Archive for the ‘Brain Health’ Category

BERRIES HELP YOUR AGING BRAIN AVOID ALZHEIMER’S DISEASE BY CLEANING DEBRIS AND TOXINS

Tuesday, August 24th, 2010

It has long been known that the polyphenol anti-oxidants found in fresh fruits (especially berries) and in nuts protect the brain from inflammation which can cause degenerative brain disease and from the build-up of arterial plaque which can cause stroke. Now we are hearing of a brand new mechanism by which eating blueberries, strawberries, acai berries and walnuts can protect the brain from degenerative diseases like Alzheimer’s.

The news came at the 240th National Meeting of the American Chemical Society the week of 8/23/10 from Shibu Poulose, Ph.D., where Dr. Polouse presented a research paper on how consuming these berries and walnuts helps the aging brain clean its own  house. Dr. Poulose is a molecular biologist with the Human Nutrition Research Center on Aging in Boston

The human brain is composed of neurons (cell bodies with long myelin sheathed axons that form synapses with adjacent cells) and glial cells or glia. The glia perform many tasks including the removal and recycling of cellular debris and toxic substances that build up in the brain. This process is called autophagy. As the human brain ages the glia become less able to perform this role, and the risk of degenerative brain disease goes up accordingly.

Amyloid precursor protein (APP) is found in brain cell membranes and synapses. It plays a role in the formation and repair of synapses and also in synaptic plasticity (the modification of synapses in response to learning new information or practicing a skill). APP gets broken down into various substances including the protein beta amyloid. One hallmark of Alzheimer’s disease is the build up of excessive amounts of beta amyloid protein in the brain, something which reduces APP formation and eventually kills off brain cells in the hippocampus, the part of the brain which encodes memories.

Could nourishment from eating berries and walnuts re-invigorate aging glia and help them remove and recycle biochemical debris before it accumulates in amounts which cause degenerative brain disease? In prior research Dr. Polouse showed that rats fed for 2 months on diets containing 2% high-antioxidant berry extract showed a reversal of age related deficit in nerve function on tasks involving learning and memory.

In his current research he wanted to find out if berry extract could stimulate the autophagy function of mouse brain glial cells. Dr. Poulose created cultures of living mouse brain cells. When he inserted berry extract in these cultures he found that the berry extract inhibited the action of a protein which shuts down the autophagy process allowing it to proceed in normal fashion. Since the mouse brain and human brain are incredibly similar, the indications are that consuming a diet rich in berries could help prevent degenerative brain diseases like Alzheimer’s. Dr. Poulose recommends eating fruits and vegetables with deep red, orange, or blue color which have plentiful anthocyanin antioxidants.

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PROTECT YOURSELF FROM EXCESSIVE RADIATION DURING CT SCANS

Monday, August 2nd, 2010

CT scanning utilizes a 360 degree beam of x-rays and a computer with special software to generate sharp, well focused and three dimensional images of internal organs in thin cross-sectional slices. Standard non-contrast head CT shows differences in tissue density which could be caused by strokes, hematomas from trauma, tumors, cysts, aneurysms and venous malformations. A relatively new technique called head CT perfusion scanning creates a map of the brain showing the distribution of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT). It is being used with increasing frequency to assess people after suspected stroke to find areas of ischemic damage where groups of brain cells died off from lack of oxygen. The theory is that blood flow is curtailed to non-vital brain tissue. Are these CT scans safe?

The answer is no. On the front page of the Sunday NY Times on 8/1/10 Walt Bogdanich reported the recent discovery of hundreds of cases in which patients who underwent a CT brain perfusion scan for post-stroke assessment received harmful overdoses of radiation. Bogdanich said that approximately 400 cases nationwide had been identified so far with 10 cases at a hospital in Glendale Adventist in Glendale, CA; 37 cases at Providence Saint Joseph Medical Center in Burbank, CA; 269 at Cedars-Sinai Medical Center in Los Angeles, CA; 16 at Bakersfield Memorial in Bakersfield, CA; dozens at Huntsville Hospital in Huntsville, AL; and an unknown number at South Lake Hospital in central Florida.

At the request of the FDA every state is now searching for problem cases, and the number of known cases is likely to escalate. Bogdanich said the most severe cases of excessive radiation occurred in Huntsville where up to 13 times the typical amount of radiation was used. At Cedars-Sinai it was up to 8 times. At Bakersfield it was up to 5.5 times. And, at Glendale it was up to 4 times. The typical amount of radiation for a CT perfusion scan of head is equivalent to 200 skull x-rays.

According to Bogdanich these cases, which began to emerge last summer, were place under investigation by the FDA 10 months ago after the NY Times made the FDA aware of them. Apparently the patients were inadvertently bombarded with excessive radiation. Possible causes include lack of proper training of CT scan technicians, lack of functioning safeguards against radiation overdose in the machine and a failure by manufacturers to design their equipment and software safely. Bogdanich said the machine manufacturers and Cedars-Sinai are in dispute over who is at fault. The Lightspeed scanner was made by GE Healthcare Inc. and GE Healthcare Technologies.

GE built in a feature which should have adjusted the radiation dose to a safe level for the patient’s size and the body part being radiated. Cedars-Sinai says this automated feature failed and consequently the patients received major overdoses of radiation. GE claims the hospital should have known how to use the automated feature, and its technicians should have noticed when the dose went too high. It also claims hospital technicians set the radiation does too high to obtain sharper images. Representatives of Cedars-Sinai and Glendale Adventist say that during multiple visits the GE reps never fully explained the automatic feature; and that the radiation machine should have bleeped to alert operators or shut itself down when the radiation level got too high. At this point the FDA investigators have not reached any conclusion, but the FDA did put out a nationwide alert on 10/8/09 to hospital radiology departments to limit and carefully monitor their radiation output during these tests.

The victims of excessive radiation suffered what Bogdanich described as “freakish hair loss,” in the pattern of a band encircling the head just above the ears. He said that expert are concerned about the potential for cancer and brain damage in these patients. Dr. Alberto Gutierrez is the FDA official who oversees diagnostic devices and who is in charge of the investigation.

No doubt the issue of fault will be litigated in many personal injury cases yet to come. Irrespective of who was at fault, the message is clear. Subjecting oneself to a brain CT perfusion scan for diagnostic purposes can be highly dangerous. Anyone reading this blog who has been asked to do this by his physician should undertake careful investigation of the practices and safety record of the radiology departments in his geographic area to determine which one is doing this test with the greatest attention to patient safety.

CT head perfusion scans are not the only scans which should give rise to concern.
In April 2010 the Archives of Internal Medicine published an article based on National Cancer Institute Data stating that radiation from CT scans will eventually result in 29,000 new cancer cases and 15,000 new cancer deaths each year at current levels of CT usage and cancer cure rates. Due to the increasing availability and recent diagnostic advances in CT technology, the use of CT has increased dramatically. In 2007, approximately 68.7 million CT examinations were performed in the United States. The new generation of CT scanners produce radiation many times more powerful than older scanners. On 12/17/09 Jeffrey Norris posted an article online at UCSF’s Science Café on this issue containing interviews with radiologists at UCSF Medical Center. They expressed great concern regarding the over-use of CT scans given the high amount of radiation they generate. UCSF has created a radiation safety committee.

I am certainly not advocating that people avoid CT scanning, which can be the best diagnostic alternative in a given situation. I am simply pointing out that as a patient you should not blithely undergo one or more CT exams with no thought given to the radiation you would receive. Mr. Norris’ article pointed out that radiation levels can vary tremendously for the same type of exam due to such things as who happens to be operating the equipment. To protect yourself you should learn as much as you can before undergoing a voluntary (non-emergency) CT scan and discuss any concerns with your radiologist. Medical advances that protect our health can also be hazardous and it behooves us to be cautious, curious and intelligent when before agreeing to undergo a diagnostic test involving radiation.

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TRAIN YOUR BRAIN USING OPEN FOCUS EXERCISES TO DIFFUSE STRESS AND RELIEVE ANXIETY OR DEPRESSION

Monday, July 26th, 2010

The human brain is an electro-chemical organ which produces a small but measurable amount of electric current in the form of gamma, beta, alpha, delta and theta waves. Each wave type has a range of frequencies associated with different types of mental activities. The brain does not emit any one wave type in pure form. At any given moment it emits a mix of two or more wave types. The predominant wave type can vary s with the part of the brain being measured. EEG brain wave patterns vary depending on whether a person is awake and actively concentrating, awake and resting, falling asleep, in deep slow wave sleep or dream (REM) sleep; in a fearful, tense and fight-flight state; in a calm, meditative state; or in states of consciousness affected by such things as sexual arousal or consumption of alcohol or drugs. Mental illnesses and alcoholism show distinctive brain wave patterns.

Neuropsychologist Les Fehmi, Ph.D., is an expert in the link between brain waves and stress reduction. After doing his post-doctoral work at the UCLA Brain Research Institute, he became a pioneer in neurofeedback therapy. Neurofeedback is a method of helping individuals reduce stress levels and anxiety symptoms by gaining control over their central nervous system using EEG biofeedback. In 1969 Dr. Fehmi co-founded the Biofeedback Society of America which later became the Association for Applied Physiology and Biofeedback. During the 1970s Dr. Fehmi used neurofeedback on hundreds of patients. He had them sit at a desk wearing a headband with a nest of electrodes attached to their scalp while they watched their EEG displayed in real time on a screen. They were asked to control their brain waves without being told how to do so, since nobody quite knows how this can be done. If they did not make the desired changes they were notified by bleeping noises and flashes of light.

Dr. Fehmi’s approach to neurofeedback was twofold. First he wanted patients to learn to synchronize their brain waves across their entire brains, because the brain operates most efficiently, effectively and under the least stress when brain cells in different brain regions are firing together (synchronously) in the same wave pattern. Second he wanted his patients to reduce beta (the highest frequency, most energetic brain waves in the range of 13-50 hertz) and increase the amount of their alpha waves (in the range of 8-12 hertz). At the higher end of beta frequency people show great mental effort, high mental energy expenditure, anxiety and tensed muscles. A college student taking an important exam who does not know the material and a driver who blares his horn and screams angrily after being cut off are in high beta. In the alpha frequency people are in a relaxed but alert state where they can observe and deal with the world without intense effort. Meditation puts people in an alpha state. You can also move from beta to alpha by closing your eyes.

During the 1970s Dr. Fehmi noticed an interesting phenomenon while treating his patients. All of them went through a difficult break-in period using neurofeedback where no matter how hard they tried they could not get the results they wanted. They couldn’t synchronize their brain waves or reduce beta and increase alpha frequencies. It was only when they gave up and were on the verge of quitting the training that they succeeded. It was only when they concluded that no amount of trying would succeed and they let go of trying, that they effortlessly brought their brain waves under conscious control. Dr. Fehmi concluded that to be successful in neurofeedback his patients had to give up their effortful orientation to the task.

This led Dr. Fehmi to realize that the how of attention (how we pay attention to something) is much more important than the what (the content of our attention). He began taking physiological measurements of people attending in effortful (beta) and relaxed (alpha) fashion. He found that effortful attention triggers the sympathetic nervous system with the adrenalized fight-flight response and over-reactivity;  whereas relaxed attention triggers the parasympathetic nervous system which keeps people calm and at ease. Dr. Fehmi also found that people learn information more quickly, more accurately and with much less effort in a relaxed mode of attention. People who approach tasks in an effortful way have greater difficulty and progress more slowly.

After years of studying attention Dr. Fehmi came up with different categories of attention. Narrow focus refers involves intense effortful attention associated with high beta waves. A person using narrow focus shrinks the aperture of his attention to one object (be it a person, thing or  idea) while pushing all other objects into the background and excluding them from consciousness insofar as possible. Open focus refers to a diffuse form of attention in which the person’s aperture of attention is wide open. In open focus a person remains aware of the object he’s attending to, but he is  simultaneously aware of his internal sensations, feelings and ideas, the objects in his environment along with their sounds, sights and smells; and the space in, around and between external objects.

Objective focus refers to a state of scientific detachment from the object of attention which is looked at as a wholly separate and distinct entity. It is accompanied by a high degree of self-consciousness, analysis and judgment. Immersed focus refers to a form of attention in which the observer experiences the object of attention from within, yield to it and joins with it. It is accompanied by sensations of union, pleasure and love and marked by a loss of self-consciousness and judgment.

According to Dr. Fehmi the most prevalent form of attentional style in our society is the narrow-objective kind. It can manifest as an obsessive-compulsive focus on a psychological or environmental object or as a denial of and shift of attention away from such an object. This kind of attention limits our awareness and stimulates fear and anxiety by separating us from our inner guidance system (our sensations, feelings, emotions, and intuitions) and from other people. Lawyers engage in the narrow-objective style of attention nearly all the time. They frequently focus on ideas, words and word meanings to the exclusion of their own physical sensations and feelings and their inner sense of what others are feelings. Dr. Fehmi says that people who are stuck in this mode of attention show awkwardness, lack of smoothness and fluidity in dealing with others and a tendency toward anxiety, worry, panic and rigidity.

Narrow-objective attention is a creature of the left brain. Our cave dwelling ancestors used it when they were out hunting or foraging and they had to scan their environment with utmost vigilance and urgency to spot predators like saber tooth tigers. Children in our day learn to use narrow-objective attention when they are told to stop day dreaming, focus on their homework and prove to their parents and teachers that they know their academic material. This amps up their nervous system. As children or as adult lawyers we can get stuck in this amped up state of great cognitive intensity which rigidifies one’s thinking and one’s muscles. Open states of attention act as a gear shifter that can take us out of this mental and physiological state in which we are stuck in over-drive. They allow us to get the best performance out of our brains and feel so much better.
Although narrow-objective attention has its uses, the problem (says Dr. Fehmi) is that we are addicted to it and we use it in many situations where it is more of a hindrance than a help. Narrow-objective focus is useful when learning the parts of the human body, but not when figuring out why a patient is dizzy or depressed. Narrow-objective focus is  useful in learning the notes to a music score but not when playing your part during a symphony orchestra performance. Narrow-objective focus may have some use during  sexual foreplay but not when making love. The key is in developing attentional flexibility so you can make use of all forms of attention at the appropriate time. Developing this flexibility helps release the psycho-physiological stress stored up through habitual use of narrow-objective attention.

When we stop excluding parts of our experience, open up our focus and allow our attention to equally and simultaneously spread out, we experience a softening of goal-directed behavior, a release of energy and a greater sense of wellbeing. The addiction to narrow-objective focus causes us to miss out on many opportunities to use open-diffused and open-immersed attention which are associated with the right brain and which give us a broader big-picture view which sparks creativity, empathy and spirituality. When the right brain is engaged sensory experiences become more fresh, vivid,  captivating, and satisfying. Our brains were designed to be multi-modal, which means they were designed to take in and integrate information from all five senses. We learn best and enjoy life most when we use our minds in a multi-modal fashion. Dr. Fehmi says that a life lived with open focus takes us away from tension, rigidity, anxiety and fatigue to ease, flexibility, efficiency, energy, productivity, spontaneity and creativity.

So how do we get there? You can either seek a solution to your problems in the content of your lived experience (memories of the past), which Dr. Fehmi says won’t work, or you can change your style of attention to open focus. When patients come to Dr. Fehmi for help he can give them neurofeedback, open focus exercises or both. The neurofeedback route is more expensive and requires multiple visits to his office in Princeton, New Jersey, to use the EEG machine.

Patients using neurofeedback benefit by producing more alpha than beta all over the brain and by harmonizing their production of alpha so the various parts of their brain emit alpha in unison like a choir. This allows information to pass through the brain more rapidly, fluidly and completely and allows for the greatest possible integration of information. It enables thinkers, artists, musicians and athletes to reach their peak performance. If you want to try this therapy your insurance might cover it, for instance if the presenting complaint was headache or insomnia. If you can’t make it to Princeton where Dr. Fehmi’s Princeton Biofeedback Center is located, you can go to his website at www.openfocus.com to find links to people he has trained in various parts of the country.

Open focus exercise therapy is inexpensive and can be done at home or at the office behind closed doors. You can do it with a CD. In 2007 Dr. Fehmi came out with The Open Focus Brain published by Trumpeter Books. It contains a companion CD with open focus exercises as well as written exercises after each chapter. I have tried the open focus exercises on CD and found them quite helpful. They put me in the same relaxed, tranquil and mildly euphoric state of mind that meditation does. Like meditation these exercises give me renewed mental clarity and extra energy. Open focus exercises and meditation both involve learning to accept rather than fight one’s sensations, feelings and ideas. In his book Dr. Fehmi talks about curing pain by turning into it, rather than running from it and trying to push it away. Whether you allow the imagined physical space around your pain or the space of your awareness to enter it and fuse with it, either way it will dissolve. The same holds true for negative thoughts and fears.

Based on his work with many thousands of patients Dr. Fehmi says that open focus work can become second nature after you do the exercises enough, and it can not only reduce your stress and anxiety, but help you with self-realization. Chronic stress breeds depression, substance abuse, insomnia, fatigue and stress-related disorders like asthma, allergies, rashes and psycho-somatic pain syndromes. When these have been cleared up, and your brain is working in alpha and firing synchronously, you can expect to experience renewed energy, productivity, enhanced relationships and improved performance in your work, sports, leisure and artistic activities.

Although open focus work is compatible with, and can be done simultaneously with, meditation, I know from experience that some people who could benefit from both modalities are not going to become long term meditators. Why? Some people don’t like sitting for prolonged periods of time in silence in the hope of reducing stress, improving mental clarity and gaining wisdom and compassion. They find listening to their own interior mental chatter intolerable – or they complain of distracting noises, physical pain or discomfort, boredom, restlessness, frustration, lack of progress and a host of other problems. Meditation isn’t for everyone. For these people open focus could be a safe, drug-free method of reducing stress, anxiety and depression while enhancing their performance of and enjoyment of their work and other activities.

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FISH OIL SUPPLEMENTS CONTAINING 1,050 MG. OF EPA PER DAY EQUAL TO ANTI-DEPRESSANTS IN RELIEVING SYMPTOMS OF MAJOR DEPRESSION

Tuesday, June 22nd, 2010

Omega-3 fatty acids are long chain, polyunsaturated fatty acids.  The nutritionally important Omega-3s are EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid) and ALA (alpha-linolenic acid). EPA and DHA are found naturally in cold water fish like salmon, mackerel, herring, sardines and anchovies. ALA is found in plants. In the 1970s nutritional scientists discovered that people who consumed large amounts of dietary Omega-3s from cold water fish had extremely low rates of cardiovascular disease. Over the past several decades a great deal of research has been done on Omega-3 nutrients.
It shows that Omega-3 consumption reduces triglyceride levels, inflammation and the formation of plaques and blood clots in the arteries; and consequently it helps prevent heart attack, stroke and dementia. Test tube studies have shown Omega-3s kill breast cancer and prostate cancer cells.
Omega-3 fatty acids make up approximately 8% of the healthy human brain. There is some evidence that deficiency of Omega-3s is linked to mental illnesses including unipolar depression, bipolar depression and even schizophrenia. There is also some evidence, not yet fully accepted by the scientific community, that Omega 3 consumption can help prevent or treat depression.  Although no one knows for certain how Omega-3s would do this, there are two general theories. One is that these nutrients help keep brain cell membranes soft and flexible at normal body temperature so they can more efficiently absorb and release neurotransmitter substances. Another is that they help strengthen myelin sheathing for brain cells axons for faster, more efficient transmission of nerve impulses. British neurosurgeon Liz Miller and American neurosurgeon Larry McCleary both advocate daily consumption of an Omega-3 supplement for brain health and prevention of depression. Dr. Miller says that 1,000 mg of EPA is a safe, effective dose and that no extra DHA is needed because DHA can compete with EPA and some EPA is converted by the body into DHA.
Although anti-depressant drugs are effective and safe for many people, about one third of people have very little or no response to these drugs and some people who do respond have unacceptable side effects so they have to discontinue the drug. Some people who might benefit from anti-depressant drugs are philosophically opposed to taking them or refuse to try them for fear of stigma. For these people it would be a great thing to have an Omega-3 supplement that effectively relieved their depressive symptoms.
On June 15, 2010 Canadian research psychiatrist Francois Lesperance of the University of Montreal published a study in the online Journal of Clinical psychiatry regarding the anti-depressive properties of high concentrations of EPA. From October 2005 to January 2009 Dr. Lesperance had 432 adult males and females with major unipolar depression participate in an eight week study. Dr. Lesperance chose patients who had not responded to conventional anti-depressant medications. During this period of time half of them took three capsules a day of OM3 Emotional Balance (a fish oil supplement) produced by isodisnatura. Their total daily dosage of Omega-3s was 1,050 mg of EPA and 150 mg of DHA. The other half took three capsules a day of a placebo pill containing sunflower oil flavored with a small quantity of fish oil. This was a double blind study in that neither the participants nor the researchers knew which pill was which. Double blind studies are considered highly reliable.
The result of the study was that for patients suffering from unipolar major depression without anxiety the fish oil supplements were as effective as anti-depressant drugs in relieving depressive symptoms, but the supplements were not effective for depressed patients with anxiety. This was the first large scale, randomized, double blind study of fish oil supplements in treating depression. Its results are quite encouraging for people who suffer from depression without anxiety. Dr. Lesperance indicated it is not yet known how taking different doses of EPA or taking supplements over a longer period of time would affect people with depression. If you suffer from persistent depression and you cannot tolerate anti-depressants, you don’t want to take them or you have failed to respond to them after 2-3 trials with different drugs, then speaking to your doctor about using EPA seems like a good idea based on results of Dr. Lesperance’s study. Even in the complete absence of depression taking a daily fish oil supplement seems like a good idea since it offers cardiovascular protection from heart attacks, strokes and dementia.

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A SMELL TEST MAY HELP WITH EARLY DIAGNOSIS OF PARKINSON’S DISEASE

Monday, June 14th, 2010
Parkinson’s disease (PD) mainly affects people over age 50. Early PD affecting people around age 40 accounts for just ten percent of all cases. It is now known that PD can occur as early as age 30, although such cases are quite rare. Eighty-five percent of all cases of PD are “idiopathic,” which they arise spontaneously and have no known origin. The average age on onset for idiopathic PD is 62.4 years old. Non-idiopathic PD results from such things as use of prescription drugs, street drugs, cerebro-vascular problems, environmental exposure to toxic substances and recurrent head trauma. There are five million cases known worldwide, but physicians believe many more cases exist which have not been diagnosed.
PD is a progressive, neuro-degenerative condition that damages and kills off dopamine producing cells in the brain, particularly in an area called the substantia nigra in the midbrain. PD causes stiff, rigid muscles; slowed movement; tremor; difficult initiating or controlling movement; unpredictable movements; balance problems; speech and swallowing problems; impairment of short term memory and multi-tasking; and depression. Although PD by itself is not fatal, PD can cause death through choking, food aspiration pneumonia or falls with head trauma. Although PD has no known cure, early initiation of treatment can prevent years of unnecessary symptoms and in some cases can slow the progression of the disease.
Treatments for PD include medications, physical therapy, voice therapy, and deep brain stimulation (DBS). Sinemet is made from levodopa and carbidopa. The levodopa is synthesized in the body into dopamine which improves problems with slowed movement and muscular rigidity. Sinemet is the most effective drug for PD. Unfortunately long term use is associated with dyskinesia (excessive, uncontrolled movements) and with restlessness and confusion.
A second class of drugs called dopamine agonists do not increase the supply of dopamine in the brain, but work by activating the brain receptors for dopamine by mimicking dopamine. These include Parlodel, Permax, Requip and Mirapex. A dopamine agonists can be taken alone or with Sinemet. These drugs have a long list of potential side effects including euphoria, hallucinations, nausea, insomnia, fatigue, dizziness, hyper-sexuality and sex addiction. A third class of drugs used for PD are inhibitors of the enzyme COMT (catechol-O-methyl transferase) which degrades dopamine. By blocking the action of COMT, these drugs leave more dopamine in brain synapses. The only COMT inhibitor which is safe for the liver is entacapone. It tends to increase involuntary movements just briefly when first taken and can cause gastro-intestinal side effects.
Physical therapy can help PD patients retain or rebuild strength, flexibility, coordination, postural stability and balance. Voice therapy can help PD patients with difficulty speaking. PD patients with some degree of muscle weakness in their gastro-intestinal tract develop constipation and they can benefit from a high fiber diet rich is fresh fruits and vegetables and whole grains.
DBS was approved by the FDA in 1997 as a safe, effective method for treating PD patients by surgical implantation of a medical device into the brain. The device, known as a brain pacemaker, sends high frequency electric signals the brain, and it has helped reduce symptoms and increase quality of life for PD patients who did not respond to drugs or had unacceptable side effects from drugs. The underlying mechanism by which DBS works is still not clear.  The therapeutic use of DBS for major depression is now under study. Serious depression is common in PD patients.
Currently PD is diagnosed clinically on the basis of muscle symptoms. The doctor will look for lack of facial expression, tremor of the arm while resting or extended, stiffness in the neck or limbs, difficulty rising from a chair, walking with short steps, walking with asymmetrical arm swing or difficulty regaining balance when the person is jerked backwards. If you show symptoms like these and you have a good response to levodopa the doctor will diagnose you with PD. It is estimated that as many as 35 to 40% of patients with PD are misdiagnosed. Late diagnosis is common because muscle symptoms of PD like rigidity, tremor and slowed movement do not show up until more than half of dopamine function has been lost.
In 2008 medical geneticist Silke Nuber, Ph.D., from the Department of Medical Genetics, University of Tubingen, Germany, created a line of transgenic mice which produced excessive levels of a protein called alpha-synuclein which was associated with the destruction of cells in the human substantia nigra. She and her colleagues published a paper that year showing these mice had reduced birth of new brain cells in their hippocampus and dying off of brain cells in their substantia nigra with cognitive and motor impairments.
In June 2010 Dr. Nuber  reported to the European Society of Human Genetics that a simple smell test could help screen people for PD before they developed obvious clinical symptoms. Dr. Nuber knew that loss of sense of smell is an early symptom of PD in humans caused by reduction in the amount of dopamine getting to olfactory receptors. For the June 2010 paper she used the same line of transgenic mice with high alpha-
synuclein. These mice had virtually no sense of smell. When exposed to the scent of a predator in their own cages they didn’t freeze, but explored their cages and sniffed everywhere. When males with this problem were given the scent of female mice they acted uninterested and depressed.
About forty percent of PD patients have depression. This may result from emotional reaction to the disease and/or from physical loss of dopamine supply to the orbito-frontal cortex where people anticipate pleasure from future activities. The researchers were able to reverse the odd behaviors of the transgenic mice in either one of two ways, by giving the mice an antibiotic that lowered their high level of alpha-synuclein (thereby normalizing dopamine levels) or by giving them anti-depressants. Dr. Nuber believes that alteration of smell is a reliable early biomarker of PD and recommends that physicians adopt the use of a smell test for patients they suspect of developing PD. Dr. Nuber wonders if early administration of an anti-depressant to such patients might produce better long term outcomes. Lancet Neurology recently reported that the drug Pramipexole was effective for treating depression in patients with PD.
What could you do to reduce the risk of developing PD if you or your doctor believed you were at serious risk?  One approach would be to increase your daily intake of Vitamin B6 under physician supervision. In  2006 researchers from the Erasmus Medical Center in the Netherlands studied around 5,300 participants over the age of 55, and found that those who had the highest intake of vitamin B6 had up to a 50 percent reduction in Parkinson’s disease risk. The researchers conjectured that B6 protected brain cells in the substantia nigra through it’s anti-oxidant activity (which would reduce occlusive plaque in the capillaries going to the substantia nigra) or by decreasing the levels of homocysteine – an amino acid that is potentially toxic to brain cells.
Dopamine is synthesized in the human body from an amino acid called tyrosine. Dietary sources of tyrosine are chicken, turkey, fish, peanuts, almonds, avocados, milk, cheese, yogurt, cottage cheese, lima beans, pumpkin seeds, and sesame seeds. If you are concerned about dopamine depletion, then increasing your intake of these food substances might be a good idea.

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NEW LINKS BETWEEN INSOMNIA, OBESITY, DEPRESSION AND DEMENTIA

Monday, May 24th, 2010

The old children’s song that contained the phrase, “the arm bone is connected to the wrist bone” had it right. Everything we do to our bodies (how we sleep, eat and exercise) has a consequence; and these consequences hook up in ways we couldn’t predict, but which we need to know to protect our precious health.

Many people know that working late hours and getting less than five hours sleep a night creates a “sleep debt,” which causes fatigue and mild impairments of cognition, coordination and reaction time. But how many people know that sleeping less than five hours a night triggers the accumulation of fat inside your abdominal cavity around your visceral organs, that this kind of fat triggers metabolic syndrome (apple shaped belly, hypertension, high blood sugar, low HDL cholesterol and high triglycerides), or that metabolic syndrome is potentially very harmful because it increases the risk of insulin resistance, Type II diabetes, heart attacks and strokes?

In March 2010 Kristen G. Hairston, M.D., M.P.H., and colleagues at the Wake Forest University School of Medicine published a study which looked at fat deposition in adults over age 40 who sacrificed sleep to work long hours. They found that sleeping less than five hours per night led to deposition of harmful fat around visceral organs. They recommend that adults over age 40 get 6-8 hours of sleep per night to avoid this potentially dangerous metabolic consequence of insomnia.

Many people know that Type II diabetes can cause blood vessel occlusion, blindness and nerve damage with numbness, tingling or burning in the hands, fingers, feet or toes. But how many people know that diabetes increases their risk of dementia? Type II diabetes can cause vascular dementia (the second most common form of dementia in the U.S. after Alzheimer’s disease) by clogging up cerebral arteries. It can also cause dementia by harming brain cells through hyper- or hypo-glycemia. Too much or too little sugar in the blood can damage or kill brain cells. Diabetics suffer harmful drops in blood sugar when they don’t eat enough or when they take too much insulin. The part of the brain most sensitive to damage from low blood sugar is the hippocampus which is involved in converting short term to long term memories and in learning new information.

A third link between diabetes and dementia has been discovered. For reasons not yet understood adults who have both diabetes and major depression are 2.7 times more likely to develop dementia as adults with diabetes only. This was the finding of a study published in the Journal of General Internal Medicine in March 2010 led by psychiatrist Wayne Keaton, M.D. of the University of Washington who teamed up with the Group Health Research Institute in Seattle and the VA Puget Sound Health Care System.

This finding was not entirely unexpected by medical researchers because diabetes alone and depression alone can both cause dementia. Depression can cause dementia through a number of mechanisms. Depression raises the level of the stress hormone cortisol and too much cortisol can damage and even shrink the hippocampus. Excess cortisol suppresses the human immune system which can allow inflammation of the central nervous system to occur. Depressed people are less likely to exercise, eat healthy or take medication (such as blood pressure or diabetes drugs). They may also increase smoking or drinking of alcoholic beverages.

Lawyers employed by law firms feel pressured to work inhuman hours to make partner or just to protect their job security. Solos and small firm lawyers in charge of their own schedules may work as many or even more hours in order to establish a law practice. Even when a lawyer has “made it,” in the sense that he is a respected, valued member of a practice whose job is safe, it’s rare to see him decrease his work hours to increase his family and leisure time. More often such lawyers continue to work long hours to fund an affluent lifestyle that includes a large house, new cars, dinner out at fancy restaurants, exotic vacations, private schools for the kids, a collection of fine art or fine wine, etc.

In the end each lawyer has to choose what matters more, extra dollars on the one side or his healthspan (the years during which he is in good health with good quality of life) and lifespan. If you stay up late and sacrifice sleep night after night to do legal work or you’re so anxious and wired from working all the time you can’t sleep, you are putting yourself at risk of obesity and metabolic syndrome. Sleep deprivation and an apple shaped belly are connected. Have you developed an apple shaped belly already? Then it’s really time to take notice and start doing something.

What can you do? Clearly you need to start cutting back on the night-time work and increasing your hours of sleep to 6-8 per night. You also need to start exercising. If you’re already overweight it’s easy to say “why bother, it’s too late.” But it really is never too late. A study published in April 2010 in the Journal of Applied Physiology showed that exercise in overweight people counters the effects of weight gain, increases metabolic health and reduces the risk of disease. Tom R. Thomas, professor in the Department of Nutrition and Exercise Physiology in the College of Human Environmental Sciences found that overweight people with metabolic syndrome often regain weight after dieting, but as long as they kept exercising they were able to keep their blood pressure, blood fats and blood sugar in a much healthier zone than peers who stopped exercising when they regained weight.

Alzheimer’s disease and other forms of dementia are marked by the loss of neuronal connections (synapses). The brain has the capacity to secrete a growth substance that helps create new synapses called BDNF (brain-derived neurotrophic factor). It is well known that physical exercise stimulates the fresh release of BDNF. In March 2010 UC Irvine neurobiologists Lulu Chen and Christine Gall published a paper in the Proceedings of the National Academy of Sciences stating that learning triggers the release of BDNF which facilitates the growth of new synapses in the hippocampus which to memory consolidation of new information. This is consistent with the fact that people who pursue lifelong learning retain their mental sharpness and mental health.

So sleep more, exercise more, eat healthier, keep learning, and keep exercising even if you’ve regained weight after dieting. I have a whole chapter on healthy eating in my book The Upward Spiral: Getting Lawyers From Daily Misery To Lifetime Wellbeing. The chapter includes discussion the nutrients and supplements you need to keep your brain healthy as you age.

Click here to purchase The Upward Spiral: Getting Lawyers From Daily Misery To Lifetime Wellbeing by Harvey Hyman

Click here to purchase  audio downloads of  MCLE lectures by Harvey Hyman

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SCIENTISTS CONFIRM THAT EXCESSIVE WORRY SHRINKS YOUR BRAIN

Sunday, May 9th, 2010

While there is no such thing as “the lawyer personality,” many lawyers are tense, moody, irritable and engage in frequent worry at work. Scientific research has now confirmed that personality type affects the tissue volume of key brain structures as we age. It turns out that conscientiousness (a positive quality which can make you a better lawyer and enhance many aspects of your life) preserves brain volume, while neuroticism measurably decreases it as early as middle age. We all know that worrying can’t help you protect the people you care about or solve any problems, but now we know it can shrink your brain as you age. Lawyers who worry all the time need to heed these findings and initiate changes in their attitude before it’s too late.

Personality theory has been around a long time. All of us remember terms like warm, cold, introvert, extrovert, thinking type, intuitive type, and so forth. Over the years different  psychologists proposed different models for human personality. The current thinking is that there are no fixed personality “types,” but rather clusters of personality traits associated with particular behavior patterns which are stable over time. Psychologists also agree that personality traits exist on a continuum, that individuals are a mix of these traits (displaying more of some than others), that traits dispose people to act in certain ways rather than absolutely determine how they will act, and that changing life circumstances can temporarily push certain traits into the foreground and others into the background.

There is some consensus that NIH psychologist Robert McCrae’s Five Factor Model most accurately captures basic differences in enduring personality features. McCrae refers to them as “the five basic ways in which individuals differ in their enduring emotional, interpersonal, experiential, attitudinal and emotional styles.” The five different factors in McCrae’s model are extraversion, agreeableness, conscientiousness, neuroticism and openness.

Extraversion equates with being energetic, enthusiastic, outgoing, talkative, trusting, playful and gregarious. Agreeable people are generous, kind, warm, sympathetic forgiving and altruistic. Conscientiousness equates with being competent, efficient, organized, self-disciplined, orderly, reliable, responsible, dependable and thorough.

People with neuroticism are tense, worried, anxious, thin-skinned, touchy, self-conscious, overly concerned with adequacy, self-pitying, depressed, hostile and self-defeating. Openness equates with being curious, imaginative, insightful, original, having a wide range of interests, valuing feelings, valuing aesthetics, enjoying fantasy and having or accepting unconventional viewpoints.

Personality is related to stress in many ways. On the most fundamental level your personality can make you more prone to the biological effects of stress or it can effectively insulate you from those effects. During the second half of the 20th century stress medicine research showed that stress can have many deleterious effects on animals and humans. These included dwarfism, immune system suppression, mood disorders (anxiety, depression), insomnia, stomach ulcers, and increased rates of diabetes, hypertension, heart attacks and strokes.

In the 1990s neurophysiologist Robert Sapolsky, Ph.D. (author of Why Zebras Don’t Get Ulcers) discovered that unremitting stress on monkeys caused them to suffer significant shrinkage in the tissue volume of a key brain structure called the hippocampus that lies in the medial temporal lobe. The hippocampus is the most important module in the brain for encoding long term memories and a healthy hippocampus is necessary for learning new information.

One way that Dr. Sapolsky induced the stress was by keeping younger, weaker males in constant, close contact with an older, stronger, dominant male who kept tormenting them because they had no means of escape. The younger males became visibly nervous, anxious and withdrawn. When Dr. Sapolsky tried to teach these highly stressed monkeys new tricks for acquiring food he saw that they were learning impaired (which could equate with being too distracted by anxiety to learn or with having a shrunken hippocampus). When he sacrificed them and measured the tissue volume of their hippocampi he determined they had significant shrinkage relative to male monkeys in the control group who had not been continually stressed.

What’s the mechanism? When a monkey’s survival is threatened he goes into a fight-flight response which prompts his hypothalamus to tell his pituitary to tell his adrenal glands to pump out the stress hormones adrenalin and cortisol. While adrenalin is quickly cleared from the system, cortisol is slow to dissipate. If a monkey is subjected too frequently to attacks, or credible threats of attacks, his blood cortisol level remains high.

In high amounts cortisol is neurotoxic. The hippocampus has more cortisol receptors than any other organ in the human body. Normally the hippocampus can tell the pituitary to put the brakes on cortisol production by the adrenal glands, but if it gets overwhelmed by too much cortisol over too long a period it loses its ability to do this. The cortisol build up from continuous stress kills off cells in the hippocampus which gradually shrinks and this leads to poor memory with learning impairment.

On May 19, 2009, Johnathan Jackson (a psychologist),  David A. Balota (a radiologist) and Denise Head (who works in psychology and radiology) at the University of St. Louis published a paper titled Exploring the relationship between personality and regional brain volume in healthy aging in the journal The Neurobiology of Aging. The purpose of their research was to determine what effect, if any, three targeted personality traits (extraversion, conscientiousness and neuroticism) had on brain volume in healthy people as they aged. Virtually all persons have some degree of brain shrinkage as they age. The researchers postulated that personality might correlate with and even causally impact the rate of brain shrinkage as people aged.

The researchers selected 79 cognitively intact adult males and females aged 44-88 who had no history of neurological disease, stroke, head injury, hypertension, drug or alcohol abuse or depression. They had all study participants complete the NEO Five-Factor Inventory, a validated measure of McCrae’s five personality trends. The researchers also had all study participants undergo brain imaging using an MRI with software that performs quantitative volumetric analysis. This means the MRI can identify neuroanatomic structures within each study participant’s brain and measure their volume in cubic centimeters.

The results were rather dramatic. Individuals with neuroticism had smaller cerebral gray matter generally with the most decrease in the ventrolateral prefrontal cortex (VLPFC), the dorsolateral prefrontal cortex (DLPFC) and the orbito-frontal cortex. The hippocampi of these individuals was normal for their age, which reflected the fact that these individuals – although neurotic – had not been subjected to lengthy periods of extreme stress akin to being sexually abused, fighting in a war, and so forth. The individuals who were high in conscientiousness had normal brain volume for their age in their VLPFC and DLPFC but higher than normal brain volume in their orbito-frontal cortex. The individuals high in extraversion had normal brain volume for their age in all three structures. The researchers concluded that personality may not only relate to, but may also moderate, age-related decline in the volume of certain key brain structures.

In plain English what this research indicates is that neurotic people (those who are generally tense, worried, anxious, moody and irritable) have a chronically elevated stress level, with chronically elevated levels of stress hormones, and they pay for it by experiencing accelerated shrinkage of key brain areas in their frontal lobes.

The VLPFC, the DLPFC and the orbito-frontal cortex are all frontal lobe structures that play key roles in “executive functioning.” This refers to the ability to plan behavior in accord with one’s goals, to keep one’s goal in mind in the face of distractions, to monitor one’s behavior for errors in task execution and correct them, to shift one’s attention if circumstances dictate and to complete tasks in a flexible manner in response to changing circumstances. These structures enable us to coordinate our cognitive resources to carry out complex tasks like multi-tasking.

Of the three structures the one that has the most to do with emotions is the orbito-frontal cortex. It’s the orbito-frontal cortex that carries out emotional self-regulation based on our awareness of other people’s expectations and reactions and our sensitivity to social rewards and punishment. People with damage to their orbito-frontal cortex experience problems with inhibiting impulses toward anger, rage, violence and substance use. The most famous example of this was Phinneas Gage, a foreman for the Rutland and  Burlington Railway in Vermont. In 1848 Gage accidentally exploded a dynamite cap which sent a 3 foot seven inch long iron tamping rocketing upward from the ground. It went through his cheek bone below his left eye and continued out the top of the head, piercing his brain and obliterating his orbito-frontal cortex on it’s way.

Prior to the incident Gage was a reliable, dependable employee who never drank, cursed or fought and who served as a leader in his church. Afterwards Gage was often late for work or missed work. He was cantankerous. He cursed and spat at people and got into lots of fistfights. He was fired from his job and kicked out of his church. He ended up in a freak show where he displayed the iron rod. He died of seizures. Remember that Gage is an extreme example, and someone who changed by virtue of severe brain trauma rather than someone who affected his brain on a cellular level by the daily stress of  his own neuroticism while practicing law. Although the researchers in this study did not perform neuropsychological testing on the study participants to see if they manifested impairment of brain functions such as executive functions or emotional  intelligence, one can infer they would have picked it up to varying degrees. Why? Because measurable shrinkage of cerebral gray matter is associated in the medical literature with decline in brain function.

What to do with this information

In Dr. Seuss’ wonderful story How The Grinch Stole Christmas he talks about how the Grinch’s heart shrank from a life of isolation, vengeful thoughts and scowling without kindness, friendship or giving. Can hearts literally shrink from such a life? I don’t know. But it’s clear that our brains can and do shrink in some very important places from spending too much time fussing, fretting, imagining the worst, worrying and handwringing. Genes are predispositions not destiny – the child of a depressed parent or an alcoholic parent can grow up free of depression or alcoholism. Personalities are the same. Personality represents a customary pattern of relating to oneself and one’s world but personality is not fixed and frozen.

A lawyer who tenses up, starts churning out worst case scenarios in his head and begins to fret and worry, whenever he faces an unanticipated challenge or a spot of bad news, can learn to relax, breathe and ground himself. There are a huge variety of techniques including seated meditation, walking meditation, yoga, slow and deep abdominal breathing, taking a walk in the nearest park, the Relaxation Response and the Body Scan that I have talked about in my book The Upward Spiral and in other blog articles, which can break the circuit between experiencing difficulty and automatically going into fight-flight. If you have a tendency toward neuroticism (from genes, your upraising or both), I strongly encourage you to begin using these techniques to overcome stress and keep your mind from being a stress factory which can literally shrink your brain.

The fewer brain cells you have as you age the greater your risk of dementia and the more prone you are to become disabled by a stroke or concussion from a fall. Stress reduction is important for all of us who want to stay healthy, active and mentally sharp our whole lives. For those of us in whom neuroticism is their dominant personality trend, stress reduction is absolutely crucial to prevent brain shrinkage and impairment of brain function. Although it’s never too late to start life long habits of stress reduction, you’re better off starting them in your forties than in your sixties or seventies when neuroticism may have done some irreversible damage. Many is the lawyer who changes the oil of his car every 3,000 miles but who doesn’t pay much attention to what’s under his own hood. For your health and wellbeing as you age, please remember to take good care of your brain by managing your stress.

Meditation, smiling and laughter have all been clinically proven to reduce blood cortisol. Meditation has been proven, through the use of volumetric brain MRI studies on Buddhist monks, to increase the thickness of the cerebral cortex, in particular frontal lobe structures dedicated to concentration and the insula (which enables us to have empathy for others). Please consider meditating everyday. It’s good for your brain and good for your life.

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