The soul, stress, sugar and spin

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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 and the myth of optimism bias

“What are little girls are made of?  Sugar and spice, and all things nice.”

It sounds sweet doesn’t it?  We like to connect with these rosy little memes that warm our cockles and make us feel good about the world and ourselves.  We think of all of the examples in our own experience, which seems to confirm the saying.  We may think of a few examples that don’t quite fit, but they’re just the exception that proves the rule.

It doesn’t seem to matter what the saying or proverb is, we usually just assume it’s true.  Think of some other examples:
“Blondes have more fun.”
“Women can’t read maps.”
“White guys can’t dance.”

In all of these things, we tend to experience what psychologists call confirmation bias (Princeton University, 2014), our own mini-delusion in which we fool ourselves into believing a half-truth.  It looks right on first glance, and we can easily think of a few confirming examples, so without deeper inspection, we assume it must be true.

When Dr Leaf proclaims that,

“Science shows we are wired for love with a natural optimism bias”

the same process kicks in.  But in truth, science doesn’t show anything of the sort.  What science shows is that we learn love and fear, and our genetics influences the way we see the world, our personality.

We are prewired to LEARN to love and fear.  It doesn’t come naturally.  We require exposure to both love and to fear for these emotions to develop.  The Bucharest Early Intervention Project is a study looking at the long-term psychological and physical health of children in Bucharest, one group who remained in an orphanage, and the other, a group of children that were eventually adopted.  Analysis of the cohort of the two groups of children showed that negative affect was the same for both groups.  However positive affect and emotional reactivity was significantly reduced in the institutionalised children (Bos et al., 2011).  This shows that children who lived in an institution all of their lives and given limited emotional stimulation had lower levels of positive affect (ie: love, happiness) compared to a child that was adopted.

The children in the institution did not have high positive affect because they were not shown love.  Those children who were adopted were higher on positive affect because they were shown love by their adopted parents.  Both groups were exposed to distress and fear during their time in the orphanage, so their negative affect was the same across both groups.  Thus, love and fear don’t come naturally.  They need to be learned.

Personality is “the combination of characteristics or qualities that form an individuals distinctive character.” (“Oxford Dictionary of English – 3rd Edition,” 2010) As Professor Greg Henriques wrote in psychology today, “Personality traits are longstanding patterns of thoughts, feelings, and actions which tend to stabilize in adulthood and remain relatively fixed. There are five broad trait domains, one of which is labeled Neuroticism, and it generally corresponds to the sensitivity of the negative affect system, where a person high in Neuroticism is someone who is a worrier, easily upset, often down or irritable, and demonstrates high emotional reactivity to stress.” (Henriques, 2012) Personality is heavily influenced by genetics, with up to 60% of our personality pre-determined by our genes (Vinkhuyzen et al., 2012), expressed through the function of the serotonin and dopamine transporter systems in our brain (Caspi, Hariri, Holmes, Uher, & Moffitt, 2010; Chen et al., 2011; Felten, Montag, Markett, Walter, & Reuter, 2011).

So some people *ARE* natural optimists – their genetic heritage blessed them with a rosy outlook and their early life experiences cemented it in.  These naturally optimistic people, and the people who know them, are the ones who take Dr Leaf’s word as truth because they see it in themselves or their friends.  But the fact that some people are naturally wired for pessimism or a neurotic personality disproves Dr Leaf’s assertion.

Its important that Dr Leaf’s misleading meme is seen for what it is.  If we assume that we’re all pre-wired for love and optimism, then those who are pessimistic must be deficient or deviant, and the fact they can’t change must mean they are incompetent or lazy.  If we know the truth, those who are less optimistic won’t be unnecessarily judged or marginalised.

I should point out that what I’ve said isn’t a free licence to be cranky or sullen all the time.  The natural pessimist still needs to be able to negotiate their way through life, and being a misery-guts makes it hard to get what you need from other people in any business, social or interpersonal relationship.  We have the ability to learn, and the person with a neurotic personality can still learn ways of dealing with people in a positive way.

But if you naturally see the glass half-empty, don’t tell yourself that you’re abnormal, or that you aren’t good enough.  You are who you are.  Accept who you are, because while there are weaknesses inherent to having neurotic personality traits, there are also strengths, such as the enhanced awareness of deception, or protection from gullibility (Forgas & East, 2008).

A good thing to have when searching for the truth.

 References

Bos, K., Zeanah, C. H., Fox, N. A., Drury, S. S., McLaughlin, K. A., & Nelson, C. A. (2011). Psychiatric outcomes in young children with a history of institutionalization. Harv Rev Psychiatry, 19(1), 15-24. doi: 10.3109/10673229.2011.549773

Caspi, A., Hariri, A. R., Holmes, A., Uher, R., & Moffitt, T. E. (2010). Genetic sensitivity to the environment: the case of the serotonin transporter gene and its implications for studying complex diseases and traits. Am J Psychiatry, 167(5), 509-527. doi: 10.1176/appi.ajp.2010.09101452

Chen, C., Chen, C., Moyzis, R., Stern, H., He, Q., Li, H., . . . Dong, Q. (2011). Contributions of dopamine-related genes and environmental factors to highly sensitive personality: a multi-step neuronal system-level approach. PLoS One, 6(7), e21636. doi: 10.1371/journal.pone.0021636

Felten, A., Montag, C., Markett, S., Walter, N. T., & Reuter, M. (2011). Genetically determined dopamine availability predicts disposition for depression. Brain Behav, 1(2), 109-118. doi: 10.1002/brb3.20

Forgas, J. P., & East, R. (2008). On being happy and gullible: Mood effects on skepticism and the detection of deception. Journal of Experimental Social Psychology, 44, 1362-1367.

Henriques, G. (2012). (When) Are You Neurotic?  Retrieved from http://www.psychologytoday.com/blog/theory-knowledge/201211/when-are-you-neurotic

Oxford Dictionary of English – 3rd Edition. (2010)   (3rd edition ed.). Oxford, UK: Oxford University Press.

Princeton University. (2014). Confirmation bias.   Retrieved January 10, 2014, from http://www.princeton.edu/~achaney/tmve/wiki100k/docs/Confirmation_bias.html

Vinkhuyzen, A. A., Pedersen, N. L., Yang, J., Lee, S. H., Magnusson, P. K., Iacono, W. G., . . . Wray, N. R. (2012). Common SNPs explain some of the variation in the personality dimensions of neuroticism and extraversion. Transl Psychiatry, 2, e102. doi: 10.1038/tp.2012.27