The soul, stress, sugar and spin

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Stress and sugar.  In our post-modern society’s orthorexic narrative, these are two of the biggest villains.  So combining them into a diabolical duo reinforces their evil even more.

Dr Caroline Leaf is a communication pathologist, self-titled cognitive neuroscientist and Christian life coach.  In her latest newsletter to her adoring fans, Dr Leaf has accused sugar and stress of mass murder, with our soul’s approach to stress as their accomplice.

I’m sure Dr Leaf means well, but just because she’s not trying to frighten sales out of the gullible and vulnerable doesn’t mean she gets a free pass on the accuracy of her information.

To boil it down, Dr Leaf’s argument goes something like this:

Our choices turn good stress into bad stress
Bad stress releases excess cortisol which leads to disease and death
Therefore our choices to stress causes disease and death

We control our choices through our minds
Therefore, our mind is the key to stress illness
(oh, and sugar …)

The arguments seem plausible on the surface.  Most people have heard enough about stress to know about ‘good’ stress and ‘bad’ stress.  It doesn’t seem too much of a stretch to say that ‘bad’ stress is a significant cause of disease and death.  In the middle of her essay, Dr Leaf jumps from stress to sugar with no preceding link, but again, most people have heard that sugar is unhealthy, so they would probably just accept that statement too.

Unfortunately for Dr Leaf, her article has several critical errors which turn her well-meaning educational essay into a science-fiction short story.

To start with, her essay is built on the dysfunctional premise that the mind controls the brain, so each higher argument or premise is fundamentally skewed from the outset, and in doing so, Dr Leaf simply creates a circular argument of distorted factoids.

For example, her opening sentence: “The hypothalamus is a central player in how the mind (soul) controls the body’s reaction to stress and foods.”  The hypothalamus is a part of the limbic system deep in the brain.  It’s the main pathway from the brain to the endocrine system as Dr Leaf goes on to correctly assert, but essentially it runs on auto-pilot, responding automatically to information already being processed at a level beyond the reach of our conscious awareness and control.  For example, the hypothalamus regulates our body temperature, but it does so without our conscious control.  We can not consciously will our body temperature up or down just with our minds.

It’s the same with the stress response – there are many times where people have a subconscious stress response, where their mind feels like there’s nothing to be afraid of, but their hypothalamus is still priming their system for fight or flight.  White coat hypertension is a prime example.  White coat hypertension, or “White Coat Syndrome” is the phenomenon of people having high blood pressure in their doctor’s office but not at home.  Patients will say to me all the time, “I don’t know why my blood pressure is so high in here.  I feel fine.  I know there’s nothing to be afraid of here.”  But while their conscious mind is relaxed, their deeper subconscious brain remembers those injections that hurt, or that one time a doctor stuck the tongue depressor too far down their throat and they felt like they choked on it, and their hypothalamus is preparing them for whatever nastiness the doctor has for them this time.

Dr Leaf’s statement fails because she wrongly equates our brain with our mind, a subtle perversion which doesn’t just invalidate her premise, but significantly skews the essay as a whole.

As a quick aside, Dr Leaf also says that the hypothalamus “integrates signals from the mind and body, sending them throughout our bodies so that we can react in an appropriate and functional manner, ‘so that the whole body is healthy and growing and full of love’ (Eph. 4:16 NLT)”.  Ephesians 4:16 isn’t talking about the physical body, but about the body of Christ.  You don’t need to be a Biblical scholar to know this, you just have to be able to read.  Here is what the Bible says, “And He Himself gave some to be apostles, some prophets, some evangelists, and some pastors and teachers, for the equipping of the saints for the work of ministry, for the edifying of the body of Christ, till we all come to the unity of the faith and of the knowledge of the Son of God, to a perfect man, to the measure of the stature of the fullness of Christ; that we should no longer be children, tossed to and fro and carried about with every wind of doctrine, by the trickery of men, in the cunning craftiness of deceitful plotting, but, speaking the truth in love, may grow up in all things into Him who is the head — Christ — from whom the whole body, joined and knit together by what every joint supplies, according to the effective working by which every part does its share, causes growth of the body for the edifying of itself in love.” (Ephesians 4:11-16, emphasis added).

There’s no subtlety about this misuse of scripture.  Even non-Christians would be able to figure out that this verse has nothing to do with the physical body.  Dr Leaf has demonstrated that she either doesn’t read the Bible or doesn’t understand it.  Either way, this is a shameful indictment on Dr Leaf’s claim that she’s a “Biblical expert”, and should be ringing alarm bells for every pastor that is considering letting her get behind the pulpit of their church.

Dr Leaf rolls on with her list of medical misinformation.  Some of it is subtle (the “stages of stress”, also termed the General Adaptation Model, is an outdated model of the stress response [1], and CRF and ACTH are released during all stages of stress, not just stage 1).  Some of it is outlandish, like her claim that high levels of stress leads to Cushing’s Syndrome (see http://emedicine.medscape.com/article/2233083-overview#a4 for a list of the causes of Cushing’s Syndrome and note that stress isn’t on the list).

Dr Leaf’s also suggested that it was solely our perception of stress that was the key factor in the outcome of stress, making reference to “a study” showing a 43% increase in mortality if you thought stress was bad.  This is an example of cherry-picking at it’s finest, where one study’s findings are misrepresented to try and support one’s pre-existing position.  Dr Leaf didn’t bother to list her references at the end of the article, instead expecting people to find it for themselves, but I’ve previously seen the study she’s referring to.  Keller and colleagues published the study in 2012 [2].  Their survey suggested a correlation between overall mortality and the combination of lots of stress and the belief that stress is bad.  But remember, correlation does not equal causation, a golden rule which Dr Leaf is quick to ignore when the correlation suits her argument.  The Keller study, while interesting, did not control for the impact of neuroticism, the “negative” personality type which is largely genetically determined and is independently associated with a higher mortality [3-9].  It does not prove that thinking about your stress in a better way makes you live longer.

Dr Leaf went on to claim that “the researchers estimated that the 18,200 people who died, died from the belief that stress is bad for you—that is more than two thousand deaths a year.”  Even here, Dr Leaf manages to get her facts wrong.  The authors actually wrote, “Using these cumulative hazards at the end of the study follow-up period under the assumption of causality, it was estimated that the excess deaths attributable to this combination of stress measures over the study period was 182,079 (controlling for all other covariates), or about 20,231 deaths per year (over 9 years).”

Dr Leaf can’t even get her vexatious arguments right.  Not that the number really matters, because notice how the authors described the magic number as an “assumption of causality”.  Basically the authors said, ‘Well, IF this was the cause of death, then these would be the numbers of deaths attributable.’  They NEVER said that anyone actually died because of their beliefs about stress.  Indeed, the results showed that just believing that stress was bad didn’t make any difference to the mortality rate as Dr Leaf suggested – it was the interaction of high stress AND the belief it was bad that was associated with a higher mortality.  But why let pesky issues like methodological rigour get in the way of sensationalist hyperbole.

Then in the penultimate paragraph, Dr Leaf suddenly decides to throw sugar into the mix.  Somehow without justification, stress is bad and therefore sugar is also bad, and they both throw the hypothalamus and the rest of the body into toxicity.

Dr Caroline Leaf is promoted, by herself and by many in the Christian church, as a Biblical and scientific expert, but in one short promotional essay, Dr Leaf makes multiple critical scientific and exegetical errors.  In other words, her errors in discussing scientific findings and basic Biblical text are so massive that they are incongruent with her claim to be an expert.

Something needs to change – either Dr Leaf revises her knowledge and improves her accuracy, or she needs to stop misleading people from pulpits, both virtual and real.

References

[1]        McEwen BS. Stressed or stressed out: what is the difference? Journal of psychiatry & neuroscience : JPN 2005 Sep;30(5):315-8.
[2]        Keller A, Litzelman K, Wisk LE, et al. Does the perception that stress affects health matter? The association with health and mortality. Health Psychol 2012 Sep;31(5):677-84
[3]        Okbay A, Baselmans BM, De Neve JE, et al. Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses. Nature genetics 2016 Apr 18.
[4]        Servaas MN, Riese H, Renken RJ, et al. The effect of criticism on functional brain connectivity and associations with neuroticism. PloS one 2013;8(7):e69606.
[5]        Hansell NK, Wright MJ, Medland SE, et al. Genetic co-morbidity between neuroticism, anxiety/depression and somatic distress in a population sample of adolescent and young adult twins. Psychological medicine 2012 Jun;42(6):1249-60.
[6]        Koelsch S, Enge J, Jentschke S. Cardiac signatures of personality. PloS one 2012;7(2):e31441.
[7]        Vinkhuyzen AA, Pedersen NL, Yang J, et al. Common SNPs explain some of the variation in the personality dimensions of neuroticism and extraversion. Translational psychiatry 2012;2:e102.
[8]        Gonda X, Fountoulakis KN, Juhasz G, et al. Association of the s allele of the 5-HTTLPR with neuroticism-related traits and temperaments in a psychiatrically healthy population. Eur Arch Psychiatry Clin Neurosci 2009 Mar;259(2):106-13.
[9]        Lahey BB. Public health significance of neuroticism. Am Psychol 2009 May-Jun;64(4):241-56.

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Dr Caroline Leaf – credit where credit’s due

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It’s not often I see something positive in Dr Leaf’s work, but today was one such occasion.

I’m often (legitimately) critical of Dr Leaf’s paucity of references and citations for her Facebook posts and social media memes.  Today was different – Dr Leaf made a statement and backed it up with an easily obtainable peer-reviewed journal article.  It’s a shame it wasn’t backed up by an accurate interpretation, but it’s a positive step none-the-less.

Dr Leaf claimed that “People who served others experienced a 68% increase in healing compared to those who only got treatment for themselves.”

Since the article was so easy to find, I decided to look it up.  The article was by Poulin et al, “Giving to others and the association between stress and mortality”, in the American Journal of Public Health [1].  Actually, the article was familiar, because Dr Leaf has written about the same article before, but her social media post that time was more nebulous.

So does the study by Poulin and his colleagues show that people who served others experienced a 68% increase in healing compared to those who only got treatment for themselves?  In a word … no.

First of all, the study wasn’t looking at healing, it was looking at mortality.  They may seem similar, but getting better from something (“healing”) is not the same as not dying from something (“mortality”).

Second, no one in the study was being “treated”.  I’m not sure where Dr Leaf got the idea that the control group was getting “treatment”.  The study compared those who self-reported “helping behavior directed toward close others … in any of 4 unpaid helping activities directed toward friends, neighbors, or relatives who did not live with them” versus those that did not.

Thirdly, there’s no mention of a 68% improvement anywhere in the article.  The article gives its results as hazard ratios.  For the non-statisticians, the hazard ratio is “the ratio of the particular event taking place in treatment group compared to control group.”  The simplest (probably over-simplified way) way of thinking about hazard ratios is to do a simple sum – the hazard ratio minus 1 is the percentage increase or decrease in risk, where a positive number is an increased risk and a negative number is a decreased risk.  So a hazard ratio of 1.13 means that a person in the exposure group has a 13% increased risk compared to the control group (=1.13 – 1).  And a hazard ratio of 0.7 means a 30% decreased risk (0.7 – 1 = -0.3).  So for the helping group to have a 68% decreased risk of dying, the hazard ratio would be 0.32 (0.32 – 1 = -0.68).

If you’re lost in the numbers, don’t stress.  The point is that Dr Leaf was very specific about the helping group increasing in healing by 68%, but there’s nothing in the results to suggest this.  The study authors wrote, “When we adjusted for age, baseline health and functioning, and key psychosocial variables, Cox proportional hazard models for mortality revealed a significant interaction between helping behavior and stressful events (hazard ratio [HR] = 0.58; P < .05; 95% confidence interval [CI] = 0.35, 0.98). Specifically, stress did not predict mortality risk among individuals who provided help to others in the past year (HR = 0.96; 95% CI = 0.79, 1.18), but stress did predict mortality among those who did not provide help to others (HR = 1.30; P < .05; 95% CI = 1.05, 1.62).”  Unless I’m missing something, there’s nothing in the results that remotely suggests a 68% improvement in anything.

And for what it’s worth, the study shows very weak associations anyway (in statistical terms, the confidence intervals are broad, and almost cross 1), so even if the study really did say something about a “68% increase in healing”, it’s something that is only slightly more likely to occur than by chance alone.  Then there’s other evidence that contradicts this particular study’s findings, so in all fairness, this study shouldn’t be used to base social media memes on in the first place.

Overall, it’s good that Dr Leaf cited an article in her social media meme, but her interpretation of the study was poor, something more at the level of a university freshman than a supposed expert in her field.  And it reflects badly on the Christian church that this is the level of ‘expertise’ that the church accepts and then promotes.

I would encourage Dr Leaf to continue to cite references for her memes, but she really needs to learn how to interpret clinical studies if she and the church are going to continue to promote her as some sort of expert.

References

[1]        Poulin MJ, Brown SL, Dillard AJ, Smith DM. Giving to others and the association between stress and mortality. Am J Public Health 2013 Sep;103(9):1649-55.

Where do you draw the line? On vaccination and freedom of speech

I was skimming my Facebook feed this afternoon, and I had to take a second glance at one of the articles when my brain eventually caught up with what was on the screen.

Australian nurses who spread anti-vaccination messages will now face prosecution”, it said.

My first reaction was, “Wow … that was unexpected.”

So unexpected, in fact, I initially thought it was a hoax.  Then I noticed the story was being reported by several sources, some of which looked reputable.  Perhaps this wasn’t a viral meme after all.  I went to the Australian Health Practitioner Regulatory Authority’s website to get direct confirmation, and sure enough, it was no joke—AHPRA and the Nursing and Midwifery Board of Australia (NMBA) recently issued a statement saying exactly what was reported.

“The NMBA has become aware that there are a small number of registered nurses, enrolled nurses and midwives who are promoting anti-vaccination statements to patients and the public via social media which contradict the best available scientific evidence. The NMBA is taking this opportunity to make its expectations about providing advice on vaccinations clear to registered nurses, enrolled nurses and midwives.”

“The NMBA expects all registered nurses, enrolled nurses and midwives to use the best available evidence in making practice decisions. This includes providing information to the public about public health issues.”

“Any published anti-vaccination material and/or advice which is false, misleading or deceptive which is being distributed by a registered nurse, enrolled nurse or midwife (including via social media) may also constitute a summary offence under the National Law and could result in prosecution by AHPRA.”
~ http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Position-Statements/vaccination.aspx

Vaccination is a pet subject for me—I’m a strong advocate for immunisation and I detest those who would misconstrue the science of vaccines to suit their own twisted agenda.  I think there’s a special place in hell set aside for Jenny McCarthy and Andrew Wakefield.

That said, I’m still a teensy bit uneasy about this new approach by AHPRA, because as much as I hate hearing about people mislead by anti-vaxxers, I want to protect freedom of speech.

Muzzling free speech is a two-edged sword.  Yes, you might stop slimy crack-pots like Wakefield from spreading their malicious fiction, but you also run the risk of stifling legitimate debate.

There’s no evidence that vaccines have toxic levels of mercury or aluminium, or that vaccines cause autism or cancer.  To suggest otherwise is unscientific, and I have no problems in categorically stating that vaccination opponents are currently wrong.  But … what if a legitimate concern about a vaccine arises?  I’m not suggesting the evidence for vaccination is unsettled, but rather, what if a new vaccine is developed that does have unforeseen complications?  Will gag laws prevent a whistle-blower from coming forward for fear of being tarred as “anti-vaccination”?  I wouldn’t put it past the developing drug company from using such a tactic if they wanted an easy way to defend their product.

The other aspect to consider is broader—is this the thin end of the wedge?  If we start gagging health professionals from speaking out against the consensus on immunisation, then what’s next? Abortion law reform? Euthanasia? Climate change?  Each of these issues remains controversial and each side of each issue claims to have science on its side.  Should the side with the perceived ‘consensus’ have the authority or the right to suppress debate from their opponents?

Besides, the problem of anti-vaccination propaganda goes way beyond nurses making comments on social media.  AHPRA’s power only extends to registered health practitioners in Australia.  It doesn’t stop naturopaths or “nutritionists” from promoting anti-vaccination views, and it seems it hasn’t stopped certain chiropractors from subverting the rules either.  It doesn’t stop alternative-health hawkers overseas.

Despite my misgivings, I’m still in favour of AHPRA’s move.  It’s a step in the right direction, and it’s being done for the right reasons—to protect patients from rogue operators that would betray their trust—although this edict might need further discussion before extending it to all AHPRA health practitioners.

Perhaps we should focus on promoting the truth instead of trying to suppress the lies.  For every anti-vaccination blog, there should be a hundred promoting the science behind vaccines.  For every anti-vaxxer celebrity that gets thirty seconds of air time, there should be thirty minutes of air time for reputable scientists and vaccination advocates.  Anti-vaxxers should be able to say what they want even if it’s pseudoscience, but they should be prepared to be pilloried by real scientists using proven facts.

Perhaps that’s a better way to protect all the rights of the community.

What do you think?  Feel free to leave your comments below.

The Secret Teaching of Dr Caroline Leaf

Unless you’ve lived under a rock for the decade, “The Secret” is no secret.  We’ve all heard of the book or the movie, or the countless gurus that promote how they’ve made millions of dollars and found untold happiness by unlocking the power of the Law of Attraction.  You can have that same success too if you buy their book or attend their seminar, or sign up to be part of their network marketing scheme.

Let’s be honest, we’ve probably all, at some point, indulged someone telling us that we just need to think positive or visualise our goal and it will be ours.  It’s even something that many preachers over the years have sold to us in various guises, like hyper-faith, name it and claim it, sowing your seed.

The Secret claims that if we understand we’re all energy, one with the universe and its power, then we can leverage that power to create or receive anything we want with our thoughts.  We just need to think positively and visualise it.  It’s a repackaging of the human potential movement, new age philosophy and cosmic consciousness, all of which is a repackaging of pantheism and Eastern religious teaching.

The author, Rhonda Byrne, (who I’m embarrassed to say is Australian) wrote, “If you’re feeling good, it is because you are thinking good thoughts.”  Ok, but what about when you’re thinking good thoughts and you still feel bad?  What exactly are ‘good thoughts’ anyway?

She also wrote, “Remember that your thoughts are the primary cause of everything.”  So the rise of ISIS is because of my thoughts.  Donald Trump might be President … my thoughts.  An oceanic tectonic shift cuts the undersea trunk line taking out the internet for half the eastern seaboard … Sorry, my bad, I was having negative thoughts again.

So The Secret really doesn’t make a lot of objective sense.  I could go on, but it’s been taken down well enough by a number of commentators and critics over the last decade or so (https://skeptoid.com/episodes/4096; http://www.christianitytoday.com/ct/2007/june/20.71.html), so I’m not going to reinvent the wheel.  But suffice to say, The Secret fundamentally sells the power of thought to shape our reality … wait, that sounds oddly familiar.  Dr Leaf said the same thing at TD Jakes’ church, the Potter’s House, only this week.

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@bishopjakes proudly shared this Instagram post which Dr Leaf duly forwarded to her adoring fans.  “You can shape your reality by the way you think” was even the title of her message.  (She followed it up with an e-mail to her subscribers saying the exact same thing …)

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Dr Leaf’s teaching is eerily similar to The Secret in many other ways.  That quote from before: “Remember that your thoughts are the primary cause of everything” sounds remarkably similar to “Thoughts influence every decision, word, action and physical reaction we make.” (Who Switched Off My Brain, p13)

There are lots of others.  From The Secret:

“Everything else you see and experience in this world is effect, and that includes your feelings. The cause is always your thoughts.”

“Every thought of yours is a real thing – a force.”

“Everything else you see and experience in this world is effect, and that includes your feelings. The cause is always your thoughts.”

“Food cannot cause you to put on weight, unless you think it can.” (This one made me giggle more than the others … yep, those three bottles of Coke I just drank have absolutely no effect on my waistline because I believe that excessive soda consumption is slimming …)

“Your imagination is an extremely powerful tool.”

“Quantum physicists tell us that the entire universe emerged from thought!”

“Quantum physics … says that you can’t have a universe without mind entering into it, and that the mind is actually shaping the very thing that is perceived.”

“The amazing work and discoveries of the quantum physicists over the last eighty years has brought us a greater understanding of the unfathomable power of the human mind to create.”

“Thoughts are magnetic, and thoughts have a frequency. As you think thoughts, they are sent out into the Universe, and they magnetically attract all like things that are on the same frequency. Everything sent out returns to the source – you.”

“There are no limits to what you can create for you, because your ability to think is unlimited!”

Compare that to just a small sample of Dr Leaf’s work:

“Our mind is designed to control the body, not the other way around.  Matter does not control us; we control matter through our thinking and choosing.” (Switch On Your Brain, p33)

“Research shows that 75 to 98 percent of mental, physical and behavioral illness comes from ones thought life.” (Switch On Your Brain, p33)

“DNA actually changes shape according to our thoughts.” (Switch On Your Brain, p35)

“Whatever you are thinking about affects every cell in your body.” (Switch On Your Brain, p94)

“Everything you do and say is first a thought in your physical brain.  You think, then you do, which cycles back to the original thought, changing it and the thoughts connected to it in a dynamic interrelationship.  If your thinking is off … then your communication though what you do and say is off, and vice versa.” (Switch On Your Brain, pp98-99)

“Quantum theory converts science’s conception of humans from being mere cogs in a gigantic, mechanical machine to being freethinking agents whose conscious, free choices affect the physical world.” (Switch On Your Brain: p120-1)

“Thought signals seem to move faster than the speed of light and in ways that classical physics cannot explain.  This means our mind controls matter, and is therefore a creative force.” (Switch On Your Brain, p121)

“These statistics show that the mindset behind the meal – the thinking behind the meal – plays a dominant role in the process of food-related health issues …” (Think and Eat Yourself Smart, p84)

The only difference between The Secret and Dr Leaf’s ministry is Dr Leaf’s claim that science and scripture support it, though lexical contortions of scripture, and cherry-picked pseudoscience does not qualify as supporting evidence.

In the last ten years since The Secret was published, many critics have lined up to pull it apart, some prominent Christians included.  So they should, because The Secret is an abhorrent, unscientific concoction of new age humanism, or as one critic astutely put it, “spiritual narcissism”.

I’ve dissected Dr Leaf’s teaching over the last three-and-a-bit years and shown that her science is wanting, and her scripture is tenuous.  As this week’s sermon aptly demonstrates, Dr Leaf’s teaching appears to be a lukewarm re-serving of The Secret, sprinkled with some scripture and pseudoscience to try and make it more palatable for the Christian church.  Despite the shared narratives of self-obsession and magical thinking, the Christian church still fawns over Dr Leaf.  It’s embarrassing to see the same Christian leaders and media outlets lambaste The Secret but unquestioningly accept the same message woven through Dr Leaf’s teaching.  Dr Leaf’s teaching is so close to The Secret I’m surprised Rhonda Byrne hasn’t asked for royalties.

“The only thing necessary for the triumph of evil is for good men to do nothing”.  The same goes for ignorance—the only thing necessary for the triumph of ignorance is for smart men (and women) to do nothing.  We also need consistency.  Rejecting The Secret but accepting the same teaching from Dr Leaf creates a cultural cognitive dissonance amongst the Church that’s unhealthy.

Church, it’s time to stand against mistruth no matter what the source.

Bibliography

Byrne, R., The Secret, Atria Books, New York. 2006 ISBN 978-1-58270-170-7

Leaf C., Who Switched Off My Brain? Controlling toxic thoughts and emotions. 2nd ed. Southlake, TX, USA: Inprov, Ltd, 2009.

Leaf C.M., Switch On Your Brain: The Key to Peak Happiness, Thinking, and Health. Grand Rapids, Michigan: Baker Books, 2013.

Leaf C.M., Think and Eat Yourself Smart. USA: Baker Books, 2016.