One very promising approach to understanding many psychological problems is to look at them from an evolutionary perspective: to see if clinical observations can be re-framed around the evolution of the brain.

Our brains are a hodgepodge of bits and pieces that have evolved over millions of years. We still have regions that evolved in reptiles, as well as the stunningly complex neocortex that has been developing over the last few hundred thousand years. Most of the time the different systems and circuits cooperate, but that cooperation falls apart if people are under the influence of alcohol or dugs, or in different types of neurological and psychological problems. Then the older and more “primitive” regions of the brain take over. That is typically what happens when a drunk wants becomes irritable or wants to fight. It is also what can happen in people who have sustained damage or have abnormal development of the frontal lobes of the brain. Alternatively it may happen if something over-stimulates the primitive regions of the brain.

Colleagues in London have been doing experiments with a computer game that could be immensely valuable for people with panic attacks and some types of anxiety disorders.

Working with healthy volunteers, Dean Mobbs and colleagues at the Wellcome Trust Centre for Neuroimaging at University College, London, used a Pac Man-like computer game, in which subjects were chased through a maze by an artificial predator. If caught, they received a mild electric shock.

At the same time, brain scans measuring blood flow showed that when the predator was a long way off, lower parts of the prefrontal cortex area of the brain were active. This region is associated with complex decision-making, such as planning an escape.

But when the predator moved closer, activity shifted to the periaqueductal gray area, which is responsible for rapid response survival mechanisms such as fighting, flighting or freezing.

This shows us that the brain’s response to fear changes as a threat gets nearer: the more impulsive region takes over from the decision-making regions as a threat looms closer. A problem in the balance between the two regions could explain some anxiety disorders. Most sufferers report that they “know” that their fears are illogical, but they react anyway. So the key question is what is it that shifts the balance of activities between the forebrain and midbrain regions of the brain?

This new research is published in the journal Science, and builds on similar findings in animals, including tests on rats that were performed at the University of Colorado in Boulder and published in 2005. In those experiments rats with a non-functioning prefrontal cortex did not cope with stress as well as those with normal brains.

From an evolutionary perspective, maintaining the correct balance between the different regions of the brain that handle fear help animals to avoid or escape predators.

There are some situations where we only have to be wary about potential threats, but other times we need to react without thought. The closer a threat, the more impulsive will be your response. If the threat is large enough and close enough we lose any semblance of free will and just take action.

Just as happens when someone is in the throes of a severe anxiety attack.

One of the main reasons that I created this blog is that I want to empower you: I want to give to give you the information that you need to care for yourself and the people around you.

One of the problems with many new treatments is that they promise the earth, sometimes drag people away from things that may help them and then fail to deliver.

This is something that I struggled with in the field of holistic medicine for thirty years. I constantly hear and see fantastic claims that cannot be right and are often based on a complete misunderstanding of how the body functions. On the other hand there are some highly unorthodox methods and techniques that can be amazingly helpful. My job has been to find out which is which!

But it is not only in the field of unorthodox medicine. I have recently heard about something very questionable in the field of psychotherapy. Somebody has invented a new form of therapy that cuts across and ignores decades of research. He is now offering certifications in his method. So long as you have a very basic healthcare qualification, you pay him a few hundred dollars, do an online training and then you can set up shop as a therapist. Many members of the public do not know how little regulation there is for some of these therapies.

Here are some guidelines for checking out a new therapy or remedy:

1. Efficacy
Be suspicious of any treatment or therapist if they:

• Claim that a treatment works for everyone: I have yet to find ANY treatment that works for everyone
• Only use case histories or testimonials as proof. The plural of anecdote id not evidence. If we see or hear about something that looks promising, it is essential to confirm the reports with systematic, independent controlled research. Be aware that if that has not been done, the person selling you the treatment or the therapist claiming to help is essentially experimenting on you. And if they want to experiment they need your consent and the approval of an Institutional Review Board. And don’t buy into the “my work is so brilliant and cutting edge that nobody will publish it in a journal.” It is hard to publish really new work, but we cannot believe what people are saying until it has been subjected to peer review: other experts go through the work with a fine toothcomb to see if it is right.
• Cite only one study as proof. Hundreds of promising studies have turned out to be dead ends when someone else tried to repeat it. You can be a lot more confident if several studies have shown the same thing.
• Cites a study that did not have a control (comparison) group. That is always a first step in evaluating a new treatment.
• Cite a study that you cannot see yourself. We spend a lot of time checking some of the claims made on infomercials and websites. They often talk about some obscure study in a hard-to-find journal written in a foreign language. We go and find the papers and if necessary translate them. We constantly find that the studies quoted contain results that are 180 degrees away from what they claim.
• Only reference themselves. This recently came to light with a form of therapy that comes with a short book. There was not one scientific citation, but loads of self-references, so it looked as if there was something credible behind it.
• Testing a treatment without a control group is a necessary first step in investigating a new treatment, but subsequent studies with appropriate control groups are needed to clearly establish the effectiveness of the intervention.

2. Safety?
Be wary if:

• A therapist or someone promoting a remedy cannot tell you the exact consequences of not following up with some other treatment. Safety is not only about the safety of a product or a therapy: it is also about the risks of declining a proven treatment
• A therapist tells you stop any other treatment that you are on without discussing the risks of stopping it, and without discussing the situation with any previous therapist. It does not matter whether you were on a medication or having acupuncture. Different treatments interact, and stopping and starting can be risky. If a therapist who does not prescribe medications tells you stop them, be very, very careful. There are precise ways to discontinue most treatments
• A remedy comes without precise directions about how to use it
• Something does not list its contents or ingredients
• A product has no information or warnings about side effects
• If a product or therapeutic approach is described as natural, with the implication that natural means safe. Hurricanes, arsenic and deadly nightshade are all natural!

3. Promotion
Be very cautious if a therapy or treatment:

• Claims to be based on a secret formula or a secret that has been deliberately hidden from you
• Claims that the particular treatment or therapy is being suppressed or unfairly attacked by the medical or therapeutic communities
• Claims to work immediately and permanently for everyone
• Is described as an “Amazing breakthrough” or a “Miracle.”
• Claims to be a cure for something that other experts believe is incurable. They could be right, but then we have to go back to the first point about efficacy
• Is only promoted through infomercials, self-promoting books, online or by mail order

4. Evaluating Media Reports

• When evaluating reports of health care options, consider the following questions:
• What is the source of the information? Good sources of information include medical schools, government agencies (such as the National Institutes of Health and the National Institute of Mental Health), professional medical associations, and national disorder/disease-specific organizations. Information from studies in reputable, peer-reviewed medical journals is more credible than popular media reports.
• Who is the authority? The affiliations and relevant credentials of “experts” should be provided, though initials behind a name do not always mean that the person is an authority. Reputable medical journals now require researchers to reveal possible conflicts of interest, such as when a researcher conducting a study also owns a company marketing the treatment being studied or has any other potential conflict of interest.
• Who funded the research? It may be important to also know who funded a particular research project.
• Is the finding preliminary or confirmed? Unfortunately, a preliminary finding is often reported in the media as a “breakthrough” result. An “interesting preliminary finding” is a more realistic appraisal of what often appears in headlines as an “exciting new breakthrough.” You should track results over time and seek out the original source, such as a professional scientific publication, to get a fuller understanding of the research findings

5. What Are the Financial Implications of This New Therapy or Remedy?

• Is the treatment covered by health insurance?
• What out-of-pocket financial obligation will you or your family have?
• How long will this out-of-pocket financial obligation be?
• Is there any kind of guarantee?
  

Tips for Finding Reliable Information Online
The good news is that the Internet is becoming an excellent source of medical information. The bad news is that with its low cost and global entry, the Web is also home to a great deal of unreliable health information.
In addition to the tips cited earlier, Web surfing really needs some special considerations:
Know the source. The domain name tells you the source of information on the Web site, and the last part of the domain name tells you about the source. For example:
.edu = university/educational
.biz/.com = company/commercial
.org = non-profit organization
.gov = government agency

The same rules do not always apply if you are looking at websites in other countries.
Obtain a “second opinion” regarding information on the Web. Pick a key phrase or name and run it through a search engine to find other discussions of the topic or talk to your health care professional.

Experts who spend time and trouble evaluating reports and then publish their findings online will often answer questions. RichardGPettyMD.blogs.com is one that does, and there are many others.

I have the dubious distinction of living in a part of the United States with one of the highest rates of methamphetamine abuse in the country. Around here most of the first time users are teenage girls who are trying to lose weight.

In the last few years the spread of methamphetamine abuse across the United States has been as rapid as it has been alarming. Until about six years ago, methamphetamine use was seen mostly in the western and rural United States. Then it jumped over the Mississippi and continued its demonic march to the sea and Georgia has been hit like a ton of bricks.

Not only can crystal met ravage the brains of users, they can get a wide range of physical problems including inflammatory and immune problems throughout the body.

Methamphetamine abuse has now expanded rapidly throughout the rest of the country and across different ethnic groups. According to the 2005 National Survey on Drug Use and Health it is estimated that 10.4 million Americans ages 12 or older have used methamphetamine at least once in their lifetimes for non-medical reasons.

There is a new and important study from the Scripps Institute that has shown that long-term methamphetamine use changes circulating proteins in drug users, causing aberrant immune responses. As a result, increased levels of pro-inflammatory cytokines - proteins that are involved in immune responses - may initiate a previously unrecognized molecular mechanism for the development of cardiovascular disorders including vasculitis, an inflammation of the blood vessels.

It appears that methamphetamine can add sugars (a.k.a. “glycate”) proteins. The researchers found that the immune system responds dramatically to this methamphetamine-induced glycation, which may lead to vascular inflammation. There was a direct relationship between methamphetamine intake and the level of circulating antibodies in animal models. This immune response, coupled with antibodies binding to methamphetamine, might make the drug less biologically available leading to an increased need for higher and higher doses, a problem found among chronic methamphetamine users.

The resulting glycated proteins are called advanced glycation end products (AGEs) that modify the function of proteins and are associated with a number of diseases including diabetes and Alzheimer’s disease.

Methamphetamine-AGE proteins not only increased antibody production, but also were strong enough to overcome the drug’s natural immunosuppressive qualities. Furthermore, a wide range of cytokines directly linked to AGE exposure were increased in rats that self-administered methamphetamine.

The study also showed that even limited daily access to the drug was enough to produce an over-expression of vascular endothelial growth factor which is a potent signaling cytokine involved in angiogenesis and vasodilatation.

If you know anyone tempted to dice with this vile toxin, ask them to have a look here.

I grew up in a culture where the aftermath of the Great Depression and the Second World War meant that every child was expected to eat everything on their plates. That created a bit of a problem when I first moved to the United States: my conditioning led me to try and eat every morsel of those huge American portions. Fortunately I quickly noticed the impact on my waistline.

I love simple but practical and important experiments. I have just read about some very nice research from the University of Calgary in Alberta, Canada that fits the bill. It appears that simply using plates and cereal bowls with markers for proper portion sizes can help obese patients with diabetes lose weight. As a result, some can even decrease their use of glucose-controlling medications, according to a report in the Archives of Internal Medicine.

Between 1960 and 2000, the proportion of U.S. adults who were obese increased from 13.4% to 30.9%. There is clearly an association between type 2 diabetes and obesity although it is not quite as simple as saying that obesity causes diabetes, at least not until the obesity becomes extreme. But we have known for half a century that calorie restriction may improve blood sugar control in diabetics, partially by contributing to weight loss.

The enormous increase in obesity has closely paralleled the explosion of portion sizes of both food and soft drinks.

The researchers conducted a six-month controlled trial of commercially available portion control plates and bowls in 2004. The plates were divided into sections for carbohydrates, proteins, cheese and sauce, with the rest left open for vegetables. The sections approximately totaled an 800-calorie meal for men and a 650-calorie meal for women. The cereal bowl was designed to allow a 200-calorie meal of cereal and milk. The subjects consisted of 130 obese patients with diabetes with an average age 56, half of whom were randomly assigned to use the plate for their largest meal and the bowl when they ate cereal for breakfast. The other half of the participants received usual care, which consisted of dietary assessment and teaching by dieticians.

At the end of the six-months, 122 patients remained in the study. Individuals using the portion-control dishes lost an average of 1.8 percent of their body weight, while those receiving usual care lost an average of 0.1 percent. A significantly larger proportion of those using the dishes - 16.9 percent vs. 4.6 percent - lost at least 5 percent of their body weight.

In addition, at the end of the six months, 26.2% needed a decrease in their diabetes medications compared with 10.8% in the control group.

These results are important: a 5% weight loss has been shown to be clinically significant in terms of decreasing morbidity and mortality associated with obesity-linked disorders.

Simple, straightforward and very practical.

Try it!

One of the worries about getting older is that aging can adversely affect our balance and increases the chance that we can slip and fall. This is even more of a problem in people with loss of sensation in the soles of the feet due to diabetic peripheral neuropathy and other diseases. T’ai Chi Ch’uan has previously been shown to improve balance in healthy elderly adults.

A new study from the Biomedical Engineering Program, Milwaukee School of Engineering, Milwaukee, Wisconsin was just published in the journal Diabetes Technology and Therapeutics.

The aim of the study was to see if T’ai Chi improved both balance and sensory perception in the soles of the feet in healthy elderly adults and elderly adults with diabetes and sensory loss in the feet. Eighteen elderly people with a mean age of 73.1 years were tested for sensation and balance before t’ai chi training and again after 6 months of weekly sessions. Participants were grouped by their initial scores on tests of sensory perception, in order to calculate the effects of t’ai chi on sensory perception.

Plantar (soles of feet) sensation results showed that all the participants showed significant improvement in sensory ability with the 6 months of t’ai chi training. All groups also had a general improvement in all balance measures, with the greatest improvement seen in those subjects with large sensory losses. Hemoglobin A1c measurements – a standard way of estimating control of blood glucose - also decreased as a result of the intervention.

The study was small, but the effectiveness of t’ai chi training as a method of improving plantar sensation and balance in elderly adults with sensory loss, with and without diabetes, was impressive.

Another one of those things that is supposed to be impossible!