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Author: Sima

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Yes! An approach to ADHD that makes sense. Nice piece from Richard A. Friedman, professor of clinical psychiatry and director of the psychopharmacology clinic at the Weill Cornell Medical College. From NY Times:

A Natural Fix for A.D.H.D.

Attention deficit hyperactivity disorder is now the most prevalent psychiatric illness of young people in America, affecting 11 percent of them at some point between the ages of 4 and 17. The rates of both diagnosis and treatment have increased so much in the past decade that you may wonder whether something that affects so many people can really be a disease.

And for a good reason. Recent neuroscience research shows that people with A.D.H.D. are actually hard-wired for novelty-seeking — a trait that had, until relatively recently, a distinct evolutionary advantage. Compared with the rest of us, they have sluggish and underfed brain reward circuits, so much of everyday life feels routine and understimulating.

To compensate, they are drawn to new and exciting experiences and get famously impatient and restless with the regimented structure that characterizes our modern world. In short, people with A.D.H.D. may not have a disease, so much as a set of behavioral traits that don’t match the expectations of our contemporary culture.

From the standpoint of teachers, parents and the world at large, the problem with people with A.D.H.D. looks like a lack of focus and attention and impulsive behavior. But if you have the “illness,” the real problem is that, to your brain, the world that you live in essentially feels not very interesting.The more novel and unpredictable the experience, the greater the activity in your reward center. But what is stimulating to one person may be dull — or even unbearably exciting — to another. There is great variability in the sensitivity of this reward circuit.

These findings suggest that people with A.D.H.D are walking around with reward circuits that are less sensitive at baseline than those of the rest of us. Having a sluggish reward circuit makes normally interesting activities seem dull and would explain, in part, why people with A.D.H.D. find repetitive and routine tasks unrewarding and even painfully boring.

Another patient of mine, a 28-year-old man, was having a lot of trouble at his desk job in an advertising firm. Having to sit at a desk for long hours and focus his attention on one task was nearly impossible. He would multitask, listening to music and texting, while “working” to prevent activities from becoming routine. Eventually he quit his job and threw himself into a start-up company, which has him on the road in constantly changing environments. He is much happier and — little surprise — has lost his symptoms of A.D.H.D.

My patient “treated” his A.D.H.D simply by changing the conditions of his work environment from one that was highly routine to one that was varied and unpredictable. All of a sudden, his greatest liabilities — his impatience, short attention span and restlessness — became assets. And this, I think, gets to the heart of what is happening in A.D.H.D.

Consider that humans evolved over millions of years as nomadic hunter-gatherers. It was not until we invented agriculture, about 10,000 years ago, that we settled down and started living more sedentary — and boring — lives. As hunters, we had to adapt to an ever-changing environment where the dangers were as unpredictable as our next meal. In such a context, having a rapidly shifting but intense attention span and a taste for novelty would have proved highly advantageous in locating and securing rewards — like a mate and a nice chunk of mastodon. In short, having the profile of what we now call A.D.H.D. would have made you a Paleolithic success story.

So if you are nomadic, having a gene that promotes A.D.H.D.-like behavior is clearly advantageous (you are better nourished), but the same trait is a disadvantage if you live in a settled context.

You may wonder what accounts for the recent explosive increase in the rates of A.D.H.D. diagnosis and its treatment through medication. The lifetime prevalence in children has increased to 11 percent in 2011 from 7.8 percent in 2003 — a whopping 41 percent increase — according to the Centers for Disease Control and Prevention. And 6.1 percent of young people were taking some A.D.H.D. medication in 2011, a 28 percent increase since 2007. Most alarmingly, more than 10,000 toddlers at ages 2 and 3 were found to be taking these drugs, far outside any established pediatric guidelines.

Some of the rising prevalence of A.D.H.D. is doubtless driven by the pharmaceutical industry, whose profitable drugs are the mainstay of treatment. Others blame burdensome levels of homework, but the data show otherwise. Studies consistently show that the number of hours of homework for high school students has remained steady for the past 30 years.

I think another social factor that, in part, may be driving the “epidemic” of A.D.H.D. has gone unnoticed: the increasingly stark contrast between the regimented and demanding school environment and the highly stimulating digital world, where young people spend their time outside school. Digital life, with its vivid gaming and exciting social media, is a world of immediate gratification where practically any desire or fantasy can be realized in the blink of an eye. By comparison, school would seem even duller to a novelty-seeking kid living in the early 21st century than in previous decades, and the comparatively boring school environment might accentuate students’ inattentive behavior, making their teachers more likely to see it and driving up the number of diagnoses.

Perhaps one explanation is that adults have far more freedom to choose the environment in which they live and the kind of work they do so that it better matches their cognitive style and reward preferences. If you were a restless kid who couldn’t sit still in school, you might choose to be an entrepreneur or carpenter, but you would be unlikely to become an accountant. 

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Lasting benefits from lifestyle changes (Mediterranean diet and exercise). From Science Daily:

Mediterranean diets have lasting health benefits

The health benefits of switching to a Mediterranean style diet and upping the amount of time spent exercising for a period of just eight weeks can still be seen a year after stopping the regime, a new study has shown.

The research by Sheffield Hallam University and the University of Lincoln in the UK revealed that the diet and exercise combination leads to improved blood flow in cells in the inner lining of the blood vessels -- called the endothelial cells -- a full 12 months after completing participation in the intervention programme.

Endothelial cells line the interior of the entire vascular system of the human body -- from the large arteries to the smallest capillaries -- and improvements in their function could reduce the risk of people developing cardiovascular disease, the study said.

Researchers believe the long-term health benefits observed after such a short intervention could be due to molecular changes associated with the Mediterranean diet. Traditional Mediterranean cuisine is based on olive oil, fruit, vegetables and salad, fish, legumes, whole grain foods, wine and limited consumption of red meat.

The study focused on healthy people over the age of 50. Participants were originally assessed over an eight-week period.One group was encouraged to eat more vegetables, fruit, olive oil, tree nuts and fresh oily fish, as well as take up a moderate exercise regime, while the other just took up exercise alone.

The results showed more health improvements in the Mediterranean diet group than the exercise only group, which one year later, were still evident despite the lifestyle changes implemented during the study no longer being carefully followed.

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Published on 1 Comment on Vegan Diet May Be Best For Weight Loss

I think many will say: Oh no! Totally vegan is best for weight loss?? From Science Daily:

Vegan diet best for weight loss even with carbohydrate consumption, study finds

People shed more weight on an entirely plant based diet, even if carbohydrates are also included, a study has concluded. Other benefits of eating a vegan diet include decreased levels of saturated and unsaturated fat, lower BMIs, and improved macro nutrients.

The study, conducted by the university's Arnold School of Public Health and published in The International Journal of Applied and Basic Nutritional Sciences, compared the amount of weight lost by those on vegan diets to those on a mostly plant-based diet, and those eating an omnivorous diet with a mix of animal products and plant based foods. At the end of six months, individuals on the vegan diet lost more weight than the other two groups by an average of 4.3%, or 16.5 pounds.

The study followed participants who were randomly assigned to one of five diets on the dietary spectrum: vegan which excludes all animal products, semi-vegetarian with occasional meat intake; pesco-vegetarian which excludes all meat except seafood; vegetarian which excludes all meat and seafood but includes animal products, and omnivorous, which excludes no foods.

Participants followed their assigned dietary restrictions for six months, with all groups except the omnivorous participating in weekly group meetings. Those who stuck to the vegan diet showed the greatest weight loss at the two and six month marks.The lead author on this study, Gabrielle Turner-McGrievy notes that the diet consumed by vegan participants was high in carbohydrates that rate low on the glycemic index. 

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Think lifestyle changes, not medications. From Medical Daily:

Mild Hypertension Should Be Treated With Advice On Lifestyle Changes, Not Medication

In 2013, Dr. Iona Heath, a retired general practitioner published an article in the Journal of  the American Medical Association, in which she spoke about the side effects of overtreatment and overdiagnosis of mild hypertension. Now, in a new study, researchers revisit this idea, saying that unnecessary treatment of mild hypertension in low-risk patients is harming them and putting a burden on health care resources. They also argue that there's a need to reexamine criteria for diagnosing hypertension and treating blood pressure. 

About 40 percent of the world’s population, including 67 million American adults, have hypertension. Over half are classified as having mild hypertension. 

More than half of people with mild hypertension are treated with drugs, but there has been no evidence to suggest that blood pressure-lowering drugs prevent heart attacks. Instead of prescribing drugs to control mild hypertension, the authors urge clinicians to recommend healthier lifestyles to patients, which include exercising, quitting smoking, and decreased alcohol consumption. They also urge clinics to improve the accuracy of blood pressure-measuring instruments and to inform patients about measuring blood pressure at home. 

From Medical Xpress:

Experts raise concern over unnecessary treatment of mild hypertension in low risk people

Lowering the drug threshold for high blood pressure has exposed millions of low-risk people around the world to drug treatment of uncertain benefit at huge cost to health systems, warn US experts in BMJ today. Dr Stephen Martin and colleagues argue that this strategy is failing patients and wasting healthcare resources.

Over half of people with mild hypertension are treated with medication. Yet treating low risk mildly hypertensive patients with drugs has not been proven to reduce cardiovascular disease or death. The authors argue that overemphasis on drug treatment "risks adverse effects, such as increased risk of falls, and misses opportunities to modify individual lifestyle choices and tackle lifestyle factors at a public health level."

And for those over 65 the levels can be even higher. From Science News:

'Mild' control of systolic blood pressure in older adults is adequate: 150 is good enough

A broad review of the use of medications to reduce blood pressure has confirmed that "mild" control of systolic pressure is adequate for adults age 65 or older -- in the elderly, there's no clear benefit to more aggressive use of medications to achieve a lower pressure. Historically, most medical practitioners tried to achieve control of systolic pressure -- the higher of the two blood pressure readings -- to 140 or less. Recently changed guidelines now suggest that for adults over 60, keeping the systolic pressure at 150 or less is adequate, and this extensive analysis confirms that.

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Take note: research has linked a lack of microbial diversity in human guts to various diseases. A solution: Eat more plants! From Science Daily:

Compared with apes, people's gut bacteria lack diversity, study finds

The microbes living in people's guts are much less diverse than those in humans' closest relatives, the African apes, an apparently long evolutionary trend that appears to be speeding up in more modern societies, with possible implications for human health, according to a new study.

Based on an analysis of how humans and three lineages of ape diverged from common ancestors, researchers determined that within the lineage that gave rise to modern humans, microbial diversity changed slowly and steadily for millions of years, but that rate of change has accelerated lately in humans from some parts of the world.

People in nonindustrialized societies have gut microbiomes that are 60 percent different from those of chimpanzees. Meanwhile, those living in the U.S. have gut microbiomes that are 70 percent different from those of chimps.

 "On the other hand, in apparently only hundreds of years -- and possibly a lot fewer -- people in the United States lost a great deal of diversity in the bacteria living in their gut."

That rapid change might translate into negative health effects for Americans. Previous research has shown that compared with several populations, people living in the U.S. have the lowest diversity of gut microbes. Still other research has linked a lack of microbial diversity in human guts to various diseases such as asthma, colon cancer and autoimmune diseases.

One possible explanation for humans evolving to have less diversity in their gut microbiomes is that they shifted to a diet with more meat and fewer plants. Plants require complex communities of microbes to break them down, which is not as true for meat.

As for why Americans have experienced much more rapid changes in microbial diversity compared with people in less industrialized societies, some experts have suggested more time spent indoors, increased use of antibacterial soaps and cleaners, widespread use of antibiotics and high numbers of births by Cesarean section all may play a role. Antibiotics and antimicrobial cleaners can kill good bacteria along with the bad, and C-section deliveries prevent babies from receiving certain bacteria from the mother typically conferred during vaginal births.

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Red meat,bacteria, and atherosclerosis.From Medical Xpress:

Why does red meat increase the risk for cardiovascular disease? Blame our gut bacteria

New research provides details on how gut bacteria turn a nutrient found in red meat into metabolites that increase the risk of developing heart disease. Publishing in the November 4th issue of the journal Cell Metabolism, the findings may lead to new strategies for safeguarding individuals' cardiovascular health.

Previous research led by Dr. Stanley Hazen, of Lerner Research Institute and the Miller Family Heart and Vascular Institute at Cleveland Clinic, revealed a pathway by which red meat can promote atherosclerosis, or hardening of the arteries. Essentially, bacteria in the gut convert L-carnitine, a nutrient abundant in red meat, into a compound called trimethylamine, which in turn changes to a metabolite named trimethylamine-N-oxide (TMAO), which promotes atherosclerosis. Now Dr. Hazen and his team extend their earlier research and identify another metabolite, called gamma-butyrobetaine, that is generated to an even greater extent by gut bacteria after L-carnitine is ingested, and it too contributes to atherosclerosis.

The discovery that metabolism of L-carnitine involves two different gut microbial pathways, as well as different types of bacteria, suggests new targets for preventing atherosclerosis—for example, by inhibiting various bacterial enzymes or shifting gut bacterial composition with probiotics and other treatments.

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An amazing and unforgettable story of a man researching the gut microbes that are increasingly lost in developed Westernized populations. And do go read the original story (see link).From Popular Science:

Scientist Gives Himself Fecal Transplant To Try A Hunter-Gatherer's Microbiome

Why a field researcher from America has exposed his colon to the gut microbiome of a tribesman from Tanzania.

It's not often we encounter a story that begins with a line like this: “AS THE SUN set over Lake Eyasi in Tanzania, nearly thirty minutes had passed since I had inserted a turkey baster into my bum and injected the feces of a Hadza man – a member of one of the last remaining hunter-gatherer tribes in the world – into the nether regions of my distal colon.”

The guy behind this essay, Jeff Leach, is part of a multi-national scientific research team that by his account has been living with the Hadza, hunter-gatherers in Tanzania, for over a year. They have collected hundreds of samples from humans, animals, and the environment in order to observe how the microbial communities in and around the Hadza change with the dramatic seasonal weather shifts in East Africa: six months of near-steady rain followed by six dry months.

The question driving the research is “what a normal or healthy microbiome might have looked like before the niceties and medications of late whacked the crap out of our gut bugs in the so-called modern world,” Leach writes.

The Hadza are contemporary people, Leach writes, not an undiscovered stone-age civilization. But they're excellent subjects for this research because they still live on plant and animal foods that humans have hunted and gathered for millennia, and their use of western medications is extremely limited.

The health impacts of what lives (or doesn't) in our guts are getting increased attention in Western dietary and medical circles -- and eating foods containing "probiotics" just scratches the surface. Recent research suggests that use of antibiotics may be fundamentally altering our gut biomes for the worse, increasing rates of allergies, asthma and weight gain.

As for fecal transplants, they're no longer career killers in polite medical conversation. Swapping poop from healthy to sick persons is now an up-and-up treatment for curing chronic gastrointestinal disease. The launch of the OpenBiome fecal transplant bank in the U.S. earlier this year seems to signal that the technique is going mainstream.

As for Jeff Leach, he describes his primary scientific motivation for self-administering a fecal transplant as testing the hypothesis "of microbial extinction, something I believe we all suffer from in the western world and may be at the root of what’s making us sick." The biggest change Leach and his girlfriend have noticed since the transplant is that he's passing a lot less gas. 

Read the rest of his very readable, informative and down-to-earth essay: (Re)Becoming Human: what happened the day I replaced 99% of the genes in my body with that [sic] of a hunter-gatherer.

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It is estimated that between 14,000 to 30,000 Americans die each year from Clostridium difficile infections. So finding a bacteria that could protect people from C. difficile is a big deal. However, it is only one bacteria, and sick people typically are depleted of a microbial community, not just one bacteria. From Science News:

Harmless bacterium edges out intestinal germ

Gut infections from the bacterium Clostridium difficile can be fought with a closely related but harmless microbe known as C. scindens. The friendly bacterium combats infection in mice by converting molecules produced in the liver into forms that inhibit C. difficile growth,researchers report October 22 in Nature.

C. scindens also appears to protect people from infection, the researchers found in a preliminary study in humans. The new findings could begin a path to the next generation of therapies using gut bacteria, says Alexander Khoruts, a gastroenterologist at the University of Minnesota in Minneapolis.

People who become infected with C. difficile typically have taken antibiotics, which wipe out the beneficial microbes in the gut, giving C. difficile a chance to take root. The infection can lead to cramps, diarrhea and even death. An estimated 500,000 to 1 million people get C. difficile infections each year in the United States. People with C. difficile receive more antibiotics to treat the infection or a fecal transplant to restore healthy microbes to the gut.

Several research groups have been trying to identify gut bacteria that are resilient in the face of C. difficile so that physicians can give patients those bacteria as a treatment, says Eric Pamer, an immunologist at Memorial Sloan Kettering Cancer Center. Single strains of bacteria such as C. scindens would offer significant advantages over fecal transplants: With a transplant, doctors screen the donated feces for pathogens that might sicken the recipient. But, Pamer says, “there are many things, viruses that have yet to be identified, that could be in a crude fecal product that might cause trouble.”  

Pamer and his team gave mice antibiotics to deplete beneficial microbes but not wipe them out completely. The researchers then fed the mice C. difficile spores and identified microbes that appeared in mice with lower amounts of C. difficile in their guts. C. scindens was the clear victor. It is harmless and present in most people, but in very low numbers.

The researchers also examined the microbial populations of 24 patients undergoing stem cell transplants. Those patients had lowered microbial diversity after receiving combinations of antibiotics, radiation and chemotherapy. The patients who didn’t develop C. difficile after the transplant were more likely to have C. scindens in their guts.

The researchers also investigated how C. scindens combats C. difficile. C. difficile begins growing after it is exposed to certain molecules secreted in bile after a meal. However, another form of the molecule inhibits C. difficile growth. C. scindens transforms the molecule from one form to the other, boosting resistance to C. difficile.  

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Again,the same message: get moving for health, including cognitive function. From Science Daily:

To reap the brain benefits of physical activity, just get moving

Everyone knows that exercise makes you feel more mentally alert at any age. But do you need to follow a specific training program to improve your cognitive function? Science has shown that the important thing is to just get moving. It's that simple.

The study compared the effects of different training methods on the cognitive functions of people aged 62 to 84 years. Two groups were assigned a high-intensity aerobic and strength-training program, whereas the third group performed tasks that targeted gross motor activities (coordination, balance, ball games, locomotive tasks, and flexibility). While the aerobics and strength-training were the only exercises that led to physical fitness improvements after 10 weeks (in terms of body composition, VO2 max, and maximum strength), all three groups showed equivalent improvement in cognitive performance.

The subjects in the third group performed activities that can easily be done at home, which is excellent news for sedentary people who can't see themselves suddenly going to a gym to work out. To improve your cognitive health, you can simply start by doing any activity you like. 

"Our study targeted executive functions, or the functions that allow us to continue reacting effectively to a changing environment. We use these functions to plan, organize, develop strategies, pay attention to and remember details, and manage time and space," explained Dr. Louis Bherer, PhD.

"For a long time, it was believed that only aerobic exercise could improve executive functions. More recently, science has shown that strength-training also leads to positive results. Our new findings suggest that structured activities that aim to improve gross motor skills can also improve executive functions, which decline as we age. I would like seniors to remember that they have the power to improve their physical and cognitive health at any age and that they have many avenues to reach this goal," concluded Dr. Nicolas Berryman, PhD.

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The studies are adding up that phthalates are harmful to humans of all ages, but uniquely so to the developing fetus. Boys exposed to high levels of phthalates before birth may have slightly altered genitals, specifically a shortened anogenital distance (the length between the anus and the genitals). This is concerning because in adulthood, this is associated with reduced semen quality and lower fertility in males - and considered a sign of incomplete masculinization. So try to avoid or lower exposure to phthalates during pregnancy (see posts on ENDOCRINE DISRUPTORS). From Environmental Health Perspectives:

Plastics chemical linked to changes in baby boys' genitals

Boys exposed in the womb to high levels of a chemical found in vinyl products are born with slightly altered genital development, according to research published today.The study of nearly 200 Swedish babies is the first to link the chemical di-isononyl phthalate (DiNP) to changes in the development of the human male reproductive tract.

Previous studies of baby boys in three countries found that a similar plastics chemical, DEHP, was associated with the same type of changes in their genitalia. Less is known about the reproductive risks of DiNP, a chemical which scientists say may be replacing DEHP in many products such as vinyl toys, flooring and packaging. In mice, high levels block testosterone and alter testicular development.

“Our data suggest that this substitute phthalate may not be safer than the chemical it is replacing,” wrote the researchers, led by Carl-Gustaf Bornehag at Sweden’s Karlstad University, in the journal Environmental Health Perspectives. Levels of DiNP in U.S. adults and children have more than doubled in the past decade.

The researchers measured metabolites of five phthalates in the urine of pregnant women during the first trimester. Development of male reproductive organs begins during that period, said senior study author Shanna Swan, a professor of reproductive science at Mount Sinai Hospital in New York. The researchers then measured the anogenital distance – the length between the anus and the genitals – when the boys were on average 21 months old. Boys who had been exposed to the highest levels of DiNP in the womb averaged a distance that was slightly shorter – about seven-hundredths of an inch – than the boys with the lowest exposures. “These were really subtle changes,” Swan said.

Considered a sign of incomplete masculinization, shortened anogenital distance in men has been associated with abnormal testicular development and reduced semen quality and fertility. In men, this measurement is typically 50 to 100 percent longer than in women. But it’s unknown whether a slightly shorter distance in infants corresponds with any fertility problems later in life.

For other phthalates, the study found shorter anogenital distance with higher concentrations, but the findings were not statistically significant, meaning they may have been due to chance. The Swedish women in the new study had phthalate levels similar to U.S. women in Swan's previous studies. Those studies, published in 2005 and 2008, linked several phthalates to shorter anogenital distance.

The scientists said exposures to the chemical can come from food or through skin contact with home furnishings or child-care articles. In 2008, the United States temporarily banned use of DiNP and two other phthalate plasticizers in toys and other children's products.... While it’s nearly impossible to eliminate exposure to phthalates, Swan suggested that pregnant women may be able to reduce their exposures by incorporating unprocessed, unpackaged foods into the diet and by avoiding heating or storing foods in plastic containers.