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.”

Screen Shot 2016-05-29 at 10.25.58 PM

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

IMG_4312

Milsons Park, Neutral Bay

Cremorne20160820 Web

Cremorne

Point Piper

Point Piper

Macquarie Lighthouse

Macquarie Lighthouse

Blues Point Reserve

Blues Point Reserve

Blues Point Reserve

Blues Point Reserve

References

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

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

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

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

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

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

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

Dr Caroline Leaf and Her House of Cards

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

MIND CHANGES BRAIN? READ THIS …

Screen Shot 2016-06-21 at 9.45.03 PM

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.

Dr Caroline Leaf and the mind-brain revisited

 

Screen Shot 2016-05-29 at 10.25.58 PM

Dr Leaf has been promoting her food philosophy lately, but yesterday and today, she has come back to one of her favourite neuroscience topics.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. It’s her belief that “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 …”.

This is one of the flaws that terminally weakens her teaching, and leads to scientifically irrational statements like yesterday’s meme:

“God has designed the mind as seperate from the brain. The brain simply stores the information from the mind and your mind controls your brain.”

On what basis does she make such a claim? I’ve reviewed the scripture relating to the triune being hypothesis. The Bible doesn’t say that our mind is seperate to our brain, nor that it dominates and controls our brain. Dr Leaf’s statement yesterday is simply assumption based on more assumption. It’s like an intellectual house of cards. The slightest puff of scrutiny and the whole thing comes crashing down on itself.

Screen Shot 2016-05-30 at 8.06.38 PM

To try and reinforce her message today, Dr Leaf quoted Dr Jeffrey Schwartz, psychiatrist and neuroscientist, “The mind has the ability to causally affect and change pathways in the brain.” Jeffrey M. Schwartz is an OCD researcher from the UCLA School of Medicine. It appears he lets his Buddhist anti-materialism philosophy cloud his scientific judgement.

Well Dr Leaf, I see your expert and I raise you. Dr David Eagleman is an author and neuroscientist at Baylor College of Medicine in Texas. He has written more than 100 scientific papers on neuroscience, and has published numerous best-selling non-fiction books including ‘Incognito, The Secret Lives of the Brain’ which was a New York Times best-seller. He isn’t an irrational anti-materialist.

He said, “It is clear at this point that we are irrevocably tied to the 3 pounds of strange computational material found within our skulls. The brain is utterly alien to us, and yet our personalities, hopes, fears and aspirations all depend on the integrity of this biological tissue. How do we know this? Because when the brain changes, we change. Our personality, decision-making, risk-aversion, the capacity to see colours or name animals – all these can change, in very specific ways, when the brain is altered by tumours, strokes, drugs, disease or trauma. As much as we like to think about the body and mind living separate existences, the mental is not separable from the physical.” https://goo.gl/uFKF47

This statement makes much more logical sense. The functions of the mind are all vulnerable to changes in the brain. Take medications as one particular example. Caffeine makes us more alert, alcohol makes us sleepy or disinhibited. Marijuana makes it’s users relaxed and hungry, and sometimes paranoid. Pathological gambling, hypersexuality, and compulsive shopping together sound like a party weekend in Las Vegas, but they’re all side effects linked with Dopamine Agonist Drugs, which are used to treat Parkinson’s disease. There are many other examples of many other physical and chemical changes in the brain that affect the mind.

Conversely, there is limited evidence of the effect of the mind on the brain. Sure, there is some evidence of experienced meditators who have larger areas in their brain dedicated to what they meditate on, but the same effect has been shown in other parts of the brain unrelated to our conscious awareness.

But since the mind is a function of the brain, whatever effect the ‘mind’ has on the brain is, in reality, just the brain effecting itself.

So Dr Leaf can cherry-pick from her favourite authors all she wants, but quoting a supportive neuroscientist doesn’t diminish the crushing weight of scientific evidence which opposes her philosophical assumptions. If she wants to continue to proffer such statements, she would be better served to come up with some actual evidence, not just biased opinion.

Anti-depressants – Not the messiah

 “He’s not the messiah, he’s a very naughty boy, now go away!” 

 Ah, Monty Python – six university students with a penchant for satire who changed the face of comedy.  They say that “Imitation is the sincerest form of flattery”, and if that’s the case, Monty Python should be very flattered!  Nearly five decades later, you still hear people throwing around lines from their sketches and getting a laugh.

Their movie, “The Life of Brian” remains one of the most critically acclaimed and most controversial of all movies.  It was the story of Brian, born in the stable next door to Jesus, and who later in life unintentionally becomes the focus of a bunch of people who mistakenly believe he’s the messiah.  One morning he opens his window to find a large crowd of people waiting for him outside his house, leaving his mother to try and dismiss the crowd with that now famous rebuke.

The crowd at Brian’s window aptly demonstrates a quirk in our collective psyche.  We humans have a bipolar tendency to latch on to something that seems like a good idea at the time and blow it’s benefits out of all proportion, only to later discover it wasn’t as good as our overblown expectations and unfairly despise it on the rebound.

Anti-depressant medications are a bit like Monty Python’s Brian.  Back in the late 1980’s when Prozac first came on the market, doctors saw it as the mental health messiah.  Prozac improved cases of long-standing severe depression and was much safer in overdose compared to older classes of psychiatric medications.  The idea that depression and other mental illnesses were related to chemical imbalances fit nicely with the cultural shift away from the Freudian psychotherapy model that was prevalent at the time.  People were describing life changing experiences on Prozac: “One morning I woke up and really did want to live … It was as if the miasma of depression had lifted off me, in the same way that the fog in San Francisco rises as the day wears on.” [1]  Prescribing for Prozac and other SSRI anti-depressants took off.

Fast forward to the present day, where the pendulum has swung back violently.  Anti-depressants are considered by some to be nothing more than over-prescribed placebo medications used by a pill-happy, time-poor culture demanding simple cures for complex problems.  Some commentators have gone so far as to label anti-depressants as an evil tool of the corrupt capitalist psychiatric establishment.

“Anti-depressants are not the messiah, they’re very naughty boys, now go away!” they exclaim.

But are anti-depressants really the enemy, or could they still be friendly, even if they’re not the messiah?

In the Medical Journal of Australia this month, two Australian psychiatrists, Christopher Davey and Andrew Chanen, carefully review the place of anti-depressants in modern medicine [2].  It’s a very balanced and pragmatic view.

They bring together all the evidence to show that while anti-depressants aren’t the elixir of happiness that we once assumed, they also don’t deserve the accusation that they’re nothing but fakes.

When drugs are scientifically tested, they’re usually studied in placebo-controlled trials.  The medications are given to one target group of people and a fake medicine is given to a similar group.  In the best trials, the patients aren’t aware of which they’re actually getting, and the physicians aren’t aware either.  That way personal bias and expectations can be reduced.  To reduce these biases even further, other scientists can pool all of the quality research on a topic in what’s called a meta-analysis.

Trials on anti-depressants initially showed very strong positive results, or in other words, the patients on the drug did much better than those on the placebo.  Anti-depressants lost a lot of their shine in the last decade or so as researchers began pointing out that the placebo effect, the number of patients improving on the fake medicine, was also very high.

There was also the serious, and largely legitimate accusation that drug companies ignored trials with less favourable results to make their drugs look better.  The reputation of anti-depressants was forever tarnished.

One of the most out-spoken critics of anti-depressants, Harvard psychologist Irving Kirsch, tried to show that when all of the trials on anti-depressants were taken together, the placebo effect wasn’t just close to the effectiveness of the real medicine, but was actually the same.

The problem with Kirsch’s analysis is that not all trials are created equal.  Some have negative results because they were poor trials in the first place.  When experts reapplied Kirsch’s methods to the best quality trials, the results suggested that anti-depressants are still effective, but for moderate and severe depression [1].  Anti-depressants for mild depression weren’t of great benefit.

This is take home point number one: Don’t believe the hype.  Anti-depressants are useful, but not for all cases of depression. #happypillshelp

So if anti-depressants aren’t useful for all cases of depression, are other therapies better? This is where psychological therapies come in to the equation.  Those who are the most vocal opponents of modern psychiatry and psychiatric medications are also the most vocal promoters of the benefits of talking therapies.  They won’t admit it, but there’s usually an ideological bias or financial incentive driving the feverish worship of talking therapies and their overzealous defence.

Though in the cold hard light of evidence-based science, talking therapies aren’t much of a panacea either.  Pim Cuijpers, a professor of Clinical Psychology in Amsterdam lead a team who reviewed the effectiveness of trials of psychotherapy, and found that their effectiveness has also been overstated over the last few decades.  Quality studies show that talking therapies are equivalent in effectiveness compared to anti-depressants for depression [3].

What’s important to understand about talking therapies in general is that any benefit they have is related to changing behaviour, but that’s not dependent on changing your thoughts first [4-6].  Talking and thinking differently is fine, but unless that results in a change to your actions, there will probably be little benefit.

This is take home message number two: Talking therapies help, but you don’t need to change your thinking, you need to change your actions. #walkthetalk

The million-dollar question is how to apply all of this.  If talking therapies have the same benefit as anti-depressants, then do we go for tablets before talking or the other way around?  Are both together more powerful than each one alone?

In their paper, Davey and Chanen outline what has become the generally accepted pecking order for anti-depressant therapy.  They recommend that all patients should be offered talking treatments where it’s available.  Medication should only be considered if:

  1. a person’s depression is moderate or severe;
  2. a person doesn’t want to engage with talking therapies; or
  3. talking therapies haven’t worked.

Some overseas guidelines recommend this order based on projected bang for your buck.  While talking therapies are initially more expensive, they seem to have a more durable effect than medications, which are initially cheaper and easier, but have a greater cost with prolonged use [7].  In other words, if you learn better resilience and coping skills, you’re less likely to fall back into depression, compared to the use of the medications.

This is take home message number three: Use talking therapies first, with medications as a back up. #skillsthenpills

At this point in history, we seem to finally be finding some balance.  Just as anti-depressants aren’t the messiah, they’re not the devil either, despite the vocal minority doing their best to demonise them.

With a few decades of research and clinical experience since Prozac was first released on to the market, we’re finally getting an accurate picture of the place of talking therapies and medications in the treatment of depression.  Both are equally effective, and each have their place in the management of mental illness in our modern world.

References

[1]        Mukherjee S. Post Prozac Nation – The Science and History of Treating Depression. The New York Times. 2012 Apr 19
[2]        Davey CG, Chanen AM. The unfulfilled promise of the antidepressant medications. Med J Aust 2016 May 16;204(9):348-50.
[3]        Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychological medicine 2010 Feb;40(2):211-23.
[4]        Herbert JD, Forman EM. The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness. Acceptance and Mindfulness in Cognitive Behavior Therapy: John Wiley & Sons, Inc., 2011;1-25.
[5]        Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clinical psychology review 2007 Mar;27(2):173-87.
[6]        Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of consulting and clinical psychology 2008 Jun;76(3):468-77.
[7]        Anderson I. Depression. The Treatment and Management of Depression in Adults (Update). NICE clinical guideline 90.2009. London: The British Psychological Society and The Royal College of Psychiatrists, 2010.

IMPORTANT

If you have questions about what treatment type might be better for you in your situation, please talk to your local GP, psychologist or psychiatrist, or if you need urgent crisis support, then:

In Australia

  • you can call either Lifeline on 13 11 14,
  • BeyondBlue provides a number of different support options
  • the BeyondBlue Support Service provides advice and support via telephone 24/7 (call 1300 22 4636)
  • daily web chat (between 3pm–12am)
  • email (with a response provided within 24 hours) via their website https://www.beyondblue.org.au/about-us/contact-us.

In the US
-> call the National Suicide Prevention Lifeline by calling 1-800-273-TALK (8255).

In New Zealand
-> call Lifeline Aotearoa 24/7 Helpline on 0800 543 354

In the UK
-> Samaritans offer a 24 hour help line, on 116 123.

 

Book review: “Think and Eat Yourself Smart” by Dr Caroline Leaf

ThinkAndEatYourselfSmart_Cover_Web

Think and Eat Yourself Smart
Dr Caroline Leaf
328 pages, Published by Baker Books USA

My rating: 2 / 10

As a society, we are obsessed with food.  With copious food blogs, celebrity chefs and reality cooking shows, food has become more about our social status and self-identity than about nourishment.

Food has always been intimately connected to our health and well-being, and the modern food obsession has taken that to extreme levels as well.   Organic, paleo, sugarless, raw food, cleansing and other popular diets have morphed into ‘movements’, the polite shorthand way of describing popular obsessions that are borderline cults.

Trying to cash in on this wave of cultural orthorexia is Dr Caroline Leaf with her latest book, “Think and Eat Yourself Smart”, published in early April by Baker Books.

Dr Leaf describes the book as “an attempt to reintroduce a culture of thinking and effort back into eating, one based on diligently stewarding the body and world God entrusted to us.  In the spirit of renewing the mind, it is a lifestyle book that seeks to reimagine what we eat within an integrated spirit, mind and body framework.”

And that would be fine in theory, though in practice, Dr Leaf uses the book more as a vehicle for divulging her personal food preferences and her socio-political ideology while recycling most of her dubious brain science.

But before we go any further, let me issue a disclaimer: There’ll be some who will look this review and assume I’m being critical of Dr Leaf’s book for the sake of being critical.  I recognise that I’m not Dr Leaf’s number one fan, however, I want to say from the outset of this review that I have approached this as dispassionately and objectively as I can.

“Think and Eat Yourself Smart” is certainly not all bad.  Dr Leaf raises some legitimate issues.  For example, she’s critical of the vitamin and supplement industry and the staggering cost of supplements compared to their very limited benefits.  She discusses the previous dietary advice regarding low-fat foods, and how the misguided attempt to reduce our dietary fat intake lead to a compensatory increase in starch and sugars.  She also discussed the current concerns about too much sugar and refined carbohydrates, and raises the very real problem of food waste and food security.  The recipes at the back of the book contain the usual over-rated hipster foodie ingredients like dandelion, kale, quinoa and chia seeds to maintain Dr Leaf’s foodie creds, although some of the recipes themselves sound alright.

Unfortunately, every truth is outweighed by a multiplex of factoids and misrepresentations.  Dr Leaf clearly favours organic food, which despite her claims, have not been shown to be better tasting, more nutritious, less toxic, and better for the environment.  She’s clearly against genetically modified organisms (or GMO’s), a stance which is more populist than scientific.

Dr Leaf’s underlying premises are also deeply flawed.  It’s clear that she’s been heavily influenced by the work of Michael Pollan and other post-modern food gurus of the same ilk.  She’s critical of modern food systems including all food processing, food transportation, and supermarkets, claiming that modern agriculture and food processing destroys all nutrients and taste.  Dr Leaf claims that “Real food is food grown the way God intended: fresh and nutritious, predominantly local, seasonal, grass-fed, as wild as possible, free of synthetic chemicals, whole or minimally processed, and ecologically diverse.” (p29)

Dr Leaf’s definition of “real food” is nothing more than a romanticised post-modern social construct, and claiming it’s God’s idea doesn’t make it any less misleading.  Of course we want our food to be fresh, and we also want it to be nutritious.  But fresh and nutritious are not dependent on being local, seasonal, ecologically diverse (whatever that means), grass-fed and wild.  In fact, how something can be grass-fed and wild seems contradictory.  Processing food makes it safer, and in most cases, more nutritious that the unprocessed farm gate versions.  There’s virtually no pesticide residues left on conventional produce either, so that’s a moot point.

In fact, modern food is actually easier to eat and digest, more nutritious, tastier, safer, and longer lasting than ever before in human history. Today’s canned and frozen foods are infinitely healthier than in the past, and in some cases, more nutritious than the vegetables straight off the farm (canned tomatoes, for example, because nutrients are more easily absorbed from cooked tomatoes).  Dr Leaf’s idealised view of our agrarian past is false, and the notion that we should return to it is inane.

Dr Leaf also spends a great deal of time trying relate our nutritional health to our thinking.  I discussed this in the pre-review of the book, here.  She claims that “Research shows that 75 to 98% of current mental, physical, emotional and behavioural illnesses and issues come from our thought life; only 2 to 25% come from a combination of genetics and what enters our bodies through food, Medication, 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.” (p84)

Again, this is a false premise based on bogus science.  75 to 98% of current mental, physical, emotional and behavioural illnesses and issues do not come from our thought life.  What you think and how you feel makes no difference to how your body processes the nutrients you put into it.

This excessive focus on the power of thought is a segue back to her previous teaching, a justification as to why she as a self-titled cognitive neuroscientist should be writing about food.  Unfortunately, the information contained in the second part of the book makes it obvious that she’s not an expert on either.

Sure, Dr Leaf discusses responsibility and choices which are important to what we put in our mouths, but there are so many other variables that are more intrinsic to our individual diets than just personal responsibility.  Like, poverty, income, education, cooking skills or geographic location for example.

Dr Leaf claims that how you think changes how you eat, and how you eat changes how you think.  Except the last part of that statement is mutually exclusive to her premise that the mind is separate to the brain and controls the brain.  What you put in your mouth might change the function of your brain, but how can that change the way you think if the mind is separate to the brain?

This paradox is the death-knell to her books credibility and usefulness.  Not that it makes any difference to Dr Leaf, who conveniently forgets this central tenet of her teaching whenever it suits her.

The advice she provides is also off-track.  The answer to processed food isn’t to plant your own garden, or raise your own chickens, or join a local agro-economic food co-op.  That sort of advice is impractical for the vast majority of her audience.  It excludes everyone who lives in a modern city, or who, like me, has an uncanny ability to kill all but the hardiest of plants.  Even her exhortation to eat “real food” is unnecessarily complicated.

Ultimately, Dr Leaf’s advice isn’t dangerous, but just old and confusing.  Most of the useful information she gives is obscured by the plethora of unnecessary and irrelevant opinions and factoids.  It’s also nothing new.  There have been countless books and blogs written by real nutritionists and dieticians that say the same essential things in much simpler ways.  Even John Oliver did a better job of explaining problems associated with sugar and our modern food systems (* Warning * – Strong language and adult themes).  He’s an agnostic satirical comedian who doesn’t pretend to be a scientific expert, and he still get’s the message across more effectively than Dr Leaf.

To conclude, if you want sound nutritional advice, I’d suggest you head for books by actual dieticians. Professor Rosemary Stanton is one author I would recommend. She’s a Professor of Nutritional Science and Visiting Fellow of the School of Medicinal Sciences at the University of New South Wales.  She’s published hundreds of academic and consumer articles including 33 books on good nutrition.  She’s been lecturing and writing about good food for longer than I’ve been alive.

In contrast, Dr Leaf’s book “Think and Eat Yourself Smart” is a repackaging of stale opinion and dubious science by an author who isn’t a nutritionist, or even a cognitive neuroscientist for that matter.  There might be some helpful advice in there, but it would be difficult for an average reader to pick out what’s beneficial and what’s bogus.

To that end, “Think and Eat Yourself Smart” is a lot like a frozen microwave dinner.  It looks good on the packaging, but what you get on the inside isn’t the same.  There’s a few nutritional morsels, to be sure, but most of it is just offal and gristle that’s been homogenised to an unrecognisable mush and then reassembled.

If you’re a Dr Leaf devotee, or you’re interested in her socio-political views, then by all means, buy this book.  If you want sound nutritional advice, look elsewhere.

 

“Think and Eat Yourself Smart”: a pre-review

Update: Read my full review of “Think and Eat Yourself Smart” here.

Screen Shot 2016-03-30 at 6.55.43 PM

They say, “Never judge a book by its cover.”  What about judging it by its marketing?

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She’s also a wannabe nutritionist.  Her latest book is “Think and Eat Yourself Smart”, due for official release at the end of April.

I haven’t read her book yet so I’m not really sure what she’s going to say.  It might be a well reasoned and soundly researched discussion about healthy eating, except there are some conflicting ideas that are appearing in Dr Leaf’s own marketing of the book, so I’m not holding out much promise.

For example, yesterday Dr Leaf suggested 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.”

This is bogus science.  It doesn’t matter if I’m convinced that eating a half gallon tub of ice cream is nutritious or not, it’s going to have the same nutritional effect on my body (namely, none).  It’s not 80 percent healthy because I believe it’s healthy.

Dr Leaf has made this assertion based on other bogus science – “How does thinking affect eating, and how does eating affect thinking? Research shows that 75 to 98% of current mental, physical, emotional and behavioural illnesses and issues come from our thought life; only 2 to 25% come from a combination of genetics and what enters our bodies through food, Medication, pollution, chemicals, and so on.”

Dr Leaf’s assertion that “75 to 98% of current mental, physical, emotional and behavioural illnesses and issues come from our thought life” is a favourite factoid of hers that forms the basis of most of her teaching.  Except that it’s wrong.  It has no basis in fact.  I’ve discussed this at length in several blogs and in my book (see here for a more detailed explanation of Dr Leaf’s 98% myth).

It’s unclear just how much of her book Dr Leaf has based on this false assumption, but the fact that it’s there in the first place sets a bad precedent for the rest of the book.

Only time will tell, of course.  I’d like to be proven wrong, but unfortunately, Dr Leafs latest book seems to be plagued with the same poor science as her other tomes.

Watch this space …