All in a tangle – Dr Caroline Leaf tries to explain Alzheimer disease

Posted on July 21, 2019 by cedwardpitt

In her latest blog post, Dr Caroline Leaf attempted to tackle the complex topic of Alzheimer disease.

Alzheimer disease is an important topic. It’s the most common progressive neurodegenerative disease worldwide and accounts for 60 to 80% of dementia cases. It causes a spectrum of memory impairment from forgetting where the car keys are through to forgetting to eat or drink. According to the 2018 report by the Alzheimer’s Association, an estimated 5.7 million Americans are diagnosed with Alzheimer dementia, costing their economy $277 billion in 2018 [1]. That’s a staggering economic cost, but the human cost is higher. Alzheimer’s exacts a great emotional toll on someone’s family and friends, both in terms of carer stress, and in seeing the person they love gradually slip away as the disease slowly erodes their personality until there’s nothing left.

There are two main forms of Alzheimer disease, an early onset type which accounts for about 5% cases, and a late onset type which accounts for the rest. Early onset Alzheimer disease occurs before the age of 65. It’s also called Familial Alzheimer disease because it’s caused by one of three autosomal dominant genes (if you have a copy of the gene, then you will get the disease). Late onset Alzheimer disease, as the name suggests, occurs late, after the age of 65. It’s more complex and is associated with a mix of both genetic, lifestyle and environmental risk factors.

The neurobiology of Alzheimer disease is complicated. Essentially, the symptoms of Alzheimer disease result from the death of too many nerve cells in the parts of the brain that manage memory and planning, but scientists are still trying to establish exactly why the nerve cells die. There are a number of pieces of the jigsaw already in place.

For example, scientists know that amyloid plaques and neurofibrilliary tangles are part of the disease process. These result from genetic changes to a number of enzymes which are critical to the nerve cells maintaining their structural integrity. It was first thought that these particular cell changes were critical factors to the nerve cells dying, but there are a number of other contributing factors that are also involved, such as changes to the metabolism of the nerve cells [2], inflammation of the brain, changes in the brain’s immune function, and changes to nerve cell responses to insult or injury (technically, endocytosis and apotosis, just in case you were wondering)[3].

In fact, it may be that the plaques and tangles are not the cause of the damage but are simply present while the other causes such as neuro-inflammation are doing all of the damage in the background. This is possible as there are a small group of people that have cellular changes of plaques and tangles, but who do not have the clinical signs of dementia. This was one of the discoveries in the Nun Study. We’ll talk more about the Nun Study later in the post.

Whether it’s the plaques and tangles doing the damage or not, most of these changes are happening well and truly before a person ever shows any symptoms. In fact, by the time a person has some mild cognitive impairment, the plaques have reached their maximum level and the tangles are close behind. This makes Alzheimer disease clinically challenging. It would be ideal if we could start treatment early in the course of the disease before the damage has been established, but right now, the fact is that by the time a person is showing signs of memory loss, the damage to the cells is already done.

This begs the question, can we reduce our risk of Alzheimer disease? There’s no good treatment for it, and even if there was, prevention is always better that cure. So what causes Alzheimer disease in the first place?

There are a number of factors which contribute to the development of Alzheimer disease, some of which we can change, but some of which we can’t.

Unmodifiable Risk Factors

Aging

Aging is the greatest risk factor for late onset Alzheimer disease. The older you get, the more likely you are to get the disease. Statistically, late onset Alzheimer disease will affect 3% of people between the ages 65–74, 17% of people aged 75–84 and 32% of people that are aged 85 years or older [1].

That’s not to say that Alzheimer disease and normal aging are the same. Everything shrinks and shrivels as you get older and the brain is no exception. And it’s true that Alzheimer disease and normal aging share some similarities in the parts of the brain most affected. However, these occur much more rapidly in Alzheimer disease compared to normal aging [4].

So, while aging is a necessary and significant risk factor for late onset Alzheimer disease, aging alone is not sufficient to cause Alzheimer disease.

Also, normal aging of the brain is not dementia. And forgetting things is not dementia. Everyone forgets things. My teenage children forget lots of things I tell them. They don’t have dementia. Getting old doesn’t mean getting senile. Some elderly people remain as sharp as a tack until the rest of their body gives up on them.

Genetics

There are a number of genes which have been associated with Alzheimer disease.

As I alluded to earlier, early onset Alzheimer disease is strongly hereditary, with three different autosomal dominant genes that lead to its development. They are known as APP, PSEN1and PSEN2genes[5]. The APPgene encodes for a protein is sequentially cleaved into peptides which then aggregate and form amyloid plaques. PSEN1and PSEN2encode subunits of one of the enzymes which breaks up the amyloid protein. Then there is a problem with one of the genes, the breakdown of the amyloid proteins is limited and the amyloid plaques start to accumulate at a much earlier age.

For late onset Alzheimer disease, there are 21 associated gene variants which are either splice variants, or single nucleotide polymorphisms (SNPs), and while they don’t cause Alzheimer disease, they increase the risk when they interact with other risk factors. Each of the genes is important to one of the five main biological processes that influence the cellular structure and function of nerve cells.

(taken from Eid A, Mhatre I, Richardson JR. Gene-environment interactions in Alzheimer’s disease: A potential path to precision medicine. Pharmacol Ther. 2019;199:173-87)

The risk that any of these genes confers for developing Alzheimer disease is ultimately dependent on other risk factors, but one of the most well-known of the genes related to Alzheimer disease is the gene APOE4. Apolipoprotein (APO) is a lipid carrier and is significantly involved in cholesterol metabolism. In humans, it’s expressed as either E2, E3 or E4 variants. The E4 variant has a much lower affinity for lipoproteins than its siblings, and if you have the APOE4, you have much poorer cholesterol metabolism – in your liver cells and in your brain cells. Again, this fact may not seem important now but it will be more important later in the post.

If you inherit a copy of the APOE4 gene from your mother and your father, you have an 8 – 12 times greater risk of developing Alzheimer disease than another person without both copies of the gene.

Family history

So if there are genes that can send your risk of Alzheimer disease through the roof, then it follows that having a family history of Alzheimer disease is a risk factor.

Individuals who have a first-degree relative, such as a parent, brother or sister who was diagnosed with Alzheimer disease are predisposed to develop the disease with a 4–10 times increased risk, compared to individuals who do not [6].

Of course, family history is not all to do with genetic risk factors, but it’s usually a combination of both genetics and share home environment between parents and siblings, hence why the risk conferred is not as high as APOE4, but is still very high.

Ethnicity

Early studies suggested that Alzheimer disease was more common in certain races, although the thought was that the risk was related to social and economic conditions common to those races, and not to specific genes.

Recently, better genetic studies have linked a few genes with some races. For example, there is a link with genes such as APOE4 which is twice as likely in African-American’s than other races, or a higher rate of mutations in the CLU gene amongst Caucasians [7].

Gender

There is a strong gender difference for Alzheimer disease. Overall, women are twice as likely to develop Alzheimer disease than men are.

There are a few possible reasons why this might be so. Inflammatory mechanisms might play a part, as does the function of the part of the cell called mitochondria. Hormonal differences might make some differences as well, specifically in relation to the oestrogen or the cell receptors for oestrogen.

There are also some gender differences in the way other genes play out. For example, it’s known that women with the APOE4 gene will experience a faster cognitive decline than men with the same gene [8]. Sorry ladies.

Modifiable Risk Factors

So whether we like it or not, there are some risk factors for Alzheimer disease that we can’t change. We can’t change our genes, our race, or our gender. We can’t get any younger either.

What about the risk factors for Alzheimer disease that we might be able to change?

Education

There’s some correlation between how much education someone has had and their risk of Alzheimer disease.

A meta-analysis by Larsson and colleagues which examined studies through to mid 2014 reported a statistical association of low education attainment (less than or equivalent to primary school) and increased Alzheimer disease risk. For those with a primary education or lower, the risk of Alzheimer disease was 41 to 60 percent higher compared to someone who had better than primary school. In a separate study, those who completed higher education (university level or above) had a lower risk of Alzheimer disease compared to those without higher education – approximately 11 percent per year of completed university level education [9]. There is some evidence that Alzheimer disease patients with higher education have a bigger part of the brain related to memory which is thought to be protective (if you have a bigger memory part of the brain, it will take longer to shrink in Alzheimer’s).

Two points to think about here. First, these studies are not demonstrating cause and effect. They don’t definitely prove that learning more stuff protects you from Alzheimer disease. The statistics could simply reflect that people with the ability to learn more information had more robust nerve cells and connections to start with.

Also, while a 60 percent increase in risk sounds high, remember that the APOE4 gene carries a 1200 percent increased risk. Comparatively speaking, the effect of education is actually quite small compared to other risk factors.

Metabolic factors

Remember how we talked before about cholesterol and the APOE4 variants? If you have both copies of the APOE4 gene, your liver cells and your brain cells aren’t good at handling lipoproteins.

Your liver cells are important in regulating your blood cholesterol. Your brain cells are important for handling the amyloid proteins and lipids for making new nerve cell branches.

With APOE4, the liver doesn’t handle the blood cholesterol properly and you end up with high cholesterol and cholesterol plaques in the coronary arteries. When the brain cells don’t handle cholesterol properly, there is an increase in plaques and tangles and neuro-inflammation which increases the risk of Alzheimer disease.

At one stage, researchers thought that having a higher blood cholesterol was linked to Alzheimer disease but further research has shown that the results are inconsistent – some studies show a link while others show no link at all. So all in all, there’s probably no cause and effect relationship with cholesterol and Alzheimer disease. In fact, there’s some suggestion that high cholesterol is not a causative factor, but rather the result of Alzheimer disease [10] or simply a correlation, related to an underlying genetic or metabolic disorder which is common to both conditions.

Blood sugar was also considered to be a key factor for Alzheimer disease. The Rotterdam Study conducted in the 1990s linked diabetes to Alzheimer disease [11], while a more recent nationwide population-based study in Taiwan showed that there was a higher incidence of dementia in diabetic patients [12].

While it may be that high blood sugar leads to Alzheimer disease, more recent research has suggested that there is a two-way interaction between Alzheimer disease and diabetes – diabetes increases the risk of Alzheimer disease, but Alzheimer disease increases the risk of diabetes. Other scientists have recognised that there is a metabolic disease with overlapping molecular mechanisms shared between diabetes and Alzheimer disease. These molecular mechanisms relate to less total insulin and higher insulin resistance, a mix of the pathologies seen in type 1 and type 2 diabetes – hence why one scientist called the underlying metabolic disorder “type 3 diabetes” [13].

So while cholesterol and blood sugar are linked to Alzheimer disease, it’s not clear whether aggressively lowering them would decrease the risk of Alzheimer disease or not.

Lifestyle choices (food and exercise)

If it’s not clear how much our metabolic factors have on our Alzheimer disease risk, what about the food we eat?

There’s some evidence that having a healthy lifestyle reduces the risk of Alzheimer disease, but it’s not known what factors of lifestyle are the most important. There was a study done on residents of New York City, and those who had a strict adherence to a Mediterranean diet and who participated in physical activity decreased their Alzheimer disease risk by about 35 percent [14]. That’s promising, but while there have been lots of studies into various aspects of diet and Alzheimer disease, it’s not clear what exactly works and why [15].

We can’t dismiss lifestyle changes, but more research is needed.

Others

Smoking and alcohol are usually implicated in everything bad, and one would expect that their role in Alzheimer disease would be the same. So it surprised everyone when one meta-analysis declared that smoking had a protective effect on Alzheimer disease.

The result sounded too good to be true and it probably is. It’s likely that either smoking killed off all of the weaker people and only left those “healthier” smokers for the study population, or that smokers would have gotten Alzheimer disease had it not been for the fact that the smoking simply killed them off first.

Moral of the story – don’t take up smoking in the hope it will protect you from Alzheimer disease. Even if it did, the lung cancer and emphysema will get you first.

Alcohol, on the other hand, was fairly neutral in broad population studies. That may be because the benefits of a small amount of wine drinking were being averaged out by the harmful effects of drinking too much hard liquor. When the amount and type of alcohol drunk was separated out, there’s some evidence that a little bit of wine infrequently is somewhat preventative of Alzheimer disease [16].

Air pollution is a potential risk factor for Alzheimer disease. It’s thought that the high exposure to chemicals and particulate matter in the air increases neuro-inflammation and death of the nerve cells leading to Alzheimer disease. In a case-control study in Taiwan, individuals with the highest exposure to air pollution had a 2 to 4-fold increased risk in developing Alzheimer disease [17].

There are similar concerns about the risk of pesticide exposure and Alzheimer disease, although there are often a lot more confounders within the research itself, which makes the associations somewhat weaker. Still, evidence is generally supportive of a link between pesticide exposure and the development of Alzheimer disease.

Risk factors – what can we learn?

In summary, there are a lot of different risk factors which are involved in Alzheimer disease, some of which can be influenced, and some which cannot.

Alzheimer disease is not a homogeneous disease that can be treated with one specific drug, but rather AD presents as a spectrum, with complex interactions between genetic, lifestyle and environmental factors. So to really understand a person’s risk for Alzheimer disease, the interactions of these risk factors need to be understood which actually makes things exponentially harder.

That means that anyone telling you to eat this, or learn that, or do my program to reduce the risk of Alzheimer disease clearly doesn’t understand just how complicated Alzheimer disease is and has oversimplified things way too much.

Which brings us back to Dr Leaf and her blog.

I was surprised that Dr Leaf even tried to broach the subject of Alzheimer disease, because diseases like Alzheimers disprove her most fundamental assumption. Dr Leaf has always taught that the mind is separate to the brain and is in control of the brain. But if that were the case, the brain changes in Alzheimer disease would make no difference to a person’s cognition and memory. Yet Dr Leaf admits throughout the entire post that the brain changes in Alzheimer disease do cause changes in the mind.

Dr Leaf can’t have it both ways. Real cognitive neuroscientists don’t constantly contradict themselves, tripping themselves up on the most fundamental of all facts. Dr Leaf needs to correct her most fundamental of all her assumptions and admit that the mind is a product of the physical brain and does not control the brain.

Dr Leaf also needs to stop exaggerating her “research and clinical experience”. She’s quick to point over every time she opens her mouth that she has decades of research and clinical experience, but such repeated and unjustified exaggeration is just another form of lying. Her research was an outdated and irrelevant PhD in the late 1990’s, based on a theory which she tested on school children. Her limited clinical experience was as a therapist for children with acquired brain injuries.

Alzheimer disease affects the other end of the age spectrum and has nothing to do with acquired brain injury. It is the absolute polar opposite of Dr Leaf’s already limited research and clinical experience. Dr Leaf is like an Eskimo trying to build an igloo in the Sahara.

Dr Leaf’s credibility on the subject quickly evaporates with her introductory caution:

Before we go into too much detail, I want to remind you that our expectations can change the nature of our biology, including our brains! Indeed, recent research suggests just fearing that you will get Alzheimer’s can potentially increase your chance of getting it by up to 60%.

Dr Leaf doesn’t offer any proof that “Our expectations change the nature of our biology” but she does allude to “recent research” which suggests that “just fearing that you will get Alzheimer’s can potentially increase your chance of getting it by up to 60%”. She doesn’t reference that either. She could be referring to the research from Yale which she alludes to later in her post, although that research by Levy and colleagues didn’t mention anything about the risk of Alzheimer disease increasing by 60 percent [18]. In fact, given certain methodological weaknesses, it didn’t conclusively prove that negative beliefs about aging did anything to the brain, but that’s a topic for another day.

Dr Leaf made several attempts throughout the rest of the blog to portray Alzheimer disease as a disease related to toxic thoughts and poor lifestyle choices. For example:

There is now a growing body of research that approaches the question of Alzheimer’s and the dementias as a preventable lifestyle disease, rather than a genetic or biological fault. More and more scientists are looking at Alzheimer’s and the dementias as the result of a combination of factors, including how toxic stress and trauma are managed, the quality of someone’s thought life, individual diets and exercise, how we can be exposed to certain chemicals and toxic substances, the impact of former head injuries, and the effect of certain medications.

That statement is just a big furphy. Yes, Alzheimer disease is the result of a complex interaction of genes and environmental factors. Yes, there is some evidence looking at the interactions of diet and exercise, environmental exposures and former head injuries (although there’s very mixed evidence for the role of brain trauma in Alzheimer disease. It’s not clear cut [19]). But there is no ‘growing body of research’ that claims Alzheimer disease is not strongly genetic or biological, and there’s certainly no real scientist dumb enough to call Alzheimers a “preventable lifestyle disease”.

The evidence is pretty clear, that there are very strong genetic factors for developing Alzheimer disease. Yes, some of them can be modified by environmental factors, but it’s foolhardy to claim that Alzheimer disease can be entirely prevented, based on the current evidence I outlined earlier. Dr Leaf is rushing in where angels fear to tread.

Dr Leaf’s baseless exaggerations don’t stop there.

It is therefore unsurprising that professor Stuart Hammerhoff of Arizona University, who has done groundbreaking research on consciousness and memory, argues that the kind of thinking and resultant memories we build impacts our cell division and can contribute to the development of Alzheimer’s and the dementias.

Dr Leaf includes a hyperlink which when clicked, takes you to this article: https://www.theglobeandmail.com/life/health-and-fitness/health/conditions/new-theory-targets-different-origins-of-alzheimers/article4210442/.

It’s not a scientific paper, but a newspaper article which is more than seven years old. The only thing it says about Professor Stuart Hameroff is this:

One of the co-authors, Stuart Hameroff at the Center for Consciousness Studies at the University of Arizona, has argued that microtubules may also be involved in consciousness.

That’s it. There’s nothing else in the article about Prof Hameroff at all, nothing to back up Dr Leaf’s wild claim that our thinking and our memories alters cell division and contributes to the development of Alzheimers and dementia. Dr Leaf is just confabulating.

Dr Leaf also claims that:

One of the many studies that have come out of this research, done by the Buck Institute for Research on Aging, showed dramatic improvement in patients diagnosed with Alzheimer’s and the dementias when they were put on an individualized lifestyle-based program that includes diet, exercise and learning.

Again, that’s a gross exaggeration. The “research” that Dr Leaf is alluding to is a paper written by Bredesen [20]. It’s a narrative paper which describes a total of ten cases. That’s it – just ten cases. That’s nowhere near enough information to draw even the weakest of conclusions, but it gets worse. The paper only gives a formal description of three patients and their treatments, the rest were listed in a table. So there is even less data to draw any definitive conclusions from. The other serious weaknesses of the paper were that the patients self-identified, and most of them didn’t have dementia at all, but instead had “amnestic mild cognitive impairment” or “subjective cognitive impairment”. In other words, they were a little forgetful, or they only thought they were forgetful. The one subject that did have Alzheimer disease continued to rapidly deteriorate in spite of the program.

If you took Dr Leaf at her word, you would think that this treatment program was working miracles and clearly proved that Alzheimer disease could be cured by lifestyle treatment. The study showed anything but.

Again, Dr Leaf is proving herself untrustworthy – either she knew that the study failed to demonstrate significant results and she was deliberately deceptive, or she didn’t understand that the results of the study were not conclusive, in which case she’s too ignorant to be treated as an expert.

In the same vein, Dr Leaf writes:

Another famous study, known as the “Nun Study,” followed a number of nuns over several years, showing that, although extensive Alzheimer’s markers were seen in their brains during autopsy (namely neurofibrillary plaques and tangles), none of them showed the symptoms of Alzheimer’s and the dementias in their lifetime. These nuns led lifestyles that focused on disciplined and detoxed thought lives, extensive learning to build their cognitive reserves, helping others and healthy diet and exercise, which helped keep their minds healthy even as their brains aged!

The hyperlink that Dr Leaf included was to a Wikipedia page which again, said nothing about the nuns who were apparently impervious to the effects of Alzheimers. It did say that

Researchers have also accessed the convent archive to review documents amassed throughout the lives of the nuns in the study. Among the documents reviewed were autobiographical essays that had been written by the nuns upon joining the sisterhood; upon review, it was found that an essay’s lack of linguistic density (e.g., complexity, vivacity, fluency) functioned as a significant predictor of its author’s risk for developing Alzheimer’s disease in old age. The approximate mean age of the nuns at the time of writing was merely 22 years. Roughly 80% of nuns whose writing was measured as lacking in linguistic density went on to develop Alzheimer’s disease in old age; meanwhile, of those whose writing was not lacking, only 10% later developed the disease.

As it turns out, lots of nuns did end up with dementia after all … well that’s awkward – the page that Dr Leaf used to try and support her argument actually directly contradicted her.

Wikipedia’s entry was supported by the original journal article in the research from Riley et al [21]. And after a bit of gentle trawling of the scientific literature, I also found this article from Latimer and colleagues which said, “Interestingly, our results show very similar rates of apparent cognitive resilience (5% in the HAAS and 7% in the Nun Study) to high level neuropathologic changes” [22].

So, sure, some nuns did indeed have some plaques and tangles without showing signs of the disease, but not 100 percent of them as Dr Leaf tried to make out. In reality, it was only 7 percent of them! And given what we know from the current research, plaques and tangles often precede clinical symptoms, so it may be that the nuns in question were on their way to cognitive impairment, but they hadn’t quite made it. Who knows. One thing’s for sure, the “lifestyles that focused on disciplined and detoxed thought lives” didn’t stop dementia affecting most of the nuns in the study.

Dr Leaf finishes off her post with what she thinks will help prevent Alzheimer disease. Given that she clearly doesn’t understand Alzheimer disease, we need to take what she advises with a large dose of salt. Let’s look at what Dr Leaf suggested and see if it lines up with actual research.

Research shows that education, literacy, regular engagement in mentally-stimulating activities and so on results in an abundance of and flexibility in these neural connections, which help us build up and strengthen our cognitive reserves and protect our brain against the onset of Alzheimer’s and the dementias.
Like everything in life, the more you use your ability to think, the more you get better at it and the stronger your brain gets!

Rating: Half-true

Education has a small positive benefit, but the research isn’t clear if that’s cause or correlation. So yes, stimulate your brain and see what happens. It might not help stave off Alzheimer disease, but at least it will make the journey interesting it nothing else.

What else can you do to prevent Alzheimer’s and the dementias, or help someone already suffering cognitive decline?
1. Detoxing the brain:
I have written extensively about the importance of detoxing the brain by dealing with our thought life in a deliberate and intentional way. Our minds and brains are simply not designed to keep toxic habits and toxic trauma; we are designed to process and deal with issues. If, however, we suppress our problems, over time our genome can become damaged, which will increase the potential for cognitive decline as we age. This is why it is important to build up a strong cognitive reserves AND live a “detoxing lifestyle”, which essentially means that you make examining and detoxing your thoughts and emotions a daily habit. We want to have good stuff in our brain, yes, but we don’t want the neurochemical chaos of a bad thought life affecting our healthy cognitive reserves!

Rating: BS (“Bad Science”)

This is Dr Leaf’s favourite pseudoscientific claptrap, her neurolinguistic-programming-voodoo-nonsense that has no scientific basis whatsoever. Skip it and move on.

2. Social connections:
Intentionally developing deep meaningful relationships can help build up our cognitive reserves against Alzheimer’s and the dementias – our brains are designed to socialize! Loneliness and social isolation, on the other hand, can seriously impact the health of our brains, making us vulnerable to all sorts of diseases, including ones associated with cognitive decline and the dementias …

Rating: Half-true

Loneliness has deleterious effects on health, but there’s nothing in the research to suggest that loneliness is a risk factor for Alzheimer disease. Like we discussed about education and mental stimulation before, I think you should make friends and enhance your social connections. There’s no guarantee that it will make any difference to your risk of Alzheimer disease, but it will make things fun and interesting at least.

3. Sleep:
Dr. Lisa Genova, a neuroscientist, wrote the book Still Alice (this was also made into a movie), which describes the impact of the early onset of Alzheimer’s. She believes that buildup of plaques and tangles associated with Alzheimer’s can be averted, since it takes about 10 to 20 years before a tipping point is reached and cognitive decline becomes symptomatic. We all build plaques and tangles, but it takes at least a decade for them to actually affect our ability to remember, so there is hope!
There are things we can do to prevent this buildup, and sleep is an important one. During a slow-wave, deep sleep cycle, the glial cells rinse cerebrospinal fluid throughout our brains, which clears away a lot of the metabolic waste that accumulates during the day, including amyloid beta associated with the dementias. Bad sleeping patterns, however, can cause the amyloid beta to pile up and affect our memory. Essentially, sleep is like a deep cleanse for the brain!

Rating: What?

Dr Leaf’s advice here isn’t necessarily BS, it’s just plain confusing as she takes two unrelated chunks of information and tries to conflate them.

I don’t know if Dr Lisa Genova is a neuroscientist, or if she thinks the build-up of plaques and tangles can be averted or not. The science as I outlined earlier in the post shows that the rise in plaques and tangles predate clinical symptoms, so you don’t know if you have them or not. If that’s the case, how can you hope to reverse them. Science is working on it, but it’s not there yet.

Irrespective, Dr Leaf doesn’t present any evidence to support her statement that sleep clears amyloid proteins. And neither is there any evidence that sleep has a significant impact on the development of Alzheimer disease.

I think it’s good general advice to try and get a reasonable amount of good quality sleep so you can wake up refreshed. Whether it changes your Alzheimer disease risk, who knows.

2. Diet:
We can now say with a good degree of certainty that consuming highly processed, sugar-, salt-, and fat-laden foods contributes to increased levels of obesity, cardiovascular disease, diabetes, stroke, allergies, autism, learning disabilities, and autoimmune disorders and Alzheimer’s! Some of the ways modern, highly processed and refined foods can contribute to Alzheimer’s and the dementias include added, highly-processed sugars, which cause your insulin to spike and the enteric nervous system of your gut to secrete an abnormal amount of amyloid protein. This will start destroying the blood-brain barrier, and can contribute to the formation of the amyloid plaques of Alzheimer’s disease. Some researchers now even refer to Alzheimer’s as type III diabetes!

Rating: Complete and utter BS

High sugar and high fat foods is certainly a contributing factor to obesity and to diabetes, and indirectly to cardiovascular disease and stroke. That’s where the intelligence in Dr Leaf’s statement comes to a grinding halt. The rest of it is just a stream of fictitious nonsense without any basis in reality.

The western diet does not contribute to allergies, and it’s scientifically impossible for it to contribute to autism since autism is a genetic condition which expresses itself during foetal development, and I am yet to see a foetus chow down on a cheeseburger. But wait, there’s more – learning disabilities, and autoimmune disorders too, and of course, Alzheimer disease. Who cares that there’s no definitive trials to clearly prove that Alzheimer disease is in any way connected to our diets.

But apparently it’s the evil sugar which causes insulin to make the gut nervous system secrete amyloid proteins which destroy the blood brain barrier. When you put enough medical terms in a sentence, you would fool about 99 percent of people. But looking past the random string of medical jargon, it’s clear that Dr Leaf is deluded. The structural damage in Alzheimer disease comes from the nerve cell’s poor lipid metabolism, most of which comes from a gene which codes for a lipid carrying protein. Lipids have nothing to do with sugar. Besides, who cares if the enteric nervous system secretes amyloid … the enteric nervous system is in the gut [23], not the brain. Even her inconsistencies are inconsistent.

Dr Leaf’s throw-away line at the end, “Some researchers now even refer to Alzheimer’s as type III diabetes!” is ignorant or intentionally misleading. We’ve already established that the name “Type 3 diabetes” referred to the fact that scientists have recognised a metabolic disease with overlapping molecular mechanisms shared between diabetes and Alzheimer disease, not that Alzheimer disease is a metabolic disorder. Alzheimer disease is not because of too much sugar or bad lifestyle choices.

5. Exercise:
There is extensive research on the importance of exercise as a preventative tool against Alzheimer’s and the dementias. A number of studies show that people who exercise often improve their memory performance, and show greater increase in brain blood flow to the hippocampus, the key brain region that deals with converting short-term memory to long-term memory, which is particularly affected by Alzheimer’s disease.

Rating: Plausible

I don’t know what the state of the research is, but the study discussed earlier in the post about lifestyle changes did show improvement in risk for those who exercised. And out of all of Dr Leaf’s pronouncements, at least this one has scientific plausibility.

Exercise promotes a growth factor in the brain called BDNF. BDNF does stimulate the growth of new nerve cell branches. Growth of new nerve cell branches results in improved mood. It’s not entirely implausible to think that it would help with new memory formation and an enhanced hippocampus.

How much it really prevents Alzheimer disease is not clear, but given that exercise is universally good for you, I think it should be first on the list, not the last.

Dr Leaf – in a tangle

So in summary, Alzheimer disease is a complex multifactorial disease with a number of factors that affect its development, some of which can be changed, while others cannot.

Dr Leaf doesn’t understand this. Her reading of the literature about Alzheimer disease is limited and skewed by her biased assumptions about toxic thinking and lifestyle. Sure, there are some risk factors for Alzheimer disease which may be related to lifestyle and which may be modifiable, but Dr Leaf has failed to synthesise that information into the broader understanding of Alzheimer disease.

So some of her advice is helpful. Most of it is not. If you’re concerned that you or a loved one might have early memory loss, please don’t listen to Dr Leaf – see a real doctor instead and get the right advice.

References

[1] Alzheimer’s A. 2018 Alzheimer’s disease facts and figures. Alzheimers Dement 2018;14(3):367-429.

[2] Area-Gomez E, Schon EA. On the Pathogenesis of Alzheimer’s Disease: The MAM Hypothesis. FASEB J 2017 Mar;31(3):864-67.

[3] Eid A, Mhatre I, Richardson JR. Gene-environment interactions in Alzheimer’s disease: A potential path to precision medicine. Pharmacol Ther 2019 Jul;199:173-87.

[4] Toepper M. Dissociating Normal Aging from Alzheimer’s Disease: A View from Cognitive Neuroscience. J Alzheimers Dis 2017;57(2):331-52.

[5] Dai MH, Zheng H, Zeng LD, Zhang Y. The genes associated with early-onset Alzheimer’s disease. Oncotarget 2018 Mar 13;9(19):15132-43.

[6] Cupples LA, Farrer LA, Sadovnick AD, Relkin N, Whitehouse P, Green RC. Estimating risk curves for first-degree relatives of patients with Alzheimer’s disease: the REVEAL study. Genet Med 2004 Jul-Aug;6(4):192-6.

[7] Nordestgaard LT, Tybjaerg-Hansen A, Rasmussen KL, Nordestgaard BG, Frikke-Schmidt R. Genetic variation in clusterin and risk of dementia and ischemic vascular disease in the general population: cohort studies and meta-analyses of 362,338 individuals. BMC medicine 2018 Mar 14;16(1):39.

[8] Altmann A, Tian L, Henderson VW, Greicius MD, Investigators AsDNI. Sex modifies the APOE‐related risk of developing Alzheimer disease. Annals of neurology 2014;75(4):563-73.

[9] Larsson SC, Traylor M, Malik R, et al. Modifiable pathways in Alzheimer’s disease: Mendelian randomisation analysis. Bmj 2017 Dec 6;359:j5375.

[10] Rantanen K, Strandberg A, Pitkälä K, Tilvis R, Salomaa V, Strandberg T. Cholesterol in midlife increases the risk of Alzheimer’s disease during an up to 43-year follow-up. European Geriatric Medicine 2014;5(6):390-93.

[11] Ott A, Stolk R, Van Harskamp F, Pols H, Hofman A, Breteler M. Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology 1999;53(9):1937-37.

[12] Huang C-C, Chung C-M, Leu H-B, et al. Diabetes mellitus and the risk of Alzheimer’s disease: a nationwide population-based study. PloS one 2014;9(1):e87095.

[13] de la Monte SM. Type 3 diabetes is sporadic Alzheimer׳s disease: mini-review. European Neuropsychopharmacology 2014;24(12):1954-60.

[14] Scarmeas N, Luchsinger JA, Schupf N, et al. Physical activity, diet, and risk of Alzheimer disease. JAMA : the journal of the American Medical Association 2009 Aug 12;302(6):627-37.

[15] Hu N, Yu J-T, Tan L, Wang Y-L, Sun L, Tan L. Nutrition and the risk of Alzheimer’s disease. BioMed research international 2013;2013.

[16] Heymann D, Stern Y, Cosentino S, Tatarina-Nulman O, Dorrejo JN, Gu Y. The Association Between Alcohol Use and the Progression of Alzheimer’s Disease. Curr Alzheimer Res 2016;13(12):1356-62.

[17] Wu YC, Lin YC, Yu HL, et al. Association between air pollutants and dementia risk in the elderly. Alzheimers Dement (Amst) 2015 Jun;1(2):220-8.

[18] Levy BR, Ferrucci L, Zonderman AB, Slade MD, Troncoso J, Resnick SM. A culture-brain link: Negative age stereotypes predict Alzheimer’s disease biomarkers. Psychol Aging 2016 Feb;31(1):82-8.

[19] Kokiko-Cochran ON, Godbout JP. The Inflammatory Continuum of Traumatic Brain Injury and Alzheimer’s Disease. Front Immunol 2018;9:672.

[20] Bredesen DE. Reversal of cognitive decline: a novel therapeutic program. Aging (Albany NY) 2014 Sep;6(9):707-17.

[21] Riley KP, Snowdon DA, Desrosiers MF, Markesbery WR. Early life linguistic ability, late life cognitive function, and neuropathology: findings from the Nun Study. Neurobiology of aging 2005 Mar;26(3):341-7.

[22] Latimer CS, Keene CD, Flanagan ME, et al. Resistance to Alzheimer Disease Neuropathologic Changes and Apparent Cognitive Resilience in the Nun and Honolulu-Asia Aging Studies. J Neuropathol Exp Neurol 2017 Jun 1;76(6):458-66.

[23] Costa M, Brookes SJH, Hennig GW. Anatomy and physiology of the enteric nervous system. Gut 2000;47(suppl 4):iv15-iv19.

Anxiety – It’s not a ‘real’ disease until it is

Posted on July 15, 2019 by cedwardpitt

“I feel awful, doc”, one man said to me today. “I’m never going to call a cold ‘the flu’ again”, he said as he shivered away under three jumpers, aching and mildly delirious.

It’s the middle of winter here in Australia, and Influenza A is cutting a swathe through the community. Everyone who walks in with a stuffy nose thinks they have ‘the flu’, that is, until they actually get Influenza and they realise just how atrocious having the real flu is.

It’s the same with mental health and illness. So many people think think that anxiety or depression aren’t real diseases. They think that everyone gets a bit sad at times, or gets a bit stressed, so depression and anxiety aren’t real diseases, they’re just normal emotions, or what weak people experience because they don’t have the inner strength to cope.

Such stigma isn’t helped when people who like to think they’re experts in mental health write blogs which declare that “anxiety is a signal that we need to listen to, not an illness we need to manage. It is a reaction to life’s challenges, not a biological disease to be treated.”

Yes, that’s right people, pretend experts are quick to tell you that the debilitating condition you’re experiencing isn’t a real disease.

Saying “Anxiety isn’t a real disease, it’s just a warning sign, a normal part of life” is a bit like saying, “You don’t really have Influenza, you just have a cold. Harden up princess … you don’t need to be ventilated in ICU, it’s just a virus. I took some Vitamin C and I was better in just a couple of days. What’s wrong with you?”

Part of the problem is because of how we use the word “anxiety”, which can mean different things to different people. To a lot of people, being anxious is the same as being a little frightened. To others, it’s being really scared, but with good reason (like if you were confronted by a very venomous snake).

Medically speaking, anxiety isn’t just being frightened or stressed. After all, it’s normal to be frightened or stressed. A little bit of fear is protective. There are dangers all around us, and our brain is our “don’t get killed” organ. If we had no fear at all, we’d end up becoming road kill. A little bit of fear, in the right amount, for the right reason and in the right place and time, is actually very protective.

But to label all anxiety as normal, or to claim that anxiety is not a mental illness is obnoxious and ignorant.

That’s because anxiety at the wrong time and in the wrong amount can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. At the extreme, anxiety disorders are as debilitating as any major illness.

There are six main disorders that come under the “anxiety disorders” umbrella, reflecting either an abnormal focus of anxiety or an abnormal intensity:
1. Panic Disorder (abnormally intense anxiety episodes)
2. Social Anxiety Disorder (abnormal anxiety of social interactions)
3. Post-traumatic Stress Disorder (abnormally intense episodes of anxiety following trauma)
4. Obsessive-Compulsive Disorder (abnormally intense and abnormally focussed anxiety resulting in compulsive behaviours)
5. Specific phobias (abnormally focussed anxiety on one particular trigger), and
6. Generalised Anxiety Disorder (abnormal anxiety of everything)

The common underlying theme of anxiety is uncertainty. Clinical psychologists Dan Grupe and Jack Nitschke from the University of Wisconsin wrote in Nature Reviews Neuroscience that “Anxiety is a future-orientated emotion, and anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain.” [1]

The fear of uncertainty that defines anxiety comes from genetic changes that affect the structure and function of the brain, primarily in the regions of the amygdala and the pre-frontal cortex. As a result of these changes, the brain processes information incorrectly.

For example:
> the brain thinks that threats are more likely and will be worse than they are,
> the brain spends more time looking for possible threats,
> the brain fails to learn what conditions are safe, which is aggravated by avoidance, and
> the brain assumes that unavoidable uncertainty is more likely to be bad than good.

It’s important to understand at this point that anxiety disorders aren’t the result of poor personal choices. They’re the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [2]. The other way of looking at it is that people who don’t suffer from anxiety disorders have a fully functional capacity for resilience [3,4].

The main point of this post is simply this – pretend experts are everywhere, and they are usually various combinations of ignorant, stupid or lazy. They might try and tell you that your debilitating anxiety isn’t really a mental illness, but they’re usually the ones who have never experienced just how atrocious a true anxiety disorder is. Don’t listen to them, no matter how many equally ignorant followers they have on social media. Just like Influenza can make you really sick but there is treatment, so it is with an anxiety disorder – the anxiety disorder may be much harder to get through, but with the right treatment and support, you can get through it.

~~~

If you are struggling with anxiety or depression, help … real help … is available. See your general practitioner or psychologist, or if you’re in crisis and you need to talk to someone urgently:

In Australia
> you can call either Lifeline on 13 11 14, or
> 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) and
>> 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
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

References
1. Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews Neuroscience 2013 Jul;14(7):488-501.
2. Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2.
3. Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10.
4. Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84.

Stop mislabelling labels.

Posted on February 21, 2018 by cedwardpitt

The last time I looked through the supermarket, I bought some baked beans. How did I know the can I took off the shelf was full of baked beans and not freshly harvested sheep’s innards? Because the label on the can said so.

Labels aren’t perfect of course. Every now and then, a can of something has the wrong label applied in the factory. Usually it’s nothing too sinister – no accidental swaps of some goat entrails instead of your tinned salmon. Instead, it’s usually something similar – tuna gets labelled as salmon and vice versa, and the worst that happens is that the tuna mornay you’ve just made had an unexpected flavour. Even these sorts of mild mix ups are rare. Overall, we trust that the labels are guides and the information they provide us helps us make an informed decision about what do to with that particular can and its contents.

It would be pretty silly for some random person to preach out the front of the supermarket, ranting about how all labels for a particular thing are all wrong.

“Uh, just because the occasional can of tuna was accidentally filled with cat food doesn’t mean to say that all labels are wrong. And just because one person had a bad experience with the wrong label, the supermarket shouldn’t stop using them … otherwise how else is anyone supposed to manage their cans effectively without labels? Honestly, stop looking like a fool by preaching about labels and let the rest of us finish our shopping.”

Dr Caroline Leaf, communication pathologist, self-titled cognitive neuroscientist, and a self-elected champion of irrelevant mental health advocacy, has come out all guns ablazin’ over ADHD labels again. She needs to give it a rest – she’s just like the crazy person standing in front of the supermarket.

“Labels for ADHD are bad”, she says. “Look at Avery Jackson, who was labeled ADHD but did not accept the label. He went on to earn multiple degrees and become one of the top neurosurgeons in the U.S!” The underlying message – labelling a child with ADHD will lock then into a life of pathetic excuses and they won’t ever reach their full potential until they renounce the curse of their ADHD label.

For every scary anecdote about the evils of ADHD and the mental prison that everyone with such a label is supposed to find themselves in, there are ten more where the ADHD label helped them. There are so many more people where the ADHD label helped them to finally understand their condition and receive the correct treatment, enabling them to reach their potential and improve their life in leaps and bounds.

Take, for example, one of my patients called Little Jimmy (not his real name). When Little Jimmy was in the early primary school grades, he was a bit of a fidgeter and couldn’t concentrate well enough at school or at home to complete his homework tasks. His mother took him to a naturopath who told him he had a disorder of “pyrolles disease”. Thankfully, mum brought him to see me, and after a careful history and a long chat, Little Jimmy went to see a specialist who diagnosed him with ADHD and commenced him on stimulant medications. Before his label, Little Jimmy’s reading levels were languishing at the bottom off his class after two years of stagnation. He was more than a year behind in reading levels and going nowhere fast. Two weeks after getting his label and the right medication, he went to the top three reading levels in the class. His mother told me of the massive gains he made, and the flow-on effect this had to his self-esteem and confidence in other areas of his school work and school life. She cried as she recounted his story, and then I cried too.

So perhaps Avery Jackson became an orthopaedic surgeon because he chose to ignore his label of ADHD and worked hard anyway. Good for him. Little Jimmy got a label of ADHD and because of it, he learnt to read. Now he’s got the chance to follow in Avery Jackson’s footsteps, BECAUSE of his label.

Labels are important. Without them, we wouldn’t know how to know who needs which treatment. Labels can help people overcome some of the strongest barriers and connect with others for support.

And let’s face it, if someone really wanted to, they don’t need a label of ADHD to find excuses in life.

So labels are not a hinderance, but rather, they are a guide to help you know what’s going on so informed choices can be made. In Dr Leaf’s mind, those kids with ADHD are just naughty children, with bad parents, who are using the label of ADHD to cover their poor parenting and their bad behaviour. Clearly all they need to do is to stop their toxic thinking and they wouldn’t need their medications, but they would be cured.

Dr Leaf is wrong … she can stand and scream blue murder about labels and ADHD all she wants. But just like the crazy random person screaming about labels in front of the supermarket, it means very little. It’s not helping her cause, and if anything, it’s sewing distrust in an system that, despite it’s flaws, works very well, and has helped thousands of children and adults alike to achieve their potential.

That’s the power of labels, and Dr Leaf would do herself and all her followers a favour if she stopped mislabelling them.

Anti-psychotics, damn lies and statistics

Posted on June 12, 2017 by cedwardpitt

Today, I was asked to clarify some information surrounding an earlier post about Carrie Fisher and the role that anti-psychotic medications may or may not have played in her death from a heart attack. I appreciated the question which was about whether I’d seen the statistics put up by the Mad In America (MIA) blogger who wrote about Carrie Fisher (the blog which, incidentally, Dr Leaf had then uncritically decided to slyly try to regift it in the form of her newsletter article).

In the opening of her post, the MIA blogger said, “There’s an important question here. Is she one of the cases in point to explain why our community has a 25 year lower life expectancy?” and then threw in a table plucked out of context from a journal article. At least, unlike Dr Leaf, the MIA blogger was intellectually honest enough to attach the source of the table, which was an article published in the European Heart Journal in 2012.

While the MIA blogger is certainly entitled to her opinion, I thought it was worth discussing the statistics in a bit more detail, if for nothing else than to give some context to the whole “anti-psychotics kill you” trope that keeps getting around.

First, there needs to be the proper context. No one is denying that there’s a higher mortality rate amongst people with schizophrenia and other forms of psychosis, though I don’t see exactly where she got her “25 year lower life expectancy” line from. To me, that seems excessive.

Then to the study itself. The paper that the table is extracted from is Honkola et al [1]. The study specifically examines the association between the use of different classes of psychiatric medications with the rate of sudden cardiac death during a coronary event (a heart attack, or angina).

In her post, the MIA blogger throws around a lot of numbers but she was loathe to put her numbers in the right context. For example, she claimed that “smoking is four times safer than the older types of antipsychotics. And it’s twice as safe to smoke as it is to take any antipsychotic, including the newer ones”. Except, her comparison is a fallacy of conflation – she’s comparing the all cause mortality of smoking (which is more like three-fold rather than two-fold, just FYI [2]) with the highly specific ‘sudden cardiac death during a heart attack’ mortality of the study she’s referencing. It’s apples and oranges – the groups aren’t directly comparable.

Besides, even if her numbers were directly applicable, the positively immoral sounding four-fold increase in the rate of death sounds is just an association, not a cause. There is a dictum in science, “Correlation is not the same as causation.” Just because two things occur together does not mean that one causes the other. There may be other explanations beside the medication that might explain that number, including but not limited to, statistical anomalies and lifestyle factors, and other factors not considered in the analysis.

There are other problems with relevance too. Most of the numbers in the table were small and not statistically significant (that is, could have been related to chance alone). The only strong numbers were for old anti-psychotics, phenothiazines, tricyclic antidepressants and butyrophenones, none of which are first line medications for psychosis or depression anymore. Newer anti-depressants and the newer atypical anti-psychotics did not have a statistically significant association.

And, like I said before, this study is looking at the association between sudden cardiac death in people having a heart attack, which is a very specific form of mortality. It’s not particularly applicable to everyone on the medications, so even if the 4- or 8-fold increase is rock solid, you can’t translate that statistic to everyone on anti-psychotic medications or anti-depressants, or Carrie Fisher for that matter since no one really knows how she died other than she had a heart attack. The rest is just disrespectful speculation.

For me, rather than trying to take a table full of weak and inapplicable statistics and beat a conclusion out of them, a more useful thing would be to know the benefit or harm of anti-psychotics on all causes of death. If anti-psychotics were really as poisonous as Dr Leaf and the MIA blogger portrayed, then all-cause mortality would be much higher in those exposed to the drugs versus those who were never exposed to the drug, which is why this study by Torniainen and colleagues [3] is particularly interesting, and in particular, this graph – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393693/figure/F1/

In this study, the chance of dying from any cause was significantly higher in those people with schizophrenia who were never treated with anti-psychotics compared to those who were treated.

Does this answer the question why there is a lower rate of mortality? Not really, because in fairness, this study also showed just an association between no anti-psychotics and a higher death rate. It doesn’t specifically prove causation one way or another.

Does it show that we should throw anti-psychotics around like lollies, or that they are wonder drugs without any associated harm? No, they are medicines and need to be used responsibly.

It does show there’s a general benefit to anti-psychotics for people with schizophrenia so they’re not the toxic killers Dr Leaf and the MIA blogger try and make them out to be.

Anyone can cherry-pick weak statistics and bend them to suit their self-interested propaganda. The remedy to damn lies and statistics is to look more broadly and consider the strength of the numbers and their context. When we do that with the studies on anti-psychotic medications we see that they aren’t the evil killers that some people would like to make them out to be.

References
[1]        Honkola J, Hookana E, Malinen S, et al. Psychotropic medications and the risk of sudden cardiac death during an acute coronary event. Eur Heart J 2012 Mar;33(6):745-51
[2]        Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. The New England journal of medicine 2013 Jan 24;368(4):341-50
[3]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63

Hollywood knows more about cognitive neuroscience than Dr Caroline Leaf

Posted on April 22, 2017 by cedwardpitt

Anyone ever watched the Will Smith movie, “Concussion”?

The movie is based on the true story of Dr Bennet Omalu who is a Nigerian-born pathologist (a pathologist is a forensic specialist who is able to determine the cause of a person’s disease and death). Dr Omalu became curious as to why otherwise healthy middle-aged men were displaying changes to their behaviour and memory before dying at a young age.

What he found was changes to the brain of these NFL players similar to that seen in Alzheimer’s Disease. The recurrent physical head trauma sustained by those football players was resulting in abnormal proteins in their brain cells. The abnormal proteins resulted in the destruction of those brain cells. As a result of the destruction of those brain cells, the thinking and behaviour of those players changed.

After initially denying the link, the NFL was forced to change their policy on repetitive head trauma under the weight of the avalanche of confirmatory data that followed in support of Dr Omalu’s findings and it’s been reported that “as of the summer of 2015, more than 5,000 former players were involved in a consolidated lawsuit, with a settlement figure of $765 million deemed insufficient by a judge”.

But good news for the NFL … self-titled cognitive neuroscientist Dr Caroline Leaf reassures us that “Your mind controls your brain. Your brain does not control your mind.”

Maybe she can act for the NFL as their star witness.

But if I were her, I wouldn’t be holding my breath. After all, it’s not like she’s able to mount particularly strong logical arguments. Today she wrote on Facebook, “It’s important to remember that our thinking changes the structure of our brains because our minds are separate from our brains.”

How is the mind going to control the brain if they’re separate? Suggesting that one thing controls another carries the implication that they are intrinsically linked. If your hands are separated from the steering wheel of your car, are you in control of your car?

The other reason why Dr Leaf won’t be getting a call from Roger Goodell any time soon is because she isn’t really an expert on cognitive neuroscience as much as she’s convinced the Christian church otherwise.

Oh, and then there’s that minor detail that even Hollywood knows more about cognitive neuroscience than she does. The whole point of “Concussion” is that brain damage results in disordered thinking which is the exact opposite of what Dr Leaf is trying to claim, and it’s hard to withstand any real scrutiny when your hypothesis has been trumped by a Hollywood screenplay.

The mind is a function of the brain, it does not control the brain. The fact that Dr Leaf can not or will not bow to the weight of the undeniable scientific evidence means that she is either delusional, ignorant or utterly obstinate. The fact that the western church is still willing to deify Dr Leaf in spite of these qualities is a stain on the reputation of the church and a blight on it’s witness to a world which only needs to look to Hollywood to find more credible information than what’s coming from Dr Leaf’s pulpit.

Dr Caroline Leaf on Drugs

Posted on March 22, 2017 by cedwardpitt

We all have a drug problem.

Well, we do according to communication pathologist and self-titled cognitive neuroscientist-come-health guru, Dr Caroline Leaf. She’s pretty chirpy for a woman with essentially no health credentials. She did a PhD two decades ago on a specialized area of educational psychology, but she has no medical training or experience. Essentially she is the Christian equivalent of the health and relationships section of a tabloid newspaper. Her information lurches between unfounded and the bleeding obvious.

Today’s e-mail newsletter, “Mental Health News March 2017” is a mixture of both. It’s more moderate than usual in its tone, but it’s still inspired by her open rejection of pharmaceuticals, especially medications for mental health which she has railed against many times.

Her second paragraph is a specific case in point. “Although many medications have saved lives and can help us, we cannot have a quick-fix-pop-a-pill mentality for everything in life, and we should not denigrate alternative methods of health and healing, such as diet, exercise, human relationship, love, compassion and therapy, particularly when it comes to mental health.”

She’s right – we shouldn’t have a quick-fix-pop-a-pill mentality, but she overstates her case. Most people don’t want pills for everything – people want good care and good treatment. Sometimes that involves a pill, sometimes it just involves reassurance. This is bread and butter for any good GP, and I’d love to show Dr Leaf what the front-line of medicine looks like if she ever wanted to see (seriously, the offer’s open).

And who’s denigrating diet and exercise? Diet and exercise aren’t “alternative” health, they’re mainstream. Is Dr Leaf so out of touch that she can’t see this?

Her bias against pharmaceuticals is more obvious in their third paragraph. Pharmaceutical medications are not a major cause of death. According to the Centre of Disease Control, the top ten causes of death in the US are:

* Heart disease
* Cancer (malignant neoplasms)
* Chronic lower respiratory disease
* Accidents (unintentional injuries)
* Stroke (cerebrovascular diseases)
* Alzheimer’s disease
* Diabetes
* Influenza and pneumonia
* Kidney disease (nephritis, nephrotic syndrome, and nephrosis)
* Suicide

Notice how medications do not feature on that list. Dr Leaf is so biased against medications that she is willing to ignore official government data in favour of her own bias.

But the truth is, pharmaceutical grade medications have revolutionised our lives. When used in the right way, for the right people, they improve our quality and quantity of life. They give people independence. They give people choice. They help people work, spend time with their family and care for others where that may not have been possible otherwise.

Do medications have side effects? Can people feel worse sometimes while taking them? Of course! We need to be realistic. Pharmaceutical medications are powerful agents and we have to use them respectfully. Prescription drugs are like power tools. In the right hands they can do wonders, but they can also be very dangerous when used incorrectly. But while medications can be used incorrectly, using that as a reason why we should use less drugs is like arguing that we should use less knives because sometimes they cut people, or that we should drive less cars because there are car accidents.

Oh, and what was that about the widespread manipulation of data and results in the world of science? Dr Leaf would never misrepresent the results of her studies, or misrepresent the results of other people’s research, in order to make her products look better than they are?

Lifestyle is important, and in some cases, lifestyle is more important than medication, but there is much more nuance involved. You need different tools for different jobs. Imagine a surgeon going into surgery and the scrub nurse passed over a nerf scalpel. It wouldn’t be particularly helpful would it. Or what if the scrub nurse passed over a butter knife? The surgeon might get the job done but with great difficulty, without the precision needed.

What a surgeon needs to perform surgery is an extremely sharp stainless steel scalpel blade. It is more effective and more precise. It might occasionally do some unintentional harm, but it will be a lot more effective than a butter knife (and a nerf scalpel!)

There are three different levels of treatment in health – “alternative” medicines, lifestyle treatments, and pharmaceuticals. “Alternative” medicines are, by definition, useless. As comedian Tim Minchin says, “Do you know what they call alternative medicine that’s been proven to work? Medicine.” Alternative medicines are probably not going to cause a lot of harm other than making their user poorer for wasting their time, but they’re highly unlikely to do any good.

Lifestyle treatments are the equivalent of the butter knife. They work, but their effect is non-specific and cumulative. Hear me right, “non-specific and cumulative” is not code for “ineffective”. Exercise is one of the most effective non-pharmacological health strategies with clearly proven benefits, but like all lifestyle changes, the effect is fairly general, and the benefit accumulates.

And sometimes, despite doing everything right, people still get sick, and this is where pharmaceuticals have their place. They are like the scalpel – they might have some unwanted effects, but in the right hands, when used correctly, they make a specific and tangible difference to a person’s life and health.

Dr Leaf then goes on to assert that “Changing your lifestyle and, significantly, the way you THINK can have dramatic effects on your health”. That’s a furphy. Thoughts make no difference to our health (I’ve shown how little difference thought makes to our health in my review of Dr Leaf’s book “Think and Eat Yourself Smart”). Some scientists may have recommended produce over Prozac, but that doesn’t mean to say they’re right.

And Dr Leaf has trotted out the same worn, tired old factoid about loving and serving others that I’ve shown to be inaccurate as well.

If you want to improve your health without medications, then start walking. Eat vegetables. Drink water. Don’t waste your time and money buying into Dr Leaf’s inaccurate teaching.

Dr Caroline Leaf and osteoporosis – Brittle facts on brittle bones

Posted on February 23, 2017 by cedwardpitt

In the fifteenth chapter of his gospel account, Matthew described a conversation that Jesus had with his disciples. Jesus had just reprimanded the Pharisees for their hypocrisy, and the disciples came back to Jesus to report that the Pharisees weren’t very happy about it.

“Then the disciples came to him and asked, ‘Do you know that the Pharisees were offended when they heard this?’ He replied, ‘Every plant that my heavenly Father has not planted will be pulled up by the roots. Leave them; they are blind guides. If the blind lead the blind, both will fall into a pit.’” (Matthew 15:12-14)

When it comes to many subjects, Dr Leaf is a blind guide. Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. She’s not a medical doctor – her title is academic, an award for her PhD in communication pathology over twenty years ago. She has no medical training whatsoever, which makes it a little offensive when she feels she’s qualified to lecture people about medical conditions like osteoporosis.

In an episode of her TV show broadcast this week, Dr Leaf offered a B-grade attempt at mimicking Dr Oz by trying to use her biased ideology to explain a serious medical condition, and in so doing, gave a performance laden with droll irony, a example of the Dunning-Kruger effect in its purest form.

Her co-host was Dr Avery M. Jackson III, a neurosurgeon in Michigan, who Google confuses with Dr Jackson Avery of Grey Sloan Memorial Hospital fame. Dr Jackson has an impressive bio which is replete with advanced work on osteoporotic crush fractures of the spine. One wonders why a specialist of such high regard would associate himself with a scientific philistine who doesn’t understand how genes work, and who regularly contradicts her own position.

Or why he would allow Dr Leaf to publicly associate him with claims like:
“Osteoporosis can be caused by bad thinking and bad eating”,
“Not only is it considered a silent epidemic, but (osteoporosis) has its roots in mind and lifestyle choices”, and
“much can be done on a preventative level like diet and starting young with lifestyle choices and the way we use our minds. Mind is involved in everything!”

Actually, the biggest contributors to the risk of osteoporosis are genetics, ageing and the loss of gonadal function (menopause or low testicular function). Which of these are controlled by the mind, Dr Leaf? It’s not that lifestyle has no influence on osteoporosis, but Dr Leaf overstates the case.

If you want some useful advice on osteoporosis, I’d encourage you to get your information from reputable experts, not wannabe experts like Dr Leaf. To reduce your risk of developing osteoporosis, Osteoporosis Australia recommends
* 3-5 serves of calcium rich food daily
* adequate sunlight
* regular weight bearing exercise
(you can get more specific information here: http://www.osteoporosis.org.au/prevention. For medical advice tailored to your circumstances, see your GP or physician)

Dr Leaf needs to move on from her unscientific premise that the mind is in control of everything. It’s patently false, and it terminally biases nearly everything she says. She needs to open her scientific eyes rather than staying blind to the truth.

Free will isn’t free

Posted on December 23, 2016 by cedwardpitt

It’s only two days before Christmas. I know most people in the last forty-eight hours before the Yuletide would be focussing on last minute shopping for presents or foraging for the ingredients for their Christmas feasts, or making their last minute arrangements for their holiday celebrations. So now may not be the right time to post something meaty about the philosophy of free will, but hey, it might just make for a welcome distraction. Come with me, if you’re game, down the rabbit hole of our choices.

Dr Leaf, communication pathologist and self-titled cognitive neuroscientist, posted a quote today from former Regius Professor of Divinity at the University of Oxford, Keith Ward: “Free will is a place where people can decide to do what is right or to do what is wrong and nothing determines their choice – lots of things influence their choice but nothing determines it except them”.

But is it, really? Clearly Professor Ward is a very learned fellow, but what strikes me about Dr Leaf’s quote of the day is Professor Ward’s false moral dichotomy, and his over-simplistic implication that every choice is a fully conscious choice. Perhaps his quote is taken out of context by Dr Leaf and his intended message has been skewed. It wouldn’t be the first time Dr Leaf has cherry-picked and misquoted.

Dr Leaf added in her ‘me too’ comment – “So we are responsible and can be held responsible for our choices – this is confirmed by science and scripture”.

I should say, it’s not that Dr Leaf’s comment is completely wrong – we are held responsible for our choices, but this isn’t confirmed by science or by scripture, it is something that is legal more than it is scientific or scriptural.

As humans, we have a strong feeling of voluntary control over our actions, that everything we do is something that we choose to do. This sense of control is so fundamental to our existence that much of our social system depends on it, such as our laws and the penalties for breaking them [1].

Except that science has proven that our sense of full control is largely an illusion.

I understand this idea might be hard for some people to accept. We’re taught that we have full control over our actions or ideas. We experience this sense of control from the vantage point of our own perception. It’s hard to believe that we’re not really in full control of our actions and choices. The dominant paradigm in the Christian church is the idea of free will. We’re taught that the words we say and things we do are the exclusive product of our will. Cognitive neuroscience paints a different picture.

The modern neuroscience of the will started with Benjamin Libet. Professor Libet was a researcher in physiology at the University of California San Francisco. He was initially studying the electrical properties of different sensations in the brain, but in the early 1980’s, he performed an experiment to look at the electrical readings that take place when a person decides on an action. His subjects would decide to perform a simple movement of their arm or hand, and say when they were aware of the intention to act. Electrodes connected to the subject’s heads measured their brain activity before, during, and after their decision to act.

What was remarkable was that there was a clear spike in electrical activity occurring up to a full second before a test subject was consciously aware of the intention to act [2]. Libet suggested that an unconscious process was responsible for the ‘willed’ action.

Other studies since that time have confirmed Libet’s results. In fact, a study in 2008 showed that predictable brain activity occurred up to eight seconds before a person was aware of their intention to act [3].

This predictable unconscious spike of brain activity prior to awareness of our intention to act has been verified over and over and is beyond doubt, but there’s still lots of debate as to exactly what it means. Defenders of the idea of free will have tried presenting alternative explanations of the pre-awareness unconscious activity, but none of them line up with the proven, repeatable science.

So if we don’t have full conscious control of our actions, what does go on in our brains when we perform an action?

Again, I won’t go into the fine print, but it’s important to understand that our brain does most of its work at a subconscious level, which includes the planning and execution of our actions [4, 5]. The brain takes the information presented to it, as well as information from memories, and makes a prediction of the best course of action. This means that our processing of goals, rewards, and actions can be affected by ‘subliminal priming’ (in other words, information we process below our conscious level can affect the decision about the best course of action [5]).

Even though we’re not aware of every process the brain employs in our subconscious to formulate the best plan of action and to prime our system ready for that action, there is a element of awareness that provides real-time monitoring and a veto function [4]. Like if you were about to complain about your job and then suddenly remembered you were talking to your boss, you could stop yourself from saying something you might later regret.

What does it all mean? The take-away message here is this: We have limited will, not free will.

We still have some capacity to choose, but our conscious choices are dependent on our subconscious brain activity, our experience and knowledge.

We can make choices, or “exercise our will”, if you like, but within the constraints of a number of factors beyond our conscious control. We can “pull the brake”, so to speak, and stop an action that our subconscious brain activity primed us for, but wasn’t such a good idea when a bit more thought was applied. Our brain also uses our experience and knowledge to predict the best action to take, and because some of our knowledge and experience comes from exercising our limited choices, we can also say we have some input into our decisions.

So in this sense, Prof Ward is correct – lots of things influence people’s choices and ultimately, the choice someone makes is their choice. I don’t make your choices for you, they are your choices. Except that it’s inaccurate and misleading to think of our will as being entirely conscious and thought driven. We make a lot of subconscious decisions every day, often based on subconscious priming. Most actions we take, day in and day out, are not influenced by our conscious thought. They may sometimes make it into our subconscious awareness, and if they do, it’s often after the fact.

Have ever had a “Why did I say that” experiences, where your brain is thinking one thing and your mouth says another? These are times that demonstrate the difference in the systems at work in our brains, which are usually co-ordinated, but not always. There are other demonstrations of this as well, like specific brain pathologies leading to conditions such as Alien Hand Syndrome.

These sort of conditions show that intention is not the same as action.

Sure, most of the time they’re aligned, but not always. And this is the key to Dr Leaf’s quote of the day today – the underlying assumption is that all of our choices are reflected in our actions, when really, our choices are better thought of as our intentions (although again, it’s still not that simple … is it morally wrong if you try to hurt someone but you don’t, or is it morally wrong if you try not to hurt someone, but you do?)

Professor Ward’s quote also sets up a false dichotomy of free will into only right or only wrong, and doesn’t take into account the intellectual or developmental capacity of a person to make a choice. Would you expect a two-year-old to judge a complex moral life or death situation? A more practical example is should people with dementia be able to make their own financial and health-related decisions?

Most reasonable people would say, “Well, that depends …” and that’s the correct answer here. Nothing in the real world of human morality and choice is black or white. There is always some subtlety, some nuance.

When put in context, the black-and-white thinking and teaching of Dr Leaf is shown up as shallow and inadequate. Her little quote of the day doesn’t prove that free will is Biblically and scientifically supported, far from it. All it shows is that Dr Leaf’s views are narrow and blinkered, and aren’t reflective of any scientific or scriptural expertise.

Dr Leaf is welcome to her opinion, but until she gains some actual expertise, she should reconsider her choice to share it.

References

[1]        Haggard P. Human volition: towards a neuroscience of will. Nature reviews Neuroscience 2008 Dec;9(4):934-46.
[2]        Libet B, Gleason CA, Wright EW, Pearl DK. Time of conscious intention to act in relation to onset of cerebral activity (readiness-potential). The unconscious initiation of a freely voluntary act. Brain : a journal of neurology 1983 Sep;26 (Pt 3):623-42.
[3]        Soon CS, Brass M, Heinze HJ, Haynes JD. Unconscious determinants of free decisions in the human brain. Nature neuroscience 2008 May;3(5):543-5.
[4]        Bonn GB. Re-conceptualizing free will for the 21st century: acting independently with a limited role for consciousness. Frontiers in psychology 205;4:920.
[5]        Horga G, Maia TV. Conscious and unconscious processes in cognitive control: a theoretical perspective and a novel empirical approach. Frontiers in human neuroscience 204;6:199.

The soul, stress, sugar and spin

Posted on October 29, 2016 by cedwardpitt

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References

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

Dr Caroline Leaf – Not a mental health expert

Posted on September 27, 2016 by cedwardpitt

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

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

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

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

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

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

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

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

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

References

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

Dr C. Edward Pitt

Faith, Hope, Love, Science.

Tag Archives: neurobiology

Anxiety – It’s not a ‘real’ disease until it is

Anti-psychotics, damn lies and statistics

Hollywood knows more about cognitive neuroscience than Dr Caroline Leaf

Dr Caroline Leaf on Drugs

Dr Caroline Leaf and osteoporosis – Brittle facts on brittle bones

Free will isn’t free

The soul, stress, sugar and spin

Dr Caroline Leaf – Not a mental health expert