60 seconds – Dr Leaf and Anxiety

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Dr Caroline Leaf, communication pathologist and self-titled cognitive neuroscientist, says that “A chaotic mind filled with rogue thoughts of anxiety and worry sends out the wrong signals and affects you right down to the level of your DNA!” She also says that “Toxic thinking destroys the brain!”

In other words:

Anxiety → Toxic thought → DNA changes +  Brain damage

But that’s not what science says. According to modern research, anxiety disorders are the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [1]. The other way of looking at it is that people who don’t suffer from anxiety disorders have a fully functional capacity for resilience [2,3].

In other words:

DNA changes + External stress → Anxiety

Dr Leaf’s teaching is backwards. Perhaps it’s time she turned it around.

References

[1] Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2
[2] Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10
[3] Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84

Dr Leaf and Anxiety

Can you really Think and Eat Yourself Smart?

Sydney_skyline_at_dusk_-_Dec_2008

Today I’m in Sydney, a vibrant, bustling city which centres on one of the most beautiful harbours in the world.  When I booked my flights in April, I was originally going to spend the day attending Dr Caroline Leaf’s Australian Think and Eat Yourself Smart workshop.  Dr Leaf and her minions revoked my ticket a few weeks later.  She also changed the workshop twitter hashtag from #thinkandeatsmart to just #eatsmart, so perhaps Dr Leaf doesn’t want free thinking at the workshop.

It’s such a shame really, because I was looking forward to being part of the history of Dr Leaf’s first workshop on Australian soil.  But no matter … why waste a perfectly good plane ticket when I can have a day to sightsee, take photos, and catch a few Pokemon here and there as well.

And as a special something for all the people who’re attending the workshop today with Dr Leaf, I thought I’d pen a blog in their honour … something for them to ponder as they listen to Dr Leaf’s presentation, and maybe even provide them with a nidus of a question to pose to her during the day.  So here goes …

As the name would suggest, the Think and Eat Yourself Smart workshop is based on Dr Leaf’s book, Think and Eat Yourself Smart.  Does the book (and the subsequent workshop) deliver what it promises?  That is, can you really think and eat yourself smart?  It’s all well and good for Dr Leaf to espouse her fringe opinions on the food industry and modern farming, and to recycle nutritional information that doctors and dieticians have been promoting for years, but if her book can’t deliver on its titular promise, then it’s just an unoriginal rehash.

To support her thesis that we can think and eat ourselves smart, Dr Leaf declares that what you think affects what you eat, and what you eat affects what you think.  It’s on these intertwined ideas that Dr Leaf’s book stands or falls.  Let’s look at those statements in more detail.

Statement number 1 – “What you think affects what you eat”

Dr Leaf has a broad approach with this premise.  She suggests that the mindset that you have will not only determine what you consume, but also how your body will process it.

For example, she said on page 84 of Think and Eat Yourself Smart, “Research shows that 75 – 98 percent of current mental, physical, emotional and behavioural illnesses and issues come from our thought life; only 2 – 25 percent come from a combination of genetics and what enters our bodies through food, medications, pollution, chemicals, and so on.  These statistics show that the mindset behind the meal – the thinking behind the meal – plays a dominant role in the process of human food related health issues, approximately 80 percent.  Hence the title of this book: you have to think and eat yourself smart, happy and healthy.”

She goes on to say, “If we do not have a healthy mind, then nothing else in our life will be healthy, including our eating habits.”

We can break down these statements to assess their validity.

First of all, this statement is predicated on her 98 percent myth, something which I’ve previously proven to be implausible, but which Dr Leaf continues to use despite the overwhelming evidence against it.  To arrive at this conclusion, Dr Leaf has over-extrapolated, paraphrased, and exaggerated a handful of sources that were either out-of-date, clearly biased, or irrelevant.  She even had the gall to ascribe a made-up figure to an article which, ironically, twice contradicted her.  If you want to know more, see Chapter 10 in my book (http://www.debunkingdrleaf.com/chapter-10/)

This means that Dr Leaf’s statement, and indeed, her entire book, is built on gross misrepresentations of illegitimate resources.  Genetics and our external environment actually play a much greater role than she is willing to give credit for.  The mindset behind the meal is largely irrelevant – nowhere near 80 percent as Dr Leaf suggests.

But for the sake of argument, let’s take a couple of well-known medical conditions that are often associated with lifestyle and compare the research examining the difference that thinking and food make to them.  After all, if your mindset really is responsible for more than 80 percent of our health, then these two very common conditions should improve by more than 80 percent when thought patterns are changed.

Example 1: Hypertension.

Hypertension is also known as high blood pressure.  First, a brief explanation of what the numbers mean when talking about blood pressure so we’re on the same page: Blood pressure is measured in units of millimetres of mercury (or mmHg).  The old sphygmomanometers were hand pumps attached to a rubber bladder and a column of liquid metal mercury.  The blood pressure reading was however high the column of mercury rose at the two ends of the cardiac cycle.  There are always two numbers, expressed as ‘number 1 over number 2’ and written as N1/N2, like 120/80 or ‘one hundred and twenty over eighty’.  The top number is the maximum pressure in the arterial system when the heart pumps the blood into the arteries.  The bottom number is the pressure left over in the arterial system just before the heart beats again.  A blood pressure of 120/80 is the gold-standard physiological reference of normal blood pressure.  A blood pressure consistently above 140/90 is considered high.

Primary hypertension, which accounts for about 95 percent of all cases, has a strong genetic component.  According to eMedicine, “Epidemiological studies using twin data and data from Framingham Heart Study families reveal that BP has a substantial heritable component, ranging from 33-57%.” (http://emedicine.medscape.com/article/241381-overview#a4)  Environmental causes account for nearly all of the rest.  Secondary hypertension is related to a number of different diseases of the arteries, kidneys, hormone system and many others.  Diet is clearly part of those environmental causes.  Psychological stress is in there too, but the question is, how important is it?  If Dr Leaf is right, it should be 80 percent.

According to medical research, reducing alcohol intake to one standard drink per day or less reduces the systolic blood pressure (the top number) by between 2 and 4 mmHg.  Reducing salt to less than 6g a day decreases the systolic blood pressure by between 2 and 8 mmHg.   At best, that’s a 12mmHg reduction.  The DASH diet is as close to Dr Leaf’s macrobiotic tree-hugging anti-MAD diet as one could reasonably get, relying not just on cutting out salt, but also consuming low fat milk and lots of fruit and vegetables.  At best, the DASH diet could shave another 6mmHg from the standard low salt diet.  So that’s a grand total of 18mmHg with even the most optimistic of expectations.

Compared to diet, the best improvement in blood pressure from mind control is 5mmHg at best (and given the size and quality of the studies, that’s being generous) (Anderson et al, 2008; Barnes et al, 2008).

So for hypertension, changing your thinking has, at best, only about a quarter as powerful as changing your diet, not four times more powerful as Dr Leaf would have us believe.  One more nail in in the coffin for Dr Leaf’s theories.

Example 2: Dyslipidaemia.

Dyslipidaemia is medical jargon for cholesterol behaving badly.  Cholesterol is a waxy substance that’s found as a component of the fats in our diet.  To simplify a complex process, we need cholesterol to make our cell membranes, and cholesterol is also an essential building block for most of our hormones.  Cholesterol is usually carried around the body on protein transports called lipoproteins.  If there’s over-production of these lipoprotein particles or they’re not cleared by the liver properly, then the cholesterol they carry can get up to mischief.  The pathways and means of lipid metabolism in the human body reflect complex processes, and genetics, certain medical conditions, medications, and environmental factors can change how the lipoproteins behave.

So how much does thinking affect our cholesterol?  Well, there isn’t a lot of research looking at the subject, but a few studies have looked at cholesterol (specifically triglycerides, one of the lipids in the cholesterol ‘team’) and ‘mind-body practices’ (such as self-prayer, meditation, yoga, breathing exercises, or any other form of mind-body related relaxation technique or practice).  In a cross-sectional analysis of a cohort from the Rotterdam Study, Younge and colleagues examined the association between mind-body practices and the blood levels of triglyceride.  They found that mind-body practices were associated with a triglyceride level 0.00034 mmol/L less than those who did not perform mind-body practices (Younge et al, 2015).  That’s nearly imperceptible, possibly an artefact.  In fact, the average effect of placebos (the fake pills given as a control in therapeutic drug trials) are far greater – 0.1 mmol/L on average (Edwards and Moore, 2003).  Dietary interventions such as low carbohydrate diets decreased triglycerides by 0.26 mmol/L compared to low fat diets (Mansoor et al, 2016), and low fat diets up to 0.27 mmol/L lower than standard diets (Hooper, 2012).  Statins, the lipid-lowering medications, reduce triglycerides by between 0.2-0.4 mmol/L depending on the specific drug studied (Edwards and Moore, 2003).

The point of all this isn’t so much the specific numbers but the obvious difference between the (lack of) power of thought over an important lifestyle condition compared to the effectiveness of diet and medications.  If thinking was four times more important to the process of human food related health issues as Dr Leafs proposes, then thought-related ‘mind-body’ interventions should be at least four times more effective than any other intervention.  But the numbers don’t reflect that – ’Mind-body’ interventions are 1000 times weaker than dietary or drug interventions.

So Dr Leaf’s pronouncement that “the mindset behind the meal – the thinking behind the meal – plays a dominant role in the process of human food related health issues, approximately 80 percent” is complete bunkum.  There is no evidence to support the 98 percent myth which forms her statements underlying premise, and the examples of hypertension and dyslipidaemia, two common lifestyle conditions with proven genetic and dietary links, prove that thought based interventions are much, much weaker than dietary or drug interventions.

Therefore Dr Leaf’s claim that what you think affects what you eat is entirely baseless.

Statement number 2 – “What you eat affects what you think”

Dr Leaf writes, “Although your brain is only 2 percent of the weight of your body, it consumes 20 percent of the total energy (oxygen) and 65 percent of the glucose – what you eat will directly affect the brain’s ability to function on a significant scale.  Your brain has ‘first dibs’ on everything you eat.  I call this the ’20 percent factor’ or the eating behind the thinking, and it underscores the fact that how and what we eat affects our mind, brain and body.” (p84-5)

On face value, the statement seems to hold some weight.  Food does have an impact on how our brain works.  It certainly isn’t the only factor though – demands in the environment, our oxygen levels, our hormones, the function of our major organs, infections or injury, and our levels of sleep, all play a significant role on how our brain functions too.  But strictly speaking, what we eat does have an impact on how we think – if we haven’t eaten, or if we don’t consume enough calories, especially carbohydrates, our body slows some of our bodily functions down to preserve energy, including some of our cerebral functions.  So when you hear people complain that they can’t think because they have low blood sugar, that may in fact be true.  On the other hand, a pure glucose load can shift the balance of the amino acid tryptophan in our body, which enables the brain to produce more of the neurotransmitter serotonin, which can lift our mood.  Or ingesting food or drinks with stimulants like caffeine, such as my morning espresso, also improves how we think by making us more alert.

Unfortunately, Dr Leaf’s application of this premise goes several steps too far.  Later on page 85, Dr Leaf says, “if you eat while emotional, your body does not digest your food correctly.”

Well, that statement may contain an element of truth but only because it’s so hazy and indefinite that it’s applicable in the broadest sense.  Technically, we’re always emotional to one degree or another.  Even if I assume that Dr Leaf’s is meaning ‘angry’ when she says ‘emotional’ then it’s not so much that our body digests food incorrectly, but just differently.   When you’re highly aroused (physiologically, not sexually, just to clarify), your body goes into fight or flight mode.  The body diverts blood away from your intestines and towards your muscles, heart and lungs, so that you have the energy to handle the crisis.  The food in your stomach and guts isn’t going anywhere, and your body leaves it where it is to come back to it later when the crisis has been averted.  This is a normal physiological response.  The body still digests the food and absorbs it correctly, things are just delayed a little (Kiecolt-Glaser, 2010).

The biggest problem with Dr Leaf’s ‘eating behind the thinking’ argument is that it directly undermines her previous teaching.

Dr Leaf has made multiple social media posts claiming that the mind is separate from the brain and controls the brain.  She’s written much the same sentiment in her books.  Take a meme she posted to social media in May 2016.  It said, “As triune beings made in God’s image, we are spirit, mind (soul) and body – and our brain being part of the body does the bidding of the mind …”, and “God has designed the mind as separate from the brain. The brain simply stores the information from the mind and your mind controls your brain.”

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So the obvious question is, “If God designed our mind (our thinking) to be separate from the brain and to control the brain, then how can the food we eat make any difference to what we think? My diet affects my brain through the amount and timing of glucose I ingest, but can my diet can’t affect my thinking if the mind is separate to the brain and controls the brain?

Either the mind is separate to the brain, or it’s not.  It can’t be both.  If the mind is separate to the brain, then what you eat can’t affect what you think and the book becomes an emaciated shadow of rhetoric.  If the mind is dependent on the brain then the book and seminar maintain some semblance of validity, but the rest of Dr Leaf’s ministry crumbles like a well-made cheesecake crust, since the entirety of Dr Leaf’s ministry rests on her idea that the mind is separate from the brain and controls the brain, not the other way around (https://cedwardpitt.com/2016/05/30/dr-caroline-leaf-and-the-mind-brain-revisited/).

At the very least, this must be embarrassing for Dr Leaf, and if she keeps shooting herself in the foot, people will eventually notice that she’s limping.

So other than the free-range, fair-trade, grass fed, organic agro-ecologically produced kale and spinach root muffins and the chia and dandelion broth, it appears that the attendees at Dr Leaf’s workshop today may not be getting what they signed up for.  What you think does not radically change your health, or influence what your food does to your body, and the food you eat does not significantly change how you think.  Our diet is important to our health, but we can’t think and eat ourselves smart.

To all the attendees at the workshop, I hope you got something valuable out of the workshop.  While you were all sitting in a small room, listening to Dr Leaf and snacking on lemon and quinoa stuffed free-range quail giblets, Sydney was outdoing itself.  Not that I’m rubbing it in or anything, but see for yourself …

Kirribilli View

Dr Mary Booth lookout

Milsons Point

Milsons Point

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Milsons Park, Neutral Bay

Cremorne20160820 Web

Cremorne

Point Piper

Point Piper

Macquarie Lighthouse

Macquarie Lighthouse

Blues Point Reserve

Blues Point Reserve

Blues Point Reserve

Blues Point Reserve

References

Anderson JW, Liu C, Kryscio RJ. Blood pressure response to transcendental meditation: a meta-analysis. Am J Hypertens 2008 Mar;21(3):310-6

Barnes VA, Pendergrast RA, Harshfield GA, Treiber FA. Impact of breathing awareness meditation on ambulatory blood pressure and sodium handling in prehypertensive African American adolescents. Ethn Dis 2008 Winter;18(1):1-5

Edwards JE, Moore RA. Statins in hypercholesterolaemia: a dose-specific meta-analysis of lipid changes in randomised, double blind trials. BMC Family practice. 2003 Dec 1;4(1):1.

Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD. Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. Bmj. 2012 Dec 6;345:e7666.

Kiecolt-Glaser JK. Stress, food, and inflammation: psychoneuroimmunology and nutrition at the cutting edge. Psychosomatic Medicine. 2010 May;72(4):365.

Mansoor N, Vinknes KJ, Veierød MB, Retterstøl K. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. British Journal of Nutrition. 2016 Feb 14;115(03):466-79.

Younge JO, Leening MJ, Tiemeier H, Franco OH, Kiefte-de Jong J, Hofman A, Roos-Hesselink JW, Hunink MM. Association between mind-body practice and cardiometabolic risk factors: The Rotterdam Study. Psychosomatic medicine. 2015 Sep 1;77(7):775-83.

Dr Caroline Leaf and Her House of Cards

Dr Caroline Leaf has built herself an empire like a house of cards.

Not like the Netflix drama, “House of Cards”.  Dr Leaf is nothing like Frank Underwood, although some of President Underwood’s best quotes might be applicable to her ministry … “The road to power is paved with hypocrisy, and casualties” and “There’s no better way to overpower a trickle of doubt than with a flood of naked truth”.

Rather, Dr Leaf’s empire resembles a giant house of cards.  It might look majestic and inspiring, but it only takes one puff of scrutiny and the entire thing collapses on itself.

Many people have asked me over the years, in person and on comments on the blog, whether I have ever spoken to Dr Leaf, Matthew 18-style, about the concerns that I have with her ministry.  Did I approach Dr Leaf privately first, then approach leadership, before going public?  Have I given Dr Leaf the right of reply?  Am I just being critical for criticisms sake?

To mark the auspicious occasion of Dr Leaf’s arrival in Australia for her 2016 tour, I’ve decided to definitively answer those questions.  Knowledge is power, so I think it’s important that Dr Leaf’s followers, and those who read my site looking for answers, can see the process that has taken place.  That way, people can judge for themselves whether my actions and Dr Leaf’s responses are justified or not.

I heard Dr Leaf preach for the first time in early August 2013.  I had heard her name bandied around, but didn’t know anything about her, so while she was in Australia that year I decided I would find out who she was and what she had to say.  I attended her service at Kings Christian Church on the Gold Coast, and I left with very strong concerns about her scientific and scriptural accuracy.  How was I to respond?

In Matthew 18:15-17, Jesus gives us the following template for resolving issues between believers,

“If your brother or sister sins, go and point out their fault, just between the two of you. If they listen to you, you have won them over. But if they will not listen, take one or two others along, so that ‘every matter may be established by the testimony of two or three witnesses.’ If they still refuse to listen, tell it to the church; and if they refuse to listen even to the church, treat them as you would a pagan or a tax collector.”

The verse talks about sin here, though for the record I’m not saying Dr Leaf ‘sinned’ when she spoke, although some of what she said certainly flirted with heresy.  Still, it was important enough that I felt it needed to be addressed.  So I followed the biblical pattern as best as I could.

“If your brother or sister sins, go and point out their fault, just between the two of you.”
That’s a bit hard because Dr Leaf chooses to avoid the rank and file members of the congregations she visits.  Certainly on that day I first heard her preach, she was nowhere to be seen after the services.

“… take one or two others along, so that ‘every matter may be established by the testimony of two or three witnesses.’”
Again, that’s a bit hard when Dr Leaf disappears after the service, and moves from church to church.

However, I tried to do the next best thing, in that I e-mailed the pastor of Kings Christian Church to voice my concerns.

“If they still refuse to listen, tell it to the church …”
I also took step number three.  I took my concerns to the church worldwide via my very first blogs on Dr Leaf’s ministry.

As it panned out, the senior pastor at Kings offered to pass on my concerns to Dr Leaf.  A short time later, I got a reply from Dr Leaf’s team, not privately in response to the e-mail, but publically as a comment on my blog.  Mac Leaf, Dr Leaf’s husband, didn’t address any of the significant issues that I raised, but asserted that his wife was completely justified and I was clearly out of touch.

And so I replied to his ad hominem dismissal, and my reply has become the most read of all of my posts.  As part of that blog, I gave an open invitation for Dr or Mr Leaf to respond.  The offer was met with stone cold silence.

I’ve made other offers since.  I offered to meet with Dr Leaf in any city in Australia, at my expense, to discuss my concerns and give her the opportunity to respond.  More silence.  I expanded the offer to include any city in New Zealand as well.  Still no response.

In August last year, Dr Leaf came to preach at Nexus Church in Brisbane.  This was only the second time I had an opportunity to hear her speak live.  Her teaching hadn’t improved any, but I thought that I would at least introduce myself and shake her hand as I considered that the honourable thing to do.  However, I was physically blocked by her presidential style detail – she was literally surrounded by eight people and there was auxiliary guard posted at the door to block anyone from approaching her human shield.  I doubt even President Obama would have more people surrounding him.  Ironically, Dr Leaf’s main text that morning was of the woman with the issue of blood.  At least that woman got to talk to Jesus.  I didn’t get anywhere near Dr Leaf.

After another year of silence, Dr Leaf is again flying south for the winter.  For the first time, Dr Leaf has planned a workshop in Australia on this trip, the “Think and Eat Yourself Smart” workshop in Sydney on the 20th of August.  When I first learned of her workshop in April, I thought it was too good an opportunity to pass up.  There was no question and answer time on the program for the day, but that didn’t bother me.  The sound of Dr Leaf’s silence was deafening, and I wasn’t going to waste my time trying to foist myself on her.  But I wanted to attend to get a deeper perspective on Dr Leaf’s food fantasies to better deconstruct them.  I booked my ticket on-line on the 12th of April and when the ticket was confirmed, I booked my flights and accommodation.

On the 27th of May, six weeks after booking my place at the workshop, I received the following e-mail: “We have cancelled your registration for the Think and Eat Yourself Smart Conference in Sydney, Australia.  Here is your refund advice. Blessings, Dr Leaf Team.”

No reason was given for the cancellation, and when I questioned the decision, no explanation followed.  The most I got was a belated offer to refund my flights and accommodation costs.

Now, I realise that critiquing someone’s work in such great depth isn’t exactly endearing and I’m not on Dr Leaf’s Christmas card list, but being a critic isn’t grounds for refusal of entry.  Not that Dr Leaf ever seemed to care about what I said.  She made no effort to communicate with me over the last three years, at all, and she certainly hadn’t changed her teaching.  She seemed completely indifferent to what I had to say, so cancelling my registration was unexpected.

I could think of many reasons why she or her team would take this action.  One of them was that I might have personally offended her.  It has never been my intention, but perhaps I misread the sound of her silence, and rather than Dr Leaf completely ignoring my work, she had been following it and was offended by it.

I decided that the most mature thing I could do in this situation was to approach her directly to apologise, not for my ongoing critique of her teachings, but for any unintentional personal offense, and to see if there was any scope for compromise.  I sent the final letter to her via her husband’s e-mail on the 22nd of June.  I offered my sincere apologies for any personal offense she may have taken, and I offered to meet with her whilst in Sydney, either before or after her workshop, to see if there was any middle ground.  If she did not want to meet, or if we met but ended up agreeing to disagree, then I promised not to make any further contact with her.  We would shake hands, and that would be the end of it.

On the 6th of July I received a reply.  Not from Dr Leaf, and not from her husband, but from her lawyer.  The general gist of the letter was, You’re welcome to your opinion, but you’re not welcome to hear her speak.  Dr Leaf has no personal grudge against you, but don’t ever try to make any personal contact with Dr Leaf ever again.

I offered an olive branch and Dr Leaf took it from me, slapped me in the face with it and threw it back.

So ladies and gentlemen, this is where Dr Leaf and I stand.  I feel like I’ve done everything that I could’ve to resolve my concerns with Dr Leaf in the manner ascribed in Matthew 18:15-17.  I never wanted to be best buddies with her, or to be even vaguely liked by her, but it is disappointing that she can not bring herself to write a couple of sentences of reply to my offer of apology.

Many will consider her actions entirely justifiable.  They might say that I’ve been rude or harassing, that trying to contact her directly was simply intimidating, and that I have no right to question her since I’m not a cognitive neuroscientist.

I could understand that logic if I was personally harassing and intimidating her, but I’ve always tried to remain critical of her work, not her personally.  I have only seen her twice in person, and only ever tried to talk to her once.  I have only communicated directly with her once, and that was rebuffed.

Others will consider that the problem lies with Dr Leaf herself.  They may consider her actions demonstrate a fragile ego, or extreme hubris, or anti-intellectual hypocrisy.

Perhaps she realises that her house of cards empire is built on indefensible science which forces her to avoid scrutiny at any cost.

Who knows?  Her refusal to engage means that we’re all none the wiser, and all we can do is speculate.

All I can say is that I’ve tried to follow the biblical model for resolving interpersonal issues, gone out of my way to give Dr Leaf the courtesy of the right of reply, and to act first and apologise when I thought personal offense may have been taken.  That Dr Leaf has not taken up my offer on any of it is no skin off my nose, but I don’t think there is anything more that I can do.  The ball remains in Dr Leaf’s court, or house of cards as the case maybe.

What do you think?  You’re welcome to express your opinion in the comments section below.

Lancet confirms fat is bad

Earlier this week, the prestigious medical journal The Lancet published an article about the health effects of obesity [1].

Spoiler alert – obesity kills you.

That sounds a lot like old news.  Why is a leading medical journal wasting space printing studies that tell us what we already know?  Well, up until now, the answer wasn’t as settled as people might have thought.

From the earliest writings of the ancient Greeks, fat people were always considered weak-willed or morally lacking.  Obese people either over-indulged or were lazy sods that deserved the indignation of the clearly morally superior skinny people.  Medical science initially seemed to back up that notion with hard data.  Body Mass Index (or BMI, your weight in kilograms divided by your height in metres squared) between 20 and 25 was the ultimate goal, and if you were above that, you were set to live a shorter and unhappier life.

Then a few years ago, a few studies came out showing that being overweight wasn’t as dire as people thought, and in fact, some studies showed that being overweight and mildly obese offered a small survival advantage over a weight in the “normal” range [2].  This was known as the obesity paradox.

So questions hung in the air like the sickly sweet smell of freshly baked donuts – Did the medical community get obesity wrong?  Were we meant to be cuddly instead of bony?  Were the lard nazi’s tricking us into lifestyles of kale and sit ups under false pretences?

The study by the objectively named Global BMI Mortality Collaboration seems to have definitively answered those questions.  The Global BMI Mortality Collaboration was a collective effort of more than 500 researchers from more than 32 countries, who pooled the resources of 239 different studies involving more than 10 million adults.  The collaborators weeded out more than 6 million people to form a group of 3,951,455 people who had never smoked and had not been diagnosed with a chronic disease before being recruited, and who had survived for more than 5 years after being recruited.  This made their group of participants in this study as statistically robust as possible.  These participants were followed for about 14 years.  Overall, 385,879 of them died.  To see whether obesity had an impact on mortality, they adjusted the raw numbers for age and gender, and calculated the likelihood of a participant dying depending in their BMI.

It isn’t good news for those of us who are of ample proportion.  Compared to those in the healthiest weight range, the most obese had a two-and-half times greater risk of dying from any cause.  Those who were overweight but not obese, which the previous studies suggested may have been ok, had an increased risk of dying too, but only by about 7%.  Obese males had a higher risk of dying than obese females, and obesity was worse for you if you were obese and young rather than obese and old.  Though before all the skinny people start skiting, those with a BMI of under 20 also had a higher mortality.  The best place to be was with a BMI of 20-25.

 

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Statistically speaking, this is a really strong study, so the conclusions it draws are hard to argue with.  It confirms that the BMI of 20-25 is the ideal weight, and that either extreme of body weight is certainly undesirable.

There are a couple of things to note.  Firstly, being overweight still isn’t that bad.  Sure, it’s not ideal like the older studies may have said, but a 7% increase in all-cause mortality isn’t going to particularly cut your life short.  So don’t panic about your love handles just yet.

Secondly, despite the statistical power of this study, it really only answers the single question: Is obesity related to mortality?  It answers it, and it answers it conclusively, but it doesn’t tell us how or why obesity and mortality are related, which are more important questions overall.

Because while it’s necessary to know that obesity, illness and death are related, knowing how they are related can then help us understand the why of obesity, which will then help doctors give patients real information that they can use.

For example, the Lancet study didn’t look at causation.  Is it that obesity causes chronic diseases which then cause early mortality like is the case with smoking?  Or is it that there’s another cause underlying both obesity and chronic disease, with obesity being unfairly framed in a guilt-by-association way?

Obesity Guilty Framed

What about mitigating factors?  If you’re fat but you’re also very fit, what’s your mortality then?  If you have a gastric bypass or a gastric sleeve and you shed a hundred pounds, does your mortality improve?  I’ll try and answer some of these question in future blogs.

Like all good research, this study in The Lancet seems to have generated more questions than answers.  What’s certain is that more research needs to be done.

If you are obese and you are concerned about your health, then talk to your GP or dietician.  Be sensible with your health.  Sure, obesity isn’t great, but you can sometimes do as much damage to yourself through poorly designed weight loss programs than you can with a dozen donuts.

References
[1]        Global BMI Mortality Collaboration. Body-mass index and all-cause mortality: individual participant data meta-analysis of 239 prospective studies in four continents. Lancet 2016 13 july 2016.
[2]        Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA : the journal of the American Medical Association 2013 Jan 2;309(1):71-82.

Strong marketing can’t make up for weak ideas

Well Dr Leaf, 10 out of 10 for persistence.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. In the last month or so, Dr Leaf has been hammering home her foundational belief that the mind is in control of the brain, and indeed, that your thoughts are the key to everything in life, a bit like 42 in “The Hitchhikers Guide to the Galaxy”. According to Dr Leaf, your thoughts are the answer to life, the universe, and everything.

Dr Leaf has attempted to prove her point through quotes from neuroscientists, from her own teaching, and from some published research. All she’s ended up proving is that she’s so desperate to prop up the concept that she’ll stoop to cherry-picking articles and massaging quotes. Poor form for a woman who promotes herself as a scientist.

Today’s meme is the spiritual justification of her position, expressed as a lovely little graphic with a verse from Proverbs 4:23. It’s a real Pinterest special. Most people would look at the pretty picture and accept the quote without question. It’s good marketing for sure.

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But if you strip back all of the eye-candy, is the meme still worth posting? Is Dr Leaf’s meme an accurate depiction of what Proverbs 4:23 truly means.

First things first, is the meme an accurate quote? In this case, it is. The Good News Bible really does say, “Be careful how you think; your life is shaped by your thoughts.” (https://www.biblegateway.com/passage/?search=Proverbs+4%3A23&version=GNT)

So the next question is, is the Good News version an accurate translation of the scripture? It’s interesting that nearly every other translation doesn’t mention thoughts and thinking at all:

New International Version = Above all else, guard your heart, for everything you do flows from it.
New Living Translation = Guard your heart above all else, for it determines the course of your life.
English Standard Version = Keep your heart with all vigilance, for from it flow the springs of life.
New American Standard Bible = Watch over your heart with all diligence, For from it flow the springs of life.
King James Bible = Keep thy heart with all diligence; for out of it are the issues of life.
Holman Christian Standard Bible = Guard your heart above all else, for it is the source of life.
International Standard Version = Above everything else guard your heart, because from it flow the springs of life.
NET Bible = Guard your heart with all vigilance, for from it are the sources of life.
Aramaic Bible in Plain English = Keep your heart with all caution because from it is the outgoing of life.
GOD’S WORD® Translation = Guard your heart more than anything else, because the source of your life flows from it.
JPS Tanakh 1917 = Above all that thou guardest keep thy heart; For out of it are the issues of life.
New American Standard 1977 = Watch over your heart with all diligence, For from it flow the springs of life.
Jubilee Bible 2000 = Above all else, guard thy heart; for out of it flows the issues of life.
King James 2000 Bible = Keep your heart with all diligence; for out of it are the issues of life.
American King James Version = Keep your heart with all diligence; for out of it are the issues of life.
American Standard Version = Keep thy heart with all diligence; For out of it are the issues of life.
Douay-Rheims Bible = With all watchfulness keep thy heart, because life issueth out from it.
Darby Bible Translation = Keep thy heart more than anything that is guarded; for out of it are the issues of life.
English Revised Version = Keep thy heart with all diligence; for out of it are the issues of life.
Webster’s Bible Translation = Keep thy heart with all diligence; for out of it are the issues of life.
World English Bible = Keep your heart with all diligence, for out of it is the wellspring of life.
Young’s Literal Translation = Above every charge keep thy heart, For out of it are the outgoings of life.

Nearly every other English translation refers to “the heart”. Obviously not the literal “heart”, that muscular blood pump in the middle of our chests, but the metaphoric heart, the human soul. So even on majority rules, the Good News Bible translation is looking shaky. Is there any further corroborating evidence to help us understand which version is the most correct?

The answer would be in the original Hebrew. The word for ‘heart’ in Proverbs 4:23 is לֵב (leb), and more broadly is a word relating to the soul, ‘inner man, mind, will, heart, understanding’ (https://www.blueletterbible.org/lang/lexicon/lexicon.cfm?Strongs=H3820&t=KJV). In some verses, the word in used in reference to what would be considered thoughts, but in many others, the word is used to describe a person’s feelings or motivations, or attitudes, or even specific intelligence and manual skills. For example:

Genesis 17:17: “Then Abraham fell upon his face, and laughed, and said in his heart, Shall a child be born unto him that is an hundred years old? and shall Sarah, that is ninety years old, bear?”
Genesis 42:28: “And he said unto his brethren, My money is restored; and, lo, it is even in my sack: and their heart failed them, and they were afraid, saying one to another, What is this that God hath done unto us?”
Exodus 8:32: “And Pharaoh hardened his heart at this time also, neither would he let the people go.”
Exodus 35:35: “Them hath he filled with wisdom of heart, to work all manner of work, of the engraver, and of the cunning workman, and of the embroiderer, in blue, and in purple, in scarlet, and in fine linen, and of the weaver, even of them that do any work, and of those that devise cunning work.”

So it appears the Good News Bible is actually a poor translation. Again, this is an example of Dr Leaf cherry picking something that suits her theory out of a bulk of divergent views. No matter how she tries to sell the concept, the idea that the mind controls your brain and that your thoughts control your destiny is scientifically and scripturally weak. Persistence and good marketing isn’t going to change that.

MIND CHANGES BRAIN? READ THIS …

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They say that if you want something badly enough, you can make it happen … you just have to believe in it to make it work.  Wish upon a star, believe in yourself, speak positively, think things into being … it’s the sort of magical thinking that forms the backbone of Hollywood scripts and self-help books everywhere.

But that’s not how science works.  In the real world, believing in something doesn’t make it magically happen.  Holding onto a belief and trying to make it work leads to bias and error.  Instead of finding the truth, you end up fooling yourself into believing a lie.

This is the trap that Dr Leaf has fallen into as she continually tries to perpetuate the unscientific notion that the mind changes the brain.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  Her philosophical assumptions start with the concept that the mind is separate from and controls the physical brain, and continue to unravel from there.

The problem is that Dr Leaf can’t (or won’t) take a hint.  I’ve discussed the mind-brain link in other blogs in recent times (here and here), but yet Dr Leaf continues to insist that the mind can change the brain.  It’s as if she believes that if she says it for long enough it might actually come true.

Today, Dr Leaf claimed that “newly published” research from Yale claimed that, “Individuals who hold negative beliefs about aging are more likely to have brain changes associated with Alzheimer’s disease.”  Except that this research is not really new since it was published last year, and Dr Leaf tried to draw the same tenuous conclusions then as she’s doing now.

She quoted from the interview that one of the authors did for the PR puff piece that promoted the scientific article:

“We believe it is the stress generated by the negative beliefs about aging that individuals sometimes internalize from society that can result in pathological brain changes,” said Levy. “Although the findings are concerning, it is encouraging to realize that these negative beliefs about aging can be mitigated and positive beliefs about aging can be reinforced, so that the adverse impact is not inevitable”.

Well, the issue is clearly settled then, all over bar the shouting.  Except that the promotional article doesn’t go through all of the flaws in the methodology of the study or the alternative explanations to their findings.  Like that the study by Levy, “A Culture-Brain Link: Negative Age Stereotypes Predict Alzheimer’s Disease Biomarkers” [1], only showed a weak correlation between a single historical sample of attitude towards aging and some changes in the brain that are known to be markers for Alzheimer Dementia some three decades later.

They certainly didn’t show that stress, or a person’s attitude to aging, in anyway causes Alzheimer Dementia.  And they didn’t correct for genetics in this study which is the major contributor to the risk of developing Alzheimer’s [2].  So no matter what Dr Leaf or the Yale PR department thinks, the results of the study mean very little.

But why let the lack of ACTUAL EVIDENCE get in the way of a good story.

It’s sad to see someone of the standing of Dr Leaf’s shamelessly demoralise themselves, scrambling to defend the indefensible, hoping beyond hope that what they believe will become the truth if they try hard enough.  It doesn’t matter how much Dr Leaf wants to believe that the mind changes the brain, that’s not what science says, and clutching at straws citing weak single studies and tangential press releases isn’t going to alter that.

References
[1]        Levy BR, Slade MD, Ferrucci L, Zonderman AB, Troncoso J, Resnick SM. A Culture-Brain Link: Negative Age Stereotypes Predict Alzheimer’s Disease Biomarkers. Psychology and Aging 2015;30(4).
[2]        Reitz C, Brayne C, Mayeux R. Epidemiology of Alzheimer disease. Nat Rev Neurol 2011 Mar;7(3):137-52.

Prescribing dangerous drugs for a made up disease

Honestly, I don’t know if I can go on much longer.

I feel like every time I approach the wild waters of social media, I find myself drowning in a sea of shameless ignorance.  It’s like a post-modern intellectual zombie apocalypse where brainless morons roam cyberspace, relishing the opportunity to infect the minds of the innocent and gullible with their delusions of expertise.

As I’m sitting here writing, the little angel on my right shoulder is trying to get my attention.  “Everyone’s entitled to their own opinion,” she whispers softly.

Except it’s hard to hear when the little devil on my other shoulder is digging his pitch-fork in my brain and twisting it to make a point.  “But their opinion is crap,” he angrily retorts.

Tonight, the subject of my inner voice’s great debate was the Facebook headline, “ADHD: Drugs to treat disorder could create heart problems for children, researchers say.  Children under 18 who had ADHD and were prescribed methylphenidate were more likely to get an irregular heartbeat in the first two months, researchers said.”

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The little paragraph on Facebook didn’t mention any important facts, like what the article was that they quoted, or that the actual number of events linked with drug were miniscule.

That didn’t stop some clearly stupid people from publically venting their rancid opinions all over social media.

There were the usual paranoid delusions claiming that ADHD is over-diagnosed so that the American Psychiatric Association could get more funding from pharmaceutical companies.  Or that Ritalin has never been properly tested, and that children on Ritalin have been human experiments for the last 30 years.

Then there were all of the old chestnuts too, like ADHD is because of poor parenting or poor diet, or teachers with sub-par intelligence who aren’t challenging their pupils enough.  And who needs Ritalin anyway when all you have to do is stop feeding them artificial flavours and colours, high fructose corn syrup, GMO’s and fast foods.  Better yet, treat them with cannabis.

There were also some brazen displays of intellectual impotence within the heady mix of stupidity, like the people who suggested that children shouldn’t be given ANY drugs unless they’ve got diseases like cancer.  ‘Cause, clearly, paracetamol and penicillin are just as toxic as Ritalin.

Then there was the cherry on top:

“The doctor who came up with ‘ADHD’ and ‘ADD’ confessed on his deathbed that they were made-up diseases.”

Really??  Oh, come on, that’s both pathetic and grossly insulting.  ADHD is a real disease.  It’s been proven by real scientists and real doctors working in real labs and real hospitals.  Yet in the post-modern mind-bubble, an unverified viral meme on social media carries more weight than decades of scientific enquiry by some of the worlds smartest people.

For those of us who aren’t intellectual zombies, there was no death-bed confession about ADHD’s concoction.  According to a fact-check by Snopes.com, the doctor who ‘made up’ ADHD never said ADHD wasn’t real, but only that he thought the biological cause of ADHD was over-estimated.

Those who clearly knew nothing about ADHD or its treatment decided to further perpetuate their ignorance by embellishing and catastrophizing the “heart problems” that the Facebook headline alluded to.  Except that if they had bothered to review the article Facebook was referring to, they would have seen that there really wasn’t anything going on.

According to the article “Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study” [1], the only significant heart issue with Ritalin is a condition broadly classified as ‘arrhythmia’, which is medical speak for an irregular heart beat.  However, the peak risk for arrhythmia in the study was in children with congenital heart defects in the first few days of treatment.  For this, the relative risk was 3.49.  That means that a child with an already dodgy heart will have a three and a half times greater risk of an irregular heart rhythm than a child with a normal heart who’s not on Ritalin.  This sounds terrible, but “lies, damn lies and statistics” – in reality, the overall number of children who will actually get an arrhythmia because of Ritalin is still incredibly low because the total number of children who get arrhythmias is incredibly low.  Mathematically speaking, 3.49 x diddly-squat is still diddly-squat.

Besides, all of this is old news.  The current study was simply trying to use a larger source of data to get better statistics on case-reports of the possible effects of Ritalin.  But in the product information of methylphenidate, heart problems are clearly listed as a possible complication.  Because of this, and to ensure that Ritalin isn’t thrown around like candy, only medical specialists like paediatricians and child psychiatrists can start a child on medications like Ritalin.

So the reaction to the new study is nothing more than a storm in a tea-cup, but it clearly demonstrates the stigma and ignorance towards ADHD that, I’m ashamed to say, still exists in our modern, progressive society.

Is it any wonder then that parents actively avoid getting an assessment for their struggling children, or do everything they can to avoid Ritalin even when they have a clear-cut diagnosis of ADHD?  ADHD causes enough suffering by itself, but the baseless and incoherent ranting of the uninformed masses adds stifling layers of unnecessary stigma and misery to those who deserve our support, not misleading advice or irrational judgement.

References

[1]        Shin JY, Roughead EE, Park BJ, Pratt NL. Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. BMJ 2016;353:i2550.