The movement to treat the whole person is a lot more developed in Europe than tit is in the United States. So it is always gratifying to see research on integrated medicine on this side of the pond. Even if there are critics who call anything holistic “woo woo,” the fact is that patients like the approach, and there is a developing research base.

A new study from the Mayo Clinic indicates that massage therapy decreases pain levels for patients after heart surgery. During a five-month period in 2005, 58 patients undergoing surgery participated in a pilot study to examine the effect of massage on pain after surgery. Of the 30 who received massage, the mean pain scores were less than 1 on a scale of 1 to 10, with 10 as the most painful.

Before the massage therapy, these patients rated their pain at an average of 3 on a 10-point scale. In the control group of 28, pain levels remained the same over the same period, according to findings published in the current issue of Complementary Therapies in Clinical Practice.

As a result of the pilot study, Mayo now has a full-time massage therapist available for patients after heart surgery, and a larger, randomized study is under way.

The reason for the study was that patients often report that tension, stress, pain and anxiety get in the way of their recovery after cardiac surgery. Therefore apart from massage, the researchers are also exploring the use of stress management, music therapy and guided imagery as adjuncts to the best of modern medicine.

This makes good sense, and I shall keep you posted as more information is published.

Dyslexia can be a real difficulty for many children, although for many it has been a gift: they have succeeded very well in life by mobilizing other psychological and neurological resources. Sir Richard Branson, the founder of Virgin Enterprises, Thomas Edison and Albert Einstein are all said to have had dyslexia.

There are many types of dyslexia, but in the most common - developmental dyslexia – children confuse letters and syllables when they read.

It now appears that some children with dyslexia struggle to read because their brains are not correctly wired to process fast-changing sounds, according to a study published this month in the journal Restorative Neurology and Neuroscience.

However sound training using computer exercises was able to rewire children’s brains, correcting the sound processing problem and improving reading.

More than 30 years ago Paula Tallal of Rutgers University proposed that children with dyslexia might have an underlying problem processing sound, but it has never been tested using brain imaging. The researchers used functional MRI imaging (fMRI) to examine how the brains of twenty two 9- to 12-year old children with developmental dyslexia, and normal readers, responded to sounds, both before and after using educational software called Fast ForWord Language.

The first test involved measuring how the children’s brains responded to either fast-changing or slow-changing sounds that resembled speech. The fast-changing sounds altered in pitch or other acoustic qualities quickly. In just tens of milliseconds, as occurs in normal speech. The slow-changing sounds changed over only hundreds of milliseconds.

In normal readers, 11 brain areas became more active when the children listened to fast changing, compared to slow changing, sounds. In dyslexic children, the fast-changing sounds did not stimulate high levels of activity in these regions of the brain. Instead, dyslexic children processed the fast-changing sounds as if they were slow changing. They used the same regions of the brain but at lower intensity.

We know that infants must correctly process fast-changing sounds as they learn language. They use sound processing to create a sound map of their native language. If they are unable to analyze fast-changing sounds, their sound map may become confused. The idea is that they run into trouble when they first see printed letters because the children’s brains now try to match their internal sound map to letters that they see on the page. Linking normal letters to confused sounds may lead to syllable-confused reading.

But the brains of the children with dyslexia changed after completing exercises in a computer program known as

The Fast ForWord Language program does not involve reading at all, but only listening to sounds, starting with simple, changing noises, like chirps that swooped up in pitch. The children then have to respond with a clicker when the chirp’s pitch goes up or down. At first the sounds are played slowly, but they gradually speed up, becoming more challenging for dyslexic children. The exercises are then repeated with increasingly complex sounds: syllables, words, and finally, sentences.

The fMRI study showed that these repetitive exercises appeared to rewire the dyslexic children’s brains: after eight weeks of daily sessions - about 60 hours in total - their brains responded more like the brains of typical readers when they were processing fast-changing sounds, and at the same time their reading improved.

It is still early days for this research, and we do not yet know whether the improvements in reading and in the brain will be sustained.

This research may make it possible to identify children at risk of dyslexia even before they start learning to read. It is also possible that other approaches to learning sounds, such as learning to sing or play an instrument may be effective, since most of us learn music with gradual, repetitive, and intense listening and move up to faster changing sounds.

Many of us run into problems when we try to make decisions. In a special section in the October 26 issue of the journal Science, Martin Paulus who is a professor in the Department of Psychiatry at the University of California in San Diego, has marshaled a growing body of evidence that human decision-making is inextricably linked to an individuals’ need to maintain a homeostatic balance.

He goes on to suggest that psychiatrists may need to approach the treatment of psychiatric patients from a new direction: by understanding that such individuals’ behavior and decision-making are based on an attempt to reach an inner equilibrium, in the same way that we try to being our temperature or blood pressure back to a set point. And if the thermostat is broken we may see mental illness and substance abuse.

This makes good sense: in the past decision-making process as a considered series of options and values, but that is not what we see in the clinic. People with addictions and some mental illnesses keep making bad choices, despite being intelligent and insightful.

Recent neuroimaging research shows strong support for the homeostatic nature of decision-making:
The insula is involved in processing interoceptive information: the body’s internal state or sense of balance
Damage to the insula stops addiction to cigarettes
Some of the same brain structures implicated in the urge to take drugs are involved in other biological urges

The question addressed in part by this paper are whether changes in decision-making behavior and associated brain functions are a result of pre-existing characteristics - which may predispose individuals to use drugs - or occur as a consequence of long-term use.

This is certainly an interesting idea, and we shall have to see how it fits as we collect further data.

“The quality of a decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.”
–Sun Tzu (Chinese Military Strategist and Author of the “Art of War”, c.400-c.430 B.C.E.)

“The risk of a wrong decision is preferable to the terror of indecision.”
–Maimonides (a.k.a. Rabbi Moses ben Maimon, Spanish-born Jewish Philosopher and Physician, 1135-1204)

“All you have to decide is what to do with the time that is given you.”
–J.R.R. Tolkien (South African-born English Writer, Linguist, Oxford Don and a Member of C.S. Lewis’ Literary Group, “The Inklings,” 1892-1973)

“Decisions are doorway to change and change starts from a moment of decision. One decision can change your life forever!”
–Tony Robbins (American Motivational Speaker and Writer, 1960-)

“Nothing is more difficult, and therefore more precious, than to be able to decide.”
–Napoleon Bonaparte (Corsican-born French Military Strategist, General and, from 1804-1814, Emperor of the French, 1769-1821)

Having grown up at a time and in a culture where it was expected that everyone would finish every morsel of food on his plate, it was quite a shock to come to the United States and to be confronted by mountains of food. During my first few months I dutifully consumed everything on my plate and soon noticed the effect on my waistline. But it brought home to me the power of social and cultural factors in eating.

Though each of us is responsible for how much we eat, research suggests that cultural and social norms can make it hard for us to choose appropriate portion sizes. The November 2007 issue of Harvard Women’s Health Watch has published an interesting article about the way in which misperceptions about portions can affect calorie intake.

A first point is that many of us tend to treat portions as equivalent to nutritional servings. A serving is a specific quantity of food designated on the basis of nutritional need. However, a portion–the amount you actually get on your plate, in the package, or at the counter–is often much larger. Many of us do not always read the Nutrition Facts label, and may find ourselves eating two or three servings’ worth. Studies suggest that we might be satisfied with smaller portions if larger ones were not so easily available. Other research has shown that the more plentiful the food, the more we eat. I know form my own experience that both of those are true.

The Harvard Women’s Health Watch offers some advice for “keeping portions in proportion:”

• Train your eye: Measure out servings - not portions - of the food you commonly eat so you know what a single serving looks like
• Change your tableware: Use a smaller bowl or a mug for cereal and a smaller plate at dinner
• Control portions at home: To discourage second helpings, serve food in the kitchen and take it to the table on plates
• Eat at regular intervals throughout the day: Do not wait until you are hungry, since you are then more likely to overindulge at the next meal
• Control portions while eating out: Avoid buffets and salad bars. Instead of a dinner, order a low-fat appetizer and a large salad with dressing on the side

These are all simple and straightforward pieces of advice that will be familiar to anyone working in the weight and metabolism field.

On another occasion I shall give you a few more of my own tips, including “Perimeter shopping”

If you believe everything that your read in the media or hear on those infomercials, you would think that you should spend all day munching pounds of fruits and vegetables while taking megadoses supplements chasers.

While that may sound good in theory, in practice things are not so simple and this approach may actually do you harm.

A good example has just come to light in a report from the Institute of Food Research in the United Kingdom that has just been published in the British Journal of Nutrition.

We have talked before about the potential value of fortifying food with folic acid. Apart from reducing the risk of neural tube defects in babies, it may also reduce the risk of depression.

The new report suggests that fortifying flour with folic acid may lead to a range of health problems.

Folic acid is a synthetic form of folate, a B vitamin found in a wide variety of foods including liver and leafy green vegetables. Folates are metabolized in the intestine, whereas folic acid is metabolized in the liver. The liver is an easily saturated system, and at doses of half the amount being proposed for fortification that could lead to significant unmetabolized folic acid entering the blood stream.

This excess folic acid could cause a number of problems:
It may interfere with some treatments for leukemia and arthritis
Women being treated for ectopic pregnancies
Men with a family history of colon cancer
People with blocked arteries being treated with a stent
In women undergoing in-vitro fertilization, it may increase the likelihood of conceiving multiple embryos
Unmetabolized folic acid accelerates cognitive decline in the elderly with low levels of vitamin B12 (If they have normal levels of B12, folic acid may slow brain aging)
While dietary folates have a protective effect against some cancers, folic acid supplementation may increase the incidence of colon cancer
Folic acid may increase the incidence of breast cancer in postmenopausal women, though other studies have shown the opposite

The trouble is that it could take 10-20 years for any potential harmful effects of unmetabolized folic acid to become apparent.

The latest study follows a letter to the Food Standards Agency from Sir Liam Donaldson, the Chief Medical Officer of England, requesting further expert consideration of two recent studies linking folic acid to bowel cancer before the government gives the final go-ahead for mandatory fortification of food with folic acid. However the Food Standards Agency has stuck to its position that fortification is safe. Mandatory fortification has already been introduced in the US, where it has been required since 1998, Canada and Chile, where it has cut neural tube defect rates by up to half.

Professor Nicholas Wald, director of the Wolfson Institute of Preventive Medicine, said:

“Fortification would prevent many cases of spina bifida and would also benefit the health of the country as a whole. Further delay in this public health measure will result in hundreds more babies being disabled by this serious disorder, or pregnancies being needlessly terminated due to a neural tube defect.”

When it comes to analyzing risks and benefits, one of the most important things is to realize that more is not necessarily better, and that folate and folic acid are not the same thing at all.

Second is the point that we discussed before: some people have the right genes to be able to metabolize folic acid with impunity, while others may get a range of problems from taking it.