“There is no female mind. The brain is not an organ of sex. As well speak of a female liver.” Charlotte Perkins Gilman (American Feminist Writer and Editor, 1860-1935)

It is easy to understand the sentiments behind this well-known statement by a pioneer feminist, but the fact is that it is dead wrong. In recent years there have been a host of new discoveries into the very marked gender differences not just in the brain, but also in the liver and for that matter throughout the body. Differences that have important implications for your health and well-being. For some years I worked with a husband and wife team who had made important discoveries about gender differences in the brain. In fact some of this work made the front page of Newsweek magazine. The female member of the team once told me how, after giving a lecture at a prestigious University, she had been scolded by some people who told her that her research was undermining the movement toward gender equality, and that she should stop what she was doing. I leave it to you to make up you own mind about that.

Yes, there are demonstrable differences in the brains of men and women, but ONLY when looked at statistically. There is as much variation in brain structure as there is in height or skin color. There are also gender differences in cognitive ability, but again there are huge variations. As a male I should have a good sense of direction. In fact my sense of direction is so bad that I once joked that we should put up signs inside my house directing me toward the kitchen and the den! An over-emphasis on gender differences can have some undesirable consequences: couples therapists tell me that if clients have become overly dependent on the Mars/Venus concept, they will often have to schedule an extra 3-4 sessions to “deprogram” them.

Are gender differences in the brain and in cognition culturally determined? Probably not: experiments conducted since the 1960s have found that gender differences in cognition, emotion and perception appear to be trans-cultural, and what is more some of the same differences are found in animals. Higher rates of depression are found in women around the world, while autism is more common in boys. Estrogen and testosterone have profound effects on the developing brain. More than 20 years ago Norman Geschwind, one of my early mentors, published some challenging speculations about the interactions of sex hormones with the brain, and handedness, migraine and autoimmune disease. Some cognitive skills change during the menstrual cycle, a fact that has allegedly been used by some professional female chess players, who regulate their cycles with the oral contraceptive to ensure that they hit the big tournaments at times in their cycles when their reasoning and visuospatial abilities are at their best. The Scottish Grandmaster Jonathan Rowson discusses some of these issues in this month’s issue of the magazine New in Chess.

If we leave aside the brain, there are also enormous gender differences in other parts of the body that have significant implications for health. Apart form obvious differences in size, women tend to have more subcutaneous fat than men, so medicines that go into and are stored in fat have to be dosed differently in men and women. There are big differences in one of the key enzymes in the liver that is involved in dealing with toxins or in metabolizing drugs: important to know if you are being prescribed medicines. Women’s stomachs also tend to empty more slowly than men’s: yet another reason for being careful to take gender into account when prescribing medicines.

Amidst all of these physical differences, that I am going to explore in future entries, it is important not to lose sight of the different cultural demands on men and women. In the United States and Europe more women than ever are being expected to fulfill multiple roles: worker, wife, mother, cook, chauffeur, nurse and planner, to name only a few. It is no surprise that so many women are facing a condition that I call, for obvious reasons, “Overload.”

In my book Healing, Meaning and Purpose, I discuss some of the drawbacks of conventional methods of helping people cope and some novel solutions. As an example, I have known many people who have gone to stress management classes, that have meant them rushing across town, missing dinner, doing the class and then rushing home to put the children to bed and check their email. That kind of thing is not very likely to be helpful. When I taught T’ai Chi and Qigong classes, I would usually spend the first 45 minutes helping people wind down before we could get to work.

In response to this chronic overload, I have spent many years devising extremely brief things that people can do to help themselves in the course of a day. I have a principle that has guided me for years: for most people, if it takes more than one minute, it’s going to be very difficult to fit it in. But once they have found that one minute, other minutes often begin to follow. I shall shortly be going into the studio to record some more of my one-minute miracles, and early in the spring, we shall begin to attach some podcasts to this blog.

There is an important article in a recent issue of the Journal of the American Medical Association (Effects of Sleep Inertia on Cognition Adam T. Wertz; Kenneth P. Wright Jr; Joseph M. Ronda; Charles A. Czeisler JAMA. 2006;295:163-164.)

The study by a team at the Brigham and Women’s Hospital in Boston and the University of Colorado examined the phenomenon of sleep inertia: how long it takes for someone to wake up and think effectively, and to compare that with thinking after a person has been awake for 24 hours. For most of the first three years after I graduated from medical school, I worked on what was then known as a “one in two” on-call roster: every other night and every other weekend. Fortunately that inhumane system was abandoned some years ago, but it was not uncommon to be up and working for three straight days at the weekends, and we all became absolute experts on sleep and how to handle sleep deprivation. The problem was that if we did manage to get a few minutes sleep, there was always the chance of being awoken and being asked immediately to perform important tasks that would require very high levels of thinking and analysis. The results of this new study will not be a surprise to anyone who has done night work, or anyone who has been out all night burning the candle at both ends.

The study participants had had six nights of monitored sleep lasting eight hours per night, they were given a performance test that involved adding randomly generated, two-digit numbers. Based on the results of this test, the researchers concluded the subjects exhibited the most severe impairments to their short-term memory, counting skills and cognitive abilities from sleep inertia within the first three minutes after awakening. The most severe effects of sleep inertia generally dissipated within the first 10 minutes, although its effects were often detectable for up to two hours.

The study follows other research that has looked at the effects of going without sleep for over 24 hours, and found that the cognitive impairments were roughly the same as being drunk. Yet in the Colorado experiments, the cognitive skills of test subjects were worse upon awakening than after extended sleep deprivation: In a nutshell, the effects of sleep inertia may be as bad as or worse than being legally drunk. The most likely explanation is that certain areas of the brain take longer to "wake up".

Previous research has shown that the prefrontal cortex, which is responsible for executive functions: planning, problem solving, complex thought and emotional control, is one of the brain regions that takes longer to come "on-line" following sleep.

What should be the conclusions from these studies?

1. Ideally, nobody should be doing anything really important for 15 to 30 minutes after they wake up.

2. If you are asleep, it’s a much bigger transition to go from that to being awake, rather than staying awake, even for a long time, because then you will be aware that you are drowsy.

3. The study did not examine emotion and motivation, and that may come in to play. If you are asleep in a hotel and the fire alarms go off, you may well be able to wake up and think very well and very quickly for a few minutes, but then you brain plays “catch-up,” and you will once again we groggy and cognitively impaired.

As a young doctor, there was no option: I had to wake up fast and be able to think straight. So I just did it, and fortunately the quality of my decisions seemed to be fine when older and wiser physicians checked them the next morning. Though I am VERY pleased not to have to work like that any more!

Technorati tags: Sleep, thinking,

What do Lord Byron, Dylan Thomas and Pablo Picasso have in common? Not only were they all creative, they also had lively and probably exhausting sex lives. British researchers have recently found evidence that this connection may be no coincidence.

Daniel Nettle from the University of Newcastle upon Tyne and Helen Clegg of the Open University have spent some years examining the puzzle of schizophrenia. This is without doubt one of the most savage and distressing illness to afflict humanity. There is a heritable component, yet sufferers themselves often find it very hard to maintain relationships, have many physical illnesses and tend to have fewer children themselves. Yet the illness persists, and indeed appears to have become far more common in the middle of the 18th century, roughly coinciding with the beginning of the Industrial Revolution. The question then is whether some mild forms of the illness may have survival advantage. Theses investigators have been looking at some of the personality traits that may be predictive of schizophrenia. They found high rates of what is known as “Schizotypy” amongst the artists and poets.

The typical features of schizotypal personality disorder are:

1. Unusual experiences, including odd perceptions, magical thinking and sometimes hallucinations

2. Cognitive disorganization

3. Impulsivity

4. Non-conformity with regard to rules and social conventions

5. Often introverted, though some become overly sociable

People with schizotypal personality may develop schizophrenia symptoms if stressed, and they are found more commonly in the families of people with full-blown schizophrenia.

Psychologists have previously found that the creativity of professional artists and poets acts almost like a sexual magnetic, and it has long been thought that creative people are more likely to engage in increased sexual activity, but this research is the first to prove it. The average number of sexual partners for artists and poets was between four and ten, compared with three for non-creative types. Statistics also showed that the average number of sexual partners for both men and women rose in line with an increase in the amount of creative activity.

Links have been made before between bipolar disorder and creativity and also between creativity and schizotypy. An essential feature of creativity is the ability to put together unusual associations and ideas. In the schizotypal person who is creative, this is kept in balance, but in schizophrenia these association can become bizarre. Schizotypy tends to be associated with cognitive activation and sometimes greater sociability.

Apart from art and poetry, it is an open secret in the psychiatric community that several Nobel Prize-winning scientists have schizotypy, at least two have been diagnosed with schizophrenia, including John Nash of Beautiful Mind fame, and several famous Nobel Laureates have first-degree relatives with schizophrenia. The numbers are much higher than in the general population.

Some commentators have suggested that if you want to be lucky in love, perhaps you need to be more creative. We cannot all be a Byron or a Picasso, but I would suggest that injecting a little more creativity into your current relationships and if you are looking for new ones, being more open and creative about how and whom you meet, will likely make encounters more congenial for both of you.

Technorati tags: creativity, schizotypy, Picasso,

Our brains are delicate organs sustained by a fine balance of fatty and amino acids, minerals and vitamins.

Virtually everyone of us has had the experience of a mood change if we become hypoglycemic, or sleepiness after eating chocolate or tryptophan-containing turkey. The scientific literature is full of reports about the impact of different foods and combinations of food on mood, alertness and cognition. Some of the links are not obvious. I was brought up with the old wives tale that children become sleepy after lunch or dinner because blood was being diverted to the intestines. Not so: sugary and fatty foods cause sleepiness by altering the secretion of insulin by the pancreas, which in turn effects the uptake of key amino acids in the brain, which in turn impact the synthesis of some neurotransmitters.

There has also been another yet more serious issue that has been turning up in the literature for decades, and that is the inter-relationships between diet, nutrition and mental illness. Epidemiological studies have found a clear relationship between the consumption of fish and the incidence and prevalence rates around the world: high fish consuming countries tend to have less depression. This relationship has held up in studies around the globe, so it is unlikely that it is simply that people living by the ocean in warm sunny countries are less likely to become depressed. These observations were part of what led Dr Andrew Stoll at Harvard to first study the impact of fish oils, containing omega-3 fatty acids, on mood. The results of the early studies were more impressive than the later ones, but the fact remains that fish oils have been helpful in a proportion of patients. The experimental work continues, in order to try and find the best and most effective mixture of fatty acids.

There is a theoretical reason why this might be: fish oils can change the characteristics of the membranes of many cells, including those in the brain, and thereby influence the firing and response of some neurotransmitters important in the maintenance of mood.

There have been recent reports from well-conducted studies of the impact on nutritional supplementation on reducing violence in prisons and that work is also continuing. The BBC has picked up on an eagerly awaited report from the Mental Health Foundation and Sustain. Called Feeding Minds this report by mental health advocates and food campaigners is ambitious and presents a good summary of the current state of the evidence, though its findings are sure to be controversial.

The report points out that changes in the composition of Western diets with the proliferation of industrialized farming and pesticide use and the depletion of some essential nutrients in the soil has coincided with a continuing increase in the incidence and prevalence rates of mental illness. It is always difficult to prove causality with research like this, since there have been many other social changes which could equally account for a rise in the rates of mental illness, to say nothing of ever-changing diagnostic criteria, that have sometimes labeled people with mental illness who would at one time have been described just as “different” or “eccentric” or “difficult.” But it is also fair to say that few people doubt the link between cigarette smoking and lung cancer, but to prove causality is bound to be difficult. This is very different from the situation with infectious diseases. Here we have had a set of four criteria which we can use to show whether or not an infectious organism is the cause of a disease. Known as Koch’s Postulates, which have guided us for 122 years and have so far been proven time and time again. These postulates have been modified over the years, yet still formed the basis of the work which lead to the 2005 Nobel Prize in Physiology or Medicine.

Sad to say, things are not so clear when looking at nutrition and mental illness. But let’s look at a few key items in the report:

1. Depression: I have mentioned this one already, and the report also emphasizes the link between depression and low consumption of fish that are high in omega-3 fatty acids

2. Schizophrenia: A link between some fatty acids and schizophrenia was first proposed by the late Dr. David Horrobin in the 1970s, and increasing epidemiological evidence has shown that sufferers have lower levels of polyunsaturated fatty acids (PUFA). There have been many studies which have attempted to modulate them to treat the disease, with some measure of success. Just this month there is a report in the British Journal of Psychiatry on the adjunctive use of PUFAs in the closely related condition of bipolar disorder.

3. Alzheimer’s disease: Some studies have suggested that a high consumption of vegetables, particularly those containing folate, can protect against or slow the progression of this brain disorder.

4. Attention deficit and/or hyperactivity disorder: Research shown that some children with these disorders are low in iron and fatty acids, though it is not so clear whether treatment with these agents will help these children.

In my book Healing, Meaning and Purpose, I talk at length about the dietary and other physical changes over the last 100 years, and this report adds more. In the last 50 years, our consumption of omega-3 rich fish has fallen by two thirds, and over the same time course we have dropped our consumption of vegetables by 34%. There is something else more subtle, that I did not see in the report. In the decades after the second world war, British children were routinely given daily cod liver oil tablets rich in omega-3 fatty acids, as well as free school milk.

The report makes a point that I have before in entries here: people cannot be held totally responsible for maintaining healthy diets: some food and farming policies have lead to a situation in which people may no longer have access to healthy and nutritious foods. And that will likely cause further increases in some mental illness. And artificial supplements can rarely replace the real thing.

The evidence base associating nutrient intake and mental health is in its infancy, but it is clearly an area that needs a great deal more attention.

The recommendations in the new report are eminently sensible, and few would quibble with any of them. Before making any nutritional changes, always discuss them with your health care provider.

I would like to make a final point that I am going to amplify elsewhere:

If any health intervention is good for you, it should help more than one system of the body. So a diet that is good for mental health should also be good for the health of blood vessels, heart and skin. A diet like Nicholas Perricone’s, that aims to help skin aging, should also be good for the brain and the cardiovascular system. This is always a good way of checking to see if something is good for you and whether to adopt someone’s advice.

Technorati tags: Mentall health Nutrition Feeding Minds

My colleagues over at the Psychiatric Resource Forum just got this FDA warning and asked me what I thought. I am reproducing in its entirety:

“MedWatch - The FDA Safety Information and Adverse Event Reporting Program The FDA warned consumers not to use two unapproved drug products that are being marketed as dietary supplements for weight loss. Emagrece Sim Dietary Supplement, also known as the Brazilian Diet Pill, and Herbathin Dietary Supplement may contain several active ingredients, including controlled substances, found in prescription drugs that could lead to serious side effects or injury. They contain chlordiazepoxide HCl (the active ingredient in Librium), and fluoxetine HCl (the active ingredient in Prozac). Emagrece Sim and Herbathin were also found to contain Fenproporex, a stimulant that is not approved for marketing in the United States. Consumers are advised not to use the Emagrece Sim and Herbathin products and to return them to the suppliers. There may be other manufacturers or suppliers of imported Emagrece Sim and Herbathin, and consumers should exercise caution in using any of these imported products.

Read the complete MedWatch 2006 Safety summary, by using the following link: FDA news release

My Comments: Sadly this sort of thing is not uncommon. An unknown but clinically significant proportion of the Ayurvedic and Chinese herbs that are imported into the United States and Europe contain steroids and other drugs. I once diagnosed two cases of Cushing’s syndrome that were the result of people taking imported Indian herbs. One of them was an Indian man who was referred for weakness of his proximal muscles, which prevented him from walking up the stairs. He also add other classic symptoms of Cushing’s syndrome: he had gained weight, particularly in the face and around the abdomen, he had high blood pressure and diabetes mellitus. The other had a less florid presentation. There have been quite a number of publications on the subject of adulteration of herbal remedies.

Several years ago I became involved in an investigation of some apparently miraculous cures of eczema with Chinese herbal remedies, and sadly some of these had also been adulterated with corticosteroids. This was a real shame, because some of the herbal remedies actually helped eczema even if they did not contain steroids. These cases are all the more sad, because there are also large numbers of companies that make Indian and Chinese herbs to the highest possible standards, yet the bad apples have put even these under scrutiny.

The message must be that just because something is natural does not guarantee that it is safe. I have said before, but it bears repeating that arsenic, deadly nightshade and hurricanes are all natural. It is essential to obtain any herbals from a reputable source and to ensure that your health care provider knows exactly what you are taking: apart form the topic of adulteration, there are hundreds of potential interactions between herbal and prescription medicines.

Within the last three months, I have written an educational program for professionals that explores these issues in considerable detail, and makes recommendations about reliable suppliers of herbs.

Technorati tags: brazilian diet, diet pills, herbal medicines