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Microbes: We are them. They are us.

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We have known for centuries that we share our bodies with microbes. But we always assumed they lived in places, like skin, mouth, and gastrointestinal tract, which are “outside” our bodies, and that they just use us for housing. Living on us but not interacting with us.

However, new findings from the Human Microbiome Project and other lines of study have strongly suggested that our relationships with our microbes are much closer than we thought. Much closer.

Who, or what, are we?

DNA studies of human tissue have revealed that, at least in number of cells, there are nearly as many of  “them” as “us”. But they are too small for us to see them. But, for instance, about 90% of the cells in the gut are microbes!

Not only that, but microbes seem to inhabit every tissue of our bodies, albeit in small numbers (at least compared to skin and guts). And yes. This includes the brain.

What are they doing there?

 

Most of our microbes are in our guts.

 

There are hundreds of different species of microbes that include bacteria, viruses, and fungi, which inhabit our gut. Because they are so numerous (and because they can be studied in things like poo), we know more about the populations of microbes in our guts than in the other parts of our bodies. The vast, vast majority of them are peaceful, and some of them make nutrients (short chain fatty acids) and vitamins (such as vitamin K) that we need. Some make our food easier to harvest energy from (great in a famine, but not if we are trying to lose weight). Others make neurotransmitters and hormones, such as serotonin, histamine, and GABA, which can influence immune cells and other cells in our guts. This may be one way microbes affect our behavior.

 

Microbes affect our behavior?

The first clue that microbes can influence behavior came from a study showing that that Toxoplasma gondii infections in mice make them less afraid of cats. Why? It turns out Toxoplasma lives in cats, and part of its life cycle involves being excreted in cat poo, which is then eaten by mice. When a cat eats the mouse, the toxoplasma gets back into its favorite host. So if mice are less afraid of cats, the cats have a better chance of eating them. Which is great for the Toxoplasma, if not for the mouse.

So far there are no examples of microbes being that specific about the way they change behavior in humans. However, in rodents and people, having an imbalance in the microbial species in the gut (called “dysbiosis”) can lead to anxiety. This effect is mediated by a nerve that connects the gut and brain (the vagus nerve), and it is thought that the anxiety is important as a signal that something is not right in the gut. Dysbiosis in humans is pretty common, thanks to antibiotic use, food additives and pesticides, and generally poor nutrition.

This means that what is going on with our microbes in our guts has very important implications for mental health, especially anxiety. It’s striking how many people suffer from stomach and gut disorders, dysbiosis, and anxiety symptoms. Many more people suffer anxiety without really knowing why, and are feeling frustrated and helpless because therapies directed towards the brain aren’t helping. It might be a good idea to start thinking about what is going on in their guts!

Microbes seem to play roles in disease, but not only the way we used to think.

When we think of microbes and disease, we think of things like the flu, food poisoning, and other infections. But the vast majority of microbes in our body are actually helping prevent infections with dangerous microbes. Each part of our body (nose, gut, skin, vagina) has it’s own specific population of microbes, that are unique to each of us. Those microbes know who is supposed to be there, and who isn’t. A healthy balanced population of microbes seems to act like police, by preventing dangerous bacteria from overgrowing and causing disease. In this way, they are able to keep us healthy in the sea of micro-organisms that we live in.

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Can we influence the microbes in our guts?

Bacteria have receptors for our hormones and neurotransmitters. This means that what is going on in our bodies can influence their growth and possibly behavior. For instance, the neurotransmitter norepinephrine, which is released when we are stressed, can make certain pathogenic bacteria grow faster and be more virulent (cite Mark).

Recent studies indicate that what we eat influences the types of species, and how much they grow. So this is one more important reason to eat a healthy diet. Different kinds of foods support different species of bacteria, helping to promote “diversity” (which is good).

On the other hand, antibiotic and pesticide residues in food can be toxic to microbes, and this is one of the most compelling reasons to eat organic-type foods. Similarly, it’s important to avoid antibiotics (including “sanitizers”) unless they are truly necessary. Antibiotic overuse is a big contributor to the development of dysbiosis. I will write more on this in a future blog, because dysbiosis is turning out to be a major player in chronic disease, from gut inflammation to diabetes, to neurodegenerative diseases.

The bottom line for staying healthy, then, is to work with our microbes by managing stress and eating a healthy varied diet.

Our Guts, Our Selves

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When people talk about “gut feelings”- something they can’t really rationalize, but feel as though the emotion is “coming from the heart” or “I feel it in my guts”, are those feelings actually coming from the heart or gut?

Well no.

But this doesn’t mean that the heart and gut do not influence our moods, decisions, and behavior. They do, especially the gut.

How could the gut possibly influence our minds, and why?

First let’s address the question of why.

Although we often tend to treat our bodies as just something to walk our minds around, our bodies are important parts of who we are (for an account of what it is like to lose a sense of your body, see “The Disembodied Lady”, by Oliver Sacks, in The Man Who Mistook His Wife For A Hat).

But the gut is special! That is, if you are any kind of a complex animal, you have to have one. Even tardigrades, the super tough little animals that can survive extreme conditions, like being frozen to -300 degrees Kelvin, or being subjected to radiation in Space, have a gut. No heart or lungs, but they do have a gut.

Two tardigrades.

For us more complex animals, we need our guts to digest and absorb nutrients. This frees our brains to engage in more interesting things: art, music, building things, being social… and on and on.

Other important things happen in the gut beyond absorbing nutrients (as important as that is). For instance, some cells of the immune system are “programmed” there, and their interactions with the cells and microbes in the gut influence their later functions. The cells can become inflammatory, or regulatory/ anti-inflammatory. This has implications for tissues beyond the gut, and contributes to risk for asthma, allergy, and autoimmune disease.

But still- why do things that go on in the gut influence our mood and behavior?

Perhaps because when things go wrong in the gut, it has no way to tell the brain specifically what is wrong. So it just signals that something is not right, driving the experience of anxiety (especially). And anxiety is a normal response to something not being right. Of course it would sure be nice to know what exactly is wrong in the gut, but knowing that gut problems can drive anxiety symptoms can help understand the etiology of treatment resistant anxiety, and suggest possible treatments (more on that in a future blog).

So how does this work?

The gut is full of nerves. Some of them of them are “intrinsic”- that is they are part of the guts own nervous system (alias The Gut-Brain, or enteric nervous system), and some are “extrinsic” and come from the brain and spinal cord (sympathetic and parasympathetic). These nerves both influence GI function (motor) or report back to the brain on things that are happening in the gut (sensory). Of the two types, sensory nerves predominate. This implies that the brain is VERY interested in what is going on in the gut.

This sensory information from the gut (interoception)is important in regulating things like physiology and eating behavior (knowing when we are hungry, or when we have eaten enough). But the information from the gut also drives activity in brain regions and neural circuits involved in emotions, memory, stress and coping.

It can sometimes really feel like our emotions are coming from our gut. This is because we perceive our own emotions via a Brain-Body-Brain loop. Emotions are generated in subcortical brain regions that, among other things, influence the autonomic nervous system that controls physiological functioning. Then we perceive the results of that activity, such as sweaty palms or butterflies in the stomach, and attribute it to anxiety, for instance. Our ability to notice these physical effects of emotions seem to be important for psychological health, and decision making, because when there are damage or poor functioning in brain regions involved in this process, people are not able to deal with emotions or learn from the consequences of bad decisions.

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Interestingly, and importantly, some to the brain regions and circuits influenced by the gut are part of what is called the brain’s default mode, which (to make a long story short) turns out to be very important in constructing our sense of self. So- our sense of our selves is more than a mental construct. It includes our bodies, and especially our guts.

“We are what eat” in more ways than one!

donut man

Why I Love Greek Yogurt

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Just a few years ago, probiotics were considered to be an “alternative” thing that only hippies were into. Most “probiotics” were pills with only one or two bacterial species, and there was little concern about quality control. Most medical practitioners considered probiotics to be a rip-off, or a fad. And there was no evidence that probiotic bacteria can even live or form colonies in our guts, so it was assumed that they could not affect our health.

 

My how things have changed.

 

Technological advances, thanks to the Human Genome Project, have given us a much better idea of the microbes in our guts. Instead of relying on culture techniques (trying to take bacteria from our guts and grow them on an agar plate or in a tube- which they don’t like, because they only like to grow in our guts), we can now identify them using DNA/RNA sequencing of their genes. And wow! We discovered that thousands of different kinds of bacteria live in our guts, and some of them are the same as those found in probiotics.

 

Now there are so many different types of probiotics, including pills, dairy products such as yogurt and kefir, and other fermented products such as kimchi or kombucha. Which is really great, because we have so many choices. But it is really hard, because we have so many choices. How do we know what kind of probiotic would be best?

 

Right now, we really don’t know. People often ask me for recommendations on probiotics. Unfortunately, there isn’t any way yet to predict which probiotic will help any specific person. At this point it is still down to trial and error. We are all individuals, and our microbial “communities” are individual as well. Not too long from now it will be common to have our own personal microbes identified, and more studies on how exactly specific microbes interact with our immune systems and gut barrier will help us to make choices about which probiotics can helps us. But for now, we are on our own.

 

There are a few studies showing that commercially available probiotics can improve symptoms of Irritable Bowel Syndrome and Inflammatory Bowel Disease, notably one called VSL3, which is a pill formulation. Also, a “rule of thumb” is that the more species a formula has the better. This increases the chances one or more will be good for you, and the bacteria seem to work together- they may be able to enhance each other’s actions.

 

But personally, I love Greek yogurt. I eat it nearly every day for breakfast. It’s smooth and tangy and there’s so much you can do with it.

 

Eat it with fresh fruit and granola for breakfast. Or smeared on waffles with fruit.

 

Make tzatziki with it. I have always loved eating tzatziki in Greek restaurants but now make it at home. Tzatziki goes well with cut-up vegetables or pita chips, and on grilled chicken. Or you can use greek yogurt as a substitute for sour cream.

 

It is also a good source of calcium and protein, AND it contains some of my favorite probiotic bacteria species:

 

Lactobacillus Bulgaricus, Acidophilus Casei

Streptococcus Thermophilus & Bifidobacteria

 

Although, as I just mentioned, we are still a long way from being able to say which probiotic bacteria we should take, recent studies have compared people with chronic diseases seem to have fewer Lactobacillus species than healthy people, which might mean that Lactobacillus helps keep us healthy, and taking probiotics with Lactobacillus might be a good idea.

 

That’s what I tell myself as I scoop a spoonful of tzatziki onto my pita bread. Just eating it for the Lactobacillus…

 So- Bon Appetit and stay posted for more on probiotics and our microbial friends!

Mindful Eating, Or- How I lost 35 pounds by enjoying my food more

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Like many people, I found myself overweight in middle age. Quite overweight, in fact. With a BMI (Body Mass Index) of 30, I was more than overweight. My fasting blood glucose levels were still in the normal range, barely. My mother continued to remind that I have Type 2 diabetes in my family.

What to do?

As a scientist who has studied obesity and body weight regulation, I knew that dieting was not an option. The starvation response/ diet induced obesity, and all that.

So…

I decided to take my own advice.

Background: There are two kinds of things that influence how much we eat: “Head Factors” and “Gut Factors”.

Head Factors are “psychological” things such as how appetizing the food looks and smells. Social cues or influences, emotional situations, habits and conditioning (e.g. always eating a snack at 4 PM) are also powerful influences on what and when we eat.

Gut Factors are signals from the gut (and/or liver) that convey the gut’s opinion about how much we should eat, and may also influence food preference or cravings. When we first begin to eat, a hormone called “ghrelin” is released from cells in the stomach and pancreas that acts to increase our motivation for food. Which makes sense, because when we start eating we should keeping eating to continue a meal, rather than e.g. wandering away… When food hits the small intestine, though, it’s time to stop eating if you haven’t done so already, and the gut then releases “satiety factors” such as CCK and serotonin. These factors contribute to feeling of “fullness”, and reduce the drive to eat more (and the rewardingness) of what we are eating. This takes about 20 minutes though. So the faster you eat, the more you get down before the satiety factors kick in.

Healthy eating means having a balance between these two kinds of factors.

Unfortunately this balance can be hard to reach. In our society we are surrounded by food, and not all of it nutritious. Food manufacturers know that certain things like fat, salt, and sugar are widely liked and activate head factor-driven eating. And over-eating. And this can cause us to blow right past our gut factors.

How to get to that balance? One thing is to slow down eating enough so that we can listen to our guts. Which can be hard to do if the head factors are telling us how hungry we are- “eat! eat! eat!”

To encourage myself to slow down, I borrowed a demonstration used in Mindfulness-Based Stress Reduction, called the raisin exercise. For this you take a raisin, and put it in your mouth. But you don’t swallow it. You just feel it in your mouth and explore what the raisin is like. Kind of hard and wrinkly. It doesn’t taste like much. Then you bite down slowly, and the squishy inside oozes out. Now it tastes like a raisin! When you have satisfied yourself that you have explored as much about the experience with the raisin as you can, you get to swallow it.

I decided to give the raisin treatment to everything I put in my mouth. How do the tastes and textures of the food work with each other? I also decided to make a real effort to listen to my gut. Instead of eating everything on my plate, and wondering if I want a second helping, I stopped after several bites, and asked myself if I still needed to keep eating. From this I discovered a number of things:

This does serve to slow down eating.

Mindful eating does make food more rewarding, because I am more paying attention to it before it goes down. It also encourages me to eat more interesting, colorful food, which also happens to be more nutritious. Junk food like potato chips and French fries get boring pretty quickly if you are mindfully eating them.

colorfulsalad

Slowing down eating makes it easier to notice the effects of gut factors, which causes me to eat smaller portions of food.

My gut is WAY happier when I practice mindful eating. I have suffered with Irritable Bowel Syndrome (IBS) since I was a teenager. Most nights I experienced gut cramping and pain starting a couple hours after dinner. It usually went away before bed-time, but not always. But since I started mindful eating, my gut is WAY happier. After-dinner gut craps are for the most part, a thing the past.

It took a while (several weeks probably), but I began to lose weight. I had purposely not started this with the goal of losing weight because I did not want to get on the merry-go-round of weighing myself every day- yay! I lost a pound! Followed by crap crap crap I’ve gained two pounds, etc.

I noticed some of my clothes were easier to get on, but attributed this to probable laundry accidents (some things should just not go in the dryer, they get stretched out). But during a doctor visit about four months after I began mindful eating, I found I had lost 10 pounds or so. Cool!

A couple of months after that (and, importantly, after the winter holiday season) I had to go the doctor again, and found I had lost another 10 pounds or so. Very cool! Twenty pounds lost without “dieting” and feeling hungry and deprived all the time.

Since then I have continued to lose another 15 pounds, or so (I have to confess I don’t exactly know what my top weight was because I stopped looking after it went past a certain value). My metabolic values are better too.

Beyond the weight loss, which is important (!), I feel the value of the mindful eating approach to food is that it has been wonderful for me to feel more balanced and in tune with my body.

Quinoa-An Alternative Grain

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Fresh blueberries are in season now!

Evidence Based Wellness

Quinoa (“keen-wah”) is a grain originally from South America. It is getting popular now because it has high protein, is a good source of calcium, phosphorus and iron, but has little or no gluten. It is not related to the grassy grains such as wheat and rye. Rather, it is related to spinach and tumbleweeds (tumbleweeds!).

 IMG_2776

Uncooked quinoa

It is easy to cook and versatile. It can be used in dishes such as couscous and salads in place of bulgur wheat, or added to soups.

Cook it like rice: about one cup quinoa to two cups water. Bring to boil, then simmer until water is absorbed (about 12 minutes). Makes about 2 cups of cooked quinoa.

The salad below was brought by a friend to a brunch, and has the added benefits of avocado, citrus, and blueberries. It is delicious and nutritious!

Quinoa salad 3

Quinoa and Blueberry Salad

   2 cups…

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Tiramisu with Fruit

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In the U.S. we always think of Tiramisu as a tasty and maybe decadent dessert. But in Italy it is often eaten as an afternoon “pick-me-up”. Well why not? It has espresso, chocolate, and marscapone (Italian-style cream cheese). So, stimulants and protein! We like to add fruit for a refreshing tang, appealing color, and of course: micronutrients and anti-oxidants. Of course! That’s why we eat Tiramisu- for the antioxidants.

I have adapted this recipe from a blog called “Cooking for Engineers”. The blog describes the experience of comparing many different recipes and concluded this one was the simplest one that tasted like real Tiramisu. Traditionally it is made in a casserole dish but we like to put it in trifle bowl because it is nicer to see the layers.

Tiramisu with Fruit

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8 oz. heavy whipping cream

8 oz. marscapone, at room temperature (it is easier to fold into the whipped cream than when it’s cold)

1-2 Tablespoons marsala (Italian sherry)

1-2 Tablespoons vanilla

1/3 – ½ cup dark chocolate, grated

About 8 oz. (or roughly 6 double shots) espresso coffee cooled

1 box Nilla Wafers (the recipe calls for Lady Fingers but I have found that Nilla Wafers are not so sweet and can soak up more coffee than Lady fingers. They are also easier to find in stores)

Fresh fruit: blueberries work very well. Blackberries and raspberries are delicious too and all three together is lovely! Peaches would probably be nice too.

  1. Brew espresso coffee (or buy at coffee house) and let cool. Put it in a bowl or pyrex measuring cup suitable for dipping Nilla Wafers.

  1. Grate chocolate- this is tricky because dark chocolate has kind of a charge and the pieces jump all over. Use a grating container if possible to limit the mess.

  1. In a medium cooking bowl, combine heavy whipping cream, marsala, and vanilla. Beat with mixer until it’s thick enough for peaks. Fold in the marscapone gently.
  2. Dip Nilla Wafers into the espresso and layer the bottom of the serving dish. For the bottom row, do not let the Nilla Wafers soak up much coffee, or it can get a bit soggy later. That is: if you don’t eat it all the first day!

  1. When the bottom of the dish is covered with espresso-laden Nilla Wafers, spoon about 1/3 of the whipped cream-marscapone gently over them and smooth to completely cover.

  1. Layer ½ of the berries or other fruit over the whipped cream-marscapone.

  1. Sprinkle about 1/3 of the grated chocolate over the fruit, to cover.

  1. Add another layer of espresso-soaked Nilla Wafers, 1/3 whipped cream-marscapone, the rest of the fruit , and 1/3 chocolate.

  1. The top layer is espresso-soaked Nilla Wafers, the rest of the whipped cream and the rest of the chocolate.

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Refrigerate for 2-3 hours before serving.

The quantities of the ingredients, and number of layers, can be varied according to taste and preference. It takes about an hour to make. Enjoy!

Quinoa-An Alternative Grain

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Quinoa (“keen-wah”) is a grain originally from South America. It is getting popular now because it has high protein, is a good source of calcium, phosphorus and iron, but has little or no gluten. It is not related to the grassy grains such as wheat and rye. Rather, it is related to spinach and tumbleweeds (tumbleweeds!).

 IMG_2776

Uncooked quinoa

It is easy to cook and versatile. It can be used in dishes such as couscous and salads in place of bulgur wheat, or added to soups.

Cook it like rice: about one cup quinoa to two cups water. Bring to boil, then simmer until water is absorbed (about 12 minutes). Makes about 2 cups of cooked quinoa.

The salad below was brought by a friend to a brunch, and has the added benefits of avocado, citrus, and blueberries. It is delicious and nutritious!

Quinoa salad 3

Quinoa and Blueberry Salad

   2 cups quinoa, cooked

   1 cup blueberries

   2 large avocados, diced

   1 cup pecans

   Lime Basil Dressing:

   1 tbsp olive oil, extra virgin

   1 tbsp honey

   juice of 1 large lime

   4 tbsp basil, finely chopped

   1/2 tsp sea salt

   1/2 tsp ground black pepper

Directions

   In a large bowl, add cooked quinoa, blueberries and avocados.

   In a small skillet, toast pecans on low-medium heat until lightly brown, about 5 minutes. Stir frequently and watch closely not to burn. It also works to toast them in a toaster oven. Transfer to a bowl with other ingredients.

   In a small bowl, whisk together Lime Basil Dressing ingredients, pour over the salad and gently stir to combine. Serve cold.

   Storage Instructions: Refrigerate covered for up to 3 days.

Curried Roasted Carrots with Yogurt

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This dish is easy, tasty, and works well as a side dish or appetizer to bring to parties. I have adapted it from a recipe in Sunset magazine, which has lots of easy and quick recipes for colorful food!

Wash and peel 2-3 carrots (depending on size) and slice them diagonally. Peel about half a head of garlic cloves, and cut the bigger ones in half. Toss the carrots and garlic in a bowl with olive oil and spices, about

1 tsp curry powder

1/2 tsp turmeric

a pinch of ground cumin

a pinch of ground cardamom

Let them sit about 10 minutes, stir, and place in a roasting pan. Grind some sea salt over them, and roast at 350 degrees for 20-25 minutes. Let cool.

Spoon a small carton of greek yogurt into a serving dish, and put the carrots and garlics in the middle. Drizzle the olive oil left over from roasting around on the yogurt.

Eat with pita chips!

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Is “Leaky Gut” Really A Thing?

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There is no shortage of information on the internet about “Leaky Gut” and “Leaky Gut Syndrome”. For instance:

 

“4 steps to heal Leaky Gut”

“9 signs you have a leaky gut”

“Leaky Gut foods to avoid”

“Could Leaky Gut be what is troubling you?”

“Leaky Gut: Can this be destroying your health?

“How to live with and identify Leaky Gut Syndrome”

Is this really a thing?

It seems there are as many skeptics about “Leaky Gut” as there are people promoting it. When I ask audiences at my seminars “Who has heard of leaky gut syndrome?”, everyone, EVERYONE, raises their hand. When I ask “Who thinks the medical establishment takes it seriously?”, no one raises their hand, ever.

Which is unfortunate, because Leaky Gut is a thing, and can cause serious problems for some people. It may also contribute to other conditions not normally thought of as being related to gut problems.

In the basic science world, “leaky gut” is called “increased intestinal permeability”, and it is a big thing. Increased intestinal permeability is a major factor in Inflammatory Bowel Diseases (such as Crohn’s Disease) and Celiac Disease, and may contribute to non-alcoholic fatty liver disease, diabetes, asthma, autism, schizophrenia, and autoimmune disease. It may also contribute to feelings of chronic fatigue, and mood disorders. How?

It helps to understand a little about the gut, and the “gut barrier”. The lining of our gut consists of a single layer of cells, that provides a barrier between us and the outside world. Yes, the outside world!

My Psychology Graduate Advisor, Don Novin, used to say that “We are all just donuts”, with an outside, and an inside, and an outside inside.

 donut man

The barrier on our outside-outside is skin, which is tough and keeps pretty much everything out. But the barrier of our inside-outside has to be able to let in some things, like nutrients, but keep other things, like toxins and pathogens, out. This is a huge challenge.

The permeability of the barrier has to be carefully regulated. The cells that make up the barrier have to be far enough apart to allow food to be absorbed, but not so far apart that other things get in. There are proteins on the cells (such as ZO-1 and occludin) that help keep the cells close together, and the gut’s immune system also helps. If there is a problem with this regulation, the cells get too far apart and you get “leaky gut”, aka “increased intestinal permeability”.

So, what can mess up gut barrier regulation?

Some people have genetic traits that seem to lead to an exaggerated inflammatory response to microbes in the gut. These gene variants have been associated with Inflammatory Bowel Disease. If the response to microbes is inappropriate, the gut barrier becomes more permeable, and so do the blood vessels in the vicinity, leading to swelling, pain, and bleeding. The increased permeability can allow more pathogens across the barrier, increasing inflammation even more. This makes the disease worse, and can be life-threatening.

In the case of celiac disease, an allergy to gluten (found in many grains) also induces inflammation. This leads to malabsortion of nutrients, malnutrition, and damage to the gut. Other types of food allergies and sensitivities are related to unruly gut immune responses, and also lead to increased permeability. So, keeping the gut’s immune system regulated and happy is a key ingredient in a healthy gut barrier.

How do we keep our gut immune system happy?

Eating a healthy, varied diet is a big help. Eating probiotic foods may also help, because one thing that tends to upset the gut immune system is a condition called “dysbiosis”. Research into our little friends, the gut microbes, is showing that there are many different types of them, and they need to be in balance. Dysbiosis is when the populations you have are not diverse enough, and some of them do not play nice with the gut barrier. So, the barrier can become leaky and inflamed. There is some evidence that probiotics can improve gut barrier function, presumably by encouraging the gut bugs to play nice (more on this in a future blog).

One of the most important things we can do to maintain a healthy gut barrier is managing chronic stress. Chronic stress dysregulates the immune system, and impairs the expression of the barrier proteins between the cells lining the gut (epithelial cells). Not only that, but stress hormones (catecholamines: epinephrine and norepinephrine) from us can act on unruly bacteria to make them more aggressive, and probably contribute to dysbiosis. Dysbiosis also can activate gut-brain connections that can lead to mood disorders such as anxiety.

So, yes. Leaky Gut (aka increased intestinal permeability) is a thing! I suspect some of the skepticism derives from the name. “Leaky Gut” doesn’t sound very scientific, even if it is pretty descriptive. But “increased intestinal permeability” is a mouthful, so I suspect the term “Leaky Gut” will stick around.

What To Do With Kale

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Kale is so nutritious, and grows so well in home gardens. But it is kind of tough, and it can be hard to think of things to do with it. This true for other great greens, like collard and mustard as well, and dandelion greens (yes! they are edible and full of nutrients).

One trick if you want to put them in salads is to massage them a bit with your hands to soften them up.

I really like them warm, in soups or wilted in sauces.

My favorite thing to do is add them to Thai curry coconut sauce, with chicken, shrimp or tofu, and red peppers.

For this I cut up raw chicken, raw shelled shrimp or tofu, and marinade it for a little while in curry paste (or garlic chili paste) mixed with a little olive oil. Then I sautee until they are cooked through, and add a can of coconut milk (either regular or “lite” work). Then I add a couple of tablespoons of Thai curry paste (e.g. Thai Kitchen brand) and stir. I slice the greens fatly and add them to the sauce, along with cut up red pepper. When the greens are wilted, we serve it with sliced green onions and lime wedges (to squeeze over) with jasmine or basmati rice. Chopped peanuts are nice to sprinkle over it, too. It can also be mixed in with cooked Thai rice noodles (the fatter ones are easiest to work with). Either way, it’s a quick way to eat delicious, nutritious, colorful things! And if made with tofu, the dish is vegan.

Why worry about stress?

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Why start this blog by talking about Stress? There’s so much out in the media about stress, and so many seminars and workshops about stress. And “listicles” about the 7 things you can do to reduce stress!!!! (Why are they always odd numbers?) There’s a lot of information out there. But personally I find it all tends to swing between banal and overly technical. Stress is a part of life. Some people think it is good for us, motivating us to work hard. Is it really so terrible, and is it really that important manage it?

The short answer is yes.

But this blog is not about short answers, at least not that short!

Stress makes our lives less enjoyable, less meaningful, and one thing is clear- stress contributes to, and worsens, most chronic disease (for instance type II diabetes and cardiovascular disease, cancer), and can even increase inflammation. But the evidence base for how it does so is complex, especially for human studies. Part of the problem is that for scientists it is hard get a handle on just what IS stress. It reminds me of the story of the definition of pornography, supposedly given by a judge: “ I know it when I see it!”

We know when we are stressed, right?

Not always.

When we think about stress, we usually think about our emotional reactions to, and perceptions of, challenging or obnoxious situations. These are subjective experiences, which are hard to quantify in the way that is necessary for scientific study. Subjective experiences of stress can be measured by numerical scales (“rate your stress over the last week 1-9”), but it can be hard to make a summary of your feelings over time. And there is no way that the rating can be independently verified. We can never know what someone else is feeling. But scientists like to find objective measures, things that can be quantified and compared across different people, such as biomarkers. Biomarkers are things such as hormones, which vary depending on the psychological or physiological state of an individual. Common biomarkers for stress are the hormones cortisol and epinephrine, which are released into the blood during stress. Which is great, but other things besides stress can cause these hormones to be released, so they are not necessarily reliable markers of stress. This has not stopped people from operationally defining stress as an increase in cortisol (or epinephrine).

Part of the problem is that there are different kinds of stress, which can have different effects on the body. The “classic” stress response involves activation of the sympathetic nervous system (epinephrine, aka adrenaline), and the hypothalamic-pituitary adrenal system that leads to cortisol secretion. The system is designed to respond to ACUTE stressors (like getting in a car accident, or almost getting in a car accident). Activation of the stress response in these situations is good. It saves our lives.

scared cat

Part of the acute stress response is “piloerection”- fluffing our hair makes us look bigger and might scare away predators. This is probably more effective for cats! Other acute stress responses include a jump in heart rate, blood pressure and vasoconstriction, surge in blood glucose, pupil dilation, and heightened mental focus. (Sketch courtesy of Mara Gaykema)

In normal situations, when the acute stressor is over, the parasympathetic nervous system (e.g. the vagus, lots more on this later!) winds down stress responses and returns the body to a stable state. The problem is when we have stressors that are mild, but CHRONIC. Think mean boss, back-stabbing co-workers, partners with mid-life crises, teen angst. In these situations, stress responses do not get turned off, and the constant, low level of stress hormones leads to big problems with many systems in the body, including the immune, endocrine, and cardiovascular systems, and the brain. Chronic stress can even increase inflammation (more on that later), which is a hallmark of chronic disease.

But our conscious perceptions of stress are only half of the story. We can think of stress as following from the perception (or actuality) of threat. Problems with careers, interpersonal relationships, and frustrations are threats to the mind. Whenever we are sick or injured, the brain views this as a threat to the body, and responds as in many ways the same way it does to psychological stressors. So the sympathetic nervous system is activated, and levels of stress hormones such as cortisol are released. Inflammation consequent to illness or injury leads to the phenomenon of sickness behavior (more on that later)- depression, anxiety, fatigue, cognitive fuzziness, and sleep disruption. Appetite can be affected as well.

So we can be stressed, but not know it! Chronic illness is equivalent to chronic stress, and is associated with all of the problems experienced with chronic psychological stress. Unfortunately, most people with chronic diseases, and many of the practitioners working with them, are unaware that the illness is driving the fatigue, mood and cognitive problems. Chronically ill people can feel frustrated, like they should be able to “get it together”, but they can’t. This feeling, of course, is a psychological stressor. What you then end up with is a nasty vicious cycle: stress in the body (also known as “physiological” or “bottom-up” stress) induces stress in the mind (“psychological” or “top-down” stress), which enhances inflammation, making the stress in the body worse. Which makes the stress in the mind worse. And on and on. So it’s critical to somehow break that cycle, and that is going to be a major theme in future blog posts.

Introduction: Why another blog about health and neuroscience?

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735772_10200423353857460_835362537_o There is so much information about the latest findings related to health and wellness in newspapers, magazines, and on the Internet, it feels like a deluge. Some of this information is accurate and useful, some of the advice is wrong (“5 foods you should NEVER eat!”) or dangerous, and a lot of it is there just get money out of you. How to make sense of all of it? It isn’t hard for me. I have a PhD in Physiological Psychology, and have been working in the field of Psychoneuroimmunology for more than twenty years. I’ve spent 35 years in scientific research, involving hands on bench work, writing papers and grant applications, and reviewing (tons of) papers submitted for publications and grants for funding. This has required developing expertise and background in topics ranging from molecular biology to human clinical studies. After all these years I feel like I am bilingual- I speak, read, and write in English and Sciencese. The great thing is that now I have a wide-ranging knowledge base, and an ability to translate scientific results into something that non-scientists can understand. This knowledge has helped me greatly in my everyday life- not just in dealing with my own health issues and interactions with health care professionals, but in more fun things including learning to play my violin again (after not playing at all for decades). Not to mention knowing when not to click on tempting web sites! IMG_1141 The motivation for this blog comes from interactions with my friends and family, and people who come to my seminars. I’ve found that information about things like how the brain works, and what drugs do to our bodies, etc., that are so well known to basic scientists that they are pretty much dogma, is just not out there for the general public. This includes health care practitioners. It’s a little bit frustrating (not to mention kind of nerdy) to try to explain the basis for my opinions when informally talking with people, because there is just a lot of background that needs to be explained before I can get to my point. And who wants to listen to a lecture at a cocktail party? (Yes, I have pretty much done that, but just because people keep asking questions!). So this blog gives me the chance to talk about things that I think are important, interesting and useful, in a way that can be understandable to people without PhDs in Neuroscience, Physiology, Nutrition etc. I can explain things in a hopefully organized way, and provide links to science articles that back up what I’m saying. I’m looking forward to feedback and questions about the topics I address in the blog, as well as suggestions for topics I should cover. Most of the entries will be about things I think are important, and things people I have spoken to think are interesting, but some will be about recent relevant reports in the media. This informal format will give me an opportunity to say what I really think about things!