Incontinence after prostatectomy is one of the most feared complications.  The good news is that for nearly all men, it goes away.  For the very small percentage in whom it doesn’t, there is help.  This story is a very strong case in point.

In my work for the Prostate Cancer Foundation’s website,  I was lucky enough to interview JP Mac, who has had a particularly difficult struggle with incontinence after prostatectomy.  JP (real name: John P. McCann) is a novelist and an Emmy award-winning animation writer who worked for Warner Bros. and Disney.

He is also very funny.  So, when he wrote a short ebook (coming soon in paperback form) about his experience with prostate cancer – including his diagnosis in 2014 at age 61, the rush to find the right treatment and get it done before his health insurance was going to expire, his laparoscopic-robotic prostatectomy and the complications afterward, and his five-month battle to recover urinary continence after the surgery – he could legitimately have written a soap opera, or maybe even a tear-jerker; but he didn’t.

Instead, his ebook has a title that sounds like 1950s pulp fiction: They Took My Prostate: Cancer, Loss, Hope.  It’s not “Prostate Cancer Lite,” and it doesn’t minimize what he or anyone else has gone through to get back to normal after radical prostatectomy.  Far from it; in fact, his “short, hopeful essay” is a testament to what it takes to recover from this difficult but life-saving surgery: a balanced perspective, a good sense of humor, a great support system, and plain old hard work and persistence.

Here’s a message you hardly ever hear about prostate cancer, or any illness, for that matter:  It’s okay to laugh!   That doesn’t mean it’s not scary, and that it doesn’t wear you down, or that you’re not afraid you won’t ever get back to normal.

But if it’s laugh vs. cry, Mac would rather laugh.  Although no cancer is great, he says, prostate cancer is “especially seedy,” and in his case, it involved  “bloody urine, black feces, incontinence, impotence, vomiting, and various other bodily malfunctions that shouldn’t be discussed before supper.”  But he does discuss them, with the hope of helping other men and their families.  Mac knows that talking about what’s happening gives the cancer less power over your life, and helps you focus on the light at the end of the tunnel – getting your life back after the cancer is cured.

Mac is speaking out about one area, in particular, that doesn’t get talked about much: urinary incontinence.  For many men who suffer from it, in fact, there might as well be a Cone of Silence over this subject, and that’s a shame, because there is always help for urinary incontinence after radical prostatectomy.

When Mac was diagnosed with prostate cancer, his surgeon told him to buy our book, Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer.  Mac did, and he referred to it a lot – especially our review of the male plumbing, which explains why at least some temporary incontinence is just about inevitable for men after radical prostatectomy.

Note: Long-term urinary incontinence is very rare after radical prostatectomy.  Results differ depending on the surgeon; also, some men have quirky anatomy — very subtle anatomical variations (not like a leg where an arm should be, or anything like that, but even tiny differences can be important in surgery, and good surgeons know this and look for such variations).  This is why, if you are considering radical prostatectomy, it is essential to find out how many of that surgeon’s patients have long-term complications.  If your surgeon doesn’t know, consider this a red flag.

The best surgeons keep track of their patients after radical prostatectomy. “In young (men in their forties, fifties, and early sixties), healthy men operated on by an experienced surgeon,” Walsh says, “about 80 percent should be wearing no pads – or at most, a security pad to catch the occasional drop – by three months after surgery, and at 12 months, 95 to 98 percent should be continent.”  Walsh considers a man continent “if he wears no pad or if he wears a pad that is dry.  “Many men continue to wear a small pad just to be safe,” he explains.  Your surgeon may have a different definition of continence, and you should find this out before surgery.  “Most men, even at three months, are not very wet.  It’s hard to believe, but urinary control does continue to improve over two years, and occasionally, even longer than that.”

But don’t lose hope, he adds:  “For many men, the recovery of urinary control is a slow process. The most important thing you can do is not get discouraged.  If your doctor told you there is only a 2 percent chance that you will have a long-term, serious problem with urinary control, believe it.  This means there’s a 98-percent chance that you’ll be back to normal someday, even if nobody can say exactly when.”

From Three Sphincters to One

Why is urinary control an issue after surgical removal of the prostate?  Normally, Walsh says, men have not one, not two, but three separate anatomical structures to control urine.  There is a sphincter in the bladder neck, one in the prostate itself, and then there’s the external sphincter (also called the striated sphincter), below the prostate. Radical prostatectomy knocks out two of these, leaving only the external sphincter to do the work of three.

Because of the other two sphincters, in most men this external sphincter is never tested or even used much; there is no way to know before radical prostatectomy how strong it really is.  Also, like every other muscle, this sphincter loses its tone with age.  A complicating factor is that older men are more likely to have some benign enlargement of the prostate (BPH), too. This could make the bladder thicker and more muscular – and much more powerful than a sphincter that may not have been that effective to begin with.

Mac didn’t really think about this in a lot of detail until his catheter came out after the surgery.  “A nurse handed me a thick cotton pad to put in my underwear.” Mac’s urologist “warned me that the urine was coming, as surely as a Cambodian rice farmer predicting the monsoon. Little could be done, he explained, until I underwent physical therapy. There I’d learn exercises to strengthen the underused muscles of my external sphincter.”

Mac was so happy to have the catheter out that he thought the worst was over.  Cotton pad in place, he made an appointment to come back in three weeks, and took his wife out for breakfast.  “Rising an hour later after three cups of coffee,” he gushed urine “as if putting out a fire in a wastebasket.”  It turns out that the worst was just beginning.  “Basically, the bladder holds urine until a series of reflexes causes a bathroom urge.  Bladder and sphincters then receive a message from the brain to check flow until an appropriate time. When you’re incontinent, any time is just dandy.  You can experience stress incontinence with activities that suddenly increase pressure inside the abdomen, like lifting or standing. Then there’s urge incontinence, which is a sudden uncontrollable need to leak.  Finally, there’s overflow incontinence when you can’t sense if the bladder was filling.  I had all three.”

Suddenly, Mac’s new normal was a life with absolutely no bladder control.  “Movements gross and subtle, lying on my back, it didn’t matter. Everything ended in a demoralizing urine surge. I really needed that physical therapist. But our new insurance had other ideas.

While he “moped around home like the Incredible Surging Man,” his wife, Joy, spent hours on the phone wrangling with the old and new insurance companies, whose bureaucracies were “sharp as a paper cut,” Mac comments. Meanwhile, he experimented with leakage protection:  “I tried packing my regular underwear with cotton pads. That idea cratered in less than a day. Not only were ‘man diapers’ necessary, but they required cotton pads inside as well. I was soaking through three pads a day minimum. Each morning, I’d wake up drenched, smelling like an interstate washroom.”

Days passed until, Joy finally convinced the insurance company that “we were, indeed, customers and had paid for a specific plan.” Then, the insurance company insisted that the physical therapist wasn’t covered by the plan.  Mac was desperate; his urologist’s office staff stepped in to wrangle with the insurance and finally got the go-ahead for the physical therapist. While all this was happening, “I lived the life of the urine free spirit.  Avoiding coffee or soda mattered little. No internal spigot staunched the constant flow.”  Mac got sick of smelling urine, of feeling that he was “marinating in pee.”

Three or more times a night, he says, “I’d awaken with man diapers soaked and pressure on my bladder. Sitting up, I’d whiz into a hand urinal, change, clean myself, then lie back down and hope for a little sleep before the next voiding.”

At last, Mac could see a physical therapist.  Mac drove to the appointment – his first time behind the wheel since the operation – hopped out of the car, and soaked himself again.  Then he met Eva, his physical therapist, who used biofeedback to help him identify the right muscles to use.

“She hooked my perineal and abdominal muscles to a laptop via adhesive pads, and for the next hour, gave instruction in finding, then clenching and unclenching my striated sphincter in order to control urination. On the computer screen, I could monitor my efforts. A moving graph alerted me when I targeted the correct muscles.”  Mac learned how to do Kegels – clench-and-release exercises to strengthen the pelvic floor muscles below the bladder.

“I found biofeedback to be of great value,” and for Mac, it helped him start to regain bladder control.  “I know a guy who underwent the same radical robotic prostatectomy,” he says.  “Afterwards, his urologist tossed him a few sheets of diagrammed Kegel exercises and said ‘Vaya con Dios.’ No one told my friend you could overdo these exercises. While other factors may’ve been in play, his continence recovery turned out to be longer and messier than mine. Maybe a little biofeedback could’ve improved his condition quicker.”

Eva gave Mac daily exercises with frequency and duration goals.  She also encouraged him to walk daily.  Psychologically, the Kegels were important,” he notes.  “I lived with a constant dribble that could transform into a flood. Eva’s exercises provided me concrete specific actions. She also warned me against overtraining that could fatigue the striated sphincter, rendering it too tired to work.”

Five days later, at his next PT session, “I saw progress.”  For the first time, he could stand up without urinating.  Next, he learned to anticipate the “go” urge – and not wait until he felt pressure in his bladder.  “I could then reach the toilet with something left in the bladder.”  Mac discovered that, in order to stand up without putting excess pressure on his bladder, he had to walk bent over, “like Groucho Marx.” At first, he could go maybe three or steps without a surge.

Joy noticed improvement before Mac did; so did his urologist, who told him, “a lot of the discomfort you’re feeling now will pass. Once you strengthen the striated sphincter, your bladder urges will stabilize.”

There was some good news:  Two months after surgery, Mac’s PSA was undetectable.  His cancer was gone!  And finally, after much hard work, his bladder control began to return.  “With persistence, I sensed how to locate and activate my new bladder-control muscles.  Eva suggested I aim to eliminate jug peeing (with the handheld urinal at night) and excessive bathroom visits.  Using the striated sphincter, I should school the bladder, aiming for fewer, but more productive, bathroom trips. In the meantime, I discovered a cost-effective method of cutting down on cotton pads out in public. By inserting several sheets of double-ply toilet paper into my man diaper, I caught the wild leaks. Just toss and replace the tissue. It was easier than finding a stall and swapping out cotton pads.”

Then, for two nights in a row, he only urinated once. By mid-November, nearly two months after his surgery, “I’d slept an entire night without awakening to pee.  In the morning, I loped ape-like to the bathroom and urinated. Just after Thanksgiving, I stopped wearing man diapers and returned to underwear, albeit with a cotton pad and toilet paper inside.”

For Christmas, Mac and Joy flew to the Pacific Northwest to visit his sister.  Traveling was “an adventurous time, with me unable to cross forty feet of airport concourse without running into a washroom jackknifed over.  I grew to be an expert at identifying tile patterns.”

But even his “odd potty walk” would not last forever. By March 2015, “ I could check flow and walk upright to the bathroom.  My newly discovered striated sphincter knew the routine and exceeded expectations.  I’d finally turned a corner.

It might not seem like it now, if you’re going through the worst of what Mac endured, but remember: only about 2 percent of men have long-term incontinence after radical prostatectomy, and if you’re in that percentage, there is still hope. Talk to your urologist about biofeedback, which made all the difference for Mac.  Other options include collagen injections, a mesh sling to help take some of the pressure off of the sphincter, and for severe incontinence, an artificial urinary sphincter.

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

© Janet Farrar Worthington

In 1993, I actually wrote that sugar and carbs were fine. Want to be healthy? Eat more pasta and healthy grains, I wrote. Fats were the big evil. I was so wrong – but this was what the studies showed. This is what many doctors believed. Fat was our enemy. Fat was the reason we were becoming – not nearly so much as we are now, I might add – a nation of lard butts.

For decades, this was reflected in packaged “healthy” foods. Eat as many cookies as you want: yes, they’re chock full of carbs and junk calories, but no worries! They’re LOW FAT. This was the new food gospel, and we saw it proclaimed on our grocery store shelves – low-fat chips, ice cream, cakes. Guilt-free! Breakfast cereal – great! It’s got NO FAT! We saw the birth of olestra, which not only had no fat – it was indigestible! Side effects included gas, cramps, bloating, diarrhea, and, most appalling of all, “anal leakage.” Lays potato chips, Ruffles, and Doritos at the time that were “FAT FREE” and contained olestra had the word “WOW” in huge letters right there on the bag. I guess they meant the taste, but maybe they were referring to what happened when you ate it, as in: “Wow! I just pooped my brains out!”

In 1967, Nancy Sinatra had a hit song called “Sugartown.” She sang, “I got some troubles, but they won’t last. I’m gonna lay right down here in the grass, and pretty soon all my troubles will pass” (most likely, she did not mean “pass” in the olestra way) “ ‘Cause I’m in shoo-shoo-shoo, shoo-shoo-shoo, Sugar Town.” There were about five more “shoos” in that line, but you get the drift.

Sugartown was the place to be. We believed it because of review articles like one that appeared in the New England Journal of Medicine (NEJM) the same year as “Sugartown” – 1967. It discounted evidence that linked sucrose consumption to coronary heart disease. Doctors believed it. They told their patients. Their patients believed them.

It turns out that this particular study was secretly funded by the Sugar Research Foundation (SRF). Now we know, thanks to a bombshell article recently published by University of California-San Francisco scientists in the journal, PLoS Biology, that the SRF (now defunct) was completely evil. It manipulated the science.

It not only “discounted evidence linking sucrose consumption to blood lipid levels and hence coronary heart disease,” report the study’s authors, Cristin Kearns, Dorie Apollonio, and Stanton Glantz. It also “withheld information from the public” linking sugar to changes in the microbiome that can lead to bladder cancer.

But it’s not just the SRF, which later became the International Sugar Research Foundation (ISRF); it’s a bunch of sugar industry trade associations. And it wasn’t just back in the 1960s. All of these groups have “consistently denied that sucrose has any metabolic effects related to chronic disease beyond its caloric effects,” Kearns, Apollonio and Glantz state. In other words, the main side effect these groups are willing to acknowledge is that sugar makes you gain weight.

Let’s take a moment here for me to say that I love sugar. I do. I love cookies, and chocolate cake, and coconut custard pie, and Mexican Coke with real cane sugar instead of corn syrup.  But I really limit it.  I don’t like food Nazis, who tend to be snarky and condescending and who alienate people who really could benefit from what they’re trying to say by making snide statements like, “What’s next, a deep fried stick of butter?” (I actually read that this week in a nutrition magazine that means well, but its tone is so snotty that it’s off-putting.)

That’s not what I’m trying to do at all. What I’m writing about here is the disturbing idea that sugar has been linked to serious illnesses and that the sugar industry has suppressed this information. If we had known six decades ago, maybe a lot more people would be alive now, and maybe our country wouldn’t be struggling so hard with obesity, heart disease, and diabetes.

In case you’re wondering, Kearns, D.D.S., M.B.A., is an assistant professor at the University of California San Francisco (UCSF) School of Dentistry. Stanton Glantz, Ph.D., is Distinguished Professor of Tobacco Control in the Department of Medicine at UCSF. He’s seen this same kind of twisting and distorting of medical evidence a lot; the tobacco industry did it for years. Dorie Apollonio, Ph.D., is an associate professor in the Department of Clinical Pharmacy at UCSF. Together, these UCSF researchers make a formidable team.

Now, back to the 60 years of manipulating the science and hiding the harmful effects of too much sugar. As recently as 2016, the Sugar Association issued a press release blasting findings from a study published in Cancer Research. In that study, done in mice, scientists found that dietary sugar induces increased tumor growth and metastasis when compared to a non-sugar starch diet. But instead of saying, “Hey, you know, maybe you might want to consider not eating so much sugar – all things in moderation,” the Sugar Association doubled down, stating that “no credible link between ingested sugars and cancer has been established.” Nothing to see here, move along, move along. Look over there – doughnuts with sprinkles!

In this PLoS paper, the UCSF scientists lay out a trail of damning evidence. In that first project in the 1960s, one group of rats was given a diet of 75 percent fat but no sugar. A second group of rats ate a diet of less fat, just 15 percent, but 60 percent sucrose, and their little bodies metabolized all that sugar as a carbohydrate. The sugar-eating rats developed thiamine deficiency, which then led to heart failure. But in the rats that ate more complex carbohydrates and no sugar, the gut bacteria, or microbiome, changed and actually started synthesizing thiamine.

This study intrigued SRF scientists, who thought that maybe, if the microbiome could be adjusted, the gut could tolerate sugar better. This idea led to Project 259, in which scientists led by W.F.R. Pover at the University of Birmingham in the UK studied the effect of sugar in the gut between 1967 and 1971. Pover’s team showed, in rats and guinea pigs, that eating more sugar led to higher levels of triglycerides; in turn, this led to higher levels of beta-glucoronidase in urine a finding that’s linked to bladder cancer and in an internal document, scientists described this research as “one of the first demonstrations of a biological difference” between rats that eat a lot of sugar and rats that don’t.

Project 259 didn’t just link sugar consumption to cancer, but to hypertriglyceridemia, an elevated level of triclycerides (a type of fat) that raises the risk of heart disease, say the UCSF scientists, and these findings stayed hidden for decades until the UCSF scientists uncovered them. Also suppressed was evidence linking higher doses of sugar to other “renal disorders, urinary tract infections, and renal transplant rejection.” Eat sugar – reject your donor kidney!

Even worse, the sugar industry did what every good magician knows how to do: misdirect. In previous research, published in the Journal of the American Medical Association (JAMA), Glantz and Kearns, with colleague Laura Schmidt, examined SRF internal documents and historical reports and found that the SRF secretly funded studies, including one published in 1965 in the NEJM, “promoting fat as the dietary culprit in coronary heart disease.”

Imagine there’s a gunshot, and the killer quickly places the murder weapon in somebody else’s hands and starts shouting, “He did it! It’s that guy!” and then slinks away. That’s what the sugar industry did.

For six decades, we have blamed fat – and as a society, we now look more and more like the tubby earthlings on the big spaceship in the Pixar movie, “Wall-e.” We’re huge, and we’re unhealthy.

Sugartown is not so sweet.

©Janet Farrar Worthington

 

If an illness can have a stereotype, gout has one: its poster boy is a portly, wealthy gentleman who drinks too much red wine and eats too much rich food. In literature, gout is an Epicurean affliction, the runoff of opulence and “disease of kings.”

In fact, gout attacks the poor as well as the rich; it’s more like a creepy shadow that follows other diseases, piggybacks off of their risk factors, and kicks sick people when they’re down. It is also becoming more common. Read more

marijuana fieldBefore we start this discussion, please hear these words:  this is not about your right to smoke marijuana.  I don’t care if you spend every waking moment high as a kite, as long as you don’t operate heavy machinery or endanger anyone else.  I do not care.  That’s not my business.

However, I’m worried about your brain, because scientists are worried about it.  I also worry that some states have gotten so caught up in the political correctness of marijuana that they have fast-tracked legalizing it without fully understanding the science of what it does, and the biggest thing it does is reduce the circulation to every cell in your body, including the brain.  New studies have linked using marijuana to a higher risk of dementia, depression, and even schizophrenia.

The part of the brain that marijuana particularly seems to affect is the hippocampus, which is the same region of the brain that’s damaged in Alzheimer’s disease.  Wait a minute, hippo-what?  Let’s backtrack a minute, and:

Get to Know Your Hippocampus!

Actually, there are two of these in the brain, so technically it’s “hippocampi.”  There’s one on the right side, and one on the left, roughly over each ear, about an inch and a half inside your head.   

When you make a new memory, it happens in your hippocampus.  When you file that memory away in your brain and assign emotions to it, that happens in your hippocampus.  When you smell fresh oranges and think of that box of fruit your grandfather used to send your family at Christmas:  that happens in the hippocampus.  When you see an ad for “White Linen” perfume and think of the crush you had on your high school math teacher, who used to bathe in the stuff:  that happens… you guessed it.

Now, within the hippocampus, there are different compartments.  One handles spatial memories; in fact, when scientists studied London cab drivers, who have to commit the intricate labyrinth of 500-year-old city streets largely to memory, they found a connection to growth in the rear part of the hippocampus. 

marijuana bagsThe hippocampus is where, when you sleep, you process all the stuff you saw and felt during the day, and then you ship it off to your brain’s equivalent of the warehouse where they put the Ark of the Covenant after Indiana Jones found it – long-term memory.  The hippocampus is the triage area.  It’s short-term memory we’re talking about here, people. 

So, what happens when the hippocampus is damaged?  Well, autopsy studies of people with amnesia have shown damage to the hippocampus.  Damage here is linked to problems remembering names and events.  Dates, too. 

Is there any redundancy – a failsafe against damage, since we have two hippocampi?  Well, not exactly, because they’re specialized.  Damage to the left hippocampus can affect your ability to come up with the right words, and damage to the right can affect your ability to process visual information.

Cell degeneration in the hippocampus is connected to the onset of Alzheimer’s.   

Hold that thought.

Risk of Alzheimer’s

Marijuana causes abnormally low blood flow to virtually every part of your brain.  In a study published in the Jan. 12, 2017, issue of the Journal of Alzheimer’s Disease, scientists at Amen Clinics in California looked at the brains of more than 26,000 patients at American neuropsychiatric clinics between 1995 and 2005.  Of these, nearly 1,000 were pot smokers. 

All of the marijuana users had abnormal blood levels in the brain, particularly in the same regions of the brain affected by Alzheimer’s, namely the hippocampus.  They used SPECT imaging to show the brains of marijuana users compared to controls (people who did not smoke pot), and the difference was striking.   Every single pot smoker had “significantly lower blood flow” in the right hippocampus compared to the controls.  Even the investigators were surprised.  Lantie Elisabeth Jorandby, a psychiatrist and one of the study’s co-authors, said when the paper came out, “What struck me was not only the global reduction in blood flow in the marijuana users’ brains but that the hippocampus was the most affected region, due to its role in memory and Alzheimer’s disease.  Our research has proven that marijuana users have lower cerebral blood flow than non-users.”  The study’s authors concluded, “The most predictive region distinguishing marijuana users from healthy controls, the hippocampus, is a key target of Alzheimer’s disease pathology.  This study raises the possibility of deleterious (harmful) brain effects of marijuana use.”

In a blog post (http://www.amenclinics.com/blog/amen-research-marijuana-affects-blood-flow-brain/) the study’s authors talk about their findings.  There are also images of two brains (one from a marijuana user, and one from the control group) and it’s kind of like looking at a fresh piece of fruit vs. one that’s been in a dehydrator and put into some trail mix.  “Our research demonstrates that marijuana can have significant negative effects on brain function,” the investigators wrote.  “The media has given the general impression that marijuana is a safe recreational drug, this research directly challenges that notion.  Several studies of perfusion imaging in marijuana users have shown similar results compared to ours. A small … PET study in a sample of 12 marijuana users used a randomized clinical trial design to examine brain perfusion before and after marijuana use. The study results found frontal, temporal and occipital lobe hypo-perfusion (lower than normal blood flow) – all findings concordant with our study.”

In previous posts here at Vital Jake, we have talked about the importance of cerebrovascular health in preventing dementia.  Good blood flow to the brain is really important.  Trust me, you want good circulation up there, and there are ways to do this, which we’ve talked about in previous posts.   If you exercise and eat right and do all the things that have been proven to help reduce your risk of dementia – and then smoke pot, you might be wasting all that effort.

Risk of Schizophrenia

In a landmark report released by the National Academies of Sciences, Engineering, and Medicine, scientists said what we don’t know about marijuana “poses a public health risk.”  And yet, 28 states and Washington, D.C., have legalized marijuana for medical use, and eight states and D.C. have legalized it for recreational use. 

marijuana budThe report also said there is strong evidence to link using marijuana to the likelihood of developing schizophrenia and other causes of psychosis, with the highest risk among the most frequent users.   

The Royal College of Psychiatrists issued a statement that says, “There is growing evidence that people with serious mental illness, including depression and psychosis, are more likely to use cannabis or have used it for long periods of time in the past.  Regular use of the drug has appeared to double the risk of developing a psychotic episode or long-term schizophrenia.”

Now, you may wonder, does marijuana actually cause these problems, or are people who are prone to depression and/or schizophrenia trying to self-medicate, to find some relief of their symptoms?  That’s a reasonable question.

It appears that marijuana is more likely to be the cause than the cure.   Australian scientists followed 1,600 adolescents, aged 14 to 15, for seven years.  They found that “while children who use cannabis regularly have a significantly higher risk of depression, the opposite was not the case – children who already suffered from depression were not more likely than anyone else to use cannabis. However, adolescents who used cannabis daily were five times more likely to develop depression and anxiety in later life.”

Other studies show that the risk of schizophrenia or bipolar disorder appears to be dose-related, especially in adolescents.  Australian scientists found that adolescents who smoked pot were more likely to develop a psychotic illness, and to develop it about 2.7 years sooner, than those who did not.  These kids may also have a genetic predisposition to a psychiatric illness; so it may be that the ones who developed problems had a lower threshold for damage.  Would they have developed it without the marijuana use, however?  Nobody knows.

Risk of Depression

In another imaging study of 48 people, published in the Proceedings of the National Academy of Sciences, scientists showed that smoking marijuana increases the risk of depression, anxiety, restlessness, and other “negative” emotions.

They showed it in an interesting way, by looking at how the brains of study participants – pot smokers and controls – reacted to dopamine, the “feel-good” neurotransmitter (brain chemical) that affects your emotions, your movements, your ability to sense pleasure and pain, to learn, to pay attention, and to think.  Dopamine affects your mood, your sleep, and your memory, too.   

Dopamine is also part of your brain’s reward system.  Eat a sugary snack: get a hit of dopamine.  Do cocaine:  get a hit of dopamine. 

The ADHD drug Ritalin, a stimulant, raises the levels of dopamine in the brain, too, and this is what the researchers used in the study.

The pot smokers met the criteria for marijuana “abuse or dependence.”  That is, they smoked a lot of pot.  In personality tests and brain scans, the pot smokers had “significantly blunted” responses to dopamine compared with controls.  They were more lethargic, apathetic, anxious, and depressed.  Psychiatrist Nora Volkow said the scientists believe dopamine has a “downstream effect” in another area of the brain called the striatum, where your motivation comes from.

The study’s authors expressed their concern that “moves to legalize marijuana highlight the urgency to investigate effects of chronic marijuana in the human brain.” 

They used the word “urgency” because they are worried that people may be doing themselves significant harm.   

Here are some things to think about:

Another study from Imperial College London found that long-term pot use destroys dopamine.  Dopamine levels decline as we age, already; they also decline in Parkinson’s disease. 

People who already have a history of depression might not be ideally suited for marijuana.

People with a higher risk of stroke (high blood pressure, high cholesterol, prior heart disease, a history of TIA, or cerebrovascular disease) should not use marijuana because it will almost certainly diminish circulation even further and this could make them more likely to get dementia.

©Janet Farrar Worthington

Does the Paleo diet, basically, eating lean meats, nuts, fresh fruits and vegetables – foods our Stone Age, hunter-gatherer ancestors could have eaten – really make you feel better?

If it does, then why?  And how, exactly? 

What happens to the microbiome – the countless bacteria that live inside the gut – when you stop eating dairy, processed sugars and carbs?

paleo diet foodsThis is what doctors at the Amos Center for Food, Body & Mind at Johns Hopkins Bayview Medical Center want to know.  Some of their patients who have irritable bowel syndrome (characterized by constipation, diarrhea, and nausea, it also can include anxiety or depression) have reported that they have been doing better after changing to a Paleo diet. 

To help find out why, Kimberly Harer, M.D., gastroenterology fellow at the Center, designed a short-term study.  I recently interviewed Harer and her colleague, epidemiologist Noel Mueller, Ph.D., for Breakthrough, a publication of the Center for Innovative Medicine at Johns Hopkins. 

For two weeks, she says, 40 patients with IBS will be randomly assigned to eat either a Paleo diet or a standard, healthful diet.  Harer and Mueller will be looking at many things in these study participants, including “how the diet affects their GI symptoms, their quality of life, their vitality,” says Harer.  In people who have been experiencing anxiety or depression, the investigators will look for changes in these symptoms, as well.  They will study blood samples and patient responses to questionnaires about their health, and then, looking at the bacteria in stool specimens, the scientists will analyze the gut “microbiome” before and after. 

Let’s just take a moment to reflect on the concept – still fairly new in research – of a microbiome: It’s a small ecosystem made up of bacteria; this is more complex than it sounds.  Just as the earth has its own ecosystems – tundra, tropical rainforests, grasslands – your body has them, too.  Except instead of plants, these microbiomes are populated by bacteria: dozens of them, picky little cliques that only thrive in one particular spot. For example, the bacteria on the inside of your elbow are different from the bacteria on your face – and even on your face, the bacteria on the bridge of your nose are different from the bacteria between your nose and mouth; and those bacteria are different from bacteria on your chin. 

But the gut takes it to another level; it is the microbial mother lode.  In numbers alone, it’s intimidating.  “There are trillions of microbiota (tiny habitats) in the gut,” says Mueller.  And get this:  All of those bacteria in all those micro-habitats have their own genes and their own genomes, which scientists now know how to sequence.  “There are 100 to one more microbial genes than in your own human genome.”

 paleo diet pancakeThis is why scientists at the Amos Center are convinced that the microbiome has an important influence on our health.  It’s not just numbers, it’s sheer mass:  All those bacteria that live inside our gut, if you somehow got them all together in one lump, would weigh and take up about as much space as your brain – three or four pounds.  Trying to get a handle on that would be overwhelming without sophisticated computers and software, sequencing technology, and bioinformatics tools that allow scientists to recognize patterns and identify gene signatures.

Because the study of the gut’s microbiome is still so new, nobody is sure what it’s supposed to look like, and how the gut flora relates to symptoms.  “Maybe we won’t ever be able to define what is the normal gut microbiome,” says Mueller.  “Normal might be different for everybody.”

Even in identical twins, Mueller continues, the bacteria in the gut can be very different.  It is not unheard of for one twin to have a normal weight, and one to be obese. 

Already, at many hospitals gut doctors are waging war with bacteria, successfully treating patients who suffer debilitating diarrhea from recurrent Clostridium difficile (C.diff) colitis with fecal microbiota transplants.  Basically, uninfected fecal material from a relative with healthy gut bacteria is inserted into the patient’s colon, the good bacteria overwhelm the bad bacteria and the C.diff. is conquered. 

In mice, Mueller notes, scientists have found that if they take the microbiota from the fecal sample of an obese individual and inject it into a germ-free mouse, that germ-free mouse will start to become overweight, too.  “The phenotype of obesity can be replicated just through the sharing of bacteria,” he says.  There is a lot of evidence to suggest that gut bacteria play a huge role in diseases of the metabolism – which also suggests that if these bacteria can be changed, there is great potential to improve someone’s health.

In this study, says Harer, “we will look at the microbiome at three different time points.  First, the baseline, before the diet changes; then, after the Paleo or study diet.”  And then one more time: after participants go back to eating whatever they used to eat for four weeks.  Blood samples will be taken after that four-week period, as well, and patients will fill out questionnaires to report any change in their symptoms.

  “If there are differences in the blood and the stool samples, it will be interesting to see if those correlate with changes in their symptoms,” says Harer.  “And we are very interested to see whether reverting back to their old diet causes the former symptoms to come back, or whether there are lasting changes.” 

Certain families of bacteria thrive on a diet full of macaroni and cheese, soda, and ham sandwiches.  Entirely different bacteria could show up if that diet changes to lean meat, nuts, berries, and veggies.  Which raises another question: If someone gets better with the Paleo diet, “what part is the beneficial part?  Is it the lower carbs?  Is it the increase in plants, or in protein content?  Is it cutting out gluten?”  Or is it some new, beneficial bacteria that have taken precedence in the gut?

paleo diet meatIt’s important to remember that “the microbiome is just part of the study,” Harer continues.  “The question is, does this diet improve symptoms in IBS patients?  Unfortunately, there is a huge unmet need in these patients, because there are few effective treatments.”   

Many people who have IBS are not treated very thoughtfully; they get laxatives for constipation, medicine for diarrhea, and often the symptoms don’t go away because the underlying cause is still there.  The Amos Center takes a team approach with gastroenterologists, allergists and immunologists, psychiatrists, nutritionists, and scientists.  Sometimes, Harer says, people who come to the Center are “frustrated, at the end of their rope sometimes when they come to see us.  We use everyone’s input to treat them holistically, and also to try new things.”

One of these new things is a diet so simple that – as the commercials put it – “a caveman could do it.”  If the Paleo diet does indeed help make people with IBS feel better, understanding why it works at gut level is something we’re only beginning to have the scientific knowledge and tools to decipher.

©Janet Farrar Worthington

What weird quirk of human nature makes us more excited about a cure than prevention?  Imagine the headlines:  “Cure for Dementia!”  Wouldn’t you want to be one of the lucky ones to have bought stock in that company?

I have a friend who’s a dental hygienist, and you couldn’t pay me to do her job: Nobody wants to go to the dentist, nobody wants to hear about all the things they’re not doing to protect their teeth and not get gum disease. 

Nobody wants to be preached at.  We all know we need to floss our teeth*, and brush twice a day.  It’s pretty simple.  But how many people don’t floss, except maybe right before they go to the dentist?  How many of us have lied through our teeth, so to speak, and vehemently denied doing this? 

Dude, all they have to do is start poking around in there, and when they see plaque and your gums bleed at the drop of a hat, they know.  How many of us say, “I hate going to the dentist,” and then pay big money to have fillings and root canals, or worse, to get bad teeth pulled and get dentures.

Well, it’s the same thing happening here, except instead of losing your teeth, you could lose your memory, and your ability to think right. 

This story appeared in the news last week.  It didn’t make nearly as big of a splash as I thought it should:  “Exercising in Mid-Life Prevents Dementia.” 

Prevents dementia!  If you’ve ever watched a loved one struggle with dementia or Alzheimer’s, you know that this is hell on all sides. 

But this! This is really wonderful news:  Some basic lifestyle choices can delay or even prevent this from happening. 

Can you imagine if some drug company had developed a magic pill, something you take in your 40s and 50s, that prevents dementia?  People would be saying, “Sign me up!”

exerciseThis is better than a pill.  Also, it’s free!  The good news from this story is that – like many things we’ve talked about in this blog – every little thing you do makes a difference.  You don’t even need to lift weights or buy a gym membership.  You get points for walking the dog.  Just keep moving!  Any activity is good! 

An Australian researcher, Cassandra Szoeke, Ph.D., and colleagues just published these findings in the American Journal of Geriatric Psychiatry.   They followed nearly 400 women, aged 45 to 55, for more than 20 years, and gave them periodic memory tests; the women learned 10 unrelated words, and then tried to remember them 30 minutes later.

The investigators looked at everything – diet, education, marital status, employment, children, smoking, mood, physical activity, Body Mass Index, blood pressure, cholesterol, hormone levels, etc.   Although younger age and better education (this goes with the “cognitive reservoir” that seems to protect against Alzheimer’s that we talked about in this post) were linked to a better baseline test, the one factor that proved most powerful in determining who didn’t get dementia was regular physical activity

Note: In these posts, I talked about weight loss and smoking, and exercise as a way of not dying of cancer.  This isn’t even about big-effort activity.  You don’t have to jog, or pump iron, or do some extreme sport to keep your brain working. 

According to Szoeke: “Regular exercise of any type, from walking the dog to mountain climbing, emerged as the Number One protective factor against memory loss.”  Also, she continues:  “The effect of exercise is cumulative.  How much and how often you do over the course of your life adds up.”

walkingEvery little bit helps.  What if you didn’t start at age 40?  That’s okay!  Even if you start at 50, “you can make up for lost time.”  I’m going to add my two cents here and say that at any age, doing something is better than nothing, and if you can do your brain a tiny favor every time you move around, then do it.  Don’t cop out and say, “Well, I’m too old to start now, I’m toast.”  No, you’re not.  Conversely, “I’m way younger than 40, I’ve got plenty of time,” is just a terrible attitude.  You’ve got an even better chance of making a difference in your lifetime health!  

After exercise, the other things that proved to be strong protectors against memory loss were having normal blood pressure and having a high level of “good” cholesterol. 

One neat thing about this study, funded by the National Health and Medical Research Council and the Alzheimer’s Association, is that a lot of studies of memory loss start over age 60.  This is because the risk of dementia doubles every five years over age 65. 

The other:  There’s no prescription here for what you do, how hard you work out or how fast you run or walk.  The researchers found that it didn’t matter what people did, just that they did something.  The key is just daily exercise.  Seven days a week. 

“Start now,” says Szoeke, because if you wait, you will disadvantage your health.” 

*Note:  It turns out that dentists have been recommending flossing for a century without having done scientific studies to prove that it works.  Oops.  However, flossing does make your gums stronger and healthier, and removes food that otherwise might remain stuck between your teeth indefinitely, so it is a good thing to do.

©Janet Farrar Worthington

 It’s Really Hard to Lose Weight, and Now You’ve Just Depressed Me

I get it.  It is really hard to lose weight, and I would have depressed myself, too – except I know it can be done.  I am shaping up, myself, and I’m seeing results.  My kids got me to start going to the gym a few years ago.  Then I stopped doing weights and started running, but although I enjoyed it, I got plantar fasciitis and was hobbling around every morning when I got out of bed. 

Then my daughter sent me a link to this great website called Bodybuilding.com.  After doing just weights, and then switching to just cardio, I have finally figured out that it’s better to do both.  (I also want to state publicly that my daughter tried to tell me this, years ago, but I didn’t get it.  I do now.)

None of this is as hard as you might think.  Here’s the routine I have been doing:  http://www.bodybuilding.com/fun/randy29.htm

I don’t even do all of it!  It starts with crunches.  I don’t do them.  I go to my local YMCA, and frankly, the floor is gross.  They have mats you can use, but they’re gross, too.  I don’t want to be on them.  This is not your fancy clientele, as evidenced by the sign over the water fountain telling people not to spit in it.  Sometimes people don’t read the sign, that’s all I’m going to say. 

There are 12 exercises, and before you think, “oh, Lord, how long will that take,” let me reassure you that each one just takes a few minutes.  And again – I don’t do them all!  It’s not that bad. 

barbellI start with the “barbell bench press.”  I do 40 pounds.  Don’t laugh; it used to be 30.  That’s okay.  If 40 gets easy, I will move up to 50.  Baby steps, people.  Then I do the dumbbell shoulder press.  I do 12 pounds each; again, you could laugh at the girly lack of weight, but it used to be 10 pounds.  One-arm dumbbell row, 25 pounds; it used to be 15.  Wide-grip lat pulldown:  I do 50 pounds.  It used to be 40.  Seated cable rows: I do 40 pounds.  That hasn’t changed, but I was doing it wrong at first, and now that I’m doing it right, that’s a good weight for me.  Barbell curl:  I don’t do it, but I do the dumbbell curls instead; 15 pounds, used to be 10.  Triceps pushdown:  I do 45 pounds.  I used to do 40.  Barbell full squat:  The pole that holds the barbells weighs 45 pounds; I add 50 to that.  Leg extensions: I do 50 pounds; used to do 30 when I started.  Lying leg curls: I do 50 pounds.  I don’t like them, so I often don’t do them.  And that’s okay, because I’m doing the other stuff.

treadmillThen I do 20 minutes on the treadmill; I used to run, now I walk briskly.  I also have a Chocolate Lab who is insane, and I take her for long walks, too.  Combining both the weights and the walking really has made a huge difference for me.    

I have also changed what I eat.  This has been difficult, because God help me, I love comfort food.  I grew up in the South, and when I go to South Carolina to visit my family, I gravitate to fried chicken, fried okra, fried catfish… notice a theme here?  Fried foods are very bad, as we talked about in a previous post.  Also, sweet tea is the house wine in the South.  I am drinking it straight, without the cup of sugar in each gallon.  My relatives are still speaking to me.

More concerning for me, is where my body likes to store fat.  I don’t have junk in the trunk, or thunder thighs.  Instead, my body wants to put on fat right in the tummy, where it causes the heart to work hardest.  It’s not much, but it’s more than I want.

I’m eating food that is better for me, and in return, I actually feel better for it.

You may find a diet that is perfect for you, and if that’s the case, more power to you.  I have found that slow and steady wins the race. 

Here’s my best tip: Every single little thing you do makes a tiny difference.  Have mustard instead of mayo.  If you get a sandwich, skip the cheese.  Get it on whole-grain bread. 

Don’t get chips with it.  If you say, “No way, I’m getting chips,” of course that is your right, and it’s your life.  How about maybe you get the small size instead of the “sharing size?”  At least there are fewer chips in there.  You’ve got to start somewhere.

Chicken has fewer calories than beef. 

Drink only water or something with no calories, like unsweetened tea.  Avoid soda like the plague.  Alcohol has a lot of calories.  You could start to lose weight right away if you just cut back on that.  Watch out for juice; it has a lot more calories than you think.  Eat a piece of fruit instead.  If you go to Starbucks, get a Refresher, which only has about 35 calories, instead of a Frappucino.  Don’t rely on diet drinks; that’s a whole ‘nother blog post, but they still make your body crave sweet things, and this does bad things to your insulin receptors. 

Make the effort to limit processed food.  Yes, when you’re tired and you just want to eat something fast, it’s a pain to cook from scratch.  I know this.  I have never been one to make a bunch of meals ahead of time, so I can’t recommend that approach, although a lot of people do it.  But it’s not that hard to get a piece of chicken and cook it.  You can buy frozen brown rice and microwave it; it takes three minutes.  Or cut up that chicken and stick it on top of a store-bought salad mix, then add a simple vinaigrette dressing.   

Fast food is bad.  Now, you may say, “But I have no choice, I’m on the road, I can’t carry food all the time.”  Keeping in mind that you actually could carry granola bars and fruit, I’ll say, “Okay, then watch your calories.”  McDonald’s posts the calories right on the sign.  If you just have to have a burger, limit your portion size, as the doctors say.  Get one of their original small hamburgers, not a cheeseburger.  Get a small fry instead of a large.  For God’s sake, don’t get a soda.  Your insulin receptors will thank you. It’s not great, and I wish you would do something else, but at least you will save hundreds of calories right there.  (I will note here that some nutritionists would say I’m being a traitor to the cause:  “Eek! Fast food burgers and fries are evil!  Shun them!  Get a salad instead.”  But a lot of people feel that when their doctor gives them a diet, it’s “my way or the highway,” and if they leave the highway once, they might as well just stay off-road.  I am hoping you will stay on the road for the long haul.)

Speaking of salads: Salads are good, but if you load them up with a creamy ranch dressing, lots of cheese and croutons, maybe some ham or bacon for good measure, with a big side of bread and butter, you are defeating your purpose.

Take the stairs. 

Don’t drive circles around the parking lot looking for that lazy spot right in front of the store.  Park farther away from the store and walk. 

When you start to exercise, don’t start with heavy weights.  Work up to it.  Don’t get on the treadmill, run fast and then poop out after two minutes.  Start by walking slowly.  In my opinion, it’s better to walk slowly for 20 minutes than speed-walk for five.  If you don’t have access to a treadmill, set a timer and walk for 20 minutes, at any speed you choose.  Anything you do is more than you would accomplish by just sitting still.  Trying means a lot.

Don’t get discouraged.  The worst thing you can do is try something, decide it’s too hard, then quit because you just know it’s never going to happen, and that you’re a loser, or whatever you might say to yourself.  You’re not a loser because you’re trying.  No judgment, only encouragement.  You are making the effort. 

Baby steps.

This lifestyle we have – I’m including myself here, because I’m fighting it, too – has got to change. 

We can do this.

©Janet Farrar Worthington