Tag Archives: autism

ASD and GP

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“You see, but you do not observe. The distinction is clear.” ~ Sherlock Holmes (A Scandal in Bohemia)

Autism. It’s a condition that we see weekly as general practitioners. The question is, do we observe it? And if we do, what do we see it as, a series of deficits, or as a set of different strengths that can be celebrated?

For the last few days, I’ve enjoyed being a delegate at the Asia-Pacific Autism Conference in Sydney, a series of some cognitively stimulating discussions covering the full spectrum of being on the spectrum.

There’s always so much that can be gleaned from conferences like these, but for me, the take-home messages as a GP came at the book-ends of the first session and the last.

One of the first keynote presentations came from researchers at the Olga Tennison Autism Research Centre (http://www.latrobe.edu.au/otarc). Prof Cherl Dissanayake and Dr Josephine Barbaro presented their research on a tool they developed called SACS-R, an early detection tool to screen for infants at higher risk for developmental disorders.

Early detection of children on the autism spectrum is very important, something recognised by the AMA in their position statement late last year (https://ama.com.au/position-statement/autism-spectrum-disorder-2016). Despite being important, early detection can also be tricky, and many children on the autism spectrum who are relatively high functioning are often missed in general practice.

Barbaro and Dissanayake have previously tested this tool, training community child health nurses to use it as part of the standard infant health checks. The results of their work showed that the tool was robust (Estimated sensitivity ranged from 69% to 83.8%, and estimated specificity ranged from 99.8% to 99.9% for babies between 12 and 24 months – Barbaro and Dissanayake, 2010).

Barbaro and Dissanayake have continued to develop the tool, but more importantly, they have refined the tool to utilise only the factors that had the highest sensitivity, and then turned the tool into a free app, untethering the initial assessment process from the domain of professionals and potentially putting it in the hands of every parent anywhere in the world via a smart phone. The results of their study are still being finalised, but they claim that the SACS-R tool on the app has a positive predictive value of 82%, a negative predictive value of 97%, a specificity of 99.58% and a sensitivity of 72%.

The power shift that an app like this brings is important for us as GP’s. In time, parents will be doing their own assessments at home and coming in to their GP with a recommendation to have a further assessment, and we need to be prepared for this and take the recommendation seriously. But there’s also a prime opportunity here, to use the app to enhance early screening for developmental disorders in general practice, by sending a link to the parents booking in for their baby’s 12 and 18-month immunisations and discussing the results of the assessment with them when they come in. This could also be in addition to the professional version of the program that Barbaro and Dissanayake are in the process of developing.

Given the preliminary results of their longitudinal study (not yet published but in its final stages) showing a prevalence of up to 1 in 43 children, it’s likely that we will be picking up several new cases a year.

If you want to review the app yourself or consider recommending it to your patients, it’s called ASDetect and it’s available from the App Store or Google Play.

At the other end of the conference, Dr Barry Prizant presented a keynote address on “Uniquely Human: a different way of seeing autism”, based on his book of the same name and his decades of work with people on the autism spectrum.

His theme was that most people see autism as a negative. In times gone by, children on the autism spectrum were seen as profoundly deficient, to the point that they weren’t considered a person. Even today, some pundits have said that “autism is a lost, hellish world” while others have likened having autism to being a victim of the holocaust.

On the other hand, self-advocacy is growing amongst those with autism, who are working to try and change the social view that autism is a series of weaknesses to overcome, but differences to be celebrated. Not only that, but more people on the spectrum are designing research projects to understand the condition better and to translate those advances into tangible benefits, taking self-advocacy to a whole new level.

Prizant not only promoted autism self-advocacy, but also discussed the concept of neuroharmony – that there is no such thing as autistic behaviour, but only human behaviour; that so many people with autism have succeeded in their chosen fields and have made lasting contributions to the benefit of our society. He championed the notion that rather than expecting autistic people to be ‘normal’, ‘normal’ society should be embracing the differences that those on the spectrum have. As one father of a child on the spectrum told him, “You don’t grow out of autism, you grow into autism.” As John Elder Robison wrote, “Asperger’s is not a disease. It’s a way of being. There is no cure, nor is there a need for one. There is, however, a need for knowledge.”

As GP’s, when we see those children on the spectrum picked up by the enhanced early screening tools, we need to ensure we give their parents the balanced view. It’s easy to look at the negatives and the weaknesses inherent in a diagnosis of ASD. I’m not suggesting that we sugar-coat things and tell only the positive side of the story, but we need to balance out any concerns the parents have with a generous serving of hope. As one father put it, “The people who have been the most helpful to us have are those who do not take away our hope. We have learned to keep away from the ‘doom and gloom’ crowd”, while one mother wrote, “Some call it autism, others call it despair and sorrow. I happen to call it hope, beauty and fascination.”

For ASD and the average GP, change is coming – good change that will empower parents to get an earlier diagnosis, and for those with ASD to get the early intervention that will benefit their weaknesses, complement their strengths and accept who they are as people. As GP’s, we need to be flexible and accepting, observing the strengths that autism can bring to our patients, not just seeing the weaknesses.

References

Barbaro J. and Dissanayake C., “Prospective identification of autism spectrum disorders in infancy and toddlerhood using developmental surveillance: the social attention and communication study.” J Dev Behav Pediatr. 2010 Jun;31(5):376-85

Post-script, 21 September 2017

I received an e-mail from Erin from La Trobe today:

  “My name is Erin and I am a Research Assistant at La Trobe University. Currently, I am working with Dr. Josephine Barbaro on the ASDetect project.
   We would also like you and your readers to know that we’re currently seeking parents/caregivers of young children aged 11-30 months for our research study looking at how ASDetect identifies early signs of Autism (Australia only). You can register at asdetect.org/app or SMS 0409 758 602. You must register via this website to be eligible for study, so just downloading the app won’t enrol you.”

If you can, please get involved.  This is important research that has the potential to have profound benefits for some of our most vulnerable patients ~ CEP

Kintsukuroi Christians

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When I was a kid growing up, there wasn’t much that my father couldn’t repair.

Dad was extremely gifted with his hands, a talent that I certainly didn’t inherit. He was able to take a problem, come up with a practical solution in his mind’s eye, then build it out of whatever scraps of wood, metal or plastic he could lay his hands on. It was the ultimate expression of frugality and recycling that comes from a limited income and four growing children.

Dad was also able to resurrect nearly everything that broke in our house. Plates, cups, teapots, toys, tools … it seemed there wasn’t anything that couldn’t be fixed by the careful application of Araldite.

Araldite, for those unfamiliar with it, is some sort of epoxy resin that, in the right hands, possesses mystical properties of adhesion. It would stick anything to anything.

Dad’s gift for repairing things with Araldite meant that a lot of our things were patched up. Some of our most loved possessions were the most cracked. Despite being glued together several times, each item was still functional. Maybe not as pretty as it may have once been, but still useful, and more importantly, still treasured. Each time the Araldite came out, it taught me that whilst all things have the capacity to be broken, they also have the capacity for redemption.

There’s an ancient Japanese tradition that shares the same principles. For more than 400 years, the Japanese people have practiced kintsukuroi. Kintsukuroi (pronounced ‘kint soo koo ree’) is the art of repairing broken pottery with gold or silver lacquer, and the deep understanding that the piece is more beautiful for having been broken.

The edges of the broken fragments are coated with the glue made from Japanese lacquer resin and are bonded back into place. The joints are rubbed with an adhesive until the surface is perfectly smooth again. After drying, more lacquer is applied. This process is repeated many times, and gold dust is also applied. In kintsukuroi, the gold lacquer accentuates the fracture lines, and the breakage is honoured as part of that piece’s history.
Mental illness is a mystery to most people, shrouded by mythology, stigma, gossip or Hollywood hype. It’s all around us, affecting a quarter of the population every year, but so often those with mental illness hide in plain sight. Mental illness doesn’t give you a limp, a lump, or a lag. It affects feelings and thoughts, our most latent personal inner world, the iceberg underneath the waters.

On the front line of medicine, I see people with mental health problems every day, but mental health problems don’t limit themselves to the doctor’s office. They’re spread throughout our everyday lives. If one in four people have a mental health problem of one form or another, then one in four Christians have a mental health problem of one form or another. If your church experience is anything like mine, you would shake hands with at least ten people from the front door to your seat. Statistically speaking, two or three of them will have a mental illness. Could you tell?

It’s a fair bet that most people wouldn’t know if someone in their church had a mental illness. Christians battling with mental illness learn to present a happy façade, or face the judgment if they don’t), so they either hide their inner pain, or just avoid church altogether.
Experiencing a mental illness also makes people feel permanently broken. They feel like they’re never going to be whole again, or good enough, or useful, or loved. They’re often treated that way by well-meaning but ill-informed church members whose idea’s and opinions on mental illness is out-of-date.

The truth is that Christians who have experienced mental ill-health are like a kintsukuroi pot.

Mental illness may break them, sure. But they don’t stay broken. The dark and difficult times, and their recovery from their illness is simply God putting lacquer on their broken pieces, putting them back together, and rubbing gold dust into their cracks.
We are all kintsukuroi Christians – we’re more beautiful and more honoured than we were before, because of our brokenness, and our recovery.

I’m pleased to announce that my book, Kintsukuroi Christians, is now available. I’ve written this book to try and bring together the best of the medical and spiritual.
Unfortunately, good scientific information often bypasses the church. The church is typically misled by Christian ‘experts’ that preach a view of mental health based on a skewed or outdated understanding of mental illness and cognitive neuroscience. I want to present a guide to mental illness and recovery that’s easy for Christians to digest, adopting the best spiritual AND scientific perspective.

In the book, I look at some scientific basics. Our mental world is based on the physical world. Our mind is a function of the brain, just like breathing is a function of our lungs. Just as we can’t properly understand our breathing without understanding our lungs, so it is that if we’re going to understand our thinking and our minds, we are going to have to understand the way our brain works. So the first part of this book will be an unpacking of the neurobiology of thought.

We’ll also look at what promotes good mental health. Then we’ll look at what causes mental illness, specifically looking at the most common mental health disorders. I will only look at some of the most common disorders to demonstrate some general principles of psychiatric illnesses and treatments. This book won’t be an encyclopaedia, and it doesn’t need to be. I hope to provide a framework so that common and uncommon mental health disorders can be better understood. I also discuss suicide, which is sadly more common than most people realise, and is rarely discussed.

I know mental illness is difficult, and we often look at ourselves or others as though the brokenness is abhorrent, ugly and deforming.
My hope is that through Kintsukuroi Christians, you’ll see the broken pieces are mended with gold, and realise that having or recovering from a mental illness doesn’t render someone useless or broken, but that God turns our mental brokenness into beauty.

Kintsukuroi Christians is available to purchase from good Christian bookstores around the world including:

Kooyong = https://www.koorong.com/search/product/kintsukuroi-christians-christopher-pitt/9780994596895.jhtml

Amazon US = https://www.amazon.com/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Amazon UK = https://www.amazon.co.uk/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Smashwords = https://www.smashwords.com/books/view/720425

~~

Mental illness can be challenging. Sometimes learning about mental illness can bring up difficult feelings or emotions, either things that you’ve been through yourself, or because you develop a better understanding of what a loved one is going through or has been through. Sometimes old issues that have been suppressed or not properly dealt with can bubble up to the surface. If at any point you feel distressed, I strongly encourage you to talk to your local doctor, psychologist, or pastor. If the feelings are so overwhelming that you need to talk to someone quickly, then please don’t delay, but reach out to a crisis service in your country

In Australia
Lifeline 13 11 14, or
BeyondBlue
Call 1300 22 4636
Daily web chat (between 3pm–12am) and email (with a response provided within 24 hours)  https://www.beyondblue.org.au/about-us/contact-us.

USA = National Suicide Prevention Lifeline 1-800-273-TALK (8255)

New Zealand = Lifeline Aotearoa 24/7 Helpline 0800 543 354

UK = Samaritans (24 hour help line) 116 123

For other countries, Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines.

Caroline Leaf – Carrie Fisher killed by bipolar meds

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No longer content with just wilful ignorance, Dr Caroline Leaf has stooped even further by using the death of a beloved actress as a sick segue against psychiatric medications.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She markets herself as an expert in neuroscience and mental health despite not knowing how genes work (https://cedwardpitt.com/2014/09/27/dr-caroline-leaf-and-the-genetic-fluctuations-falsehood/ and https://cedwardpitt.com/2017/01/07/dr-caroline-leaf-the-christian-churchs-anti-vaxxer/).

In her latest “Mental Health News – January 2017” e-mail newsletter, Dr Leaf makes some astounding and outlandish statements about mental health.

She starts by claiming that Carrie Fisher’s death was ultimately caused by the psychiatric medications she was taking.

“Few people, however, are talking about the possible link between her heart attack and her psychiatric medication. As mental health activist Corinna West shows, ‘new antipsychotics cause weight gain, diabetes, and a bunch of other risk factors associated with heart disease.’ We have to take these risk factors seriously. We are not merely talking about statistics—we are talking about real people, people like Carrie Fisher.”

Dr Leaf, no one’s talking about the possible link between her heart attack and her psychiatric medication because we respect the Carrie Fisher too much and would rather celebrate her life and achievements, not perform a hypothetical post-mortem motivated by prejudiced speculation.

No one’s talking about the possible link between her heart attack and her psychiatric medication because no one really knows what caused Carrie Fisher’s heart attack.  No one knows if she had any other risk factors for heart attacks, or what medications she was on.  There could be a dozen other reasons why she had a heart attack.  No one else is asking because it’s none of our business.

No one’s talking about the possible link between her heart attack and her psychiatric medication because we know that psychiatric medications do much more good than harm.

No one is talking about the possible link between her heart attack and her psychiatric medication because it’s highly disrespectful to use someone’s death to promote your political or ideological position.  Using Carrie Fisher’s death as a segue to your soapbox about psychiatric medications is like someone using Princess Diana’s death as an opportunity to talk about the dangers of speeding in tunnels.  It’s ungracious, unbecoming, and in poor taste.

What’s even more dishonouring to Carrie Fisher is that Dr Leaf’s claims about psychiatric medications are not accurate.

“Sadly, individuals suffering from mental health issues ‘die, on average, 25 years earlier that the general population.’ These medications are incredibly dangerous, and we have to start asking ourselves, as the investigative journalist and mental health campaigner Robert Whitaker notes, if the benefits of these drugs truly outweigh the risks.”

Notice the giant hole in her argument?  She assumes that the increased risk of death in those with mental illness is the medications they’re on, just like she’s assumed that Carrie Fisher died because she was taking psychiatric medications.

That’s confirmation bias, not science.

Real mental health experts – the ones with training, clinical experience and research acumen – directly contradict Dr Leaf.  Experts like Correll, who say that, “Although antipsychotics have the greatest potential to adversely affect physical health, it is important to note that several large, nationwide studies providing generalizable data have suggested that all-cause mortality is higher in patients with schizophrenia not receiving antipsychotics.” [1]

In other words, the life expectancy of people with schizophrenia is shorter than the rest of the population, but it’s much shorter in schizophrenics not on meds.  Psychiatric medications help people with schizophrenia live longer.

In fact, the use of any anti-psychotic medication for a patient with schizophrenia decreased their risk of dying by nearly 20% [2] whereas the risk of dying for schizophrenics who didn’t take anti-psychotics was nearly ten times that of the healthy population [3].

This is the same for other psychiatric medications as well, “clozapine, antidepressants, and lithium, as well as anti-epileptics, are associated with reduced mortality from suicide.” [1]

Psychiatric drugs aren’t “incredibly dangerous”.  Like any tool, when used in the right way, they can bring radical transformation.  What IS incredibly dangerous is the disingenuous and ill-informed making libellous and inaccurate statements about medications they don’t understand.

Not content to just insult Carrie Fisher’s memory, Dr Leaf went on to claim that psychiatric labels are also as harmful as psychiatric drugs.  “These risks are not limited to taking medication. Psychiatric labels can also harm the individual involved. Child psychiatrist Sami Timimi recently discussed the adverse effect the autism label can have on children and adults alike. Labels can lock people in, taking away their hope for recovery, affecting their ability to perform everyday tasks and crippling their determination to live above their circumstances. Words can harm people as much as “sticks and stones” do, as psychologist Paula Caplan notes in her talk on psychiatric survivors and diagnoses.”

It’s witless to suggest that labels harm people or that they somehow lock people in and take away their hope.  The right label, which doctors call a diagnosis, doesn’t lock people in at all, it does the exact opposite:
* The right diagnosis gives hope – hope that comes from receiving the right treatment and not wasting time, money and energy pursuing the wrong treatment.
* The right diagnosis gives power – it empowers people by giving them the ability to make accurate decisions about what’s best for themselves and their loved ones.
* The right diagnosis gives certainty – in many situations, knowing what the diagnosis is reduces unnecessary anxiety and fear.

Imagine that you had a freckle on your arm, and it started growing suddenly.  You go to the doctor, and the doctor says that the freckle is actually a skin cancer.  Does that label lock you in and take away your hope?  Of course not.  It gives you the certainty of knowing that treatment is needed, and the power to decide if you want that treatment.  And it gives you hope that with the right treatment, you can continue to live a healthy life.

In the same way, a psychiatric diagnosis doesn’t lock people in and remove their hope.  A child who understands that they have autism can stop beating themselves up for being ‘odd’ and instead, they can understand that their different wiring gives them special powers that other kids don’t have.

Psychiatric labels do not harm an individual, it’s the backwards opinions of so-called mental health experts that harm individuals with psychiatric illness.  The stigma of a diagnosis is related to the way in which society treats individuals with that diagnosis, not the diagnosis itself.  Perpetuating the myth that that ‘depression and autism aren’t really diseases’ reduces the acceptance of society for those who suffer from those conditions.  That’s what causes harm.

Dr Leaf should apologise to her followers for showing such disrespect for Carrie Fisher, and to all those who take psychiatric medications.  Carrie Fisher spent her life supporting people with mental illness, trying to break down the stigma of psychiatric illness and treatment.  Her life’s work should be celebrated, not defaced by Dr Leaf and her unscientific opinion.

References

[1]        Correll CU, Detraux J, De Lepeleire J, De Hert M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World psychiatry : official journal of the World Psychiatric Association 2015 Jun;14(2):119-36.
[2]        Tiihonen J, Lonnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009 Aug 22;374(9690):620-7.
[3]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.

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Dr Caroline Leaf – The Christian church’s anti-vaxxer

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Well, this is my first post for the new year.  2016 was certainly historic!

In 2016, the Oxford Dictionaries Word of the Year was “post-truth”.  Post-truth describes the concept “in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief”.

While the popularity of the word rose in step with the popularity of the US President-Elect, post-truth as an idea has been building more and more over the last decade or so.  It’s the driving force behind other cultural phenomena of our modern world, like the alternative health and the anti-vaccination movements.

It’s also the secret to the success of Caroline Leaf.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She’s been riding the wave of our post-truth culture for years.  Dr Leaf has a set of slickly spoken mistruths that form the basis of her ministry, and are repeated constantly (including, but not limited to):

The mind controls the brain
75-98% of all physical, mental and emotional illnesses come from our thought life
The heart is a mini-brain
Our mind changes matter through quantum entanglement
ADHD and depression aren’t diseases
Anti-depressant medications are dangerous placebos

There is no scientific evidence to support any of these claims, but that hasn’t stopped her claiming, because Christians and the leadership of the Christian church believe her without question.

In the last twenty-four hours, Dr Leaf put up two separate social media posts which follow the same pattern – repeated mistruths with no basis in fact.

“What an honor to be speaking at the annual Noiva humanitarian foundation conference in Winterthur, Switzerland, which works actively with the Syrian refugees seeking to broker peace in the Middle East.  I spoke about how showing compassion and helping others improves brain health and increases physical and mental healing by around 63%!”

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Showing compassion and helping others improves brain health and increases physical and mental healing by around 63% hey?  I’m assuming she’s referring to the study by Poulin et al [1], because she’s posted this to her social media feed before, and there aren’t any other studies out there that show compassion and helping others increases physical and mental health so much … not that the Poulin study showed it either (not even close – https://cedwardpitt.com/2016/10/27/dr-caroline-leaf-credit-where-credits-due/ and https://cedwardpitt.com/2016/01/16/does-helping-others-help-you/)

On the photo she put up on social media to gloat about her little jaunt to Switzerland, the Powerpoint in the background reads, “Can the mind change the brain?”  Again, the answer is a clear ‘No’!  She tried to argue the same nonsense in her TEDx talk in early 2015 (https://cedwardpitt.com/2015/03/26/the-tedx-users-guide-to-dr-caroline-leaf/).  It was wrong then, and it’s still wrong now.

Unless Dr Leaf’s found some better resources, NOIVA should ask for their money back.  They could have fed a lot of refugees for the wasted cost of hosting Dr Leaf at their conference.

Dr Leaf’s second social media post was even more egregious.

“Our genetic makeup fluctuates by the minute based on what we are thinking and choosing.”

WRONG!  Absolutely wrong.  There is NO scientific evidence that supports this statement at all (https://cedwardpitt.com/2014/09/27/dr-caroline-leaf-and-the-genetic-fluctuations-falsehood/).  DNA is stable.  It doesn’t “fluctuate by the minute”.  It’s not influenced by our thoughts or our choices.

We may be stuck in a post-truth world but science is not, and will never be, post-truth.  Your belief in the cancer-fighting properties of turmeric doesn’t make turmeric cure cancer.  Your opinion that the MMR vaccine causes autism doesn’t change the concrete scientific evidence that it doesn’t.

By the same token, Dr Leaf might believe that our thoughts and choices change our DNA, but it doesn’t matter how many times Dr Leaf repeats the same fiction, it still doesn’t make it fact.  She can repeat ad nauseum her belief that the mind controls the brain, or our mind changes matter through quantum entanglement, or depression isn’t a disease, or all of our illnesses come from thoughts.  None of them were true the first time she made each outrageous claim, and they still aren’t true now. Scientific truth doesn’t change depending on what suits your opinion.

In fact, all Dr Leaf is doing by continually perpetuating her stock of mistruths is to disempower her audience.  Rather than encourage people to follow the facts, they are sucked into a vortex of wasted money and time.  Precious resources are spent chasing wild geese instead of putting them towards something more meaningful.  NOIVA diverting funds to support Dr Leaf’s fees instead of feeding refugees is a perfect case in point.

Worse, Dr Leaf’s teaching discourages people from taking effective medications and seeking effective treatments which can only lead to greater suffering in those who are vulnerable.

In this sense, Dr Leaf is like the anti-vaxxer of the Christian church, discouraging her followers from seeking scientifically sound treatments in favour of belief in erroneous and invalid actions with no proof of efficacy and a real risk of harm.

When will the leadership of the Christian church stand up for their parishioners and stop Dr Leaf’s fictions from infecting their churches?  The answer should be ‘now’, and that’s a fact.

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

Cutting through the Paleo hype

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Fad diets come and go. One of the most popular fad diets of recent times is Paleo.

The Palaeolithic diet, also called the ‘Stone Age diet’, or simply ‘Paleo’, is as controversial as it is popular. It’s been increasing in popularity over the last few years, and has had some amazing claims made of it by wellness bloggers and celebrity chefs. Advocates like ‘Paleo’ Pete Evans of MKR fame, claim that the Palaeolithic diet could prevent or cure poly-cystic ovarian syndrome, autism, mental illness, dementia and obesity [1].

So what does the published medical literature say? Is there really good research evidence to support the vast and extravagant claims of Paleo?

About 10 months ago, I started reviewing the medical research to try and answer that very question. My review of the medical literature turned up some interesting results, and so rather than post it just as a blog, I thought I would submit it to a peer-reviewed medical journal for publication. After a very nervous 9-month gestation of submission, review, and resubmission, my article was published today in Australian Family Physician [2].

So, why Paleo, and what’s the evidence?

Why Paleo?

The rationale for the Palaeolithic diet stems from the Evolutionary Discordance hypothesis – that human evolution ceased 10,000 years ago, and our stone-age genetics are unequipped to cope with our modern diet and lifestyle, leading to “diseases of civilization” [3-9]. Thus, only foods that were available to hunter-gatherer groups are optimal for human health – “could I eat this if I were naked with a sharp stick on the savanna?” [10] Therefore meat, fruits and vegetables are acceptable, but grains and dairy products are not [11].

Such views have drawn criticism from anthropologists, who argue that that there is no blanket prescription of an evolutionarily appropriate diet, but rather that human eating habits are primarily learned through behavioural, social and physiological mechanisms [12]. Other commentators have noted that the claims of the Palaeolithic diet are unsupported by scientific and historical evidence [13].

So the Palaeolithic diet is probably nothing like the actual palaeolithic diet. But pragmatically speaking, is a diet sans dairy and refined carbohydrates beneficial, even if it’s not historically accurate?

Published evidence on the Palaeolithic Diet

While the proponents of the Palaeolithic diet claim that it’s evidence based, there are only a limited number of controlled clinical trials comparing the Palaeolithic diet to accepted diets such as the Diabetic diet or the Mediterranean diet.

Looking at the studies as a whole, the Palaeolithic diet was often associated with increased satiety independent of caloric or macronutrient composition. In other words, gram for gram, or calorie for calorie, the Paleo diets tended to make people fuller, and therefore tend to eat less. Of course, that may have also been because the Paleo diet was considered less palatable and more difficult to adhere to [14]. A number of studies also showed improvements in body weight, waist circumference, blood pressure and blood lipids. Some studies showed improvements in blood sugar control, and some did not.

The main draw back of clinical studies of Paleo is that the studies were short, with different designs and without enough subjects to give the studies any statistical strength. The strongest of the studies, by Mellburg et al, showed no long-term differences between the Palaeolithic diet and a control diet after two years [15].

The other thing to note is that, in the studies that measured them, there was no significant difference in inflammatory markers as a result of consuming a Palaeolithic diet. So supporters of Paleo don’t have any grounds to claim that Paleo can treat autoimmune or inflammatory diseases. No clinical study on Paleo has looked at mental illness or complex developmental disorders such as autism.

Other factors also need to be considered when thinking about Paleo. Modelling of the cost of the Palaeolithic diet suggests that it is approximately 10% more expensive than an essential diet of similar nutritional value, which may limit Paleo’s usefulness for those on a low income [16]. Calcium deficiency also remains a significant issue with the Palaeolithic diet, with the study by Osterdahl et al (2008) demonstrating a calcium intake about 50% of the recommended dietary intake [17]. Uncorrected, this could increase a patients risk of osteoporosis [18].

To Paleo or not to Paleo?

The bottom line is the Paleo diet is currently over-hyped and under-researched. There are some positive findings, but these positive findings should be tempered by the lack of power of these studies, which were limited by their small numbers, heterogeneity, and short duration.

If Paleo is to be taken seriously, larger independent trials with consistent methodology and longer duration are required to confirm the initial promise in these early studies. But for now, claims that the Palaeolithic diet could treat or prevent conditions such as autism, dementia and mental illness are not supported by clinical research.

If you’re considering going on the Palaeolithic diet, I would encourage you to talk with an accredited dietician or your GP first, and make sure that it’s right for you. Or you could just eat more vegetables and drink more water, which is probably just as healthy in the long run, but without the weight of celebrity expectations.

Comparison of the current Australian Dietary Guidelines Recommendations [19] to the Palaeolithic diet [17]

Australian Dietary Guidelines The Palaeolithic Diet
Enjoy a wide variety of nutritious foods from these five groups every day:  
Plenty of vegetables, including different types and colours, and legumes/beans Ad libitum fresh vegetables and fruits
Fruit
Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as bread, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley All cereals / grain products prohibited, including maize and rice
Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans Ad libitum lean meats and poultry, fish, eggs, tofu, nuts and seeds, but all legumes prohibited
Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under 2 years) All dairy products prohibited
And drink plenty of water. Ad libitum water (mineral water allowed if tap water unavailable)

References

[1]        Duck S. Paleo diet: Health experts slam chef Pete Evans for pushing extreme views. Sunday Herald Sun. 2014 December 7.
[2]        Pitt CE. Cutting through the Paleo hype: The evidence for the Palaeolithic diet. Australian Family Physician 2016 Jan/Feb;45(1):35-38.
[3]        Konner M, Eaton SB. Paleolithic nutrition: twenty-five years later. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 2010 Dec;25(6):594-602.
[4]        Eaton SB, Eaton SB, 3rd, Konner MJ. Paleolithic nutrition revisited: a twelve-year retrospective on its nature and implications. European journal of clinical nutrition 1997 Apr;51(4):207-16.
[5]        Eaton SB, Konner M. Paleolithic nutrition. A consideration of its nature and current implications. The New England journal of medicine 1985 Jan 31;312(5):283-9.
[6]        Kuipers RS, Luxwolda MF, Dijck-Brouwer DA, et al. Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet. The British journal of nutrition 2010 Dec;104(11):1666-87.
[7]        Eaton SB, Konner MJ, Cordain L. Diet-dependent acid load, Paleolithic [corrected] nutrition, and evolutionary health promotion. The American journal of clinical nutrition 2010 Feb;91(2):295-7.
[8]        O’Keefe JH, Jr., Cordain L. Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer. Mayo Clinic proceedings 2004 Jan;79(1):101-08.
[9]        Eaton SB, Eaton SB, 3rd, Sinclair AJ, Cordain L, Mann NJ. Dietary intake of long-chain polyunsaturated fatty acids during the paleolithic. World review of nutrition and dietetics 1998;83:12-23.
[10]      Audette RV, Gilchrist T. Neanderthin : eat like a caveman to achieve a lean, strong, healthy body. 1st St. Martin’s Press ed. New York: St. Martin’s, 1999.
[11]      Lindeberg S. Paleolithic diets as a model for prevention and treatment of Western disease. American journal of human biology : the official journal of the Human Biology Council 2012 Mar-Apr;24(2):110-5.
[12]      Turner BL, Thompson AL. Beyond the Paleolithic prescription: incorporating diversity and flexibility in the study of human diet evolution. Nutrition reviews 2013 Aug;71(8):501-10.
[13]      Knight C. “Most people are simply not designed to eat pasta”: evolutionary explanations for obesity in the low-carbohydrate diet movement. Public understanding of science 2011 Sep;20(5):706-19.
[14]      Jonsson T, Granfeldt Y, Lindeberg S, Hallberg AC. Subjective satiety and other experiences of a Paleolithic diet compared to a diabetes diet in patients with type 2 diabetes. Nutrition journal 2013;12:105.
[15]      Mellberg C, Sandberg S, Ryberg M, et al. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial. European journal of clinical nutrition 2014 Mar;68(3):350-7.
[16]      Metzgar M, Rideout TC, Fontes-Villalba M, Kuipers RS. The feasibility of a Paleolithic diet for low-income consumers. Nutrition research 2011 Jun;31(6):444-51.
[17]      Osterdahl M, Kocturk T, Koochek A, Wandell PE. Effects of a short-term intervention with a paleolithic diet in healthy volunteers. European journal of clinical nutrition 2008 May;62(5):682-85.
[18]      Warensjo E, Byberg L, Melhus H, et al. Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study. BMJ 2011;342:d1473.
[19]      National Health and Medical Research Council. Australian Dietary Guidelines. Canberra: National Health and Medical Research Council; 2013.

Should pregnant women still take antidepressants if they’re depressed? – SSRI’s and the risk of autism

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As is my usual habit, I sat down tonight to do something useful and wound up flicking though Facebook instead.  Procrastination … avoidance behaviour … yeah, probably.  But at least this time it turned out to be rather useful procrastination, because I came across a science news story on Science Daily about a study linking the use of anti-depressants in pregnancy with an 87% increased risk of autism.

Actually, this is old news.  Other studies have linked the use of some anti-depressants with an increased risk of autism, such as Rai et al in 2013 [1].

The latest study to come out used data from a collaboration called the Quebec Pregnancy Cohort and studied 145,456 children between the time of their conception up to age ten.  In total, 1,045 children in that cohort were diagnosed with autism of some form, which sounds like a lot, but it was only 0.72%, which is actually lower than the currently accepted prevalence of autism in the community of 1%.

What the researchers got excited about was the risk of developing autism if the mother took an antidepressant medication at least at one time during her pregnancy.  Controlling for other variables like the age, wealth, and other health of the mothers, a woman who took an anti-depressant during pregnancy had a 1.87 times greater chance that her baby would end up with ASD, compared to women who did not take an anti-depressant [2].

An 87% increase sounds like an awful lot.  In fact, it sounds like another reason why anti-depressants should be condemned … right?

Well, like all medical research, you’ve got to consider it all in context.

First, you’ve always got to remember that correlation doesn’t always equal causation.  In this particular study, there was a large number of women being followed, and their children were followed for a long enough time to capture all of the likely diagnoses.  So that’s a strength.  They also tried to control for a large number of variable when calculating the risk of anti-depressants, which also adds more weight to the numbers.

Although the numbers are strong, studies like these can’t prove that one thing causes another, merely that they’re somehow linked.  It might be that taking anti-depressants causes the brain changes of autism in the foetus, but this sort of study can’t prove that.

Even if the relationship between anti-depressants and ASD was cause-and-effect, what’s the absolute risk?  Given the numbers in the study, probably pretty small.  With a generous assumption that ten percent of the study population was taking anti-depressants, the increase in the absolute risk of a women taking anti-depressants having a child with ASD is about 0.5%.  Or, there would be one extra case of autism for every 171 that took anti-depressants.

Hmmm … when you think of it that way, it doesn’t sound as bad.

You also have to consider the increase in risk to women and their offspring when they have depression that remains untreated, or in women that stop their anti-depressant medications.  There is some evidence that babies born to women with untreated depression are at risk of prematurity, low birth weight, and growth restriction in the womb, as well as higher impulsivity, poor social interaction, and behavioural, emotional and learning difficulties.  For the mother, pregnant women with depression are more at risk of developing postpartum depression and suicidality, as well as pregnancy complications such as preeclampsia, and an increase in high-risk health behaviour such as smoking, drug and alcohol abuse, and poor nutrition.  Women who discontinued their antidepressant therapy relapsed significantly more frequently compared with women who maintained their antidepressant use throughout pregnancy (five times the rate) [3].

So the take home messages:

  1. Yes, there’s good evidence that taking anti-depressants in pregnancy is linked to an increased risk of a child developing autism.
  2. But the overall risk is still small. There is one extra case of autism for every 171 women who take anti-depressants through their pregnancy.
  3. And this should always be balanced out by the risks to the mother and child by not adequately treating depression through pregnancy.
  4. If you are pregnant or you would like to become pregnant, and you are taking anti-depressants, do not stop them suddenly. Talk to your GP, OBGYN or psychiatrist and work out a plan that’s best for you and your baby.

References

[1]       Rai D, Lee BK, Dalman C, Golding J, Lewis G, Magnusson C. Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: population based case-control study. Bmj 2013;346:f2059.
[2]       Boukhris T, Sheehy O, Mottron L, Bérard A. Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatrics 2015:1-8.
[3]       Chan J, Natekar A, Einarson A, Koren G. Risks of untreated depression in pregnancy. Can Fam Physician 2014 Mar;60(3):242-3.

Different strokes for different folks? Why vaccinations don’t lead to mini-strokes

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Screen Shot 2015-05-31 at 4.46.48 pmOne of my Facebook friends messaged me a link the other day. It was to an article that had been popping up on his Facebook feed, originally published by Health Impact News (http://goo.gl/V3A5Mb).

The article is a report by John P. Thomas, building on the previous work of Andrew Moulden. Moulden failed his medical residency in Canada (http://goo.gl/BBKG5z), but used his doctorate in psychology to promote himself as a doctor.

Moulden believed that “Multiple factors can work together to trigger a single type of reaction in the body, which can then produce various sets of symptoms. Even though there were different sets of symptoms and different disease names given to each one, they were actually all part of a spectrum of diseases that he called Moulden Anoxia Spectrum Syndromes. Learning disabilities, autism, Alzheimer’s, irritable bowel disease, Crohn’s disease, colitis, food allergies, shaken baby syndrome, sudden infant death, idiopathic seizure disorders, Gulf War syndrome, Gardasil adverse reactions, schizophrenia, Tourette’s syndrome, chronic fatigue syndrome, fibromyalgia, expressive aphasia, impaired speech skills, attention deficit disorders, silent ischemic strokes, blood clots, idiopathic thrombocytopenia purpura, Parkinson’s disease, and other modern neurodevelopmental disorders are closely related in many ways, and are part of a larger syndrome.” (http://goo.gl/kTNRMV)

Moulden Anoxia Spectrum Syndromes isn’t found in any medical textbook, and there is no evidence that Autism, Alzheimer’s, Gulf War Syndrome, food allergies and Shaken Baby Syndrome are at all causally related.

Besides, the term ‘anoxia’ is a medical term meaning ‘without oxygen’. Moulden is obviously suggesting that every one of those disparate conditions is fundamentally caused by a lack of oxygen to somewhere, and while his logic has many flaws, this is the fatal one. Food allergies are not related to lack of oxygen. Neither are reactions to the Gardasil vaccine. And we know that Autism is defined by structural and functional changes in the brain that occur in the womb, and can be detected as early as a month after birth [1]. Autism is primarily genetic – autistic brains have excess numbers of dysfunctional nerve cells that are unable to form the correct synaptic scaffolding, leaving a brain that’s large [2, 3], but out-of-sync. There is nothing about autism that’s related to low oxygen. ADHD is similarly genetic and neurodevelopmental in origin [4]. The only thing suffering from lack of oxygen is Moulden’s theories.

Thomas then tries to extend this already tenuous medical hypothesis by claiming that vaccines cause damage to capillaries in ‘watershed’ areas which, according to his definition (not the medical definition), are “very small areas of tissue (groups of cells) that are served by a single blood vessel called a capillary” (http://goo.gl/4IlUI7) He suggests that certain cranial nerves are vulnerable to these ‘watershed’ injuries, which then result in changes in the way the face moves.

The cause for these ‘watershed’ injuries? “The blood is being sludged up in multiple areas of the body, which is causing ischemia, damage to tissue, functional disorders, and disease. This is not genetic. It is acquired. The drop in the corner of the mouth is the result of low zeta potential and the MASS process. People with autism spectrum disorders, neurodevelopmental disorders, ADHD, and those who are having adverse effects from vaccines such as hepatitis, flu, anthrax, Gardasil, DPT, MMR, etc. are having a generic response. The body is reacting to having foreign matter put into it.”

In other words, he’s suggesting that vaccinations essentially cause strokes.

From here, the article becomes a bamboozling cacophony of legitimate but irrelevant facts, diagrams, factoids, and recommendations. For example, Thomas explains the signs of damage to the third, fourth, sixth and seventh cranial nerves, and cites the damage by actual strokes as examples. Well, that’s fine, except that real strokes don’t involve damage to capillaries, but blockage of arteries, and have nothing to do with vaccination.

He also makes statements that are simply wrong, like “The seventh cranial nerve primarily controls the lower half of the face” (actually the seventh cranial nerve, also called the facial nerve, controls the muscles of the whole face – http://goo.gl/m9S7Gd). And, “When we see seventh cranial nerve damage, we can be sure that the damage is not isolated to the seventh cranial nerve – the damage is happening everywhere” (except in Bells Palsy … and some parotid tumours … and some strokes … and lots of other things).

He also makes the ridiculous claim that autism causes facial droop without explaining why, suggests that weakness of the muscles of the eyes controlled by the sixth cranial nerve is often the first sign of vaccine damage, and that ‘watershed’ damage to the brainstem from vaccination is the cause of SIDS.

Thomas then attempts to justify his conjecture by describing the case of a single baby boy whom he claims died from sudden infant death post vaccination – “His family and his physicians watched him slowly die while the respirator did his breathing for him. Basically they were watching his brain as he went through the stages of sudden infant death after vaccine exposure”. Except that death after nineteen days is not ‘sudden’, and the description of this child’s tragic death is nothing like SIDS. And his only reference to this case? Not an official forensic report, but a ‘report’ written by Andrew Moulden, which was simply an offensive and detestable attempt to leverage the heart-wrenching death of a fifteen month old boy to push his idealistic agenda (http://goo.gl/ysoCtQ).

I could go on. There are pages of material that simply defy rational thinking. He even goes on to question germ theory, and states that “Vaccines are one of the largest triggers of excessive non-specific immune hyperstimulation, which ultimately leads to blood sludging, clotting, and loss of negative zeta. The combined effect of all these factors produce illness, disability, and death.”

There is no credible medical evidence to back up any of Thomas’s claims, nor the claims of Moulden before him. Together, they openly defy centuries of scientific knowledge, modern science, and the observations of every parent whose children have been vaccinated.

Lets face it – if vaccines really caused mini-strokes, we wouldn’t need the dubious work of Moulden and his disciples to discover it. We would have all seen it.

There are a lot of very questionable theories that get promoted on the internet as valid science. Don’t fall for it. There’s no evidence for Moulden Anoxia Spectrum Syndromes, and the only connection between conditions like Irritable Bowel Syndrome, Shaken Baby Syndrome and Chronic Fatigue Syndrome is not vaccination, but the pathetic attempt to try and connect them by pseudoscientists with an idealistic barrow to push.

References

[1]        Pierce K. Exploring the Causes of Autism – The Role of Genetics and The Environment (Keynote Symposium 11). Asia Pacific Autism Conference; 2013 10 August; Adelaide, Australia: APAC 2013; 2013.

[2]        Courchesne E, Carper R, Akshoomoff N. Evidence of brain overgrowth in the first year of life in autism. JAMA : the journal of the American Medical Association 2003 Jul 16;290(3):337-44.

[3]        Shen MD, Nordahl CW, Young GS, et al. Early brain enlargement and elevated extra-axial fluid in infants who develop autism spectrum disorder. Brain : a journal of neurology 2013 Sep;136(Pt 9):2825-35.

[4]        Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.

Why all the anger?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

Dr Caroline Leaf – Scientific heresy

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Screen Shot 2015-03-30 at 7.54.04 pm

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

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

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

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

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

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

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

Screen Shot 2015-03-30 at 9.32.16 pm

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

 

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

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

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

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

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

Dr Leaf has committed scientific heresy.

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

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

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

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

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

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

References

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

Gluten mad!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

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

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

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

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

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

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

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