In the last issue we discussed excessive medical testing. Now a new study finds that “Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves.”[1] They prefer to forego treatments that may yield longer but poor quality of life, while recommending those very treatments to their patients so that they are not sued. Who can blame them, given the litigious nature of our society? Besides, patients are “educated” to expect the newest and most high tech treatments available; they may not be happy if their medical problems don’t respond to “lesser” interventions. These and many other socioeconomic and political pressures make potential solutions to excessive testing and prescribing difficult to implement.
But, there is always “good communication” between patients and doctors. Mature individuals may discuss these issues and come to an agreement on how best to proceed when facing difficult health problems. For instance, less expensive, less aggressive and wiser care may be given by Hospice care in the dawn of our lives. My home state Utah is #1 in people passing away under their care than at a hospital.[2]
If doctors and patients were to listen to each other’s views, which are influenced by socioeconomic factors, I believe that minimal testing and cheaper treatments would prevail, especially if there is an understanding that failure to reach health goals is not to be taken as “a mistake.” Discussing quality of life issues vs. aggressive therapies may free doctors to recommend the interventions they would choose for themselves. After all, there is a big difference between “healing,” or learning to live with a chronic disease, and “curing.” The latter, while sometimes possible, is rife with empty promises designed to drive profits.
~ Hugo Rodier, MD
Headaches, the tip of the iceberg?
We have known for a while that migraines are associated with a higher risk of strokes. A new study tells us why: migraines may sometimes be due to microscopic little clots that block optimal circulation to the brain.[3] Reading this may give you a headache, but hopefully this will motivate you to make changes that will clean up your arteries; don’t be satisfied with only expensive drugs that merely treat the symptoms of headaches, not the source.
While the causes of headaches are legion (neck problems, sinus congestion, stress, etc,) the most common factors are the same that lead to arterial and circulation problems, as this study indicates. A better approach involves improveing circulation by changing our diets (less saturated fats and refined sugars), and improving gut function (see last blog)[4] to optimize brain-gut connection. We could also supplement nutrients like arginine (amino acid), tryptophan (amino acid to synthesize serotonin,) vitamin B, K and D, curcumin (herb,) Coq10 (antioxidant for mitochondria,) and, if you still have some money left, antioxidants to reduce insulin resistance, like alpha lipoid acid from broccoli and resveratrol from grapes.
You may avoid drugs that curtail the absorption of those vital nutrients, like the purple pill for heartburn. It has been associated with lower levels of B vitamins that are indispensable for the synthesis of neurotransmitters. Prilosec-like drugs also curtail the absorption of magnesium, which has been associated with not only headaches, but seizures, tremors, muscle spasms and even heart problems.[5] If you are tempted to use Ibuprofen-like drugs, you need to be aware that they have been shown to have a rebound effect and to increase 2-4 times the risk of circulation problems, besides increasing blood pressure which may lead to headaches. These drugs also affect the brain directly.[6]
Brain and food update
We have already reported that our national obesity problem must be viewed as an addiction to bad foods.[7]
The Journal Family Practice News recently commented on this problem by digging up studies from years gone by that corroborate the addicting nature of refined foods.[8] For example, doctors from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism determined that there are “Overlapping neuronal circuits in addiction and obesity:”
Drugs and food exert their reinforcing effects in part by increasing dopamine (DA) in limbic regions, which has generated interest in understanding how drug abuse/addiction relates to obesity. Here, we integrate findings from positron emission tomography imaging studies on DA’s role in drug abuse/addiction and in obesity and propose a common model for these two conditions. Both in abuse/addiction and in obesity, there is an enhanced value of one type of reinforcer (drugs and food, respectively) at the expense of other reinforcers, which is a consequence of conditioned learning and resetting of reward thresholds secondary to repeated stimulation by drugs (abuse/addiction) and by large quantities of palatable food (obesity) in vulnerable individuals (i.e. genetic factors). In this model, during exposure to the reinforcer or to conditioned cues, the expected reward (processed by memory circuits) overactivates the reward and motivation circuits while inhibiting the cognitive control circuit, resulting in an inability to inhibit the drive to consume the drug or food despite attempts to do so. These neuronal circuits, which are modulated by DA, interact with one another so that disruption in one circuit can be buffered by another, which highlights the need of multiprong approaches in the treatment of addiction and obesity.”[9]
Doctors have also shown that a “Sensitivity to rewards [is] associated with high sugar food choices,”[10] and that “Both drug addiction and food addiction [are] associated with stress, reward systems, motivation, learning, inhibitory control, emotional regulation and decision making.”[11]
Despite this evidence, mainstream doctors only recommend a “balanced diet, and measure the BMI.” While dietitians go further (“eat more fruits and veggies, more fiber and refined foods in moderation,”) they still resist the troubling reality that we cannot curve our obesity epidemic unless we approach our patients as we do a drug addiction. Harsh, I know, but have you not seen the results of our efforts so far? “We are in trouble. Effective strategies for preventing and treating obesity require a commitment to addressing its causes and consequences at multiple levels-from basic research through community and policy interventions.”[12]
We cannot afford ignoring the stunning implications of “basic research” associating behavior and neurologic issues with obesity.[13] For example, childhood trauma has consistently been associated with more obesity issues in adults:
“Large effects are found due to childhood psychological problems on the ability of affected children to work and earn as adults and on intergenerational and within-generation social mobility. Adult family incomes are reduced by 28% by age 50 y, with sustained impacts on labor supply, marriage stability, and the conscientiousness and agreeableness components of the “Big Five” personality traits. Effects of psychological health disorders during childhood are far more important over a lifetime than physical health problems.”
Abuse may affect not only our adrenal glands, but also its connections to metabolism, both in the gut and the brain,[14] which may be malfunctioning BI-RECTIONALLY in obese patients:
“Microbial colonization of mammals is an evolution-driven process that modulate host physiology, many of which are associated with immunity and nutrient intake. Here, we report that colonization by gut microbiota impacts mammalian brain development and subsequent adult behavior. Hence, our results suggest that the microbial colonization process initiates signaling mechanisms that affect neuronal circuits involved in motor control and anxiety behavior.”[15]
“Bi-directionally” means that the gut and brain are influencing each other. This is why the more compromised our gut metabolism is the more depression[16] and cognitive decline[17] we see as we age. Of course, bad foods high in sugar and fat and lacking in fiber compromise our microbiota in the gut, which are in charge of metabolizing what we eat.[18] If disturbed by bad food, our gut organisms may even mess up our internal clock which may lead to insomnia.[19]
Telegraphed articles on the brain
Heavy smoking in midlife increases the risk of Alzheimer’s and vascular Dementia.” [20]
Long term antipsychotic treatment reduces brain volumes in first episode schizophrenia.[21]
Antidepressants increase risk of strokes;[22] so does Salt intake over 1.5 grams.[23]
Magnesium Sulfate before pre term birth reduces risk of cerebral palsy.[24
Early abnormalities in EEG may augur autism.[25]
Omega 3 oils alleviate depression.[26]
Smoking increases risk of Lou Gehrig’s disease.[27]
[1] J. Arch Intern Med 2011;171(7):630
[2] Sal Lake Tribune 4/12/2011
[3] “Blood vessel Microemboli, an Emerging Link Between Migraine and Stroke,” J. Neurol RevApril 2011, page 1
[4] “Cardiovascular Disease: The diet-microbe morbid union,” Journal Nature, April 2011;472:40
[5] Medical Letter 2011April 4th
[6] “Use of Ibuprofen and the Risk of Parkinson’s Disease,” J. Neurology 2011;76:863
[7] “The Emerging Link Between Alcoholism Risk and Obesity,” J. Arch Gen Psychiatry 2010;67(12):1301
[8] “Alcoholism, Gender and Obesity: intriguing links.” J. Family Practice Review, March15th 2011, page 8
[9] Abstract J. Philosophical Transactions of the Royal Society of London, October 13th 2008 doi:10.1098/rstb.0107
[10] J. Appetite 2007;48:12
[11] J. Nat. Neuroscience 2005;8:555
[12] “Obesity Prevalence in the United States,” New England J. of Medicine 2011;364:987
[13] “Low-Grade Hypothalamic Inflammation Leads to Defective Thermogenesis, Insulin Resistance, and Impaired Insulin Secretion,” J Clin Endocrinol Metab 2011:96: 869
[14] “Abuse, Trauma, and GI Illness: Is There a Link?” Am J Gastroenterol 2011;106: 14
[15] “Normal gut microbiota modulates brain development and behavior.” Accepted by the Editorial Board of J. Proceedings of the National Academy of Science, January 4, 2011
[16]” Metabolic Syndrome and Onset of Depressive Symptoms in the Elderly,” J. Diabetes Care April 2011:34:9
[17] “Metabolic Syndrome and Cognitive Decline,” J. Neurol 2011;76:518
[18] “Girth and the Gut (Bacteria),” J. Science 1 April 2011: 32-33
[19] “How Food Governs Circadian Behaviors,” PNAS March 29th 2011 Epub
[20] J. Arch of Int Med 2011;171:333
[21] J. Arch Gen Psychiatry 2011;68(2):128
[22] American J. Psy 2011, March online
[23] J. Neurology Reviews, March 2001, p1
[24] J. Neurology Reviews, March 2001, p13
[25] J. BCM Medicine On line Feb 22, 2011
[26]J. Neurology Reviews, March 2001, p9
[27] J. Arch Neurology 2011;68:207
