full attention to one thing at a time, we can learn to direct attention where we choose.”
--Eknath Easwaran (Indian-American Spiritual Teacher, Professor and Author, 1910-1999)

“Meditation is not to escape from society, but to come 
back to ourselves and see what is going on. Once there is 
seeing, there must be acting. With mindfulness, we know 
what to do and what not to do to help.”
--Thich Nhat Hahn (Vietnamese Buddhist Monk, 1926-)

“A meditator keeps his mind open every second. He is constantly investigating life, investigating his own experience, viewing existence in a detached and inquisitive way. Thus, he is constantly open to truth in any form, from any source, an at any time.”
--Henepola Gunaratana (a.k.a. Bhante G., Sri Lankan Buddhist Monk, 1927-)

Nutrition, Learning and Memory

We have talked about the burgeoning data linking food with mood, behavior and cognition.

I have just seen a new study that really adds to our knowledge and contributes information that we can all use.

Scientists in Europe, Australia and Indonesia have published data in the American Journal of Clinical Nutrition suggesting that nutrition can improve verbal learning and memory in schoolchildren.

This study was undertaken by the NEMO study group (Nutrition Enhancement for Mental Optimization) that consists of the Unilever Food and Health Research Institute (Vlaardingen, The Netherlands); CSIRO, Human Nutrition (Adelaide, Australia) and the SEAMEO-TROPMED Regional Center for Community Nutrition, University of Indonesia (Jakarta Pusat, Indonesia).

It was a 12-month study of 780 children in Australia and Indonesia in which the researchers evaluated the effects of adding a specific vitamin and mineral mixture to a daily drink.

The study population consisted of 396 well-nourished children in Australia and 384 poorly nourished children in Indonesia. In each country, the children were randomly allocated to one of four groups, receiving a drink with either:

1. A mixture of micronutrients (iron, zinc, folate and vitamins A, B-6, B-12 and C)
2. Fish oil (DHA and EPA)
3. Both the micronutrient mixture and the fish oil
4. Nothing added, i.e. placebo

In Australia, children who received the daily drink with the added vitamin and mineral mixture performed significantly better on tests of mental performance tests than children in a control group who received the drink but without added nutrients. In Indonesia a similar trend was observed, but this time only in the girls.

After twelve months, children in Australia who received the drink with the nutrient mix showed higher blood levels of these micronutrients, which means that their bodies were taking up the nutrients. In addition, they performed significantly better on tests measuring their learning and memory capabilities compared to children in the other groups. A similar trend was observed in Indonesia, but only in the girls. The addition of fish oil to the fortified drink did not conclusively show any additional effects on cognition.

This study adds to the mounting evidence that nutrition plays an important role in cognitive development in children, even in children who are enjoying a “normal” diet. Deficiencies in iron and iodine have been linked to impaired cognitive development in young children for over a century and there is now emerging evidence that deficiencies in zinc, folate and vitamin B12 may each compromise mental development in children. More recently, fish oils (EPA, DHA) have also been linked to child cognitive development.

Most previous studies have focused on deficiencies in single nutrients in young age groups, despite the well-known observation that the brain continues to grow and develop during childhood, adolescence and early adulthood. Little is known about the role of nutrition on mental development after the age of 2. In addition very other few studies have looked at the effect of offering a mix of nutrients. Until this study, there were very few randomized controlled intervention studies assessing the impact of a multiple-micronutrient intervention on cognitive function in schoolchildren.

The investigators recommend further research to investigate the exact role of DHA and EPA in healthy school-aged children. Another research focus is the further optimization of cognitive development tests with respect to their validity and sensitivity across cultures. The scientists suggest that the smaller effects of the vitamins and minerals in Indonesia could be a result of a lower sensitivity of the cognitive tests in that country.


This research raises many interesting points:

• Is it possible that the healthy Australian diet is actually nothing of the sort?
• Is it possible that if the diet is adequate, that “super-nutrition” can help a child to exceed his or her potential?
• Are there key ages when nutrition can help, or is the effect maintained across the age range?
• Does nutritional supplementation have a long-term impact on a child?
• Have we even found the optimal mixture for child cognitive development? Might higher amounts of any nutrients – particularly fish oils – produce better effects, or might they be toxic, as we saw in the case of vitamin A supplementation?
• Are we using the correct cognitive development tests to pick up changes in different cultures? As an example, could the smaller effects of the vitamins and minerals in Indonesia be a result of a lower sensitivity of the cognitive tests in that country? Or is it that the children are also missing out on some other trace nutrients?

Many questions, but the take home message is this: careful nutritional supplementation may have considerable benefits to a child, even one growing up in an affluent culture.

“Learning is a weightless treasure you always carry easily.”
--Chinese Proverb

Marriage Makes You…

A Chinese sage once said that if a woman took a pea and placed it in a large jar every time that she had sex in the first year of marriage, and then took out a pea every time that she had sex in the rest of her life, the jar would never be empty.

So many couples seem to think that a declining interest in sex I something to be expected, and agony columns and websites are crammed with complaints. Does it have to be that way? Is it just that people get bored with each other, or are too tired to bother?

Some intriguing new research suggests that there may also be a physical factor, reporting lower testosterone levels among married men compared with single, unmarried men.

The research is reported in this month’s issue of Current Anthropology by Peter B. Gray from the University of Nevada, Las Vegas, Peter T. Ellison from Harvard University and Benjamin C. Campbell from Boston University.

They investigated the links between male testosterone levels and marital status among modern-day cattle farmers from the Ariaal tribe in northern Kenya. Less than 1.5 percent of these men consider that their wives are a source of emotional support. The Ariaal males serve as herd boys until they reach puberty. They then undergo initiation, become warriors and begin to accumulate livestock. They do not marry and have children until around age 30. They value social bonds with male peers more than spousal or familial bonds. 

The researchers measured testosterone in morning and afternoon saliva samples of more than 200 Ariaal men over the age of twenty. They found that monogamously married men had lower testosterone levels than unmarried men in both the morning and afternoon. However polygynously married men with more than one wife had even lower levels of testosterone than the monogamously married men.

The data suggest that male testosterone levels might reflect variations in male mating efforts. It may also be that in the tribal setting, older men, who typically have lower testosterone levels, may have the social status and wealth to obtain more than one wife.

Given the increasing amount of data concerning the importance of testosterone for normal brain and arterial function, this may be a big wakeup call. If men do nothing once they are in a relationship, and their brains begin to think that the “hunt” is over, their testosterone levels can plummet.

And that can be fatal.

It is essential for couples to work to keep passion – and testosterone – alive.

It is not sexism, it is millions of years of evolution.

Television and Behavior Problems in Children

The debate about the possible association between watching television and children’s behavior has been going on ever since this window on the world entered our lives fifty years ago.

A new study, indicates that consistent, heavy television viewing (more than two hours a day) throughout early childhood can cause behavior, sleep and attention problems.

Yes, you did read that correctly: heavy viewing is just two hours a day!

Researchers from the Department of Population, Family, and Reproductive Health at Johns Hopkins assessed data from the Healthy Steps for Young Children national evaluation effort that looked at the effects of early, concurrent and sustained television exposure at age two and a half and again at five and a half. They also measured the effects of having a television in the child's bedroom at age five and a half.

Sixteen percent of parents said that their child watched television for more than two hours a day at age two and a half years only, which they called “early exposure;” 15 percent reported that their children watched more than two hours of television daily at five and a half years only, which they called “concurrent exposure;” and 20 percent reported more than two hours of television viewing daily at both times (sustained exposure).

Forty-one percent of children had a television in their bedroom by the age of five and a half. Sustained television viewing was associated with sleep, attention and aggressive behavior problems, and what is known as “externalizing” of problem behaviors: throwing or breaking things.

Excessive television exposure was associated with fewer social skills. Having a television in the bedroom was associated with sleep problems and less emotional reactivity in the five year olds. Early exposure to television for more than two hours a day, which decreased over time, did not cause behavior or social problems.

The American Academy of Pediatrics recommends no television viewing for children under age 2, and no more than two hours of daily media exposure for ages 2 and older.

This is scary research. How many children are parked in front of a television for hours at a time, just to get them out of the way. And what kinds of problems are we creating for our future?

One of the smartest people I know has several children who have never watched television. They are instead all multilingual and each is an expert in at least one musical instrument.

Makes you think, doesn’t it?

More Clues to the Biology of Alzheimer’s Disease

Alzheimer’s disease remains a puzzle.

Although there are plenty of people who claim that “The Cause” of Alzheimer’s is… and here you can take your pick of three-dozen theories.

The truth of the matter is that simple explanations - Aluminum, lead, stress, pollution, mycoplasma infections and the rest – fail to explain many of the established observations about the causes of the disease.

From what we know about the genes in the brain, it is highly likely that “Alzheimer’s disease” represents a group of disorders that follow an interaction of sets of genetic and environmental factors.

This notion is supported by a report from investigators at Washington University School of Medicine, St. Louis and several other prominent research centers. The study is published in today’s issue of the journal Neuron and indicates that there a biological link between a protein mutation that causes early-onset Alzheimer's disease (AD) and a gene variant linked to late-onset AD.

The investigators tried to link the function of two known causative factors in AD. Mutations in amyloid precursor protein (APP) cause early-onset Alzheimer's disease (AD), but the only genetic risk factor for late-onset AD is the ɛ4 allele of apolipoprotein E (apoE), a major carrier of cholesterol in the circulation and in cell membranes.

Previous research has shown that mutations in APP can cause early-onset AD when the protein is “cleaved” or split, producing a short toxic protein that builds up in the brain and kills neurons. 

In their experiments with mice and cultured mouse cells, the researchers linked APP to the regulation of apoE and its cholesterol transport function. They found that the normal cleavage of APP in the cell gives rise to a nontoxic fragment (called AICD) that suppresses the gene that produces the cell receptor for apoE, known as LRP1. Crouching in nerve cell membranes, this receptor enables the apoE protein to transport its cholesterol cargo into the cell.

The researchers speculated that the loss of LRP1 function in AD might cause a loss of cholesterol that causes malfunction of neurons.

These observations may turn out to be extremely important. If we can restore the activity of the receptor gene, we might have a new treatment strategy for AD.

The Genetics of Wall Street

After seeing the recent ups and downs of Wall Street, I was fascinated to see a new study in the Proceedings of the National Academy of Sciences by an international team of researchers that has demonstrated for the first time that genes exert an influence on people's behavior in a very common experimental economic game.

The Nobel Laureate Jim Watson once quipped that there were only molecules and everything else was sociology. I don’t think that he was being altogether serious, but he did highlight a yawning chasm between different ways of describing human experience.

Social scientists have been a bit reticent about acknowledging a role for genes in economic behavior. But a study by David Cesarini, from the Massachusetts Institute of Technology’s Department of Economics and colleagues in Sweden indicates that there is a genetic component to people's perception of what is fair and what is unfair.

The researchers looked at the ultimatum game, in which a proposer makes an offer to a responder on how to divide a sum of money. This offer is an ultimatum; if the responder rejects it, both parties receive nothing.

Because rejections in the game entail a zero payoff for both parties, theories of narrow self-interest predict that any positive amount will be accepted by a responder. The intriguing finding in the laboratory is that responders routinely reject free money, presumably because they feel that they want to punish proposers for offers that they think are unfair.

To study genetic influence in the game, the researchers recruited twins from the Swedish Twin Registry, and had them play the game under controlled conditions. Because identical twins share the same genes but fraternal twins do not, the researchers were able to detect genetic influences by comparing the similarity with which identical and fraternal twins played the game.

The results suggest that genetic influences account for as much as 40 percent of the variation in how people respond to unfair offers. This is much larger than the effect of common environmental influences such as upbringing.

The research indicates that many of our preferences and personal economic choices are subject to substantial genetic influence, and it will be interesting to see how they interact with social and environmental factors.

Herbal Remedies

Edzard Ernst’s group at Peninsula Medical School, Universities of Exeter in England has published another study that is critical of one aspect of complementary medicine.

They set out to summarize and evaluate the evidence from randomized clinical trials for the effectiveness of individualized herbal medicine.

They conducted a search of electronic databases and also contacted experts in the field to identify randomized controlled clinical trials of individualized herbal medicine. They then conducted an independent data extraction and assessed the quality of the studies.

They found three randomized clinical trials of individualized herbal medicine. They concluded that statistically non-significant trends favoring herbal remedies over placebo treatment in osteoarthritis of the knee probably resulted from large baseline differences and “regression to the mean.”

They also concluded that individualized treatment was superior to placebo in four of five outcome measures in the treatment of irritable bowel syndrome, but was inferior to standardized herbal treatment in all outcomes.

Finally individualized herbal treatment was no better than placebo in the prevention of chemotherapy-induced toxicity.

The final conclusion was that there is very little evidence regarding the effectiveness of individualized herbal medicine.

Though this result is rather gloomy, it is important not to throw out the baby with the bathwater.

The researchers did the right thing: they asked the experts and examined the published data. Yet every practitioner has seen herbal remedies that seem to help certain specific conditions. So my take on this study is not to abandon herbalism, but to realize that there is a great deal more research to be done.

Protecting Yourself Against Alzheimer’s Disease

I have a keen interest in healthy aging, and we have talked before about some of the strategies that can help protect you against developing cognitive decline.

New research now shows for the first time that, of all lifelong activities, only a high level of mental or cognitive activity protects against the devastating memory loss of Alzheimer's disease. High levels of social or physical activity are not enough.

Researchers from the Byrd Alzheimer's Institute bred mice that are genetically predisposed to developing the pathological changes of Alzheimer’s diseases in their brains.

They then kept the mice in one of four housing environments -- high social activity, high physical activity, high cognitive activity, or a single housing control environment and watched them from young adulthood through old age.

When the researchers tested the mice in a battery of memory tasks in old age, only the mice given a lifelong high level of cognitive activity were protected against memory impairment. In fact, these "high cognitive activity" mice performed as well as normal mice that do not develop Alzheimer's disease. However the Alzheimer's mice raised in one of the other three environments performed poorly in multiple memory tasks.

Not only was memory protected in Alzheimer's mice by a high level of cognitive activity, but also brain levels of the abnormal protein beta-amyloid were substantially reduced. This protein, thought to be key for Alzheimer's development, remained at soaring levels in the brains of Alzheimer's mice raised in social or physical activity environments. Moreover, the researchers found that only the Alzheimer's mice raised with high cognitive activity had an increase in connections between brain cells. Alzheimer's mice raised in one of the other three housing environments had much fewer connections between their brain cells.

The new study is published in the Neurobiology of Learning and Memory Journal.

The lead researcher is Gary Arendash, and he had this to say:

“Our results call into question the earlier human studies suggesting social or physical activity provides protection against Alzheimer's. Alzheimer's begins in the brain several decades before any symptoms´ show up. That means adults in their forties and fifties need to make lifestyle choices now to decrease their risk of getting Alzheimer's disease later."

This is all correct, but there is still an important question: can we really extrapolate from mice to humans? Mice are social creatures, but not to the same extent as humans beings. The lion’s share of the human brain is dedicated to social activities, so you would expect that social activities will be particularly important in the maintenance of the human brain.