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

I am so happy.  I’ve been writing for the Prostate Cancer Foundation for several months now; everything I’m writing is for men with prostate cancer and their families.  It’s right up my alley – telling men what they need to know, what their doctors might not tell them or may not even know, and most of all, doing my best to be upbeat because there is so much hope out there for men at every stage of this disease.  When the PCF says the website is a “go,” I will be able to tell you more, and share all that with you.

But here’s a preview: One story has me so fired up that I just want to give you the highlights.  It turns out that prostate cancer is a disease of inflammation, just like diabetes.  You know what inflammation is – when you skin your knee, and it gets all red and hot around the wound.  That’s your body’s way of attacking the germs, and in the case of a skinned knee, it’s a good thing.

Unfortunately, the same process gets triggered on a much smaller scale within your cells.  A lot of things can cause inflammation within the cells, including fried foods and even sexually transmitted diseases. Those are topics for another post.   

Fat can trigger inflammation, too. It turns out that people who are overweight tend to have higher glucose levels, higher insulin levels, and to produce cytokines – immune system boosters, which can encourage inflammation; sometimes inflammation is good, if it helps you fight off infection, but other times, it can put added stress on the body and perhaps tip the balance toward cancer,

healthy foodThe good news is that it is never too late to change your lifestyle – and to have this change instantly lower your cancer risk.  If you lose weight and start to exercise early in life, you may delay or even stop some of the processes that lead to prostate cancer.  If you lose weight, and if you exercise after you are diagnosed with cancer, you will certainly be in better shape for treatment.  You will also help lower your risk of having the cancer come back.  If you are battling cancer right now, losing weight and exercising may help deprive the cancer of some of the things it needs to thrive.

This is not just happening in prostate cancer.  Yale scientist Melinda Irwin, Ph.D., M.P.H., presenting her research at the big yearly meeting of the American Society of Clinical Oncology (ASCO) in Chicago, announced that she and colleagues found a “strong connection between exercise after (breast cancer) diagnosis and mortality.”  Even in women who had never really been active previously, starting regular exercise “seemed to show a great impact.” 

Irwin, an epidemiologist at the Yale School of Public Health, is probably not the favorite of the pharmaceutical industry; she has gone on record in the past pointing out that most large-scale drug trials don’t include a lifestyle component.  That’s because big Pharm “has no incentive to fund lifestyle behavioral interventions.  Why would they?  There’s no pill to take.”

And yet the connection between obesity and cancer keeps getting stronger.   ASCO, in a paper published in the online edition of the Journal of Clinical Oncology, has stated that being overweight “is associated with worsened prognosis after cancer diagnosis.”  It also said that if you are overweight and are diagnosed with cancer, chemotherapy or other treatment might not work as well; you may have more complications from treatment, may be more likely to have cancer develop somewhere else, and you have a higher risk of dying from cancer. 

ASCO estimates that as many as 84,000 cancer diagnoses each year are due to obesity, and that being overweight or obese is the cause of as much as 20 percent of all cancer-related deaths.  The National Cancer Institute has linked being overweight to “poorer outcomes in cancer patients,” and to raising the risk cancers including breast, colon, prostate, kidney, pancreas, esophagus, and gallbladder.

In a different study, European scientists just showed that having “central obesity” – fat in the belly, around the heart – makes you more likely to develop more aggressive prostate cancer.   The EPIC (for European Prospective Investigation into Cancer and Nutrition) study followed nearly 142,000 men from eight European countries for 14 years; the average age of the men when it began was 52.  Nearly 7,000 of those men were diagnosed with prostate cancer, and 934 of them died of it.  The scientists looked particularly at the men with the worst tumors.  They found there was a 14 percent greater risk of dying from prostate cancer for every 5-unit increase of Body Mass Index, and an 18 percent higher risk for every 10-centimeter (about four inches) increase in waist circumference. 

Having fat right around the waistline is already linked to Type 2 diabetes, high blood pressure, and heart disease; now, apparently, it is linked to cancer.  That’s because, unfortunately, fat in this particular location happens to surround organs, and it stresses them out.

walkingThe good news is, the risks go down as you shape up.  With every pound you lose, every bit of fat that you turn into muscle, your odds of being healthier go up.

Irwin has found that brisk walking lowered levels of two major biomarkers, insulin and “insulin-like growth factors” (IGF), in postmenopausal women who had survived breast cancer.  Both are linked to a higher risk of breast cancer.   She also has noted that breast cancer survivors who are obese have a 33 percent higher risk of having cancer return, or of dying from breast cancer, than other survivors do.

However, women who lost 6 percent of their weight through exercise and diet had a 30-percent decrease in levels of a protein associated with breast cancer, and women who exercised after being diagnosed with breast cancer had as much as a 40-percent lower risk of having the breast cancer return, and of dying.

To sum up, people who lose weight and exercise can improve their odds of not dying from cancer significantly. 

©Janet Farrar Worthington

The day of discharge from the hospital – any hospital — is like being at a bad party or uncomfortable family reunion.  It’s interminable.  Everybody’s ready for it to be over, including you; you just want to go home.

 Shortly before it’s time to go, a nurse goes over your discharge instructions.  Maybe you nod a lot – but maybe you also glaze over, feeling too worn out or overwhelmed to think about the big list of medications and follow-up appointments.

If this haziness about what you’re supposed to do when you leave the hospital sounds familiar, that’s because you’re not alone.  It happens to a lot of us, and this is not good; that discharge information is crucial.  More than 39 million hospital discharges happen every year in the U.S., and nearly 20 percent of those people wind up back in the hospital within a month.   

Francoise Marvel

Courtesy of FSU College of Medicine

These are dismal statistics.  Francoise Marvel, M.D., a second-year resident in internal medicine at Johns Hopkins Bayview Medical Center, wants to change them – starting with helping heart attack patients who are at highest risk of being readmitted within that critical first 30 days.  I recently interviewed Marvel for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

Her key to helping these people recover: their cell phones. 

Studies show that about 80 to 90 percent of Americans own a cell phone capable of receiving medical information.  Rich or poor, young or old, tech-savvy or not; doesn’t matter.  Cell phones transcend demographics.

“Unfortunately,” says Marvel, who plans to specialize in preventive cardiology, “hospital discharge is a process that is fraught with patient safety issues.”  The discharge instructions are often written by an intern or medical student, and frankly, the quality varies.  That information is then handed off to a nurse, who conveys it to the patient.

Also, the timing is bad.  Patients may get the go-ahead to leave in the morning, but the actual discharge usually doesn’t happen until late afternoon.  The day drags on, and the last thing those people may feel like doing is sitting through a mini-seminar on medications, lifestyle and dietary changes.     

And yet – especially for those who have stents put in to help a clogged artery stay open – understanding and following this information truly is a matter of life and death.  Another problem, says Marvel, is that the proverbial wheel is being reinvented with every patient.  If you have been a heart patient yourself or been in the hospital room with a relative who has, you know the drill:  Go to cardiac rehab, avoid salt, measure your pulse and blood pressure, avoid alcohol and stop smoking.  Etc. 

But if you have a newly placed stent, what you hear in those discharge instructions is extra important: You must take aspirin and Plavix, two essential blood-thinning medications – these allow your blood vessel to knit a blanket of cells to cover the stent.  That stent is very sticky. Until the cells grow around it, without those blood thinners it’s almost certain that a clot will form. 

That message doesn’t always come through loud and clear, and some patients don’t understand the urgent need to take these pills every single day and not stop for any reason, and that “if they don’t do this, they will have a massive heart attack.”

This is far too important to tell people “right before they get in a wheelchair and get picked up by a family member,” says Marvel.  She cites a 2013 study published in the Journal of the American Medical Association, showing that 40 percent of patients over 65 “who felt that they had a good understanding of their discharge instructions” could not accurately describe the reason for their hospitalization, and 54 percent “did not accurately recall instructions about their follow-up appointment.”

hospital doorAnother study of recently discharged patients aged 64 and older found that “the majority did not understand the new dosing of medications they were taking” or the reasons for medication changes.  “What we know from the research,” Marvel says, “is that many patients are likely to come back to the hospital for avoidable reasons,” and the discharge process is largely to blame.

She is designing the Health-e App for smartphones.  It will serve as a “discharge navigator,” helping patients transition from the hospital to the home after a heart attack.  Designed for people who, like most of us, “don’t know the first thing about cardiac rehab,” the app will help patients follow up with the heart doctor and connect with a pharmacy.  It will walk them through changing their diet and also will connect patients with social services and help them apply for insurance if they don’t already have it.

  After a heart attack, most patients stay four days.  Marvel plans to give the app on Day 2, to “so they feel comfortable with it and have a chance to preview the app so they’ll know why and how they need to take care of themselves when they get home.”  This user-friendly, guided, evidence-based approach, she envisions, will be much better than “the four to five pages of relatively unhelpful, EMR (electronic medical record)-automated, inconsistent instructions.” 

The American Heart Association estimates that one in five men, and one in four women, die within a year after having a heart attack.  “Looking at the risk factors for why you would die within that window, medication and therapeutic adherence – knowing what you need to do and take, and being consistent – is the number one reason,” Marvel says.  “It keeps you up at night when you realize we keep giving the same basic instructions that were typed out 50 years ago. We’re doing a huge disservice to our patients.”

Smart phones, Marvel says, can become a tool for “wraparound care.”  But right now, hospitals are not routinely using them as such.  “If I ask you, where are your car keys, you might have to think about it.  But if I ask, where’s your phone, you know where it is.  You’re wearing it, or it’s right beside you.”  She believes that using the cell phone “is going to bring us closer to our patients.  In the hospital, they see us for 15 minutes, maximum, when we’re on rounds; in fact, that’s a long encounter.  It could be as little as four or five minutes.”

Marvel is developing a prototype with the help of student volunteers from the Johns Hopkins Whiting School of Engineering.  

©Janet Farrar Worthington

Do you feel connected, or tethered?

While you’re mulling that over, here’s another one: Can you handle downtime?  The art of loafing — made famous by such characters as Huckleberry Finn; the morbidly obese passengers of the spaceship, Axiom, in the Pixar movie WALL-E; and cats everywhere – has its good points.  There’s something to be said for taking some time to daydream.

Tell that to the experts who want to help us stay on task and be more productive.  “We’ve come to consider focus and being on as ‘good,’ and idleness – especially if it goes on for too long – as ‘bad’ and unproductive.  We feel guilty if we spend too much time doing nothing,” says Stanford psychologist Emma Seppälä, Science Director of the Center for Compassion and Altruism Research and Education.  She has written a book, The Happiness Track: How to Apply the Science of Happiness to Accelerate Your Success.

Goofing off in moderation can be very helpful, especially when you’re trying to think creatively.  In fact, Seppälä says, truly successful people “are successful because they make time to not concentrate.”  By just leaving the desk and taking a walk, for instance.  “As a consequence, they think inventively and are profoundly creative.  They develop innovative solutions to problems and connect dots in brilliant ways.”

Here are three simple ways you can “unfocus” your hard-working brain – and free it up for tackling problems in new ways:

mindless wanderingDo something mindless.  Don’t just sit there staring at your computer or focusing on one monumental task.  “To get a new perspective on something, we actually need to disengage from it,” Seppälä says. Don’t worry – your brain keeps right on working on a problem, even when you aren’t actively thinking about it.  Take a shower, or go for a walk around the block, or empty the dishwasher.  You and your brain will feel refreshed.

Do nothing at all.  Silence is powerful, says Seppälä.  Meditation or even just taking a “silence break” helps you think outside the box.  This is not that easy for many of us:  “When your mind wanders, thoughts and feelings can emerge that are not necessarily pleasant.  Being alone or being un-busy or quiet can open the door to troublesome thoughts or even anxiety.”  But hang in there.  If you keep at it, you can sit through these thoughts, “or walk through them, if your silent practice is a hike or a walk,” and “they will eventually pass, leaving room for free-flowing thoughts and daydreams.”  Doing nothing is its own form of exercise, and you get better with practice.

Play.  “We are the only adult mammals who do not make time for play, outside of highly structured settings like a Sunday neighborhood soccer game or playtime with a child,” says Seppälä.  Play stimulates positive emotion, and this, in turn, leads to “greater insight and better problem solving.”  Feeling good helps you see the bigger picture, instead of feeling trapped by the details.  If you’ve gotten rusty at playing, don’t worry – this is a skill that can be relearned.

And now, back to feeling constantly connected to the world:  this is not as good as thing as the smartphone makers would like you to believe.  Just ask Jenna Woginrich, who gave up her smartphone 18 months ago.   She wrote about it in the UK newspaper, The Guardian.

She didn’t just get a low-tech flip phone to “simplify.”  No, she jettisoned having a cell phone – any cell phone — altogether.

She doesn’t miss it.  She still has a computer and a landline.  “There are a dozen ways to contact me between e-mail and social media,” she says.  “My phone has become ‘the phone.’ It’s no longer my personal assistant; it has reverted back to being a piece of furniture – like ‘the fridge’ or ‘the couch,’ two other items you also wouldn’t carry around on your butt.  I didn’t get rid of it for some hipster-inspired Luddite ideal… I cut myself off because my life is better without a cell phone.  I’m less distracted and less accessible, two things I didn’t realize were far more important than instantly knowing how many movies Kevin Kline’s been in at a moment’s notice.”

connected cablesEven though her friends think her decision was nuts, she feels “rich,” she says, because the addiction was getting to her.  “I hated that anyone, for any reason, could interrupt my life.”  Worse, she adds, “I was constantly checking e-mails and social media, or playing games.  When I found out I could download audiobooks, the earbuds never left my lobes.  I was a hard user.  I loved every second of it. I even slept with my phone by my side.  It was what I fell asleep watching, and it was the alarm that woke me up.  It was never turned off… It got so bad that I grew uncomfortable with any 30-second span of hands-free idleness.  I felt obligated to reply to every Facebook comment, text, tweet and game request.”

No mas.  She got clean.  “I look people in the eye.  I eat food instead of photographing it and am not driving half a ton of metal into oncoming traffic while looking down at a tiny screen… And while I might be missing out on being able to call 911 at any moment, it’s worth the sacrifice to me.”

Woginrich says she’s glad to be back in the world again.  “It beats waiting for the notification alert telling me that I exist.”

You probably don’t want to give up your smartphone.  But think about putting more distance between yourself and it.  Loosen the tether, and see what happens.

 

©Janet Farrar Worthington