Author Archives: Karen Weintraub

Eat Fat But Stay Thin: Mice Can Do It, Maybe Someday We Can Too

Generic lab mice

Generic lab mice

The journal Nature reports that some lab mice have lived out my food fantasy: Even though they ate a heavy, high-fat diet — my particular dream is unlimited Ben & Jerry’s — they did not become obese, because researchers found a novel way to tweak their metabolism.

Sigh. The caveats first: What works in mice might not in humans. It might not be safe. Clinical trials are not on the immediate horizon. This is no reason to stop eating healthy food and exercising.

But we can dream, right? And we can savor the explanations from Dr. Barbara Kahn of Beth Israel Deaconess Medical Center and Harvard Medical School, senior author on the Nature paper. She sums up: “We found an enzyme in fat that appears to be elevated in people with obesity and diabetes. And if we inhibit it in mice, we can increase the amount of energy that the animal burns, and thereby decrease the amount of calories that are stored as fat.”

It’s something like the extra energy you burn when you exercise, she said — except without the exercise.

Dr. Kahn’s team found a gene that, when suppressed, makes metabolism less efficient — which is actually a good thing if you’re trying to avoid obesity.

“Generally, in our lives, we think it’s good to be efficient — and it certainly is good to be efficient in time management,” she said. “But if your metabolism is efficient, it means you need fewer calories to generate the energy that cells need for their basic metabolism, and therefore, if you eat too many calories, you will put on weight. But if the cells are inefficient, they’ll burn up those extra calories and you won’t put on weight.”

So do these findings — centering on an enzyme known as nicotinamide N-methyltransferase or NNMT — indeed hold the promise of some sort of drug to prevent or treat obesity?

“The approach we used in the mice was mainly prevention,” Dr. Kahn said, “but the same idea should work for treatment of obesity. I have to caution, of course: one has to look into all the safety aspects if one considers such a treatment in humans. But all the cellular machinery is there, so it should work.” Continue reading

The OCD In Us All: Study Finds Almost Everyone Has Intrusive Thoughts

Some people with OCD wash their hands compulsively. (Wikimedia Commons)

Some people with OCD wash their hands compulsively. (Wikimedia Commons)

Confession: Every time I flush the toilet, I have to be out of the bathroom before the last of the water goes down the pipe. If I’m not — well, I don’t know. Something bad will happen. And when I’m choosing a spoon for breakfast — only breakfast, not later meals — sometimes I’m seized by the feeling that I’ve chosen the wrong spoon. If I use it, I doom the day. I put it back into the silverware tray and choose another.

I knew that I was far from alone — that Obsessive-Compulsive Disorder-type thoughts and behaviors are extremely widespread. But not this widespread. A study just out in the Journal of Obsessive-Compulsive and Related Disorders suggests to me that if you don’t have any of these thoughts and behaviors, you’re the weird one.

The study looked at 777 university students in 13 countries, including Canada, Israel, Iran and the United States. From the press release:

International study finds that 94 percent of people experience unwanted, intrusive thoughts

Montreal, April 8, 2014 — People who check whether their hands are clean or imagine their house might be on fire are not alone. New research from Concordia University and 15 other universities worldwide shows that 94 per cent of people experience unwanted, intrusive thoughts, images and/or impulses. Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

On Perception (And Pancakes): How The Brain Keeps Vision Stable

By Alexandra Morris
CommonHealth Intern

You probably didn’t think Julia Roberts could teach you much about subtle, yet critical, brain functions.

But, it turns out, she can. Recall Roberts in her iconic film “Pretty Woman.” In one scene, she is eating a croissant. But as the camera pans back to her, the croissant turned into a pancake.

It’s likely that many of us missed that blooper, and now we know why. Scientists have discovered a brain mechanism that smooths our field of vision so that we don’t notice certain subtle visual changes — such as a croissant becoming a pancake in an otherwise identical scene.

In a paper published last month in Nature Neuroscience, researchers from the University of California, Berkeley have identified a brain mechanism that helps to stabilize our field of vision. They call it, a “continuity field” — a process the brain uses to merge similar objects seen within a 15-second timeframe.

“It seems like a very odd thing the brain is doing that could make us less accurate,” said the study’s lead author, Jason Fischer, who is now a postdoctoral fellow in the Department of Brain and Cognitive Sciences at MIT. “But in fact there is this huge benefit to it — and that is stabilizing perception over time.”

To measure this process, researchers showed study participants an image with alternating light and dark bars, or “gratings,” at a random angle every five seconds. The participants were then asked to move a white bar to match the tilt of the grating that had been shown.

Here’s the video:

Researchers found that while the white bars generally aligned with the image, there were subtle differences that were biased toward the previous three or so images. These differences could be attributed to the continuity field.

Imagine, now, for example, you are driving down a highway in the pouring rain and you’re trying to read a road sign. The windshield wipers are moving; the raindrops are hitting your windshield. As you’re looking at the sign, you’re experiencing constant interruptions in your visual stream. In that case, the changes that the continuity field is causing us to miss are the raindrops and windshield wipers — you may even fail to notice them after a while. The continuity field, for the most part, is beneficial — it blocks the stuff we don’t want to see. Continue reading

Project Louise: Music Makes The Heart Beat Faster

You may be relieved to know that working out to music does not require wearing any of these 1980s styles. (ShinyFan via Wikimedia Commons)

You may be relieved to know that working out to music does not require wearing any of these 1980s styles. (ShinyFan via Wikimedia Commons)

By Louise Kennedy
Guest contributor

So it turns out this kid thing really works. I did not do great workouts on all three days that I promised to exercise, but I did get myself moving. Even better, having made this promise caused me to think about taking care of myself for my kids’ sake every single day. Being here for my children turns out to be a really great motivator.

And – who knew? – my kids are helping with Project Louise in other ways, too. The 5-year-old got me running around outside on Sunday; it didn’t even feel like a workout, but it was. (That’s my new goal: workouts that feel more like “playouts.”) And the 16-year-old has given me another boost: music to listen to while I walk or bike.

Carey Goldberg, who co-hosts CommonHealth, has been telling me for a while that I need to add music to my workouts; she was even kind enough to lend me some of her favorite CDs. She also shared some great information about why music helps, and I’ve also tracked down a bit on my own. So here’s the scoop.

First, Carey pointed me to a post on The New York Times’ Well blog in which Gretchen Reynolds summarizes a lot of the research into the connections between music and movement. The link is “fascinating and not fully understood,” Reynolds says, but “no one doubts that people respond to music during exercise.” The question is why.

A recent Scientific American article provides a few answers: “Music distracts people from pain and fatigue, elevates mood, increases endurance, reduces perceived effort and may even promote metabolic efficiency.” Continue reading

In Defense Of 12 Steps: What Science Really Tells Us About Addiction

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

Last week, Radio Boston featured an interview with Dr. Lance Dodes, author of “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” Here, two Harvard Medical School professors of psychiatry respond, arguing that Dr. Dodes misrepresents the evidence and that 12-step programs have among the strongest scientific underpinnings of any addiction treatment.

By John F. Kelly and Gene Beresin
Guest Contributors

In a recent WBUR interview, Dr. Lance Dodes discussed his new book, which attempts to “debunk” the science related to the effectiveness of 12-step mutual-help programs, such as Alcoholics Anonymous, as well as 12-step professional treatment. He claims that these approaches are almost completely ineffective and even harmful in treating substance use disorders.

What he claims has very serious implications because hundreds of Americans are dying every day as a result of addiction. If the science really does demonstrate that the millions of people who attend AA and similar 12-step organizations each week are really deluding themselves as to any benefit they may be getting, then this surely should be stated loud and clear.

In fact, however, rather than support Dr. Dodes’ position, the science actually supports the exact opposite: AA and 12-step treatments are some of the most effective and cost-effective treatment approaches for addiction.

In his book, Dr. Dodes commits the same misguided offenses he condemns. His critique of the science behind treatment of addiction is deeply flawed, and ironically, his own psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness, particularly in comparison to other methods of treatment.

Below, we address some of the specific pronouncements he made on Radio Boston and in his book in order to convey what well-conducted science actually tells us about how to treat addiction.

What he says: 12-Step programs do not work, are not backed by science, and are probably harmful.

The evidence is overwhelming that AA, and treatments that facilitate patients’ engagement with groups like AA, are among the most effective and best studied treatments for helping change addictive behavior. Continue reading

What Your Shrink Thinks? Pilot Study Opens Psych Records To Patients

(Life Mental Health/Flickr via Compfight)

(Life Mental Health/Flickr via Compfight)

Here’s how far we’ve come beyond the old stereotype of the inscrutable psychiatrist who refuses to do anything more than nod and hum. If you’re a patient in a pilot program just now getting under way at Boston’s Beth Israel Deaconess Medical Center, you’ll soon have a whole new window into your psychiatrist’s thoughts: the mental health notes in your own medical record.

Patient access to personal medical records is a growing trend, but the pilot takes it a pioneering next step, into mental health records that are often kept closed to patients. The program’s rationale — the expectation that the tactic will lead to better care — is laid out in “Let’s Show Patients Their Mental Health Records,” an article in this week’s Journal of the American Medical Association.

I spoke with its first author, Dr. Michael Kahn, a psychiatrist at Beth Israel Deaconess. Our conversation, lightly edited:

CG: Here’s my colleague’s response to the idea of patients reading their psychiatrists’ notes: ‘Omigod, that’s terrifying! Do you really want to know what they think of you, especially if you already have issues?’ How would you respond?

MK: My main response would be that ‘what they think of you’ might actually be a great relief. Many patients are quite frightened that the doctor ‘will think I’m crazy,’ and the meaning of that varies from patient to patient. Mostly, those patients are not out of touch with reality; they’re just overwhelmed, and they’re often very reluctant to ask their doctor about it because they’re afraid their doctor will say, ‘Yes, you are crazy.’

So when they read in the note that “The patient is struggling with anxiety or depression, and should get better with this treatment,” that’s often a great relief to them, because they often see they’re not as impaired or deficient or defective as they feared.

I imagine the response from many psychiatrists would also be, ‘Omigod, that’s terrifying.’ You write in JAMA that this ‘feels like entering a minefield, triggering clinicians’ worst fears about sharing notes with patients.’ And you mention specific fears — how will a patient with a personality disorder react upon learning of that diagnosis? What if patients are outraged by the terms used? How do you respond to doctors’ fears?

The first thing is to recognize that it’s a totally natural, understandable and honest fear. I think we all learn in our professional development to use these terms — you might call them jargon — that are often but not always accurate, and often but not always have more pejorative connotations.

I think clinicians know this and are concerned that if patients read, for example, that they have Borderline Personality Disorder, then they will feel insulted, shocked, demeaned. I think this is a totally understandable and reasonable anxiety on the clinician’s part, but I think for many patients — and I’ve seen this many times — if it’s introduced to them in a tactful way, they can get the message that “The reason your life is in such turmoil is not because you’re a bad person but because you have this thing we call Borderline Personality Disorder that has these features.” And patients often say, ‘Oh my God, that’s me!’ and that’s actually a relief; they feel less alone and stigmatized.

So overall, the expectation is that patients being able to see these notes would far more often be helpful than harmful? Continue reading

Life Lessons From An Ultra Rare, Potentially Fatal Disease

Sue Levy and her family on vacation in Buenos Aires fall 2013. (Courtesy)

Sue Levy and her family on vacation in Buenos Aires fall 2013. (Courtesy)

By Dr. Annie Brewster
Guest contributor

What if you were suddenly diagnosed with a potentially fatal disease just when your life, work and marriage were on track and your plans to start a family were underway?

That’s what happened to Sue R. Levy.

In 2008, at age 37, she was diagnosed with Pulmonary Lymphangioleiomyomatosis, otherwise known as LAM, a rare, chronic, progressive lung disease in which the lungs fill up with cysts. The result is gradual destruction of the normal lung architecture, compromised breathing and, in many cases, an eventual lung transplant — a procedure with major risks. The LAM Foundation reports 10-year survival, following a lung transplant, at 47 percent.

Fueled by estrogen, LAM primarily affects women in their childbearing years. With only 1,300 documented cases in North America, LAM is poorly understood; currently, there are a few experimental medications in use, but no proven treatments exist.

Prior to the diagnosis, Sue, who lives in Brookline, Mass., had a successful career as a marketing executive, she was happily married, and she and her husband had decided to have kids. Though they struggled with infertility, undergoing six unsuccessful rounds of IVF, Sue still felt that this would work out eventually.

“My whole life I thought the way the world worked is that if you were a good person and you worked hard you could avoid bad things,” she said. LAM changed everything.

Suddenly, Sue was forced to redefine herself as someone with a chronic disease and squarely face her own mortality. In addition, she had to let go of some of her dreams, notably, her desire to get pregnant, as the high levels of estrogen associated with carrying a child would accelerate her lung destruction.

Initially, she was angry. But the disease helped her focus on what she really cares about: she went to school to study nutrition and became a natural foods chef. In 2011, inspired by her own healthier lifestyle changes, she quit her marketing job and started Savory Living-Healthy Eating, a nutrition and health company that provides online healthy eating and cooking classes.

In addition, Sue and her husband now have two young daughters, conceived using egg donors and a gestational carrier.

Listen to Sue’s story here:

Interview highlights:

From ‘Healthy’ To ‘Terrifying’

If you had asked me before my LAM diagnosis I would have told you that I was a healthy person, that I am living a healthy life. There isn’t a disease in my family. This is something I don’t have to worry about and I’m doing great. What was so interesting is that the signs couldn’t have been clearer that I wasn’t. I was heavier, the energy wasn’t great. I had a lot of digestive problems and I faced infertility. But I just thought that was the way life was. I had had a lot of pain and it felt almost like this boa constrictor was around my midsection squeezing my rib cage.

So I went to the doctor and he said ‘You know I’m worried that maybe you have a blood clot in your lung, I want to go get a CT scan.’ And they did the scan and on our way back to our house I got a call from the doctor and he said ‘You need to come in right away,’ and I said ‘Oh, is it a blood clot in my lung?’ And he said no. And I said ‘Oh great!’ And he said ‘No, you need to come in right away.’

We got into the office and he actually said to me because he knew we were trying to conceive, and he said, ‘Life as you know it is about to change considerably. Continue reading

Women’s Anal Sex More Common And Still Taboo, Says Researcher

Sexual health researcher Debby Herbenick often says what the rest of us are merely just silently, sheepishly thinking.

A few years back, Herbenick, a researcher at Indiana University, co-director of the Center for Sexual Health Promotion, and a sexual health educator at the Kinsey Institute, raised the issue of pain during sex based on her landmark study of sex in the U.S. And here she is again, discussing the pros, cons and surprising new data on women and anal sex in America.

It’s worth reading her full report at Salon, titled Anal Sex: Science’s Last Taboo, but here’s a snippet:

That anal sex remains taboo may explain why a study about anodyspareunia – that is, pain during anal penetration – received little attention when it was published in the Journal of Sex & Marital Therapy. The study should have turned heads: It was the first research on anodyspareunia among women; it was conducted by a well-respected scientist (Dr. Aleksander Stulhofer from the University of Zagreb); and it was centered on young women and sex. That’s often the kind of research that attracts media attention (Young women sext! They get pregnant! They give oral sex! You get the picture …). However, anal sex remains such a strong taboo that this otherwise important study barely turned a head.

younglove

Except it did turn mine. Here’s why. In an incredibly short period of time, anal sex has become a common part of Americans’ sex lives. As of the 1990s, only about one-quarter to one-third of young women and men in the U.S. had tried anal sex at least once. Less than 20 years later, my research team’s 2009 National Survey of Sexual Health and Behavior found that as many as 40-45 percent of women and men in some age groups had tried anal sex. With its rising prevalence, I felt it was important to devote a chapter of my first book, “Because It Feels Good,” to anal health and pleasure — only to find that a magazine editor wouldn’t review it because the topic of anal sex was “not in the best interest of our readership.” Even though nearly half of American women in some age groups have done it! She added, “In the correct circles, I personally will be suggesting the book to those with whom I can share such a resource.”

Hmm. The correct circles. Which ones would those be? The ones where scores and scores of women openly sit around talking about anal sex between glasses of wine? Continue reading

Mental Health Parity: If Not Now, When?

According to ABC News, the latest alleged Ft. Hood shooter was struggling with a number of mental health problems, “ranging from depression to anxiety to sleep disturbance,” and in the midst of being evaluated for post-traumatic stress disorder.

If true, it’s a familiar story of a stressed-out soldier with mental health issues and easy access to guns: we’ve been here before.

Of course, we don’t know exactly what kind of care or treatment this shooter was receiving — and the VA system is generally better than others. Still, it’s worth reviewing the history of legislation to put mental health services on equal footing with all other medical care.

(ndanger/flickr)

(ndanger/flickr)

The latest policy brief published in the journal Health Affairs, documents the convoluted history of mental health parity, the idea that mental health care and treatment be comparable with all other types of “physical” medical care (and why make the distinction, anyway)?

Parity efforts began in earnest in the late 1990s, but still aren’t fully implemented today, despite widespread support, including from notable advocates like former Congressman Patrick Kennedy.

The paper examines some of the obstacles remaining to true mental health parity, including these:

…”Critics have argued that parity legislation alone is not enough to fix other underlying problems in how our health system provides access to treatment of mental health and substance use disorders.

The supply and availability of mental health providers has been the subject of numerous research articles. A 2009 Health Affairs article by Peter Cunningham found that two-thirds of primary care physicians reported that they were unable to get outpatient mental health services for their patients–more than twice the percentage who reported trouble finding specialist referrals, nonemergency hospital admissions, or imaging services. Mental health professionals tend to be concentrated in high-population, high-income areas, and the lack of mental health care providers in rural areas as well as in pediatrics has been well documented. Finally, there is still a stigma associated with receiving mental health or substance use treatment. Eliminating the stigma and increasing the availability of high-quality providers are two keys to increasing access to care.

…Much of the debate in implementing parity is around determining equivalence of services between mental health/substance use benefits and medical/surgical benefits. Some of the treatments for mental health and substance use disorders do not have an equivalent medical/surgical treatment, Continue reading