Dr Caroline Leaf – Not a mental health expert

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Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She wrote a PhD on a learning program developed for an educational setting.  She is not a medical doctor.  She is not a psychologist.  She has no experience or training in the diagnosis and management of mental illness.  She is no more qualified to give advice on mental illness than my hairdresser is.

And it shows in her latest social media post: “Lets really start loving as a church- true unconditional non judgmental love – pushing people away and locking them up and drugging them against their will is not the solution to the the problems of life.”

Her statements is a nonsense, nothing more than a scarecrow fallacy.  Yes, pushing people away and locking them up and drugging them against their will is not the solution to the problems of life, that’s why no one does it.  If people were locked up or drugged against their will because of “the problems of life” then we’d all be locked up and drugged.

The only people that are forcibly treated are those with the most serious of mental illnesses whose condition has deprived them of the insight they need to make the decision for themselves.  Even then, the consent for treatment is given by the next of kin, and if no next of kin can provide consent, then the consent is usually made by a independent statutory body so there’s no conflict of interest.

That Dr Leaf continues to make such inane statements about mental illness confirms that she is not fit to give the church, or anyone else for that matter, any advice on mental health.  She may have a PhD in communication pathology but that is a highly specialised field that doesn’t even begin to cross over to clinical knowledge of mental illness.

Dr Leaf has chosen to fill her vacuum of mental health experience with the opinions of Mad In America, a group that’s irrationally biased against modern mental health care.  She regurgitates their creed almost verbatim – mental illness is over diagnosed, psychiatric medications are useless and dangerous, and Dr Leaf also claims that psychiatric medications are only prescribed to bring the cabal of the American Psychiatric Association and the pharmaceutical companies more power and money.

Psychiatric medications are more helpful than harmful (Leucht et al, 2012, Torniainen et al, 2015).  I’ve discussed this in blog posts in the past.  Yes, they’re not without their side effects, and they’re not for every patient, but they have their place in psychiatric care.  That Dr Leaf can’t or won’t review this evidence is just another indictment against her ministry.  That she actively promotes the idea that pharmaceutical companies and the APA are actively attempting to harm people for their own power and riches is scandalous.

If Dr Leaf was serious about promoting good mental health through the church, she should stop promoting baseless anti-psychiatric propaganda, and start encouraging Christians with mental illness to seek the best treatment available, whether that be medications or counselling or both.  She should also start teaching the church the truth about mental illness … That mental illness isn’t caused by poor choices or toxic thoughts, but because of genetic abnormalities that make the affected persons brain more vulnerable to external stress.

Because to stop turning pain and trauma into shame, anger, fear and then hate, people need correct information to allow them to offer real loving understanding and nonjudgmental support to move through the pain.  At the moment, Dr Leaf isn’t offering the church anything even close to that.

References

Leucht S, Tardy M, Komossa K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 2012 Jun 2;379(9831):2063-71.
Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.

Dr Caroline Leaf and those three little words

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Dr Caroline Leaf, communication pathologist and self-titled cognitive neuroscientist, broke the most fundamental rules of both science and Christian teaching in her social media post today.

“Mind creates matter!  Read James 1:2”

Dr Leaf’s statement not only violates the laws of physics, but it also contradicts the Bible by elevating the human mind to the level of God himself.

  1. In our physical universe, matter, like energy, is conserved. It can not be created or destroyed.  The amount of matter that goes in to a chemical reaction is the same amount at the end of a chemical reaction.  Suggesting that our mind ‘creates’ matter violates this basic law known by every high school chemistry student.
    http://www.youtube.com/watch?v=2S6e11NBwiw
  2. There are only two explanations for the creation of matter – the Big Bang or God’s creation. Most Christians believe the second explanation, that God was the only being to create matter which he did during the six days of creation.  By saying that our minds create matter, Dr Leaf is saying that our minds have the same amount of power that God does, a suggestion that’s incongruent with basic Biblical truth.

So much for being a scientific and Biblical expert.  In just three little words, Dr Leaf manages to violate the most basic principles of science and Christianity.

To add salt to the wound, Dr Leaf tries to justify her unscientific heresy by referencing James 1:2, as if tagging a scripture will somehow vindicate her.  Except James 1:2 says, “My brethren, count it all joy when you fall into various trials”.  Well, that’s awkward … James 1:2 has nothing to do with matter or the mind.

Her meme is just as irrelevant and unscientific.

“When we ‘rejoice despite the circumstances’, the brain responds by secreting neurotransitters that help us cope.”

Ummm … the brain does everything by releasing neurotransmitters.  That’s how the brain works.  It releases neurotransmitters when awake or asleep, active or resting.  There are no specific neurotransmitters just for coping, or for when we ‘rejoice despite the circumstances’.   Her statement is meaningless.

There would many in Dr Leaf’s camp that would try and defend her statement by claiming that it was a poor choice of words perhaps, or that it was meant to be taken metaphorically not literally.  Sure, if that’s how you want to continue to delude yourself, then be my guest, but really there isn’t much wriggle room here.  How else can you interpret the words ‘create’ and ‘matter’?  You can’t really misrepresent it as matters of fact, or matters of law, or a state of affairs.  Dr Leaf meant it as the mass noun form of the word, “physical substance in general, as distinct from mind and spirit; (in physics) that which occupies space and possesses rest mass”.  And the word ‘create’ … we all know the meaning of that word, “to bring (something) into existence”.  It wouldn’t make any sense to say that the mind causes matter to happen as a result of one’s actions, or that the mind invests matter with a title of nobility.  It might be common to metaphorically say, “mind over matter” but there’s no metaphorical meaning for “mind creates matter”.

And so with just three little words, Dr Leaf contradicts the most basic of all principles of science and Christianity, and aptly demonstrates the irreconcilable deviation of her teaching from reality.  She has shown how willing she is to take an irrelevant scripture and try to use it to justify a misguided pseudoscientific proclamation.  Today’s meme calls her claim as a Biblical and scientific expert into serious question.

Dr Caroline Leaf and the Maligned Master Mind Meme

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On Facebook today, Dr Leaf published a menagerie of memes, a full house of five of her favourite little nuggets of wisdom that comprise the pillars of her teaching.  For example, “Everything you first do and say is first a thought.” And, “You alone are responsible and can be held responsible for how you react to what happens in your life: your future is open, filled with an eternity of possible situations and choices.”  Too bad that our genes, which are not the result of our choices, are the biggest influence of our personality and our capacity to cope with our external environment (Vinkhuyzen et al, 2012), and that we often do and sometimes say things without thinking (https://cedwardpitt.com/2014/11/08/dr-caroline-leaf-putting-thought-in-the-right-place/).

But the most interesting meme in today’s trick is “The mind controls the brain … the brain influences but does not control the mind.”

For years, Dr Leaf has taught that the mind is separate from and controls the brain through social media and through 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.”

With the weight of scientific evidence bearing down on her, Dr Leaf has finally given a little and made a concession.  Now the brain influences, but is still controlled by, the mind.

While it’s a step in the right direction, Dr Leaf’s meme is still wrong.  It doesn’t matter what small changes Dr Leaf makes to the window dressing of her teaching, her ministry is so structurally unsound that it’s derelict.

This is because the mind is a product of the brain.  Yes, the brain influences the mind, because the brain creates the mind.  Actual neuroscientists like Professor Bernard Baars in collaboration with mathematician and computer scientist Professor Stan Franklin have shown that the mind is simply a small projection of a much greater stream of unconscious brain activity (Baars and Franklin, 2003; Franklin, 2013; Baars, 2005)

The relationship of the brain to the mind is a little like the relationship of our cars dashboard to the engine.  We don’t see all of the actions of the engine under the hood of our car, but it powers our car nonetheless.  What we do see is the dashboard.  We can see our speed, and depending on the make and model of the car you drive, the dashboard also shows the engine temperature, revs, fuel and the warning lights for our engine and our electrics.

In the same way, our brain powers us.  It’s the engine purring along under the surface.  Our mind is the dashboard, giving us a tiny glimpse at a much greater process underneath the surface.  Suggesting that our mind is in control of our brain is like suggesting that our dashboard is in control of our engine.  The mind is a product of our brain designed to give us conscious awareness of a small portion of a much deeper stream of activity that senses our environment, alters our moods, plans our actions and then executes them.

By basing her entire ministry on such science fiction, Dr Leaf makes a mockery out of every church that hosts her, of everyone that buys her books, and of everyone who subscribes to her programs.  She also makes a mockery of herself, which is the saddest part of this whole story.  I hope that she stops making changes to the window dressings of her ministry, and starts to make the necessary changes to her foundations before it’s too late and the whole thing comes crashing down.

References

Baars, B.J., Global workspace theory of consciousness: toward a cognitive neuroscience of human experience. Progress in brain research, 2005. 150: 45-53

Baars, B.J. and Franklin, S., How conscious experience and working memory interact. Trends Cogn Sci, 2003. 7(4): 166-72  http://www.ncbi.nlm.nih.gov/pubmed/12691765 ; http://bit.ly/1a3ytQT

Franklin, S., et al., Conceptual Commitments of the LIDA Model of Cognition. Journal of Artificial General Intelligence, 2013. 4(2): 1-22

Vinkhuyzen, A.A., et al., Common SNPs explain some of the variation in the personality dimensions of neuroticism and extraversion. Transl Psychiatry, 2012. 2: e102 doi: 10.1038/tp.2012.27

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

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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.

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.

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.