An Apple A Day

Pooh-poohing Mind-Body Interaction

I surprise patients some times when I tell them that I do not believe in what is often called “mind-body interaction”. My explanation, though, convinces them not to run away and look for a different doctor. The idea that thoughts affect the body and physical disease alters emotions is right, but also very wrong. This concept falsely splits us apart.

The truth is that the brain is in the body. Every time I look at my books, there it is. The same was always true in anatomy lab, as well as looking at MRIs and CT scans. Despite this incontestable fact, there are those who view habits of thought as entirely divorced from biochemistry and physical health.

The problem starts on the medical side.  A doctor tells a patient that the tests are normal. Therefore, there is no problem or the problem is 100% emotional. Go away and fix yourself. This ignores the limitations of our testing and allows us to abdicate our response to provide help.  We fall into this trap out of ignorance at times, deluding ourselves into believing that thoughts are not biochemical, produced by and creating our physiology.  We know better.  MRIs show that the physical structure of our brains change after going through psychological counseling.  Proteins, hormones, immune factors, and alterations in the levels of a broad range of the compounds normally found in our blood, can all have subtle and lethally dramatic impacts on our brains’ ability to function, including thoughts and feelings.

On the patient side, recognizing the importance of right thinking tends to lead to blaming the victims of suffering, including themselves, for getting sick. Thoughts and feelings are supposed to be all powerful from this view point.

My experience is entirely at odds with both of these limited perspectives.

Regardless of whatever spiritual radiance/vitality we manifest, our bodies always break down.  The Law of Entropy applies to everything in the material world. You can do a lot to make your life healthier and better, but not forever.  Responding to an influenza infection, your body will work as hard as it can to create massive quantities of immune factors to save its/your life. Those immune factors make you feel tired and alter your brain and thinking.

Honestly, I can not figure out how to separate mind and brain enough to determine which is changing the other.  In reality they are one, influencing and influenced by everything.  Managing stress, thereby improving the quality of your life, is an excellent idea if you have cancer, heart trouble, depression, any other disease, or even if you are well.  Meditating increases telomere length, and then probably how long you will live.  Being angry cuts off the blood supply to your heart and kills far too many people every day.

This is not New Age, airy fairy, trivial or simply about living a beautiful life.  It is quite predictably a matter of life and death.  The only part that is unpredictable is the due date.

Building on that perspective -

Sudden cardiac death risk and emotion
Considering the effects of emotion on physical health, death is about as meaningful an outcome as one might imagine.

Swedish investigators recently determined to do something about what we know (BRAVO!). They took 362 patients who had been discharged from the hospital after a heart attack or a procedure to increase blood flow to the heart, and randomly assigned them to usual care with or without twenty sessions (2 hours) of small group cognitive therapy focusing on stress management. Patients in the counseling group were over 40% less likely to have any cardiovascular event (like a heart attack) and 28% less likely to die for any reason. It is notable that these effects were seen despite an absence of differences in the traditionally recognized risk factors (cholesterol levels, cigarettes, etc) between the groups.

Scientifically, this extremely impressive result should be confirmed but as far as those of us living in the real world, it is absolutely certain that if you do not want to die from heart disease or at least live as long as possible, you MUST become a master at stress management.

Preventing Sudden Cardiac Death

Women are less prone to heart attacks than men, but just barely.  Unfortunately, the symptoms they suffer are often not as easily recognizable as caused by their hearts, and often they have fewer symptoms.    We have much less research on women and heart disease than we have on men.

Sudden Cardiac Death (SCD) is much more common in men than in women.  You probably know of someone “who just dropped dead” one day unexpectedly.  Usually this is a surprise, coming out of the blue in the sense that most victims of SCD have not been diagnosed with coronary heart disease.  However, it turns out that a lack of diagnosis does not mean absence of disease.  At autopsy, the hearts of SCD victims usually show evidence of previously unrecognized coronary heart disease, suggesting that some of them ignored or did not recognize symptoms caused by their heart trouble.  Others, especially women and diabetics, are prone to unusual symptoms and might not even have any pain.

What are the usual symptoms?  Crushing left sided chest pain “like an elephant sitting on my chest”.  The pain can extend to the left arm or jaw.  Physical activity, emotional upset and eating can worsen the pain.  The heart will often beat rapidly or irregularly.  Shortness of breath, sweating and dizziness are also common symptoms.  Of course, each of these can have other causes, but you should not assume that the cause is minor.

Prevention is always the best idea, and studies of SCD are giving us useful ideas.  Fortunately, the major risk factors for SCD are the same in women as in men.  Harvard investigators dug into data  collected from 1984 – 2010 in the Nurse’s Health Study to learn what factors might lead to SCD.  What they found is really exciting, because it confirms that we are not so powerless against SCD as we had thought.

They found that following a healthy lifestyle dramatically reduced the risk of SCD.  The factors they considered were avoiding smoking, keeping weight down, averaging more than 30 minutes of exercise daily, and eating a Mediterranean type diet (lots of veggies, nuts, beans, fruit, fish, whole grains and moderate alcohol).  Women who did one of these right cut their risk of SCD in half.  Add another and the risk was down 60%.  Following three of these four wise health practices lowered risk by two thirds and a clean sweep of all four lowered risk of SCD by a dramatic 92%.  Looking at the data the other way around, they found that fully 81% of the Sudden Cardiac Deaths were attributable to lifestyle factors.

The recent, very brief hot spell here was good for the souls of Northern California residents who were feeling guilty about how beautiful and temperate our summer has been compared to everyone else’s. I especially loved it as the mild weather helped me train for and achieve a goal I set for myself a couple of months back. Spurred by my daughters’ decision to come home and run the Santa Rosa Half Marathon, I decided to finally settle whether my many joint surgeries had put such running activities beyond my reach. Surprisingly, my strength training, minimalist shoes, and familial inspiration allowed me to complete the race, even bettering my hoped-for pace. Sure, my pace was 50% slower than my last marathon, but I have accepted that 30+ years does change people. (Photo from Santa Rosa Press Democrat)

Far more remarkable is the success of one of you. This patient is a young man with a number of significant health problems. His severe obesity made these problems much worse, and his life was difficult. He recognized the price he was paying and committed himself to doing all he could to make his life better. He began exercising daily. He focused his diet on healthy food, including lots and lots of vegetables. Today he weighs 200 lbs less than he did when he made his decision a year ago. He tells me that the change in how he feels is even more dramatic than the change in his appearance. He inspired his girlfriend to lose 85 pounds. They have married and are now seeking to adopt a little boy whose single mother is homeless and drug-addicted.

While we cannot achieve such dramatic successes every day, each of us has the power to make fundamental changes to better ourselves. I have learned that it all comes down to making the effort, focusing on the process. It is also important to remember that big successes are the inevitable result of comparatively minor daily successes. One day choosing to make one better dietary choice, getting some exercise, keeping yourself from overreacting as you normally would, making time to relax for a few minutes all seem insignificant and trivial. However, doing the right thing today inevitably leads to a better tomorrow. There is much that is out of our control, but taking care of what is in our power can make a very big difference for ourselves and for those around us.

Most of us are social creatures. Other people are very important to our enjoyment of our daily lives. This has important impacts on our health.

Most of the time we think about this because of the difficulties social influences can present. A person who is working to overcome drug or alcohol addiction usually faces pressure from his/her old group, many of whom have the same problem. Sometimes people have to build a new social network in those challenging circumstances.

We often forget that social connections can, and should be, of great help. If your friends and family have good health habits, it can be uncomfortable not to go with the flow. You can also take an active role to better your own health and that of your friends or family.

I see this most often with exercise. Many times I have seen women training to complete their first running race together. Some people join walking groups, tennis clubs or join an athletic team because they then create a regula exercise habit built into their social network. There is social website called Get Up and Move where people challenge friends to be active by posing specific activity challenges for themselves. What better gift could there be for someone you care about than to come together in this way to feel better?

It is always smart to avoid overusing medication. Two recent studies are convincing reminders of this wisdom.

In one study, 2 million Britons using statin drugs were found to have unexpectedly increased risks of cataracts and kidney failure. While other problems like liver and muscle damage, are well-known, these links were a surprise.

Also surprising was the finding that using certain common blood pressure lowering medications was associated with a rather dramatically increased risk of cancer. Combining data from over 200,000 patients, researchers found a 1% increase in cancer rates, most notably lung cancer. While a 1% increase is not a big number, when you consider how many people take these medications, it adds up. This echoes an old but ignored study that found an association between breast cancer and higher usage of prescription medication.

It is always important to do the basic things, eating right, exercising, etc, before jumping to prescription medicines which are often powerful but often more likely to be toxic than helpful. I am consistently impressed by the power of seemingly mundane lifestyle changes. The truth is that they do more than prescription medications and in a much broader, more comprehensive way. More wholistic/holistic to use those old but quite serviceable terms. I also see that, contrary to the expectations of some, making these changes is not a sacrifice. People feel so much better that their most common regret is that they did not make the changes long ago.