A recent article in the USA Today discussed “the placebo effect” and the debate surrounding it. According to the American Medical Association “a placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated.” Perhaps more important to the understanding of the placebo effect is the belief of the patient.
According to a national (USA) survey in 2008 as many as 50% of physicians prescribe placebos at least once a month. The interaction of mind and body that underlies the placebo effect has been known for many years. Tension exists regarding the placebo as some believe it is unethical for doctors to deceive patients by not telling them about the placebo intervention. However, 1 in 20 doctors who prescribed placebos explicitly described them as such to patients. The question is do placebos actually make patients feel better and does this outweigh the responsibility to inform patients about their use.
Across studies with different medical conditions results suggest there is an active treatment effect of placebo and in some cases this may be significant. Factors such as warmth, empathy, duration of doctor-patient interaction and communication of positive expectation might play an important role in healthy outcomes. If these factors are indeed important and contributory to a positive outcome for a patient, the need to deceive is removed.
Perhaps placebo reflects the long held belief that our brains can have an impact on the condition of our body. Perhaps a message delivered by a person that the patient perceives as knowing and within a context the brain perceives as credible can lead to our own body helping to solve the medical issue. Further, given the rather consistent positive impact of “placebos” on patient outcomes it seems time to begin rethinking the therapeutic effect of mind over matter and to integrate such care into the standard regimen of our “health care system.”
As most of us get into middle age we might take special notice of our body’s ability to keep a few extra pounds around the waist. Most of us understand the importance of eating healthy and the disease risk associated with extra weight around the belly.
Recent research suggests the brain’s ability to sense gratification may be critical to overeating behavior. We may have a gene that assists us with knowing when we are filled after eating. Research now indicates that a brain that does not express satiation will lead to continued eating and increased risk of obesity.
We know that a healthy diet and regular exercise are very important for maintaining a healthy weight and avoiding obesity. However, genetics also plays a role in which an important neurochemical, Dopamine, may play a critical role. Dopamine is the primary neurochemical that regulates our pleasure sensation.
Eating temporarily boosts dopamine levels, but obesity may be associated with fewer Dopamine receptors which lead to less sensation of pleasure with eating. Research now suggests that the brain regions important to Dopamine expression when eating treats such as a milkshake does not get activated in those who are obese.
Interestingly, Dopamine has been studied as a primary mechanism for addiction and impulsive behavior including eating. Attempts are underway to try and understand how Dopamine might be triggered even in obesity to reduce impulsive eating so as to reduce gaining more weight. To read more about Dopamine, click here
I was very proud of myself recently when I generated enough determination to quit my perceived addiction to caffeine in the form of coffee. While it is true that I only consumed one cup of coffee in the morning to get my jump on the day, it is also true that my brain demanded that one cup. I know this because when I stopped or missed my cup of coffee I felt a bit sluggish and then the headaches set in if I did not get the fix for several days. We refer to this as an addiction, though some do not like to hear that word to describe their (my) behavior.
After nearly one month of not consuming any coffee and getting through the withdrawal symptoms, I pick up a new research discovery in the Journal of Neuroinflammation (volume 6, 2008) that reports caffeine blocks disruption of blood brain barrier in a rabbit model of Alzheimer’s disease. It seems caffeine consumed in the equivalent of one cup of coffee daily protects against high cholesterol diet induced increases in disruptions of the blood brain barrier, and caffeine might be useful in the treatment of Alzheimer’s.
If high levels of serum cholesterol and disruption of the blood brain barrier are indeed underlying mechanisms in the pathogenesis of Alzheimer’s it suggests I need to reconsider starting my habit again!
The important message in the story is that we continue to monitor the new findings of lifestyle and brain health and change our behavior accordingly. This should not occur in an impulsive way. Rather, the negative effects need to be weighed against the positive effects of particular behaviors. For me, I think I will restart my consumption of coffee, but keep it to ½ cup a day. Moderation is typically a great idea. In the meantime, I will keep an eye out for replication of this finding on the relationship between caffeine and protection against Alzheimer’s.
What a great time to be alive if you are interested in your own brain and how to promote its health! With the daily reports of a new finding on how to promote brain health, the development of new companies with products for brain fitness (e.g. brain games), and with the boomers generating a booming interest in this part of their being, we really are in the “golden era of brain health.”
I am so very fortunate to have been involved with brain health more than a decade ago and to witness what I described then as the emerging “Brain Wave” that was coming. It is here and we will all be better for the fact that the human brain has found its way onto the radar screen of health.
A national and world wide discussion of the human brain with a focus on proactive lifestyle towards promotion of brain health is a great and needed thing. Dementia is a real problem and a growing concern. We have the ability to be proactive and to focus on an optimistic and positive path forward as we try to implement research-based behaviors to brain reserve. By building our own brain reserve across our lifespan we probably increase our chances of delaying the onset of neurodegenerative diseases such as Alzheimer’s.
The next step to this growing brain wave is for the governmental bodies to pass legislation that incorporates national emphasis on the brain similar to what we have done for the heart; for health care payers to include incentives for leading a brain health lifestyle that might recognize lifelong learning, brain fitness, use of pedometers, diet, and meditation as critical ingredients to brain health, and for continued innovation in the business world to apply research to the market.
What a great day to be interested in promoting your own brain health!
A study published in online Neurology 3-27-08 indicates belly fat is linked to increased risk of dementia. Rachel Whitmer, a researcher at Kaiser Permanente Division of Research noted that belly fat increases the risk of diabetes, heart disease, and stroke. However, her research on 6,583 men and women ages 40-45 living in northern
California found that belly fat was also related to increased risk of dementia.
Indeed those who were obese (30 pounds or more over a healthy weight) and had collected belly fat in their 40s were 3.6 times more likely to develop dementia during the 30 to 40 year study. Even those who were not obese, yet had extra weight around the waist or belly, were 1.8 times more likely to develop dementia compared to those who were lean all over.Whitmer stated that “it is not simply about weight, but where you carry your weight.” She noted that people who are predisposed to carry their fat in their belly region may be at risk. Fat cells in the stomach secrete hormones that may play a role in diseases such as diabetes, heart disease, and now perhaps dementia.
The good news is that anyone with belly fat in their 40s can adopt a lifestyle of diet and exercise that can reduce such fat and reduce the risk of disease related to the fat. Time to get moving and eating healthier!
A recent report from the National Alzheimer’s Disease Association estimates nearly 10 million to 14 million of the baby boom generation (76 million strong) will be at risk for developing Alzheimer’s disease (AD). These numbers may actually underestimate the overall prevalence of boomers who will develop AD in their lifetime. This estimate places a heavy emotional, family and economic burden on the U.S. States given our current approach and over all understanding of the caregiver demands posed by AD. There is no reason to believe that similar nations across the world will be any different.
One method to begin addressing the rising epidemic of dementia is to establish a national or world priority on the human brain and dementia. Citizens of the great planet Earth need to have a basic understanding of their brain, something that is completely missing even in 2008. We cannot expect citizens to care for their brain if they do not understand it or the importance of a proactive healthy lifestyle across their lifespan. One idea is to include basics of brain and brain health in every elementary curriculum in the world.
National policy also has to prioritize research on treatment and prevention of dementia in ways we have not yet. Research is needed on how the brain functions, how diseases begin, new treatments for dementia, and innovation in the area of prevention. Health insurance companies should begin to incentivize lifestyles that promote brain health including lifelong learning, diets, meditation, and physical exercise. Those who continue to work or remain involved in society may be rewarded with some type of tax break. We need to think in terms of a Brain Enlightened Society.
Stroke is a clinical term that describes cell death in the brain. Stroke is a permanent and can result in significant functional impairment and even death. There are two types of strokes. The first is the most common and is referred to as ischemia. Nearly 80% of all strokes are ischemic and involves a blockage of blood flow that results in cell death. The other 20% of strokes are hemorrhagic that involves a bleeding outward from a weakened artery wall. As the blood gathers increased pressure can be placed on the surrounding brain tissue causing additional damage to the brain.
Both types of stroke are dangerous and can result in deficits of language, attention, information processing speed, and motor skills. Risk factors for stroke include advanced age, high blood pressure, diabetes, obesity, smoking, and poor diet. Typical preventative measures for stroke include the same protocol as used for the healthy heart. We have learned relatively recently how important blood flow to the brain is, particularly when we recognize that the brain commands 25% of the blood from every heart beat.