Saving Normal

I haven’t read his book. I’d like to but I’m a slow reader and there are so many books on my reading list. But I like what he says: that we should celebrate the range of our emotions, of our experience, our human condition – instead of drugging it.

Dr. Frances led the committee that wrote the 4th edition of the manual for diagnosing mental illness, the Diagnostic and Statistical Manual (DSM-IV). He has a long and distinguished career in the field of psychiatry. He’s worth listening to. (He tweets regularly at @AllenFrancesMD.)

A description:

Anyone living a full, rich life experiences ups and downs, stresses, disappointments, sorrows, and setbacks. These challenges are a normal part of being human, and they should not be treated as psychiatric disease. However, today millions of people who are really no more than “worried well” are being diagnosed as having a mental disorder and are receiving unnecessary treatment. In Saving Normal, Allen Frances, one of the world’s most influential psychiatrists, warns that mislabeling everyday problems as mental illness has shocking implications for individuals and society: stigmatizing a healthy person as mentally ill leads to unnecessary, harmful medications, the narrowing of horizons, misallocation of medical resources, and draining of the budgets of families and the nation. We also shift responsibility for our mental well-being away from our own naturally resilient and self-healing brains, which have kept us sane for hundreds of thousands of years, and into the hands of “Big Pharma,” who are reaping multi-billion-dollar profits.

Frances cautions that the new edition of the “bible of psychiatry,” the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), will turn our current diagnostic inflation into hyperinflation by converting millions of “normal” people into “mental patients.” Alarmingly, in DSM-5, normal grief will become “Major Depressive Disorder”; the forgetting seen in old age is “Mild Neurocognitive Disorder”; temper tantrums are “Disruptive Mood Dysregulation Disorder”; worrying about a medical illness is “Somatic Symptom Disorder”; gluttony is “Binge Eating Disorder”; and most of us will qualify for adult “Attention Deficit Disorder.” What’s more, all of these newly invented conditions will worsen the cruel paradox of the mental health industry: those who desperately need psychiatric help are left shamefully neglected, while the “worried well” are given the bulk of the treatment, often at their own detriment.

Masterfully charting the history of psychiatric fads throughout history, Frances argues that whenever we arbitrarily label another aspect of the human condition a “disease,” we further chip away at our human adaptability and diversity, dulling the full palette of what is normal and losing something fundamental of ourselves in the process. Saving Normal is a call to all of us to reclaim the full measure of our humanity.

I was going to highlight parts of that but I’d end up highlighting everything. There’s so much there. One thing he says … Drugs prevent us from experiencing our “natural resiliency.” Making it through difficult times can teach us coping skills. It can make us better equipped to handle the next round.

Want To Avoid Kidney Stones? Eat Less Meat

Kidney stones form in the kidneys. Pain occurs when stones move into ureters, thin tubes that allow urine to pass from kidneys to bladder.

This large, prospective, cohort study found that consumption of red meat and poultry increased risk of kidney stones, while fresh fruit decreased risk.

Diet And Risk Of Kidney Stones In The Oxford Cohort Of The European Prospective Investigation Into Cancer And Nutrition (EPIC), Nutritional Epidemilogy, 2014

In conclusion, compared to meat-eaters, vegetarians are at a lower risk of being hospitalised for kidney stones. Among meat-eaters, increasing meat intake is associated with a higher risk of developing kidney stones. Conversely, a high intake of fresh fruit, fibre and magnesium may reduce the risk.

Also:

There were no associations between dietary intake of sodium or calcium and kidney stone risk.

Mechanism:

It has been proposed that metabolism of a high protein diet may result in an increased stone risk by producing an acid load that increases urinary calcium and oxalate levels and decreases levels of citrate (an inhibitor of calcium stone formation).

Callan Pinckney: “Now, For The Wonderful Behind And Hips”

I posted about Callanetics and back pain back in May:

“Alarming Increase” In Prevalence Of Chronic Low Back Pain
Callanetics
Stay Away From These Exercises

And this:

Pinckney’s exercises, at least the ones in her back book, are designed to heal and strengthen the back and neck. If you do them regularly, they can protect you from future pain and injury. Her exercises are unlike many I’ve seen over the years: they’re not hard, they won’t injure, and they’re effective. I can’t recommend them enough.

I included her stomach exercise in my Callanetics post. Here’s her exercise for the hips and behind. (I love how she says that.) All of these exercises strengthen the muscles that support the back.

“Now, for the wonderful behind and hips…”

This is the more advanced form of this exercise. In her back book, she includes stages you’d want to complete before even attempting this. The first stage has you lying on the floor, on your side, in a fetal position, with your head resting on your arm. It feels so good it’s hard to get up from it!

Aluminum And Alzheimers Disease: Another Case Where Industry Profit Trumps Public Health

There’s been buzz in the last few months about aluminum and Alzheimer’s Disease (AD). The link got a lot of press back in the 1980’s but it went away. I thought maybe it was found to be just an association and not a true cause.

Here’s a recent study that reignighted the aluminum-AD discussion:

Aluminium in Brain Tissue In Familial Alzheimer’s Disease, Journal of Trace Elements in Medicine and Biology, March 2017

We have made the first ever measurements of aluminium in brain tissue from 12 donors diagnosed with familial Alzheimer’s disease. The concentrations of aluminium were extremely high, for example, there were values in excess of 10 μg/g tissue dry wt. in 5 of the 12 individuals. Overall, the concentrations were higher than all previous measurements of brain aluminium except cases of known aluminium-induced encephalopathy. … The unique quantitative data and the stunning images of aluminium in familial Alzheimer’s disease brain tissue raise the spectre of aluminium’s role in this devastating disease.

From Christopher Exley, the lead author of that study, who’s been studying the link for years:

Aluminum Should Now Be Considered a Primary Etiological Factor in Alzheimer’s Disease, Journal of Alzheimer’s Disease Reports, 8 June 2017

Talk about powerful statements:

Alzheimer’s disease is not an inevitable consequence of aging in the absence of a brain burden of aluminum.

Essentially without aluminum in brain tissue there would be no Alzheimer’s disease. There are a number of predispositions to the development of Alzheimer’s disease, involving both environmental and genetic factors, and each of these acts to increase the aluminum content of brain tissue at specific periods in an individual’s life. This interplay between environmental and genetic factors explains both early and late onset disease, in each case the catalyst for the disease is always the brain aluminum content and how robustly an individual’s brain responds or copes with this aluminum burden.

These are high-quality, peer-reviewed journals.

All of us have more aluminum in our bodies that our grandparents did, or their grandparents. We cook with aluminum, spray in on our bodies, eat it, drink it, breathe it. How do we to minimize its accumulation? Exley says:

Perspiration is a major route of excretion of aluminum from the body. In the absence of physical exercise, women produce only half the volume of perspiration as men and so may be predisposed to the retention of aluminum in their tissues.

And this:

Research has shown a significant protective effect of silicon in drinking water, irrespective of the aluminum content, with higher silicon reducing the incidence of Alzheimer’s disease

In addition, clinical trials involving only a small number of participants have shown that regular drinking of a silicon-rich mineral water helps to remove aluminum from the body of individuals with Alzheimer’s disease [24, 25]. For 20% of such individuals, the lowering of the body burden of aluminum following drinking a silicon-rich mineral water for just 12 weeks produced clinically significant improvements in their cognitive function [25]. The potential benefits of silicon in Alzheimer’s disease can only be explained if aluminum has a role to play in the disease.

Silicon forms a complex with aluminum and carries it out of the body via kidneys. Exley advises drinking about a liter of silicon-rich water a day:

What you need to look for is a minimum concentration of 30 mg/L or 30 ppm written as ‘silica’ on the label.

it looks like Fiji and Volvic have more silica; Perrier, San Pellegrino, and Gerolsteiner less.

Finally, why isn’t this common knowledge? And why did the seeds of this aluminum-AD hypothesis “go away” as I posed at the top of this article? Because aluminum is big business. And the aluminum industry has been pushing back:

Why Industry Propaganda and Political Interference Cannot Disguise the Inevitable Role Played by Human Exposure to Aluminum in Neurodegenerative Diseases, Including Alzheimer’s Disease, Frontiers in Neurology, October 2014

There has been and there continues to be systematic attempts by the aluminum industry to suppress research on aluminum and human health.

Doubt is their product!

High-Fat Diets And Their Link To Colon Cancer

Ugali (cornmeal “bread”) and beans. A traditional meal among native Africans.

Just another study that adds to the body of evidence that diets high in fat, protein, and animal foods – and low in carbohydrates – increase the risk for colon cancer:

Association Between Low Colonic Short-Chain Fatty Acids and High Bile Acids in High Colon Cancer Risk Populations, Nutrition and Cancer, 2012

We propose that the influence of diet on colon cancer risk is mediated by the microbiota. To investigate how dietary fat influences risk, we compared the colonic contents of 12 adult high-risk African Americans (AAs) and 10 Caucasian Americans (CAs) who consumed a high-fat diet (123 ± 11 g/d and 129 ± 17 g/d, respectively) to 13 native Africans (NAs) who subsisted on a low-fat (38 ± 3.0 g/d) diet, all aged 50–60 yr. The colonic bile acids were measured by LC-MS and the short-chain fatty acids (SCFAs) by GC. The chief secondary colonic bile acids, deoxycholic acid and lithocholic acid, were correlated with fat intake and similar between AAs and CAs, but 3–4 times higher than in AAs (p < 0.05). The major SCFAs were lower in AAs (p < 0.001) and CAs (p < 0.001) compared to AAs, but conversely, the branched chain fatty acids (BFCA) were higher.

Our results suggest that the higher risk of colon cancer in Americans may be partly explained by their high-fat and high-protein, low complex carbohydrate diet, which produces colonic residues that promote microbes to produce potentially carcinogenic secondary bile acids and less antineoplastic SCFAs. The role of BCFA in colonic carcinogenesis deserves further study.

People who ate high-fat had 3 to 4 times higher levels of bile acids in their colon. Not good. They also had fewer short-chain fatty acids (SCFAs). Also not good.

If you have a choice, and you want to lower your risk for colon cancer, eat less fat, less protein, and fewer animal foods. If you have a choice.

The Food Industry Wants The Public Confused About Nutrition

This is true. All of it. Great job putting it all together, Dr. Greger:

You can find the transcript here. Click the “View Transcript” button right under the video.

Two things:

  1. He talks about corporations pushing the “personal responsibility” angle, which gets them off the hook. Most people I know defend it! They say “no one controls what people put in their mouths except themselves” or something to that effect. Untrue. The food environment is a stronger player in controlling what people put in their mouths.
  2. Doubt is their product. Remember that.

Defecation Frequency (How Often Do You Have A Bowel Movement?)

I was reading this study and saw something unusual, well, unusual for me. Here’s the study:

Faecal pH Value And Its Modification By Dietary Means In South African Black And White Schoolchildren, South African Medical Journal, May 1979

From our studies it would seem reasonable to conclude the following: faeces from groups of rural and urban prepubertal Black schoolchildren are significantly more acid than those of White children of the same age.

The finding of the study isn’t surprising. I’ve spoken about it for years … how a high-fiber diet feeds bacteria in the colon, causing them to produce organic acids, like short-chain fatty acids. Those acids lower the pH (make more acidic) of feces. A more acidic environment in the colon is protective against colon cancer. I talked about this in my posts on resistant starch (RS). RS isn’t exactly fiber, but it feeds colonic bacteria quite well. There’s a lot of resistant starch in cooked, cooled cornmeal, a staple food in Africa. (Here’s my post on making ugali, the bread of Africa.) (Cooked, cooled pasta and potatoes also have a lot of resistant starch.)

I came across this photo while researching baobobs in Madagascar. I really liked it.

Here’s the thing that surprised me:

Feces Collection: Black Schoolchildren
Each pupil was given a cardboard plate, 23 cm (9 inches) in diameter, and a square of paper towel for covering the sample. Pupils went to the toilets in batches to lessen confusion over sampling and to avoid ‘cheating’. Approximately 90% of pupils are able to pass a stool on request, which is a common phenomenon among Black children.

Previous studies have indicated that Black children, compared with White children, defaecate roughly twice as frequently, and have about half the transit time.

Defecation on demand. Not in America!

Here’s what they were eating:

Among rural Blacks, maize meal in one form or another is still the staple diet, supplemented in certain parts with kaffir corn (Sorghum vulgare), millet and wheat products. Additional foods include dried peas, cowpeas, groundnuts, pumpkin, kaffir melon and other vegetables, fruit and wild greens (m’lino, morogo). Meat is consumed irregularly and milk is usually consumed in small quantities. … Most children eat plenty of fruit, according to region and season, such as oranges, pineapples, guavas, bananas, papaws and mangoes. Most of these are good sources of crude fibre.

I think it’s their diet, in part at least, that allows them to defecate on demand. And that diet is very McDougall-like: starch-based, low-fat. They were getting less than 15% of their calories from fat – quite low. Maize or corn meal is usually eaten 3 times a day, along with every meal, like bread. That’s a lot of resistant starch.

For the white schoolchildren (who didn’t defecate on demand, but were sent home with a carton):

Their diet is substantially the same as that eaten by Whites in Western countries. It is high in energy value, protein (especially animal protein), and fat (especially animal fat), and low in carbohydrate foods (most of which are refined).

Here in the West, passing stool is often problematic. That’s what I’ve learned in speaking to patients and people over the years. And it seems more problematic for women. This study bears that out:

Defecation Frequency And Timing, And Stool Form In The General Population: A Prospective Study, Gut, June 1992.

Although the most common bowel habit was once daily this was a minority practice in both sexes; a regular 24 hour cycle was apparent in only 40% of men and 33% of women. Another 7% of men and 4% of women seemed to have a regular twice or thrice daily bowel habit. Thus most people had irregular bowels. A third of women defecated less often than daily and 1% once a week or less. Stools at the constipated end of the scale were passed more often by women than men. In women of child bearing age bowel habit and the spectrum of stool types were shifted towards constipation and irregularity compared with older women and three cases of severe slow transit constipation were discovered in young women. Otherwise age had little effect on bowel habit or stool type. Normal stool types, defined as those least likely to evoke symptoms, accounted for only 56% of all stools in women and 61% in men. Most defecations occurred in the early morning and earlier in men than in women. We conclude that conventionally normal bowel function is enjoyed by less than half the population and that, in this aspect of human physiology, younger women are especially disadvantaged.

I’ll throw up a couple graphs from that study. Here’s frequency. Black is men, hatched is women. That peak at 24 means that many people visited the bathroom once every 24 hours. A blip at 12 means that they emptied their bowels every 12 hours, or twice a day. Men were more prone to that:

Here’s time of day. Women tended about an hour later than men:

You know what else bears that out? That defecation is a problem in the West? The array of products at the drug store meant to assist stool passage: MiraLax, Metamucil, FiberCon, Ex-Lax, Citrucel, etc.

By the way, I saw this study on an older video by Dr. Greger: