Why all the anger?

One of the latest vaccination memes to go viral on social media is an article by Arizona “paleo-cardiologist”, Dr Jack Wolfson.

Dr Wolfson did an interview with one of his local TV stations in January, during which he gave his opinion about the outbreak of measles centred around Disneyland.

He said, “We should be getting measles, mumps, rubella, chicken pox, these are the rights of our children to get it. We do not need to inject chemicals into ourselves and into our children in order to boost our immune system. I’m a big fan of what’s called paleo-nutrition, so our children eat foods that our ancestors have been eating for millions of years. That’s the best way to protect.” (http://www.azcentral.com/story/news/12-news/2015/01/23/12news-doctor-dont-vaccinate/22200535/)

His follow up article, the one going viral, is titled, “Why All the Anger?” Uh … how about because you’re a douche?

Let’s start by looking at his comments in January on Arizona’s Channel 12 News:

  1. “We should be getting measles, mumps, rubella, chicken pox, these are the rights of our children to get it”.
    Or in other words, by stopping our children getting sick, we’re depriving them of their rights. That’s a patently stupid statement. Our children have a right to expect care. We give them shelter, protection, education and good nutrition so that their lives can flourish. Vaccinations are part of that care. Sure, there are side effects of vaccines, but they are nothing compared to the abject cruelty of the diseases they prevent.
  1. “We do not need to inject chemicals into ourselves and into our children in order to boost our immune system.”
    Our immune systems do an amazing job at keeping us alive. Our immune systems will eventually fight off measles, chicken pox, or any other number of pathogens, but vaccines stop the “collateral damage”, the children who are overwhelmed by the full-blown infection and die, or are permanently disabled by it. Even for the children that come through ‘unscathed’ (i.e. not dead), illnesses like measles inflict weeks of suffering with high fevers, aching joints and muscles, severe fatigue, and any other number of symptoms, then there are the ongoing illnesses like shingles and the associated severe chronic nerve pain from viruses like chickenpox, all of which can be prevented by routine childhood vaccinations.
  1. “I’m a big fan of what’s called paleo-nutrition, so our children eat foods that our ancestors have been eating for millions of years. That’s the best way to protect.”
    Really? The Palaeolithic population were hunter-gatherers, and we know that the mortality of hunter-gatherer children is in the order of 40% (http://cast.uark.edu/local/icaes/conferences/wburg/posters/sara_stinson/stinson.html). That’s not what I would call ‘protective’. Besides, palaeontologists have shown that the food promoted as ‘paleo’ is nothing like the food that our ancestors ate (https://www.youtube.com/watch?v=BMOjVYgYaG8) so paleo-nutrition is just another baseless fad.

I’m guessing that the response he received after publically sharing his heterodox views wasn’t particularly favourable. In reply, he offered this article, which is the article now going viral on social media (http://healthimpactnews.com/2015/arizona-cardiologist-responds-to-critics-regarding-measles-and-vaccines/).

It seems to me like he has unsuccessfully tried to dig himself out of his own grave. Sure, those people who are also currently drinking the antivaccine-paleo Kool-Aid will take his side and point to this brave martyr standing up to the establishment, but ultimately his come-back is nothing more than diversionary blame-shifting.

Here’s what he had to say about who the real enemies are:

“1. Be angry at food companies. Sugar cereals, donuts, cookies, and cupcakes lead to millions of deaths per year. At its worst, chicken pox killed 100 people per year. If those chicken pox people didn’t eat cereal and donuts, they may still be alive. Call up Nabisco and Kellogg’s and complain. Protest their products. Send THEM hate-mail.
2. Be angry at fast food restaurants. Tortured meat burgers, pesticide fries, and hormone milkshakes are the problem. The problem is not Hepatitis B which is a virus contracted by drug users and those who sleep with prostitutes. And you want to inject that vaccine into your newborn?
3. Be angry at the companies who make your toxic laundry detergent, fabric softener, and dryer sheets. You and your children are wearing and breathing known carcinogens (they cause cancer). Call Bounce and Downy and let them know. These products kill more people than mumps, a virus which actually doesn’t cause anyone to die. Same with hepatitis A, a watery diarrhea.
4. Be angry at all the companies spewing pollution into our environment. These chemicals and heavy metals are known to cause autism, heart disease, cancer, autoimmune disease and every other health problem. Worldwide, these lead to 10’s of millions of deaths every year. Measles deaths are a tiny fraction compared to pollution.
5. Be angry at your parents for not breastfeeding you, co-sleeping with you, and stuffing your face with Domino’s so they can buy more Tide and finish the laundry. Breastfeeding protects your children from many infectious diseases.
6. Be angry with your doctor for being close-minded and not disclosing the ingredients in vaccines (not that they read the package insert anyway). They should tell you about the aluminum, mercury, formaldehyde, aborted fetal tissue, animal proteins, polysorbate 80, antibiotics, and other chemicals in the shots. According to the Environmental Working Group, newborns contain over 200 chemicals as detected by cord blood. Maybe your doctor feels a few more chemicals injected into your child won’t be a big deal.
7. Be angry with the cable companies and TV manufacturers for making you and your children fat and lazy, not wanting to exercise or play outside. Lack of exercise kills millions more than polio. Where are all those 80 year olds crippled by polio? I can’t seem to find many.
8. In fact, be angry with Steve Jobs and Bill Gates for creating computers so you can sit around all day blasted with electromagnetic radiation reading posts like this.
9.Be angry with pharmaceutical companies for allowing us to believe living the above life can be treated with drugs. Correctly prescribed drugs kill thousands of people per year. The flu kills just about no one. The vaccine never works.

Finally, be angry with yourself for not opening your eyes to the snow job and brainwashing which have taken over your mind. You NEVER asked the doctor any questions. You NEVER asked what is in the vaccines. You NEVER learned about these benign infections.

Let’s face it, you don’t really give a crap what your children eat. You don’t care about chemicals in their life. You don’t care if they sit around all day watching the TV or playing video games.

All you care about is drinking your Starbuck’s, your next plastic surgery, your next cocktail, your next affair, and your next sugar fix!”

Yes, it’s all your fault. You’re all too selfish to see how you’ve been conned by centuries of scientific evidence, and that only those who follow the doctrines of paleo-nutrition are truly enlightened.

It would be funny if it wasn’t so serious. This so-called man of science would have us believe that measles, chickenpox, diphtheria, polio and other vaccine preventable diseases are benign. Tell that to the 2.5 million children who die every year from vaccine-preventable diseases around the world (De Cock, Simone, Davison, & Slutsker, 2013).

“At its worst, chicken pox killed 100 people per year.” According to the CDC, his figure is correct – the average number of deaths from chickenpox from 1990-1996 was about 103 per year in the USA though he failed to mention the 11,000 hospitalisations per year caused by chickenpox (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/varicella.pdf). Measles, on the other hand, kills two people for every thousand that are infected by it (http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#complications). The 2013 US road toll was 0.107/1000 (http://www.cdc.gov/nchs/fastats/accidental-injury.htm), making measles 18 times more deadly than road transportation.

“Where are all those 80 year olds crippled by polio? I can’t seem to find many.” Well, it’s hard to find anything when you’re closed minded. Polio caused paralysis in about 1 in 100 cases, and death in up to 30% of those (http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html). Again, those figures are worse than the road toll.

“Be angry with your doctor for being close-minded and not disclosing the ingredients in vaccines (not that they read the package insert anyway). They should tell you about the aluminum, mercury, formaldehyde, aborted fetal tissue, animal proteins, polysorbate 80, antibiotics, and other chemicals in the shots”. Guess what, your doctor doesn’t tell you about aluminum, mercury, formaldehyde, aborted fetal tissue, animal proteins, polysorbate 80, antibiotics etc in vaccines because they’re either not there, or they’re there in amounts so tiny that you would have a greater exposure to them by simply eating. For example, Thiomersal (which contained mercury) has been removed from childhood vaccines since the year 2000 as a precautionary measure, even though there was never any evidence it caused any harm. Aluminium from vaccines is lower than everyday exposure from intake from diet or medications, such as antacids, and is well below the levels recommended by organisations such as the United States Agency for Toxic Substances and Disease Registry. And there is no aborted foetal tissue in vaccines (http://www.health.gov.au/internet/immunise/publishing.nsf/content/uci-myths-guideprov)

And the rest … more of the usual rhetoric of the paleo-minded – sugar, “tortured meat” burgers, “pesticide” fries, and “hormone” milkshakes, laundry detergent, pollutants that “cause autism, heart disease, cancer, autoimmune disease and every other health problem”, computers that bombard you with electromagnetic radiation … he even goes a little Freudian by blaming mothers for not breast feeding and co-sleeping enough. It’s all a bit of a stretch.

So why all the anger? Maybe it has something to do with the fact that people are sick and tired of so-called experts trying to debase solid science with some tarted up pseudoscientific fad. The public know more than what most snake-oil salesmen think they do, and they’re sick of being treated like idiots. People know that immunisation works, and trying to sell the idea that ‘paleo-nutrition’ is better than vaccination just makes you look like a douche.

References

De Cock, K. M., Simone, P. M., Davison, V., & Slutsker, L. (2013). The new global health. Emerg Infect Dis, 19(8), 1192-1197. doi: 10.3201/eid1908.130121

Scars

I’ve spent a lot of time in trees.

When I grew up, there was no such thing as video games. In those days, we were lucky to have a colour TV and four channels, but watching it was a privilege. Instead, I would usually be outside, bare foot and naive, exploring the creek behind my house and the thin ribbon of bushland that guarded it, or climbing the tree in my backyard, or picking up sticks from the ground and using them as weapons so I could fight off pretend villains like the superheroes I aspired to.

Eventually I discovered cricket and learnt to ride my bike, which changed my outdoor pass times. If I wasn’t practising my cricket skills, I would ride for hours on the footpaths and bikeways that criss-crossed my neighbourhood. There were no bike helmets in those days, and still no shoes. It was an innocent time.

My adventurous spirit and lack of protective equipment invariably resulted in injuries. Once when playing with a stick in the front yard, I somehow managed to dig the sharp end into my right leg, gouging a chunk out of my lower thigh. A few years later when riding my bike, the handlebars of my BMX came loose and trapped my legs so I was unable to peddle. It also stopped me from using the footbrake and steering properly, and there was nowhere else for me to go except into a pole next to a low concrete bridge over the creek, and then over the handlebars and onto a causeway which was covered in large rocks and debris. Amongst the injuries sustained was a large graze to my elbow, which my teenage sister helped tend and dress for me. Unfortunately no one had taught her that the dressing needed to go cotton side up, not onto the wound. A few days later, the scab had to be torn off to remove the dressing.

Several decades later, I would also find myself being thrown off a bike, but this time after a man driving a 4-Wheel Drive didn’t notice that I was riding on the footpath and kept coming out of the driveway he was in. Thankfully this time I was wearing shoes and a helmet, though it still didn’t help much when face smacked into the bitumen after bouncing of his windscreen and sprawling five metres through the air. I wasn’t that beautiful to start with, so my bitumen face didn’t matter too much and the scars eventually healed. But three weeks later when I couldn’t move my arm properly, I suspected that there was something wrong and the MRI showed a fracture of the head of my left radius (bone near my elbow).

The common link in each of my war stories was the eventual outcome – scars. I’ve now got a collection of scars ranging from small to obvious, internal and external. Scars are an interesting though rarely considered part of our normal function. Our body faces assault in various forms all the time. Usually we’re able to stop infections before they take hold. Sometimes, an infection or injury will still get the better of us, but our body will be able to heal our tissues completely, fully restoring our function and appearance as if nothing ever happened. Sometimes, there’s just too much damage, and our body has to do the best it can. It has to fill in the gap left by the irreparable tissue to maximise the structure and function of that tissue. To do that, it uses a scar.

Microscopically, scar tissue is made up of collagen, a dense fibrous tissue that’s also found in tendons. When a breach in the tissue occurs, there are three distinct phases that are followed to create a scar: the inflammatory phase, the fibroplastic phase, and the remodelling phase. The boring, intricate scientific details don’t matter for this essay, but essentially the phases are needed for cleaning up the debris, laying the scaffolding, and reinforcing the scar.

What’s more interesting are some other characteristics of scars that we don’t often appreciate. Firstly, scars hurt. Ok, so that sounds obvious … it always hurts when the injury first happens. The inflammatory phase is the time that a wound hurts the most, but in physiological terms, this phase only lasts about 48 hours. As time goes on, the scar hurts less and less, and in most scars, the pain eventually goes away completely. However, there are a few scars that are still sensitive when touched, sometimes for years.

Some people have a tendency to form bigger scars than others. This is called keloid scarring, and is a process of excessive inflammation of the forming scar tissue which causes too much collagen to be laid down. Keloid scars can be large, itchy and painful. Keloid scarring is thought to have a genetic component to it.

Even if you’re lucky to avoid keloid scarring, scars are usually considered ugly and unwanted. Maybe it’s because they’re associated with pain, or they ruin our otherwise perfect skin. Either way, many people don’t like their scars.

Scars are also weaker than normal tissue, though not by much. By the time a wound has completely healed, the scar strength is about 98% of that of the normal tissue.

Sometimes we’re afraid of getting scars, probably for the same reasons I’ve described. Doing things that are risky might lead to getting hurt, and those scars are a permanent reminder of how we not only failed but also how we hurt ourselves in the process.

Although, I think we have the wrong ideas about scarring. Sure, sometimes scars can be ugly, or painful, or weak. But scars can also tell us a lot about ourselves if we’re willing to look past the superficial and see what they really represent.

Scars can show our bravery to others, remind us of our courage, help us learn from our mistakes, and remember our successes. They can enable empathy, and remind us of our vulnerability and our humanity. They prove that we’ve overcome adversity. Altogether, they tell us our history.

When I see my scars, I remember how I should be careful with sharp objects, or to dress wounds carefully, or to watch out for 4-Wheel Drives. The caesarean scar on my wife’s abdomen reminds me of the mix of fear and joy at the birth of my two children. My scars help me to remember what others are going through in their journey. They remind me that I’m not invincible. When I ask my patients about their scars, they often tell me of how they overcame desperate illness and survived.

At Easter time, we often focus on the power of the resurrection, and so we should. Through the resurrection, we have the opportunity to embrace eternal life with a loving God, who sacrificed his own son to give us that chance.

But one thing that always intrigued me about the Easter story was that after Jesus was resurrected, in his glorious new body, he still bore the scars of the crucifixion. John gives a clear account in the gospel of John 20:24-27, “Now Thomas (also known as Didymus), one of the Twelve, was not with the disciples when Jesus came. So the other disciples told him, ‘We have seen the Lord!’ But he said to them, ‘Unless I see the nail marks in his hands and put my finger where the nails were, and put my hand into his side, I will not believe.’ A week later his disciples were in the house again, and Thomas was with them. Though the doors were locked, Jesus came and stood among them and said, ‘Peace be with you!’ Then he said to Thomas, ‘Put your finger here; see my hands. Reach out your hand and put it into my side. Stop doubting and believe.’”

Before I fully understood the significance of this verse, I had assumed that Jesus’s resurrected body was supernaturally perfect. He had just experienced the power of the resurrection after all. It sort of threw me when I realised that Jesus’s supernatural body was still scarred. And if scars are considered ugly, painful and weak, then it doesn’t seem to make sense.

I’ve come to realise that God knew exactly what he was doing. Those scars on Jesus’s hands, feet and side demonstrate that he gave up his deity to embrace humanity. They show his amazing sacrifice by taking our place on the cross. They prove that that he overcame the power of sin and death. They will remind us of his amazing love for us for the rest of eternity.

Yes, our scars seem ugly, painful and weak on the outside, but they are signs of our struggles, our strength, our victories – things that we have learnt from, and things that we can be proud of.

Scars aren’t a sign of weakness, but of our humanity. Scars are evidence that we’ve overcome adversity, that we are strong. Scars are a permanent reminder of the gift of God to man. Scars are nothing to be ashamed of.

Don’t look at your scars as a sign of weakness and shame, but instead, see your strengths through the story of your scars.

Bibliography

Gauglitz, G. G., Korting, H. C., Pavicic, T., Ruzicka, T., & Jeschke, M. G. (2011). Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med, 17(1-2), 113-125. doi: 10.2119/molmed.2009.00153

Hardy, M. A. (1989). The biology of scar formation. Phys Ther, 69(12), 1014-1024.

Dr Caroline Leaf – Scientific heresy

Screen Shot 2015-03-30 at 7.54.04 pm

Imagine that this Easter, the guest speaker at your church stands up from the pulpit and calmly mentions during the sermon that Jesus wasn’t really buried in a tomb, but was kept by his disciples in a house until he recovered enough from his wounds to go on his merry way.

What would you think of that speaker? Would you smile and nod, or even shout an ‘amen!’, buy their book, and encourage your pastor that they should be invited back again?

One would hope that there would be a polite but resounding outcry. Even if the rest of the message was perfect, you wouldn’t want someone to come back to your pulpit if they couldn’t get the basics of their subject right, even if they were considered a popular speaker or self-declared expert.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. Dr Leaf preaches every day from both physical pulpits all over the globe, and a virtual pulpit through the power of Instagram and Facebook.

Dr Leaf used her position of social media prominence today to share this little jewel, “The brain cannot change itself; you, with your love power and sound mind, change your brain.”

Um … that’s not true … at all … in any way.

For a start, the most prolific period for brain development is actually pre-birth, and then the first year of life. But foetal brains don’t have their own thoughts. It’s not like the movie “Look Who’s Talking” inside the average uterus. The brain of an unborn baby is growing and changing at an exponential rate without any thoughts to guide them [1].

Screen Shot 2015-03-30 at 9.32.16 pm

Number of synapses per constant volume of tissue as a function of pre- and postnatal age. (Stiles, J. and Jernigan, T.L., The basics of brain development. Neuropsychol Rev, 2010. 20(4): 327-48 doi: 10.1007/s11065-010-9148-4)

 

In our adult years, our brain still continues to develop. But that development isn’t dependant on our thought life. Significant consolidation of our brain’s neural pathways occur when we’re asleep [2], but our thought life isn’t active during sleep.

Model of sleep stage-specific potentiation and homeostatic scaling. Gronli, J., et al., Sleep and protein synthesis-dependent synaptic plasticity: impacts of sleep loss and stress. Front Behav Neurosci, 2013. 7: 224 doi: 10.3389/fnbeh.2013.00224

Model of sleep stage-specific potentiation and homeostatic scaling. (Gronli, J., et al., Sleep and protein synthesis-dependent synaptic plasticity: impacts of sleep loss and stress. Front Behav Neurosci, 2013. 7: 224 doi: 10.3389/fnbeh.2013.00224)

Indeed, real cognitive neuroscientists have shown that our stream of thought is simply a tiny fraction of our overall neural activity, a conscious glimpse of the brains overall function [3-5]. So you don’t change your brain at all. “You” can’t, because it’s your brain’s directed activity which causes the growth of new synaptic branches to support it, all of which is subconscious.

Therefore, suggesting that our brain can only change with our conscious control is patently false, and so clearly against the most fundamental principles of neuroscience that such a claim is the neuroscientific equivalent of saying that Jesus didn’t die on the cross, he just swooned.

Dr Leaf has committed scientific heresy.

At this point, supporters of Dr Leaf often suggest that she wasn’t speaking literally, but metaphorically. She didn’t really mean that the brain can’t change itself, just that our choices are really important.

Somehow I doubt that. Dr Leaf wasn’t being metaphorical when she claimed that her patients in her research projects grew their intelligence when they “applied their minds”:
“Now with a traumatic brain injury, basically IQ generally goes down around twenty points because of the kind of damage with traumatic brain injury. Well her IQ was 100 before the accident, it was 120 after the accident. So here with holes in her brain, and brain damage, she changed … she actually increased her intelligence. Now I’m pretty convinced at this stage, cause I’ve been working … besides her I’ve been working with lots and lots of other patients, seeing the same thing, when these students applied their mind, their brain was changing, their academic results were changing.” [6]

Dr Leaf believes that your mind can literally change your brain. It was the subject of her entire TEDx talk in February.

It sounds innocent enough until you consider the broader implications of this way of thinking – those with brain damage haven’t recovered fully because they just haven’t applied their minds enough. The same for those with learning disabilities or autism, ADHD, Downs syndrome, cerebral palsy, dyslexia, or any other neurological disorder … because you only need to “apply your minds” to change your brain. “You have a powerful mind. You have a sound mind. You have a mind that is able to … to achieve what you’re dreams are. You are as intelligent as you want to be.” [6]

Or, in other words, don’t blame it on your brain if you’re intellectually disabled, mentally ill, or vacuous. You simply haven’t applied your brain well enough. Stop sitting around and think better.

As a church, we can, and should, be doing a lot better for those amongst us who suffer from neurological and mental disorders. It starts by being more judicious with who is allowed at that privileged position of the pulpit. We need to be eliminating scientific heresy from the pulpit, not clapping and shouting ‘amen!’

References

  1. Stiles, J. and Jernigan, T.L., The basics of brain development. Neuropsychol Rev, 2010. 20(4): 327-48 doi: 10.1007/s11065-010-9148-4
  2. Gronli, J., et al., Sleep and protein synthesis-dependent synaptic plasticity: impacts of sleep loss and stress. Front Behav Neurosci, 2013. 7: 224 doi: 10.3389/fnbeh.2013.00224
  3. Baars, B.J., Global workspace theory of consciousness: toward a cognitive neuroscience of human experience. Progress in brain research, 2005. 150: 45-53
  4. Baars, B.J. and Franklin, S., An architectural model of conscious and unconscious brain functions: Global Workspace Theory and IDA. Neural Netw, 2007. 20(9): 955-61 doi: 10.1016/j.neunet.2007.09.013
  5. Franklin, S., et al., Conceptual Commitments of the LIDA Model of Cognition. Journal of Artificial General Intelligence, 2013. 4(2): 1-22
  6. Leaf, C.M., Ridiculous | TEDx Oaks Christian School | 4 Feb 2015, 2015 TEDx, 20:03. https://http://www.youtube.com/watch?v=yjhANyrKpv8

The TEDx Users Guide to Dr Caroline Leaf

On the 4th of February 2015, Dr Caroline Leaf gave her debut TED presentation, at TEDx Oakes Christian School, California.

Most TED watchers wouldn’t have heard of her before, but Caroline Leaf is a well-known name in western Christendom. She has spoken from pulpits on every continent. She’s authored one of the best selling books in the Christian market and has her own TV show on cable in the US. She’s followed by more than one hundred thousand people on Facebook, and she’s even run her own conference, with another in the pipeline. She’s a mega-star in the Christian world.

So who is this woman with the stiletto-heels and slick presentation? What was her training and background? How did she make it to the TEDx stage?

This aim of this post is to provide some context and background for those in the TED universe who have seen Dr Leaf’s TEDx presentation, and want some more information in assessing her TEDx debut, and indeed, the global Caroline Leaf phenomenon.

This review will be in four main parts: first I will give some basic information on Dr Leaf, I will compare Dr Leaf’s claims in her TEDx presentation to her published research results and some basic neuroscience, and lastly I’ll outline Dr Leaf’s general work and it’s accuracy compared to current science.

  1. WHO IS DR LEAF?

Dr Caroline Leaf was born and raised in South Africa, where she completed her school education and went on to attain the following degrees:

  1. Bachelors of Science (Logopaedics) – University of Cape Town 1985
  2. Masters in Audiology and Speech Pathology – University of Pretoria 1990
  3. Doctor Philosophiae (Communication Pathology) – University of Pretoria 1997 (http://drleaf.com/assets/files/DrCarolineLeaf_CurriculumVitae1.pdf)

Officially, Dr Leaf is qualified as a communication pathologist (which is a specialized combination of Speech Pathology and Audiology – see also: http://www.hpcsa.co.za/Uploads/editor/UserFiles/downloads/speech/slh_education_training_insitutions.pdf)

Dr Leaf worked for a number of clinics and school boards as a communication pathologist in the few years following the completion of her PhD (http://drleaf.com/assets/files/DrCarolineLeaf_CurriculumVitae1.pdf).

Dr Leaf has written a number of articles for publication in minor journals (see http://drleaf.com/assets/files/DrCarolineLeaf_CurriculumVitae1.pdf). Three of her papers were published in a small Medline indexed journal, “The South African Journal of Communication Disorders”. These are:

  1. “Mind-Mapping approach (MMA): a culture and language “free” technique”, 1993 (http://www.ncbi.nlm.nih.gov/pubmed/8047932)
  2. “The development of a model for geodesic learning: the geodesic information processing model”, 1997 (http://www.ncbi.nlm.nih.gov/pubmed/9819969)
  3. “An alternative non-traditional approach to learning: the metacognitive-mapping approach”, 1998 (http://www.ncbi.nlm.nih.gov/pubmed/10472179)

The journal happened to be edited by her supervisor and co-author, Dr Brenda Louw (see http://www.debunkingdrleaf.com/goodies), though I’m sure the selection of her articles for this journal was purely on merit.

Dr Leaf states on a number of occasions that she is a “cognitive neuroscientist”, and “a scientific and Biblical expert in the power of the human mind”.Leaf Cognitive NeuroscientistAbout Dr Leaf

This is despite the fact that Dr Leaf:

  1. does not have formal qualifications in neuroscience,
  2. has not worked at a university as a neuroscientist,
  3. has not worked in any neuroscience research labs,
  4. has not published any papers in neuroscience journals, and
  5. has not had any formal theological training.

Given the weight of evidence, Dr Leaf would be better described as an academic speech pathologist and lay preacher rather than a cognitive neuroscientist.

  1. DR LEAF’S RESEARCH RESULTS

Throughout her TEDx presentation, Dr Leaf repeatedly made reference to the results of her own research, suggesting that her pioneering work resulted in radically improved outcomes for the students involved in her research, and that her work with students one-on-one and through teacher education profoundly changed the learning of every student in her various programs.

For example, she said, “Well her IQ was 100 before the accident, it was 120 after the accident. So here with holes in her brain, and brain damage, she changed … she actually increased her intelligence. Now I’m pretty convinced at this stage, cause I’ve been working … besides her I’ve been working with lots and lots of other patients, seeing the same thing, when these students applied their mind, their brain was changing, their academic results were changing.”

Later she stated, “I wasn’t sure if this was going to have the same impact cause until this point I’d been working one on one. Well I’m happy to tell you that we had the same kind of results … The minute that the teachers actually started applying the techniques, we altered the trend significantly.”

And also, “I stand up here saying this with conviction because I have seen this over and over and over in so many different circumstances … in this country I worked in Dallas for three years in charter schools, and we found the same thing happening.”

However, her published results differ significantly from her claims.

The first research that Dr Leaf spoke of was of the sixteen-year-old girl who was the victim of a motor vehicle accident. This particular girl was Dr Leaf’s prime patient. The case study of this patient was presented in Dr Leaf’s unpublished Masters thesis, and was discussed in more detail in Dr Leaf’s paper, “Mind-Mapping approach (MMA): a culture and language “free” technique” [1], though it should be noted that no statistics were published in this paper, and on the third page of the article, Dr Leaf admitted that the result could actually have been spontaneous recovery rather than her own intervention.

Dr Leaf did further work within a number of schools for her PhD research. Dr Leaf compared the academic results for three schools for the years 1991 and 1992 to the results for 1993, during which she introduced her mind mapping approach (MMA). Generally, the results for 1993 were better than the results for 1992, which seems to indicate that Dr Leaf’s MMA training was effective. However, the results from 1991 to 1992 were already improving without her input [2: p182]. The difference in average marks between 1991 and 1992 was 1.76%, while the difference between 1992 and 1993 (the introduction of Dr Leaf’s MMA) was only 2.19%. If Dr Leaf’s program really was the cause of that improvement, then her program only resulted in a 0.43% improvement on average.

I have reproduced Dr Leaf’s original graph of the average overall results obtained in her PhD study. While Dr Leaf’s original graph makes her data look spectacular, when appropriately rescaled, the data looks quite ordinary.

Leaf1997 Thesis overall academic trends

DrLeafThesisResult_Rescaled

At best, Dr Leaf’s program gave the already positive momentum of the students a gentle nudge.

However, it should be noted that her program may have also hindered some students. Dr Leaf notes in her analysis: “The results obtained indicate that in general the academic trend in the three primary remedial schools was altered with the introduction of the MMA methods in 1993. Furthermore, it appears that the most positive response occurred in phase one (grades 1 and 2, standard 1). A positive response also occurred in phase two (standards 2-4) but this change was just outside the significance level. Phase three (standard 5), by contrast, experienced negative effects with the introduction of the MMA methods.” [2: p181]

So to summarise, according to Dr Leaf’s own data, there was no clear benefit derived from her MMA program.

Dr Leaf then discussed her work in a number of charter schools that she performed in Dallas. This was part of testing of a program called the Switch On Your Brain 5-step learning process.

Dr Leaf claims that, “The Switch On Your Brain with the 5-Step Learning Process® was assessed in a group of charter schools in the Dallas. The results showed that the students’ thinking, understanding and knowledge improved across the board. It was concluded that The Switch On Your Brain with the 5-Step Learning Process® positively changed the way the students and teachers thought and approached learning.” http://drleaf.com/about/dr-leafs-research/

However, there has been no independent research into Dr Leaf’s Switch On Your Brain learning program or even the Geodesic Information Processing Theory, the theory Dr Leaf devised and on which the Switch On Your Brain program is based.

Dr Leaf published her own internal research into the program on her website. The project was a two year program involving teachers and students at a group of four schools in the Advantage Academy group in Dallas, Texas. This involved working with more than 150 teachers and 2000 students.

Despite her glowing self-assessment, Dr Leaf’s own published numbers suggest that the program is ineffective, or quite possibly a hindrance. For example, the graph below demonstrates the qualitative analysis of “content mastery” (which the paper describes as a combination of knowledge and understanding) for reading across all grades from 3rd to 12th, compared with the results from the previous year before the Switch On Your Brain was implemented. Dr Leaf omits a basic statistical analysis, but just by looking at the similarity of the scores, these results are more likely to be a chance effect, except for the 12th grade, where the previous cohort of students increased dramatically, where as the Switch On Your Brain cohort got slightly worse.

Screen Shot 2015-02-02 at 11.27.37 pm

Rather than blame her program, Dr Leaf simply shifts the blame to the teachers: “The few cases where we see drops can be linked to teacher knowledge, attitude and skills and is diagnostic.”

The full research paper that Dr Leaf published is available at http://drleaf.com/assets/files/Web-page-AA-research-project-1.pdf if you wish to review the results for yourself.

The ineffectiveness of Dr Leaf’s program may be for many reasons, but I believe one is that it is built on a theory that relies on mind-mapping. Dr Leaf renamed her version of mind-mapping “The Metacog”, though it’s clear from her early academic work [1] that the Metacog and the Geodesic Information Processing Model [3] were based on the work of Tony Buzan. Buzan’s concept of mind-mapping has been used across multiple professional fields [4] and remains a valuable resource for brainstorming or gathering thoughts in a visual way. However, modern research (including a controlled trial within a primary school classroom environment) shows that mind mapping is a poor tool for learning [5-8].

  1. DR LEAF’S IRONIC INSPIRATIONS

Dr Leaf openly contradicts herself throughout her presentation, failing to realise that the stories she shared of her own patients disproved her vacuous inspirational memes.

Our biology affects each and every one of us. Our mind is a function of our brain. Our mind is to our brain as our breath is to our lungs. Put simply, without our brain, we would have no thoughts. If the structure and function of specific networks in our brains are altered, this changes our thinking. This is confirmed in everyday life – when someone suffers a brain injury or a stroke and they sustain damage to their brain, they suddenly lose the function of some, or all of their mind or body. Trans-cranial Magnetic Stimulation, Trans-cranial Direct Current Stimulation, metabolic states, prescription medications, illicit drugs, or everyday drugs like caffeine or alcohol have all been proven to change the subjects mental state through changes to the function of their brain. Any suggestion that our brain does not control our mind is simply ludicrous.

Clearly then our biology does control our psychology. Real cognitive neuroscientists have shown that our stream of thought is simply a tiny fraction of our overall neural activity, a conscious glimpse of the brains overall function [9-11], like the tachometer is for the engine in your car. Thus, our mind does not change our brain at all. Rather, it is our brain’s directed activity causing the growth of new synaptic branches to support it, something which the brain does without the function of conscious thought from the time when we were embryos.

Dr Leaf actually confirms this fact through her stories of her brain injured patients. After all, if “the mind is separate from the brain but influencing the brain”, then how could those victims of acquired brain injury lose cognitive function after their injury? If it were true that “each and every one of us is not a victim of our biology. We are a victor over and above our biology. We control our brain, our brain does not control us”, then how could those people with damage to their brains from strokes suddenly lose function?

The fact that Dr Leaf’s patients lost their mental or cognitive function because of damage to their brains directly contradicts her insistence that our brain and our mind are separate, and that our brain does not control our mind.

  1. FUNDAMENTALS OF DR LEAF’S OTHER TEACHING

Considered altogether, Dr Leaf’s teaching boils down to a few fundamentals;
* Thought is the main driving force that controls every other aspect of our lives (and our physical world).
* We have full control over our thoughts.
* Thought causes stress.
* Stress is directly responsible for nearly all serious physical and mental illness.
* Therefore thought causes the vast majority of human disease, making thoughts toxic, and
* If toxic thoughts cause disease, “detoxing” thoughts will cure or prevent disease.

On first inspection, each individual postulate doesn’t seem so bad. However, when fully considered and taken to their natural conclusions, they veer into conjecture and pseudoscience, as evidenced by Dr Leaf’s published works and public appearances.

For example, Dr Leaf states in her books:

“Thoughts influence every decision, word, action and physical reaction we make.” [12: p13]
“Our mind is designed to control the body, of which the brain is a part, not the other way around. Matter does not control us; we control matter through our thinking and choosing.” [13: p33]
“DNA actually changes shape according to our thoughts.” [13: p35]

On Facebook and in interviews, this translates to:

“Our genetic makeup fluctuates by the minute based on what we are thinking and choosing.” 27/9/2014
“The toxic thoughts in our minds become physical baggage in our brain, which literally cause brain damage.” 5/12/2014, 27/10/2014 and 7/10/2014
“Your mind will adjust your body’s biology and behaviour to fit with your beliefs.” 21/6/2014

“SID ROTH: But when you told me that we could change our genes I wish every doctor in the world would understand this cutting edge research because, you know, you go to a doctor and say your cholesterol was high, and they say, well, exercise, change your diet, but it could be your genes and there’s nothing you can do, so take this medicine that will have a zillion side effects. But you say, according to the latest brain research, if you follow what Jesus said you can change your genes. That’s just so amazing.
DR. LEAF: I know. It is phenomenal. If you think of it, it’s logical too, Sid …”
http://youtu.be/Uhbt_XOZTdA?t=50s. Full transcript: http://donate.sidroth.org//site/DocServer/IS571Transcript_Leaf.pdf?docID=2941

Dr Leaf draws her erroneous conclusions from the poor interpretation of poor evidence. For example, one of Dr Leaf’s favourite factoids is her statement that “Research shows that 75 to 98 percent of mental, physical and behavioral illness comes from one’s thought life.” [13: p33] Dr Leaf’s sources for this statement include, among others, an article that not only doesn’t mention the figure she attributes to it, but also directly contradicts her fundamental premise [14], and the misleading paraphrasing of an already dubious quote from a pseudoscientific author [15].

Dr Leaf also has a number of pet theories which betray her preference for pseudoscience, the main one being her assertion that the heart is actually a mini-brain that has dedicated cognitive functions. For example, in her books, she says,

“Your heart is in constant communication with your brain and the rest of your body, checking the accuracy and integrity of your thought life.   As you are about to make a decision, your heart pops in a quiet word of advice, well worth listening to, because when you listen to your heart, it secretes the ANF hormone that gives you a feeling of peace.” [12: p62, 13: p127]

Dr Leaf directly quotes the work of an organisation called HeartMath for her evidence that the heart acts as a mini-brain. Dr Leaf, via Heartmath, states that:
> The heart has a network of 40,000 neurons within it, called sensory neurites, which detect circulating hormones, neurochemicals, and sense heart rate and blood pressure,
> The heart secretes “neurotransmitters” and other hormones, which have an effect on the brain, such as atrial natriuretic factor, and oxytocin,
> The heart communicates with the brain and the rest of the body through neurological, biophysical, biochemical and “energetic” (ie: electromagnetic) means [16, 17].

HeartMath clarifies, “The heart’s brain is an intricate network of several types of neurons, neurotransmitters, proteins and support cells like those found in the brain proper. Its elaborate circuitry enables it to act independently of the cranial brain – to learn, remember, and even feel and sense.” [16]

So the “evidence” looks plausible on the surface, but absurd when considered in a broader biological context. For example, my heart may have 40,000 neurons, many of which are sensitive to circulating hormones, neurochemicals and which sense and feel, but then again, so does my rectum. Does my rectum have a mini-brain as well? Clearly not. The only brain you have is the one in your cranium. We do not think with our heart, our rectum, or any other body part.

A more in-depth rebuttal of Dr Leaf’s scientific claims can be found in my book: “Hold That Thought – Reappraising the work of Dr Caroline Leaf”, via Smashwords (https://www.smashwords.com/books/view/466848) or iTunes (https://itunes.apple.com/us/book/hold-that-thought/id908877288?mt=11).

SUMMARY

The opening question from Dr Leaf’s presentation at the 2015 TEDx Oaks Christian School was, “Can the mind change the brain?”

Clearly the answer is: “No, it can not.”

Others are welcome to disagree, but in my humble opinion, I suggest that Dr Leaf is a pseudoscientist, and that her appearance on the TEDx stage is not based on scientific acumen, but on popularity and reputation, which in turn, is based on slick self-promotion and an availability cascade (a self-reinforcing process by which an idea gains plausibility through repetition).

Dr Leaf’s ideas may have popular approval, but TEDx is a vehicle for ideas worth spreading, not ideas that are popular. According to its guidelines, TEDx requests that pseudoscience be avoided, specifically stating, “TED and TEDx are platforms for showcasing and explaining genuine advances in science … Speakers should avoid the misuse of scientific language to make unsubstantiated claims.” (http://www.ted.com/participate/organize-a-local-tedx-event/before-you-start/tedx-rules)

Dr Leaf’s claims, that her research has significantly changed the lives of the students who were blessed to receive it, is simply not born out by any of her own published data – from her original case study through to her MMA project and her Switch On Your Brain program. Whatever the underlying reason … whether its hubris, naivety, or denial that’s driving her continued promotion of her own programs … her claims are baseless, and therefore an argument can be made that she breached the TEDx guidelines in presenting them, and indeed, she should never have been invited to deliver them from a TEDx stage in the first place.

The theme for the 2015 TEDx Oaks Christian School event was “Ridiculous”. I would argue that it was ridiculous that Dr Leaf promoted her research as life changing when in reality, it’s not much better than a placebo. It was ridiculous that Dr Leaf would share stories of the changes to the cognitive functioning of her patients from their brain damage and then claim that the brain does not influence the mind. It seems that Dr Leaf’s presentation certainly fitted their theme, although probably not in the way they intended. Lets hope for their sake that their “ridiculous” decision doesn’t effect their ability to host future TEDx presentations.

Of course, that’s just my opinion. What do you think, TEDx universe?

REFERENCES

  1. Leaf, C.M., et al., Mind-Mapping approach (MMA): a culture and language” free” technique. The South African journal of communication disorders. Die Suid-Afrikaanse tydskrif vir Kommunikasieafwykings, 1993. 40: 35
  2. Leaf, C.M., The Mind Mapping Approach: a model and framework for geodesic learning, in Department of Communication Pathology, Faculty of Arts1997, University of Pretoria: Pretoria. p. 266.
  3. Leaf, C.M., et al., The development of a model for geodesic learning: the geodesic information processing model. The South African journal of communication disorders. Die Suid-Afrikaanse tydskrif vir Kommunikasieafwykings, 1997. 44: 53
  4. Eppler, M.J., A comparison between concept maps, mind maps, conceptual diagrams, and visual metaphors as complementary tools for knowledge construction and sharing. Information Visualization, 2006. 5(3): 202-10
  5. Farrand, P., et al., The efficacy of the `mind map’ study technique. Medical Education, 2002. 36(5): 426-31 doi: 10.1046/j.1365-2923.2002.01205.x
  6. Wickramasinghe, A., et al., Effectiveness of mind maps as a learning tool for medical students. South East Asian Journal of Medical Education, 2007. 1(1): 30-2
  7. D’Antoni, A.V., et al., Does the mind map learning strategy facilitate information retrieval and critical thinking in medical students? BMC Med Educ, 2010. 10: 61 doi: 10.1186/1472-6920-10-61
  8. Merchie, E. and Van Keer, H., Spontaneous Mind Map use and learning from texts: The role of instruction and student characteristics. Procedia – Social and Behavioral Sciences, 2012. 69: 1387-94
  9. Baars, B.J., Global workspace theory of consciousness: toward a cognitive neuroscience of human experience. Progress in brain research, 2005. 150: 45-53
  10. Baars, B.J. and Franklin, S., An architectural model of conscious and unconscious brain functions: Global Workspace Theory and IDA. Neural Netw, 2007. 20(9): 955-61 doi: 10.1016/j.neunet.2007.09.013
  11. Franklin, S., et al., Conceptual Commitments of the LIDA Model of Cognition. Journal of Artificial General Intelligence, 2013. 4(2): 1-22
  12. Leaf, C., Who Switched Off My Brain? Controlling toxic thoughts and emotions. 2nd ed. 2009, Inprov, Ltd, Southlake, TX, USA:
  13. Leaf, C.M., Switch On Your Brain : The Key to Peak Happiness, Thinking, and Health. 2013, Baker Books, Grand Rapids, Michigan:
  14. Cohen, S., et al., Psychological stress and disease. JAMA: the journal of the American Medical Association, 2007. 298(14): 1685-7
  15. Lipton, B.H., The biology of belief: Unleashing the power of consciousness, matter and miracles. 2008, Hay House, Inc:
  16. Rosch, P. Emotional balance and health. Science of The Heart: Exploring the Role of the Heart in Human Performance – An Overview of Research Conducted by the Institute of HeartMath 2013 [cited 2013, 16/7/2013]; Available from: http://www.heartmath.org/research/science-of-the-heart/emotional-balance-health.html.
  17. Rosch, P. Head-Heart Interactions. Science of The Heart: Exploring the Role of the Heart in Human Performance – An Overview of Research Conducted by the Institute of HeartMath 2013 [cited 2013, October 20]; Available from: http://www.heartmath.org/research/science-of-the-heart/head-heart-interactions.html.

Dr Caroline Leaf – Feed your children manure???

Screen Shot 2015-03-19 at 11.27.57 pm

I was entertained somewhat by Dr Leaf’s latest Facebook post this evening. In it, there was a pairing of water and a pot-plant, and sugary drinks and a child, with the words, “If you give this (water) to your plants? Why give this (sugary beverages) to your children.”

Without looking too closely, one might think that Dr Leaf was making a good point. Water is good, and sugar is bad, right?

With just a little more thinking, one can see that the metaphor is pretty weak. Plants aren’t children. Following the same logic of the metaphor, I should feed my children manure instead of food, since it’s clearly good enough for the pot-plant.

What is worrying about this post is Dr Leaf’s linking of diet with our Christian morals. Dr Leaf tries to link the concept of drinking water to the worship of God, because your body is a temple, and “Whether you eat or drink, or whatever you do, do it all for the glory of God.” (1 Corinthians 10:31). By logical extrapolation, Dr Leaf is therefore saying that drinking Coke is dishonouring God and the temple he gave for you. If you drink Coke, then you’re a bad Christian.

Though that’s really only Dr Leaf’s interpretation, because the scripture that she quotes isn’t talking about the composition of the food you eat but about it’s relationship to the sacrifice to idols. As far as I was aware, Coke isn’t used in any worship of idols before it’s bottled and distributed. So really, I don’t think whether you drink coke or other sodas will have any bearing on your relationship with God.

Perhaps Dr Leaf would have better spent her time outlining the studies that back up her overly dramatic statement “that sugary drinks like soda and processed orange juice can cause neurochemical havoc in your brain” rather than just hoping people will take her at her word.

Lets be real … no one in their right mind is encouraging children to have more sugar, mainly because of the excess calories, and not the hysterical notion of “neurochemical havoc”. Dr Leaf’s trying to get it right, but her poor metaphor, and the linking of ones diet to ones honouring of God probably went a step too far.

It would be nice if Dr Leaf could reexamine her knowledge of nutritional science and the scriptures that she uses so that she doesn’t weaken her credibility with such posts in the future.

The truth about ADHD

ADHD is always a popular topic … and an apoplexic topic. Any mention of ADHD seems to induce everyone within ear-shot to uncontrollably expectorate their half-baked opinion on the subject, like the Tourette’s syndrome of ignorance.

I’ve heard them all over the years …

ADHD is over diagnosed.
ADHD is just a label for bad parenting.
ADHD is caused by sugar.
ADHD is caused by food colouring / preservatives / gluten / (any other fad ‘toxin’)
ADHD is cured by diet / meditation / supplements / swiss balls.
ADHD medication (Ritalin) is overused / irresponsible / lazy parenting / harmful / ungodly.
ADHD doesn’t exist in France.
ADHD doesn’t exist at all.

I could go on, but if I do, I’m just going to get myself in a tizz.

ADHD is the new AIDS. There is so much misinformation and discrimination surrounding ADHD in our modern enlightened society that the stigma is worse than the actual illness, which really says something about how badly ADHD is treated in our communities.

One of the cruellest aspects of the cultural mismanagement of ADHD is the fact that it maligns the sufferers while simultaneously isolating them from much needed support. Saying that children with ADHD should just behave themselves, or parents of children with ADHD should just have better parenting skills is victim blaming at its worst.

In order to counter the prevalent ignorance of ADHD, even just a little, I want to give a crash course on the science so that at least somewhere on the searchable web, there is a counterbalance to the thousands of misinformed arm-chair ‘experts’ whose only experience with ADHD is reading the misguided perspectives of other so-called ‘experts’.

ADHD stands for Attention Deficit Hyperactivity Disorder.

The current formal definition that must be matched to have a diagnosis of ADHD is:

  1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
    * Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
    * Often has trouble holding attention on tasks or play activities.
    * Often does not seem to listen when spoken to directly.
    * Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
    * Often has trouble organizing tasks and activities.
    * Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
    * Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
    * Is often easily distracted
    * Is often forgetful in daily activities.
  1. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
    * Often fidgets with or taps hands or feet, or squirms in seat.
    * Often leaves seat in situations when remaining seated is expected.
    * Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
    * Often unable to play or take part in leisure activities quietly.
    * Is often “on the go” acting as if “driven by a motor”.
    * Often talks excessively.
    * Often blurts out an answer before a question has been completed.
    * Often has trouble waiting his/her turn.
    * Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:
– Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
– Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
– There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
– The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
– The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder.

(http://www.cdc.gov/ncbddd/adhd/diagnosis.html)

In Australia, ADHD cannot be formally diagnosed by anyone other than a paediatrician or a psychiatrist. So even as an experienced GP, I can’t officially diagnose it. The school counsellor or local naturopath can’t diagnose it. You can’t just pluck it out of the air. The diagnosis can only come from a medical specialist with at least a decade of university level training.

The official prevalence rate of ADHD (the number of people with a current diagnosis) is only 5%. According to some US based community surveys, nearly a half of those children are not on medication for it (http://www.cdc.gov/ncbddd/adhd/data.html). So much for Ritalin being overprescribed.

Stimulants vs nothing

ADHD is a predominantly genetic disorder which leads to specific structural deficiencies in the brain. Children with ADHD have a significant global reduction in the volume of grey matter, most prominently in a part of the brain called the right lentiform nucleus. These changes usually improve with age and improve with stimulant medication. There is also evidence of changes to the shape and size of other brain structures such as the amygdala and the thalamus (areas of the brain integral to sensory and emotional processing). Early evidence also exists which suggests changes in the white matter pathways connecting a number of critical brain regions. Studies investigating brain development have estimated that the frontal lobe development of ADHD children lags that of normal children by an average of about three years.

These changes in the brain are not caused by the child’s behaviour, since other studies have shown the same changes in the brains of unaffected first degree relatives (brothers or sisters), just to a milder degree.

Modern functional imaging techniques show that the brains of children with ADHD have abnormally low functioning in most of the brain structures related to attention and planning (numerous areas of the frontal cortex as well as the basal ganglia, thalamus and parietal cortices). At the same time, there is extra activity in portions of the brain related to the Default Mode Network (the day-dreaming part of your brain). So children with ADHD have brains in which the ‘day-dreaming’ network activity persists into, or emerges during, periods of task-related activity. This takes processing power away from the competing task-specific processing causing a deficit in performance. Studies show that Ritalin normalises this dysfunction.

The best evidence suggests that dopamine is the main neurotransmitter involved in ADHD. Other neurotransmitters are likely to be involved but the evidence is still being confirmed. Medications like Ritalin improve ADHD symptoms by increasing the amount of dopamine that the nerve cells have access to, improving the clarity of the signal between them.

Underlying all of these neural changes are genetics. While there have been no specific genes discovered in research thus far, twin studies have demonstrated a heritability of ADHD of up to 76%. The most significant environmental factors that are responsible for the remainder of the influence on ADHD are not nutritional factors such as sugar or food additives, but are low birth weight/prematurity and exposure to smoking during pregnancy.

Are there any better treatments for ADHD other than stimulants like Ritalin? Other non-stimulant medications are available although at this stage, Ritalin and Dexamphetamine still out-perform them. Cognitive therapies may mimic some of the brain changes of Ritalin but it is not clear whether the effectiveness of cognitive therapies are equal to or better than the stimulant medications. What is clear is that Ritalin doesn’t lead to a euphoric state (a “drug high”) when given orally. So children can not get addicted to Ritalin when used responsibly.

In summary, ADHD exists. It’s caused by the interaction of a number of genes and some environmental factors such as those related to prematurity, low birth weight and maternal smoking, which alter the growth and development of the brain, specifically the grey matter of the frontal cortex, the basal ganglia and thalamus, and the pathways which connect them. These structural changes cause the day-dreaming part of the brain to be more active and the attention and planning parts of the brain to be less active.

ADHD is not caused by food additives or sugar. There is no evidence that autoimmunity plays a significant part. Forcing your child to consume bone broth or stop eating gluten will not cure them.

ADHD is not caused by bad parenting. Ritalin is not evil. Medications like Ritalin and Dexamphetamine have been shown to improve the functioning of children with ADHD and improve their underlying neurological deficits.

It’s time to cut the crap. Our culture needs to stop victimising the child with ADHD and their parents, who already suffer enough from the ADHD without ignorant busy-bodies and self-titled experts chiming in and making their suffering even more pronounced. It’s time to stop judging those who choose the best for their child by medicating them, who do so in spite of the unfair and ill-informed criticism of everyone from their mother-in-law to the milkman when they do. It’s time to remove the stigma from one of the most common psychiatric disorders of childhood so that every child has an equal chance of growing into an adult that can realise their full potential.

That’s the truth about ADHD.

Bibliography:

Cortese, S. (2012). The neurobiology and genetics of Attention Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. Eur J Paediatr Neurol, 16(5), 422-433. doi: 10.1016/j.ejpn.2012.01.009

Gluten mad!

Tonight as I was browsing Facebook again, I came across an article a person had posted on gluten. The article claimed that gluten is connected to depression, and indeed, nearly every other neurological disorder for good measure.

Gluten is a protein found in certain grains like wheat, barley and rye. Gluten also makes foods taste better and improves their texture, so it’s often added to everything else.

The “gluten is toxic” meme is a very catchy one that’s doing the rounds again. I first heard of the idea that gluten is the cause of nearly every disease when I was in medical school, when every person I knew who’d seen a naturopath was told they had gluten intolerance and were conned into an unappetising and restrictive diet which didn’t make any of them better.

The same meme is now making it’s way back around again now that the low-fat, sugar-free, zucchini broth-type diet fads are waning.

The proposed link between depression, anxiety and gluten is a new twist to the old story. But with depression becoming a preeminent disease in the 21st century, the link doesn’t surprise me.

So what does the evidence say? Is gluten the culprit behind the modern scourge of mental illness?

I certainly don’t think so, at least according to my interpretation of the medical literature. As far back as 2001, researchers studying the mental health of patients with coeliac disease noted that coeliac disease patients had much higher levels of anxiety and depression than healthy matched controls (up to about three to six times greater in one study), and after a year on a gluten free diet, there were no changes to the rates of anxiety and depression (Addolorato et al., 2001).

In more recent times, larger studies have been performed. Hauser, Janke, Klump, Gregor, and Hinz (2010) confirmed higher levels of anxiety in German female coeliac patients who were on a gluten free diet, compared to the normal controlled population. Mazzone et al. (2011) showed that children with coeliac disease on gluten-free diets for about 7 years on average still showed an increased rate of anxiety and depression symptoms and showed higher scores in “harm avoidance” and “somatic complaints” as compared to healthy control subjects.

A larger cross sectional survey was performed in the Netherlands in 2013, on 2265 adults with coeliac disease (van Hees, Van der Does, & Giltay, 2013). That survey showed that a significantly higher proportion of those with coeliac disease, despite being on a strict gluten free diet, reporting a higher rate of anxiety and depression compared to the general population. It also showed (albeit in a smaller subgroup of respondents) that poor adherence with a gluten free diet did not affect the likelihood of depressive symptoms.

To be fair, cross sectional surveys and longitudinal cohorts aren’t necessarily the strongest form of evidence, but it is the best we’ve currently got. There was a recent randomised controlled trial, a stronger form of evidence, looking at the effect the introduction of gluten had on depressive symptoms in people who did not have coeliac disease but reported gluten sensitivity and were controlled on a gluten free diet (Peters, Biesiekierski, Yelland, Muir, & Gibson, 2014). While this showed some worsening of depressive symptoms in those subjects given gluten, the exposure was short, the effect was moderate, and the results should be considered cautiously given the small number of subjects reduced the power of the study.

Given the weight of evidence, I can’t help but be sceptical of books touting the ‘gluten = depression’ theory, books like “Grain Brain”. It’s author, American neurologist Dr David Perlmutter, attests that more than 38 different diseases are caused by gluten, including autism and depression. If you believe the celebrity chiropractor who reviewed Perlmutter’s work (http://www.glutenfreesociety.org/gluten-free-society-blog/gluten-leaky-brain-the-connection-to-depression/), increased intestinal permeability and intestinal dysbiosis (“leaky gut” and bad gut bacteria) combine to increase inflammation in the blood and in the brain, causing depression.

But correlation does not equal causation. Just because brain diseases, inflammation and gut problems tend to occur together does not prove that gut problems cause inflammation and brain problems. Rather, the evidence suggests that it’s the other way around, with all of the processes linked to genetics.

For example, autism is related to a number of genes that both reduce the proteins that help nerve cells grow branches (Won, Mah, & Kim, 2013), and at the same time, switch on a low grade form of inflammation (Onore, Careaga, & Ashwood, 2012). I believe it’s the pre-existing inflammation that adds to the cellular dysfunction of the brain and at the same time, promoting low grade inflammation of a number of organs, including the gut. It’s the pre-existing inflammation that causes the gut to become “leaky”, not the “leaky” gut causing the inflammation.

Because if gluten was the primary cause, then why do people with coeliac disease who do not eat gluten report more depressive and anxious symptoms than control groups who do eat gluten? Why would those with coeliac disease who are eating sporadic gluten be just as depressed as those patients who do not?

If you don’t have coeliac disease, then gluten free diets are just like Amway products. You really don’t need them, and you could probably do much better without them. All you’re really doing is just making someone else obscenely rich.

Not only are you wasting your money, but you might also be harming your health by eating gluten free foods, since most foods that are stripped of gluten are also stripped of most of their other nutrients.

As Nash and Slutzky (2014) summarise, “Every major change in our diet carries with it the possibility of unforeseen risks. Many readers — the general public, as well as medical professionals — accept what they read at first glance. Myths have been part of our medical lore for millennia. Those jumping on the gluten-free/high-fat bandwagon may be disappointed when their symptoms are not mitigated; more critically, they may be at increased risk for other, more dangerous ailments.”

If you really think you feel better off gluten, then talk to your doctor or registered dietician to make sure you remain healthy off it.

References

Addolorato, G., Capristo, E., Ghittoni, G., Valeri, C., Masciana, R., Ancona, C., & Gasbarrini, G. (2001). Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scand J Gastroenterol, 36(5), 502-506.

Hauser, W., Janke, K. H., Klump, B., Gregor, M., & Hinz, A. (2010). Anxiety and depression in adult patients with celiac disease on a gluten-free diet. World J Gastroenterol, 16(22), 2780-2787.

Mazzone, L., Reale, L., Spina, M., Guarnera, M., Lionetti, E., Martorana, S., & Mazzone, D. (2011). Compliant gluten-free children with celiac disease: an evaluation of psychological distress. BMC Pediatr, 11, 46. doi: 10.1186/1471-2431-11-46

Nash, D. T., & Slutzky, A. R. (2014). Gluten sensitivity: new epidemic or new myth? Every major change in our diet carries with it the possibility of unforeseen risks. Am J Cardiol, 114(10), 1621-1622. doi: 10.1016/j.amjcard.2014.08.024

Onore, C., Careaga, M., & Ashwood, P. (2012). The role of immune dysfunction in the pathophysiology of autism. Brain Behav Immun, 26(3), 383-392. doi: 10.1016/j.bbi.2011.08.007

Peters, S. L., Biesiekierski, J. R., Yelland, G. W., Muir, J. G., & Gibson, P. R. (2014). Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity – an exploratory clinical study. Aliment Pharmacol Ther, 39(10), 1104-1112. doi: 10.1111/apt.12730

van Hees, N. J., Van der Does, W., & Giltay, E. J. (2013). Coeliac disease, diet adherence and depressive symptoms. J Psychosom Res, 74(2), 155-160. doi: 10.1016/j.jpsychores.2012.11.007

Won, H., Mah, W., & Kim, E. (2013). Autism spectrum disorder causes, mechanisms, and treatments: focus on neuronal synapses. Front Mol Neurosci, 6, 19. doi: 10.3389/fnmol.2013.00019