Sleep, Weight, Insulin Resistance and Diabetes
I am often asked why there seem to be such close links between food and mood. Not just comfort eating, or the sudden shock of lots of carbs when we need an energy jolt, but why drugs that alter mood so often alter appetite?
You will probably not know this, gentle reader, but I only learned of it from reading scholarly papers. Apparently many people report that using marijuana makes them very hungry. On the other hand, cocaine and amphetamine affect not just the metabolism, but also appetite. The link has to do with the evolutionary development of feeding behaviors with the motivation to find food and to be satisfied by it.
Another link that has interested me for many years is the connection between metabolism and sleep. We have always presumed that this link has to do with hibernation: even humans have maintained some hibernation responses.
There is extremely good evidence that there is an inverse relationship between the number of hours that you sleep and an increase in your weight. There have been a great many studies on this, but one of the best was published by a group of researchers from the Mood and Anxiety Disorders Program, at the National Institute of Mental Health, the Psychiatric University Hospital, Zurich, Switzerland; University of Pittsburgh School of Medicine and the Department of Psychosocial Medicine, Zürich University Hospital, Switzerland in the Journal Sleep in 2004.
A report from the BBC concerning a study presented to the American Thoracic Society International Conference in San Diego provides yet more evidence of this link between sleep and weight. Researchers from Case Western Reserve University in Ohio, followed nearly 70,000 women for 16 years. They found that women who slept five or fewer hours a night were a third more likely to put on at least 33lbs (15kg) than sound sleepers during that time. It also found that compared with women who slept for seven hours a night. lighter sleepers were 15% more likely to become obese (have a Body Mass Index (BMI) of 30 or more. {BMI is calculated by dividing your weight in kilograms by the square of your height in meters}).
Previous studies, some of which I have reported before, have shown that after just a few days of sleep restriction, the hormones that control appetite cause people to become hungrier. However the women in the study appeared to eat less. I say “appeared to,” since the use of personal evaluations of food intake are notoriously inaccurate.
In dozens of countries arond the world, I am regarded as an authority in the fields of endocrinology, metabolism and nutrition. But when a group of us tried to estimate our daily intake and compare it with meticulous diaries, we discovered that we – a group of internationally renowned experts – were off by around 500 calories per day.
All kinds of explanations have been advanced, from people who didn’t sleep getting up and binge eating; to the effects of sleep-deprived people craving high carbohydrate, high fat food; to insomnia being a result of anxiety or depression that releases hormones that cause us to lay down fat in our tummies.
For all kinds of complex biochemical reasons, I have always felt that a lack of sleep would lead to an increase in insulin resistance, that may cause an increase in the deposition of fat in key regions of the body.
Some new research suggests that I may have been right on this one. A group based at Yale University School of Medicine, in New Haven, Connecticut has just published a report that should be of interest to all of us, and in particular you multi-tasking insomniacs out there.
The investigators studied a cohort of men from the Massachusetts Male Aging Study who did not have diabetes at baseline (1987–1989) and who were followed until 2004 to look for the development of diabetes mellitus. They came to the conclusion that BOTH very short and extra long sleep durations increase the risk of developing diabetes, independent of confounding factors.
The take home message?
If you do not get 7-8 hours sleep each night, you are vulnerable to a great many problems, and perhaps the biggest of all is the risk of weight gain, insulin resistance and diabetes mellitus.
I do not recommend using sleeping tablets unless absolutely necessary, and then for just a few days at a time. Instead follow all the sleep strategies that I have talked about in earlier blog entries.
During a recent visit to Danville, Virginia, I was delighted to learn that one of the non-pharmacological approaches that I have found helpful – putting a cold compress on the abdomen – was used by General Stonewall Jackson who used this very technique that I had to learn by going all the way to China.
The bottom line? Before your sleep gets disrupted by being overweight and you develop sleep apnea, try some simple sleep hygiene, and a few of these novel techniques.
Technorati tags: Insulin Insulin resistance Insulin resistance syndrome insomnia alternative medicine resilience
Happiness and Resilience
For more than two decades, my main focus has been on ways to help people become more resilient to the slings and arrows of outrageous fortune. To enable people to withstand anything that’s thrown at them: physically, psychologically, socially and spiritually. And not just to withstand them but to use adversity as the impetus for growth.
Adversity is a fact of life: it cannot be controlled. But we can control how we react to it.
This is such an important concept.
So many people try and make themselves stronger and stronger, yet there will always be something that can overwhelm the most powerful defenses. I knew of two martial artists in Hong Kong who claimed that they could defeat anyone. They were incredibly strong and had exquisite technique.
Which did not help them one bit when some villains shot them from behind by.
I have come across others who have spent their lives eating and exercising and still dying prematurely. What was the problem? They had not learned the arts of resilience, which include adaptability, flow and seemless integration with the Universe.
Over the next few days I am going to introduce you to some of the techniques that we have developed for enhancing psychological and physical resilience, before going on to reveal some of the secrets for strengthening the subtle fields of your body, and how to maintain dynamic relationships, not just with another person, but with your Higher Self.
One of the manifestations of resilience is happiness, so before we start, I would suggest that you try this small test that was published by the BBC by arrangement with Professor Ed Diener, from the University of Illinois who designed it.
Technorati tags: Resilience Happiness Flow Relationships
Human Evolution
For more than a century, the received wisdom has been that humans finished their physical evolution between one hundred thousand and fifty thousand years ago, and that there have been only minor changes in cognitive abilities over most of that time.
I have always found those assertions to be fundamentally flawed. Our bodies have changed beyond all recognition in the last few hundred years, as I’ve pointed out in my last book and CD series Healing Meaning and Purpose. Even more than that we have changed and are changing mentally. If we were to go back in time ten thousand or even one thousand years, we would find that people were cognitively, emotionally and morally quite different from modern humans. Not simply because of technology and the explosion of knowledge about the external universe, but because there is a dynamic relationship between our development as a species and our creations, with each feeding off the other.
It is only recently that a number of theoreticians, philosophers and psychologists have begun to look at the ways in which we are continuing to develop and what it means for all of us.
The German psychiatrist and philosopher Karl Jaspers first pointed out the great moral leap forward in what he called the Axial Period, between about 700-200B.C.E., during which the foundations of many of the world’s great religions first appeared, probably in response to the prevailing violence and unpleasantness of the time. More recently the Polish-born Swiss philosopher Jean Gebser started developing intriguing models of the transformations of human consciousness. In the United States, the psychologist Clare Graves developed a revolutionary concept of developing levels of development of the personality, that has evolved into Spiral Dynamics. (You may be interested to look at a review that I have just written about an excellent CD program detailing the latest developments in this field.)
And then there is Ken Wilber whose work in this field is remarkable, and whose creation of the Integral Institute promises great things. To these luminaries I now add Dudley Lynch a writer whose work I have only recently discovered.
Dudley recently wrote a very sensitive blog item about the efforts of a person with a mental illness trying to keep himself integrated in a sea of psychic chaos. He was kind enough to publish my brief response, which needs a little more detail.
The reasons for raising these points about continuing human development are these:
1.The manifest physical changes in people over the last few hundred years have enormous – and largely neglected – implications for clinical medicine.
2. It is likely not just peoples’ physical bodies that have changed, but also their subtle systems. I pointed out in my last book and CD series that the chakra system has developed to its current point only within the last few thousand years. This continuing development is also one of the reasons why some therapies that once only worked occasionally are now becoming more stable and predictable, and why some new forms of therapy – like the tapping therapies – are now being discovered.
3. It is because of these profound changes that new forms of therapy are now being developed. Not just using a supplement here, or a breathing exercise there, but precise combinations that help guide the healing of every aspect of an individual and his or her relationships and spiritual connections.
4. Some people who appear to have psychotic illnesses are moving into new developmental stages without having passed through the necessary intermediate stages. I have just read a first person account of an English journalist who could easily have been diagnosed with a manic illness, but was almost certainly undergoing a spiritual emergence.
5. Major emotional, cognitive, moral, conscious and spiritual shifts can be profoundly frightening to many people, and are doubtless one of the reasons for the profound feelings of social dislocation and violent reactions that we are observing throughout the world.
6. It is no surprise that new spiritual pathways are now emerging. Many will doubtless be very helpful to many of the thirty million Americans who count themselves as spiritual seekers, but have not yet found what they are looking for.
7. Taken together, these new understanding about the longitudinal development of people, relationships and whole societies are already having extraordinary effects on our ability to guide them all in more healthy and integrated pathways.
Technorati tags: Human evolution Axial period Ken Wilber Karl Jaspers Alternative medicine Complementary Medicine Integrated Medicine Chakras Subtle energy
Health Risks of X-Rays
There have been alarmist and often sensationalist stories about the health effects of ionizing radiation since it was first discovered. Wilhelm Conrad Röntgen won the Nobel prize in Physics in 1901 for his discovery of X-rays, and it was quickly discovered that over-exposure to X-rays was dangerous. Marie Curie – the Polish-born French scientist who won two Nobel prizes in 1903 and 1911 – died of leukemia. It has often been suspected that it was related to her long-term exposure to radiation.
As a child growing up in England, many shoe shops had primitive X-ray devices called fluoroscopes to allow kids and their parents to look at their little toes inside their shoes. Despite knowledge of the health effects of X-rays I reported in an article published fifteen years ago, that while working at a hospital in Nanjing, China, I was shocked that the ancient X-ray equipment had no shielding at all.
There is no doubt that X-rays and their more sophisticated progeny, like CT scans, have revolutionized medicine, and saved countless lives. So how do we weight the risks and benefits of diagnostic X-rays? The last thing that we want to do is to discourage people from having the medical help that they need.
Help has arrived in a new report Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2 from the National Academy of Science, published in September 2005. I think that this report should be considered the definitive and authoritative resource on the subject of radiation risk.
Dr. Richard C. Semelka has produced an outstandingly helpful summary of the report and its key recommendations.
1. The report says that medical X-rays can cause cancer, and that there is no safe lower limit. The risk is very low, and, as one might imagine, is higher in children. It is also important to be aware that cancers are not uncommon and almost always have multiple causes, so claiming a causal link between a diagnostic X-ray examination and the subsequent development of a tumor is very difficult. The main tumors said to be associated with X-rays are leukemia, thyroid and breast. The time between exposure and tumor development can be very long.
2. Therefore any use of X-rays, particularly CT scanning should be done judiciously. One of the problems in the United States is that many professionals have been forced to practice defensive medicine. They could be held legally liable if they do not do a test.
3. Professionals already use the lowest possible dose of radiation.
4. Professionals are already discussing whether there are any possibilities of substituting other types of diagnostic imaging.
Now I’m going to tell you a story. Some time ago I had a health problem that may well have been a result of exposure to radiation as a child. The health problem is now long gone, but it sensitized me to the issue. So what would I do now if a physician recommended that I have an X-ray or a CT scan? I would discuss the options:
How important is the test?
What would be the downside of not having it?
Is there any other way of getting the same answer without using X-rays?
If the answer to that one is “no, “ then what’s the lowest dose of radiation that we can use?
And how can we shield the bits of me that don’t need a dose of X-rays?
Then, even with my medical history, I personally would almost certainly go ahead and have the test. But every person would be well advised to have that discussion with their health care provider.
Many professionals read my articles, and for you, it would be worth considering getting the report, and going through Dr. Semelka’s thoughtful article.
I think it’s excellent that scientists have produced this report and that thoughtful radiologists around the world are working on the best ways of safe guarding the welfare of the public. I am going to continue to report the emerging scientific literature on this important topic.
Technorati tags: X-rays radiation carcinogenesis
A New Atlas Promises a Breakthrough in some Brain Disorders
The very first attempts to take pictures of the living brain go back to the 1930s, but it is only in the last 20 years that MRI, SPECT and PET studies of the brain have really moved the field forward. After thousands upon thousands of imaging studies, we are beginning to approach the time when we can start harvesting the data collected over these years.
We are on the cusp of an extraordinary advance in our understanding of the brain and how it can go wrong in a large number of neurological and psychiatric illnesses. But that is only a side show: being able to identify the neurological correspondences of, say a psychiatric illness, does not mean that we reduce the illness to the firing of a group of neurons. But it does mean that we are gong to be much closer to providing suitable treatment for the neurological component aspect of the illness.
There has been a dramatic demonstration of this with the publication of a new brain map of people living with a rare but important illness called William’s syndrome.
One of the biggest puzzles for those of us who look at brain scans, is why there is so much variability in the structure of the brain. In the rest of the body, veins and arteries can turn up all over the place, but nerves tend to be in pretty much the same position in everybody. This is not the case in the brain. I’ve looked at many thousands of MRI scans of the brain, and I’ve never found any two alike. It’s one of the reasons that I’m a little doubtful about some of the claims of imagers who say that they can diagnose someone by looking at a brain scan. Most of the time there’s just too much normal variation.
All over the world, there have practitioners who have claimed to derive all sorts of information from brain images. Most experts remain a bit skeptical: hundreds of experts and hundreds of millions of dollars have only enabled us to speak in generalities. Some private practitioners even perform scans for diagnosis.
Some time ago I met a psychiatrist who had an unusual theory about the causes of mental illness. He wanted us to do two MRI scans on a patient to prove his theory. When I told him that we were not yet able to do that in individuals, he was indignant, “But you’ve published all those studies showing abnormal brain structure in schizophrenia.” I explained that all the brain imaging studies have told us quite a lot about groups of people with mental illness, but little about individuals. I do not know of any academic psychiatrists anywhere in the world who think that we can yet use PET, SPECT, fMRI or MRI scans for diagnosis of mental illness. Maybe we’re just being a bit slow. Or perhaps the brain scan diagnosers haven’t got all the pieces of the puzzle just yet. Research is expensive and takes a great deal of time. Busy clinicians are eager to exploit new investigative tools for the benefit of their patients, and usually do not publish their results in peer reviewed journals. With this new research we are going to be able to see if these individual practitioners are correct.
Not only are there many inter-individual differences, but also the current state of the person can have a big impact on some types of imaging. I was recently asked to review a paper for a scientific journal in which the authors had enthusiastically explained the way in which they could now diagnose a certain illness by doing a brain scan. Sad to say, they had not asked a couple of basic questions, like the person’s mood when they were scanned. Depression reduces the flow of blood in regions of the brain, the patients turned out to be depressed, and the results were invalidated. It was a real shame, but it is so important that patients don’t get misled by investigations that cannot help them.
So the moral of the story is this. If someone wants to do any kind of investigation for diagnostic purposes, ask them first whether there is any published evidence that the test actually works: what are the sensitivity and specificity of the findings generated by the test? And who else is doing it?
“If the brain were so simple we could understand it, we would be so simple we couldn’t.”
–Lyall Watson (South African Biologist and Writer, 1939-)
Technorati tags: brain structure williams syndrome bipolar disorder PET scan
Crucial New Insights Into the Metabolism of Medications
When we examine the interactions of medicines with the body, we are interested in what the medicine does to the body, and also what the body does to the medicine: what we call pharmacokinetics and pharmacodynamics. But it has long been known that these two essential considerations are far from being the whole story: there are enormous differences in the ways in which people respond to medicines: some people need huge doses of a medicine, whilst there are others who cannot tolerate medicines at all. Though part of the explanation for those differences is clearly not just pharmacological – the same people who are super-sensitive to medicines are often also extraordinarily sensitive to acupuncture and homeopathy – there is a new kid on the block: a new factor in drug metabolism.
Men and women handle medicine differently, the time of day that a medicine is taken, as well as things like the food eaten in the last few hours can all impact the outcomes of taking a medicine. We have also known that there are many other variables in a person’s response to a medicine.
For more than two decades physicians and pharmacologists have wondered if the three pounds of bacteria living peacefully in our intestines might have a major impact on the metabolism of medicines. This question was first prompted by clinical observations: first, people with no intestinal bugs exhibited many oddities in how they handled medicine, and second, there are some rare situations in which overgrowth with unusual bacteria can chew up certain essential nutrients.
New research reported by the BBC confirms these clinical observations.
Researchers at Imperial College London and the pharmaceutical giant Pfizer have used a “pharmaco-metabonomic” approach that uses a combination of advanced chemical analysis and mathematical modeling to predict responses to drugs. Details of the research are published in the journal Nature.
The method is based on an analysis of the chemical products of the body’s metabolism. We think that examining these patterns can help diagnose diseases, predict an individual’s future illnesses, and their response to treatment.
The principle investigator is Professor Jeremy Nicholson and he has said the ‘pharmaco-metabonomic’ approach appears able to take account of individual differences in the way that drugs are absorbed and processed by the body. It differs from person to person depending on factors including the type and amount of bacteria found in the intestines.
These new techniques could be the first step towards the development of more personalized pharmacological treatments. For those of us practicing integrated medicine, this is a most welcome development.
Technorati tags: drug metabolism gender differences intestinal bacteria pharmacodynamicspharmacokinetics
Happy World Tai Chi & Qigong Day!
Saturday, April 29, 2006 is World Tai Chi & Qigong Day . The day is going to be celebrated in 60 countries around the world as well as all fifty states. The event has been recognized by the United Nations World Health Organization, and proclaimed officially for 17 US states by their governors, as well as senates, legislatures and mayors of various countries.
I taught Tai Chi and Qigong for several years, and had the privilege of studying with teachers in China and Malaysia whose methods were part of an oral tradition. Much of this material has still not been published. I recently reviewed a very nice book at the Amazon.com website. One of the things that impressed me about the book is that it contained exercises and techniques that I had been taught by Chinese Masters, but which to my knowledge have never been published anywhere else.
I thought that it might be a good moment to review the world literature on the medical effects of Tai Chi and Qigong. My search has turned up over 2,200 published reports, of which about a third are the reports of clinical trials. I have been able to analyze the data in about a half of those trials. The data now suggests that Tai Chi is genuinely useful for:
- Preventing falls in the elderly
- Improving functional mobility and some aspects of immune function
- Improving blood pressure and lipid profiles and subjective wellness
- Improving overall physical performance
- Stress reduction in HIV positive individuals
There are many other studies indicating the value of Tai Chi, but these give you a sense of some of the research that is going on at the moment.
As I mentioned in another post, qigong is both a personal practice and is used as a form of therapy. It has recently been shown to help:
- Chronic pain
- Cardiac rehabilitation in the elderly
- Chronic fatigue syndrome
- Overall immune function
- Asthma
This is by no means a comprehensive list, but as you can see, this is an active area of research.
Learning some Tai Chi and Qigong could be one of the best investments that you ever make in your own health.
Technorati Tags: Tai Chi, Qigong, Wellness, Asthma, Chronic fatigue, HIV
Fungal Contamination of Pillows
I recently came across a study from colleagues at the University of Manchester in the United Kingdom, that was published in the journal Allergy.
Fungal contamination of bedding was first studied seventy years ago, but there have been no reports in the last seventy years. In this new study, researchers sampled ten pillows with between 1.5 and 20 years of regular use. Each pillow was found to contain a substantial fungal load, with four to 16 different species being identified per sample and even higher numbers found in synthetic pillows. One of the most worrying things was that the microscopic fungus Aspergillus fumigatus was particularly common in synthetic pillows. And fungi as diverse as bread and vine moulds and those usually found on damp walls and in showers were also found in the pillows. Aspergillus is a very common fungus, carried in the air as well as being found in cellars, household plant pots, compost, computers and ground pepper and spices. I have treated many people with invasive Aspergillosis, a sometimes nasty illness that occurs mainly in the lungs and sinuses, although it can spread to other organs including the brain. It can be very difficult to treat, and as many as 1 in 25 patients who die in modern European teaching hospitals have the disease. In France and Germany, this is one of the occasions when unorthodox medicine is often used at the same time as high doses of antibiotics: proper integrated medicine.
Aspergillosis is a particular problem in people with compromised immune systems. Hospital pillows have plastic covers and so are unlikely to cause problems, but patients being discharged home – where pillows may be old and fungus-infected – could be at risk of infection. Aspergillus can also worsen asthma, particularly in adults who have had asthma for many years, and it can cause allergic sinusitis in patients with allergic tendencies. Constant exposure to fungus in bed could be problematic.
The moral of this story is be extra aware that pillows may harbor fungi that can cause or exacerbate allergies and more serious problems in people with other illnesses. If you have allergies, it is best to use foam rather than feather pillows. If you have synthetic pillows, wash them regularly in warm water and with a non-allergenic detergent. Dip the pillow one small section at a time in the solution and squeeze through the pillow. Once the pillow is clean, rinse it out at least three times to remove all of the soap and residue. Then lie the pillow out flat to dry, and turn it frequently. To fluff the pillow, take a couple of tennis balls and put them in the dryer with the pillow and air dry for about 30 minutes.
Technorati tags: fungus, integrated medicine, allergies, asthma
Personal Evaluation of Wellness
As a physician, I am trained to know what questions to ask in order to diagnose health problems and understand what course of action needs to be prescribed to alleviate or cure the problem. I can be a nightmare for my secretary if she makes my schedule tight because I can spend over an hour with a patient on a first visit. She would argue that it is more like two hours, but I will admit that I take whatever time I need to gather the pertinent information.
I recently wrote an article that allows one to conduct a personal evaluation of his or her own wellness. Click here to be taken to it. It is based on my many years of experience and research. You will notice that the questions cover the 5 main areas (Physical, Psychological, Social, Subtle and Spiritual) that are key to achieving an overall feeling of wellness and good health.
Keep in mind that this is a bit of a shortened version, there are many more questions that can be helpful. However, this should get you started about thinking of ways to improve your own sense of health, meaning and purpose.
Technorati tags: wellness, health survey,
The Status Syndrome
I have recently seen some reports in the media about a connection between money and longevity: the idea being that the more money you have, the longer you live. Which presumably means that Bill Gates will live forever. Sadly this link between wealth and longevity is a false extrapolation from some very old research. Yes, extreme poverty is associated with excess mortality, not only because of poor lifestyle and lack of access to medical screening and care, but also because adults who were of low birth weight are more likely to develop diabetes and hypertension. And people born into poverty are more likely to have been malnourished before birth, and therefore to be of low weight at birth. This relationship between low birth weight and subsequent disease is likely the result of incomplete development of the liver and kidneys before birth.
A famous study of British civil servants has indeed shown that people who work in more senior positions are more likely to live longer than people working in the lower ranks. But it has nothing to do with money. Once people have passed a certain critical material threshold, lifestyle factors have progressively less impact. There are still more smokers amongst manual workers and hours of hard work means that they have to eat high calorie high fat foods to be able t keep working, and we have not done a good job of showing people how easy it is to eat healthily on a budget.
Sir Michael Marmot is an outstanding epidemiologist working in London, who has spent three decades examining the health consequences of differences in social standing. He has discovered that there is a social gradient that predicts health outcomes: the lower a person’s social rank, the higher their risk for heart disease, diabetes, mental illness, accidents and many other health problems. Once people have passed a certain threshold of physical and material well-being, something else comes into play: other kinds of well-being that have a massive impact upon life. These are autonomy – how much control you have over your life – and opportunities for social engagement and participation. The psychological experience of inequality has profound effects on multiple body systems. Sir Michael has summarized a lot of his research in an eminently readable book entitled, appropriately, The Status Syndrome.
There is an interesting corollary of the Status Syndrome. In his book The Pecking Order, Dalton Conley presents interesting research that indicates that our level of success relative to our siblings is less the result of birth order or genetics and more the result how much family resources – time, energy, money and love – we received while growing up.
There’s not much that you can do about your birth order, but all this research has some important implications.
1. Once you have crossed a threshold that allows you access to nutritious food, exercise, stress management and health care, there is no longer any link between health and wealth. In fact, working and working to get more and more money is associated with increased mortality!
2. The amount of time, energy, money and love that the family is able to give to each child will help shape and structure their future life. That is a hugely important responsibility.
3. Ensure that you feel and know that you are autonomous: that you are in control of your life. I really urge you to work on this. One of the reasons for being concerned about the ever-increasing demands being made upon all of us is that it can make us feel out of control. I spend a great deal of time in Healing, Meaning and Purpose discussing and demonstrating techniques for taking back control of your life.
4. Are you socially engaged and participating in life? Are you doing something for your community or your church? How often do you meet new people and engage with them? Is there someone whom you haven’t seen for a while that really needs a call from you? Please do think about this: it’s not just about socializing; it’s about protecting your health and well-being, and the health and well-being of those around you.
Technorati tags: status syndrome, Michael Marmot
