Old habits die hard.

I get to hear about a great many medical and psychological problems in people in the public eye. But after 30+ years in medicine, I don’t talk about them. That’s obvious if someone is my patient: everything is completely confidential. But I also will not talk about medical problems in other people, unless they volunteer information.

Many of us have been very concerned over the physical health of the philosopher Ken WIlber.

In August I posted a brief note after he had taken a nasty tumble. I also pointed out that many of his problems with chronic fatigue syndrome could also be re-framed as "Diseases of Discipleship." Based on that, I made some predictions about other possible symptoms.

Ken has now written an extraordinarily important piece, after he suffered from a series of grand mal epileptic seizures at the beginning of December. I had heard about these problems, but would not post anything until Ken did. Even when I saw some really silly comments about the causes of his problems!

There has been speculation for many years now that many shamans had epilepsy or occasional epileptic seizures. There is also an association between one type of epilepsy and hyper-religiosity.

If you have any interest in the deeper meaning of chronic illness, the spiritual path and karma, I urge you to take a few moments to read Ken’s article.

He also mentions a website with more information about the whole Myalgic Encephalomyelitis/Chronic Fatigue complex. I have checked the out, and I agree that this is a most helpful resource.

Get well soon, Ken!

Early in my career, one of my mentors was the eminent scientist and clinician Robert Mahler. He recently passed away at the age of 81, but in the last two years of his life he was an author on two papers (1, 2) about an ailment with which he struggled for many years: Parkinson’s disease.

Despite the best treatment, he was severely incapacitated by the illness, at one stage needing a wheelchair to get from his car to his office. But his fine mind remained undimmed by the illness, and he was intrigued by reports of an association between stomach ulcers and Parkinson’s disease and of dramatic improvements in the symptoms of some people with Parkinson’s disease who were being treated with antibiotics for gastric ulcers. (Last year Barry Marshall and Robin Warren were awarded the Nobel Prize in Physiology or Medicine for their pioneering work on Helicobacter - a bacterium associated with peptic ulcers.
I mentioned in an earlier post that I have a strong sense that there are more prizes to come on the
interaction between infectious agents, inflammation, genes, the psyche
and the environment.)

Robert was one of the test subjects in a research study and his Parkinsonian symptoms got much better when he was treated with antibiotics. There are now several important pieces of research on the fascinating topic. In some people eradicating Helicobacter may convert rapidly progressive Parkinsonism to a quieter disease, although only a minority of sufferers have evidence of current infection.

There seems to be an interaction between aging, genes and this infectious agent. Clearly not everyone is helped by antibiotic treatment, but this is a whole new line of very promising research.

An important report was presented at the Scientific Meeting of the United Kingdom Society for Behavioural Medicine in Cambridge earlier this month.

A team of researchers from Leeds Metropolitan University and the University of Hull studied 62 women aged 24 to 55. They all had a Body Mass Index (BMI) over 30, which is classed as clinically obese. (Regular readers will know that most experts have moved away from using BMI to evaluate metabolic and cardiovascular risks).

The program encouraged women not to diet but to take part in exercise classes. They were required to do four hours a week of exercise, such as t’ai chi, aqua aerobics or circuit classes. So it was not necessary to become a hard core exercise freak!

The researchers found significant improvements in health and mental well-being.

The women in the study were also taught about good eating habits, including how to read food labels and cook food, and they received social support and behavioral therapy to help them respond to body cues such as hunger and feeling full.

After a year, the women had only lost a little weight but were significantly fitter and happier with themselves. Their blood pressure, heart rate and cholesterol fell and respiratory fitness increased. And the women also felt better in terms of general well-being, body image, self-perception and stress.

This small, simple study re-emphasizes what we have said to tens of thousands of people: fad diets will only help in the short term. For all practical purposes you can eat what you want, but in moderation. But try gradually to change the composition of your diet. I have written some advice on doing that. In Healing, Meaning and Purpose we also provide a number of tactics to help you tackle some of the psychological and social hurdles that may stand in the way of weight management. Which include something not often discussed: the twelve ego-fears that can be the hidden drivers to a lot of our behavior.

Understand them and you can gain a remarkable degree of control of your thinking and your emotions.

And it is exercise that should be the centerpiece of a weight management strategy.

This was re-inforced by a study published last week in the Archives of Internal Medicine: people who lost weight by restricting calories lost bone mineral density. Those with exercise-induced weight loss did not.

And as you doubtless know, loss of bone mineral density is one of the key risk factors for osteoporosis.

So please don’t buy in to some new “miracle” diets: they simply don’t exist.

Instead:

• Gradually increase your level of exercise
• Slowly change the composition of your diet
• Keep your internal organs - especially your intestine - in balance
• Develop your food awareness (I am going to do a whole post/article about that!)
• Learn how to deal with the psychological, social subtle and spiritual aspects of suboptimal eating (Check out the reources that I have already provided + a new eBook in the New Year)
  

And before you know it, you will be exactly where you want to be.

Promise!

Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.”
–Plato (Athenian Philosopher, 428-348 B.C.E.)

“The way to cheerfulness is to keep our bodies in exercise and our minds at ease.”
–Sir Richard Steele (English Dramatist and Essayist, 1672-1729)

We have previously discussed how a relatively small number of strategies can dramatically reduce your risk of cognitive decline as you get older.

Our recommendations are firmly buttressed by a most important article available for free download at the website of the Journal of the American Medical Association.

We already knew that cognitive training can improve cognitive abilities in older adults but nobody had established the effects of cognitive training on everyday function.

Sherry Willis of Pennsylvania State University led a team of scientists that followed a group of 2,832 adults, aged 65 and older -mean age 73.6 years - who were still living independently between 1998 and 2004. The seniors came from all walks of life, races, and parts of the country, including Birmingham, Alabama; Detroit, Michigan; Boston, Massachusetts and three other major cities. They all had one thing in common when the study commenced: they had no signs of cognitive impairment.

The researchers divided them into four groups of roughly 700 each: three groups that would receive training in either memory (verbal episodic memory), inductive reasoning or speed of processing (visual search and identification) with 4-session booster training at 11 and 35 months after training, and one that would serve as a control.

The memory training program consisted of mnemonic strategies for remembering word lists or texts, such as associating various words, visualizing them or organizing them in specific ways. Reasoning training taught the participants how to spot the pattern in a series, such as “a c e g i… .” The researchers boosted the subjects’ processing speed via practice, practice, practice in identifying an object on a screen after increasingly short exposures.

Over the course of the next five years the researchers asked participants to appraise their skills and to report whether the training had helped with everyday tasks. They also independently evaluated the subjects’ skills in things like finding items in a medicine cabinet. After training, 87 percent of the speed trainees, 74 percent of the reason trainees and 26 percent of memory trainees showed immediate improvement. That advantage over their untrained peers persisted over the next five years.

The training seemed to largely offset the cognitive decline suffered by nearly all of the controls as the years wore on. By the fifth year, significant skill gaps had opened between the people who had done the training and their untrained peers.

It is not enough to continue to do the crossword or sudoku puzzles. The brain must be continually stretched and challenged. It seems that to drive this effect, you have to practice things that you don’t like or things you don’t regularly practice.

Many of us have spent years working on new training strategies, and this research shows just how valuable cognitive training can be for all of us.

Over the last few years I’ve had the privilege of visiting Croatia several times. I was one of the first Western academics to go back there to teach after the war, and I’ve made many good friends. It is a beautiful country with lovely people and it is a terrible shame what happened there.

One of the big problems that remain is the incredible number of people suffering from posttraumatic stress disorder (PTSD). There continues to be some debate about whether PTSD can only occur in response to one major traumatic event in which a person feels that their life is in danger, or whether it can also occur as a result of repeated less serious traumata. We have discussed the relationships between PTSD, resilience and neurological dysfunction, and of the association between PTSD and laterality.

There has also been at least one report of an association between PTSD and atypical facial pain.

A new paper from colleagues in Croatia has clarified this association by showing that people with PTSD are at increased risk of temporomandibular muscle and joint disorder, or TMJD, which used to be known simply as temporomandibular joint (TMJ) dysfunction. This is intuitively obvious, but it is an important finding. The main complaint was of headache, and it is important not to dismiss these headaches as migraine, tension headaches or as some kind of somatization.

There is currently an $8 million project underway to establish valid and reliable TMJD diagnostic criteria. It is to be hoped that the results of the study will advance the field of TMJD research and aid clinicians in their practices. At a meeting of the American Association of Dental Research in Orlando, Florida in March, Richard Ohrbach from the University of Buffalo presented data from the study indicating that 82% of People whose recurrent headaches have been diagnosed as tension-related actually had TMJD.

In April of this year, we had the first meeting of the National Institutes of Health Pain Consortium. There’s a good report in Clinical Psychiatry News about ongoing studies from the University of Washington in Seattle. Niloofar Afari presented data that confirms the findings in the Croatian study. And provides yet more useful information.

The investigators used state records to identify twins and surveyed more than 1,700 female twins by mail and by telephone. The results so far indicate that the association between PTSD and TMJD is real and that there may be a genetic predisposition to the association.

It is important not to miss this possible association. Misdiagnosis can cause a lot of needless suffering.