Stress Eating: It’s More Complicated Than It Looks

Nearly half the American population admits to managing stress with food. (See, also: Thanksgiving.)

Eating as a stress-reducer, though, has been linked to unintended weight gain and largely condemned. But, oddly, people who lose their appetite when stressed are seen as fortunate, and their behavior is often dismissed as benign.

New research out of Germany suggests that neither situation is so clear-cut. A study just published in Psychological Science suggests that maybe stress-eating isn’t so awful after all, particularly when it comes along with a positive social interaction.

Researchers from the University of Konstanz, Germany, recruited self-identified stress-eaters (called “stress hyperphagics”) as well as people who skip meals when stressed (“stress hypophagics”). The study subjects were randomly given either positive social feedback (“social inclusion”), or experienced rejection (“social exclusion”). They were then presented with different flavors of ice cream under the guise of a “taste test,” so the subjects weren’t aware that the researchers were measuring the amount of ice cream they consumed.

icecream

As expected, stress-eaters consumed significantly more ice cream than stress-skippers after experiencing social stress. But after a positive social experience, the behavior patterns were reversed. Not only did stress-eaters consume significantly less ice cream, but stress-skippers ate a lot more. Take these two situations together, and the average calorie consumption of stress-eaters and stress-skippers was about the same.

It seems, according the the study, that rather than labeling people as “stress-eaters” and “stress-skippers,” people who alter their food intake according to their emotional state could more appropriately be called “mood-dependent eaters.”

So what does it all mean? “According to our findings, neither munchers nor skippers are considered at risk to gain weight by default,” says lead researcher Dr. Gudrun Sproesser. Continue reading

Surgeon General Nominee: Not Likely To Suffer From Invisibility

Dr. Vivek Hallegere Murthy (AP, provided by Brigham and Women's Hospital)

Dr. Vivek  Murthy (AP, provided by Brigham and Women’s Hospital)

The last surgeon general of the United States, Dr. Regina Benjamin, took flak for not doing more — or at least, given the limited powers of the office, for not speaking out more.  Forbes called her not just ineffective but “invisible.” New York Times food columnist Mark Bittman wrote a piece headlined “Our M.I.A. Surgeon General,” and accused her of failing to counteract lies by “Big Food” with the truth: that the American diet is making millions of us sick.

Somehow, I think that if President Obama’s new nominee for surgeon general, Dr. Vivek Murthy, is confirmed in the post, he will not have an invisibility problem.

First clue: The striking Reuters photo at the top of the Boston Globe profile of Dr. Murthy, who’s now 36 and affiliated with Brigham and Women’s Hospital and Harvard Medical School. He’s standing in his white coat outside the Supreme Court during the legal arguments over Obamacare in 2012, his arms crossed and his expression — well, judge for yourself. To me, he looks appalled, in a long-suffering way. (Dr. Murthy is not available for comment, but my personal interpretation is that anyone confronted often by the flaws and gaps of the American health care system tends to start looking appalled in a long-suffering way…)

Second clue, from Dr. Neel Shah, founder of the non-profit Costs of Care and a friend of the nominee:

One of the things I admire and love about Vivek is that he beats to the tune of his own drum and in many ways worked outside of the medical establishment in order to advance the interests of the American people….Doctors for America was largely an answer to the less progressive AMA.

Dr. Murthy is co-founder and president of Doctors for America, which describes itself as “a national movement of physicians and medical students working together to improve the health of the nation and to ensure that everyone has access to affordable, high quality health care.” The Globe notes that it began as Doctors For Obama in 2008, and that Dr. Murthy believes doctors should take more of the lead in efforts to improve the country’s health care system.

Other bona-fides, the Globe reports: Continue reading

Inside The Lab: Sights And Sounds Of Your Health Issues

By Dr. Michael Misialek
Guest contributor

Mine is a world very few see: pathology and laboratory medicine. More than 70 percent of the information in your medical record comes from laboratory testing. Yet chances are you’ve never been inside the lab that so influences your health care.

So I’d like to offer you a little behind-the-scenes tour of some of the sights and sounds of the top health issues facing the United States. They’re fascinating in and of themselves, but they also may give you added incentive to do what it takes for your own health.

Heart Disease

Heart disease kills more Americans than anything else, accounting for 1 in 4 deaths. Heart disease alone costs the U.S. $108.9 billion each year. Prevention is our best defense (hence the recent fuss over new statin recommendations). This begins with knowing your lipids. Seen and heard here are the sounds of automated instruments analyzing specimens to report a lipid panel.

What is a lipid panel? It includes cholesterol, LDL (low density lipoprotein, “bad cholesterol”), HDL (high density lipoprotein, “good cholesterol”) and triglycerides.

roche

Over a thousand specimens a day are typically analyzed in the Newton Wellesley Hospital chemistry lab. Tubes of blood are analyzed by automated instruments, moving from one station to the next, performing dozens of tests on a single sample. (All photos courtesy M. Misialek.)



Under the Affordable Care Act, many health insurance plans cover preventive care services, including lipid screening, at no cost to you.

Cancer

Ranking number two in leading causes of death is cancer. Screening exams such as pap smears, colonoscopies and mammograms are vital to early detection and prevention. Once again, the pathology lab plays an integral role. Below, hear and see how tissue slides are produced and evaluated by pathologists. All care begins with a diagnosis. See your physician for what screening tests are recommended for you.

coverslip

Tissue specimens, after having been cut and put on a glass slide, are stained and coverslipped. Pathologists then examine and diagnose these under a microscope.



Stroke Continue reading

Coakley: Mental Health Care Is Next Great Mass. Challenge

Attorney General Martha Coakley

Attorney General Martha Coakley

As WBUR’s Martha Bebinger reported, Massachusetts attorney general (and gubernatorial candidate) Martha Coakley is calling for the state to build “a behavioral health system for the 21st century.” Coakley spoke this morning to the Massachusetts Association of Health Plans. She recalled her brother, Edward, who began to struggle with depression at 17 and committed suicide at 33. We asked her office for the prepared text of her speech; it is excerpted below.

“…Which brings us to the third great challenge that I would like to pose to everyone today – improving access to quality behavior health care for everyone who needs it.

This is no small challenge.

There are millions of families dealing with the effects of mental illness across our country.

According to the National Institute on Mental Health, one in four adults suffers from a mental disorder in any given year. It’s probably higher.

And in a time when soldiers have returned from two separate wars, studies have shown that 20% of returning Iraq and Afghanistan veterans report symptoms of PTSD or major depression. It’s also most likely higher.

On Veterans Day, I learned that there are 22 suicides a day by veterans.

Some of you may know that my family dealt with the impact of mental illness.

My younger brother Edward was a brilliant person – he was smart, funny, a great pianist. He also suffered from depression, onset around 17 or so.

He struggled with it for much of his adult life, and my family struggled with how to help him.

When he was 33 years old, he committed suicide.

My parents had died just 1 and 3 years earlier. It was difficult for me and my sisters.

It is why I know first-hand – as many of you do – that behavior health care is as vital to the treatment of many patients as physical health care. Continue reading

Co-Sleeping Controversy, And Tips For Making Bedsharing Safer

bedshareBy Sarah Kerrigan
Guest Contributor

Over the last week, my post on co-sleeping and public policy has generated a huge, passionate response.

Comments ranged from heartfelt, personal stories of family bedsharing to adamant opposition to the practice, from questions about terminology to pleas for more information about safe bedsharing.

Riobound wrote: “I like the idea of ‘educate’ but don’t ‘dictate.’ The State should inform not impose.”

And PilgrimOnTheJames posted that “we shared our bed with each of our seven babies…for the first several months of their post-partum lives…because it allowed my wife to breast-feed them without her having to greatly disturb her much needed rest, and also, because the little tikes smelled so good and were so cute to watch sleeping. We moved them into a separate bed in our room once they were able to consistently sleep through the night. The bonds that were begun then have only grown and strengthened over the past 30+ years of family life. I thank God that we ignored the advice of many well-meaning, but totally scandalized family members and friends.”

Amelia Oliver commented, “Thank goodness the scientific community is finally considering moving away from trying to scare people out of bed-sharing and co-sleeping. The comparison with the policy of advocating abstinence instead of sex-ed is strikingly appropriate since almost everyone does it but we are all afraid to talk about it, let’s start teaching the safe way to do it.”

Molly pointed out “This article…conflates the issues of cosleeping in bed sharing, which are not the same thing. Cosleeping is risk free, end of story. Bed sharing does have risks if not done carefully and correctly.”

So in an effort to shed more light on the topic, I’ll try here to clarify the terms, explain why the research linking SIDS to bedsharing is inherently flawed, and provide some tips to make sleep as safe as possible for all babies.

1. Terminology

In the scientific community, “co-sleeping” is a general term for a child sleeping in close proximity to a caregiver, within sensory range.  “Room-sharing” is when a child sleeps in the same room as her caregiver.  Under this definition are two sub-categories: “separate-surface cosleeping,” in which the child has his own bed, and “same-surface cosleeping,” also known as bedsharing.   “Bedsharing” is the term that describes what most Americans think of when they hear “co-sleeping:” a child sleeping in an adult bed with his caregivers.  This sort of close proximity is natural to the human species.

2.  ‘Shaky Evidence’ And A Shift In Thinking

The AAP, a highly influential professional group of pediatricians, opposes bedsharing and has led the charge to promote the idea that sleeping in the same bed as your infant is dangerous. “The American Academy of Pediatrics (AAP) does not recommend any specific bed-sharing situations as safe,” the organization says in its latest statement on the matter, which then goes on to list what it characterizes as particularly unsafe bed sharing practices to be avoided “at all times,” including, “when the infant is younger than 3 months,” or with a smoker. The AAP also says bed sharing should be avoided “with someone who is excessively tired,” which makes us wonder if any of them have ever actually been parents.

But many researchers, medical professionals and worldwide organizations question the AAP’s position on bedsharing, in large part due to ‘shaky evidence’ as the basis of the academy’s position, and also given the benefits of the practice. Dr. Abraham Bergman, a prominent SIDS researcher and pediatrician said in an email that “the evidence linking bed sharing per se to the increased risk for infant death is shaky, and certainly insufficient to condemn a widespread cultural practice that has its own benefits.”  The WHO, UNICEF, La Leche League International, the Breast Feeding section of the AAP, and Academy of Breast Feeding Medicine all disagree with a sweeping recommendation to avoid bedsharing.

In an editorial published earlier this month in JAMA Pediatrics called “Bedsharing per se Is Not Dangerous” Bergman wrote: Continue reading

Why A Sex Therapist Worries About Teens Viewing Internet Porn

(Photo: Robin Lubbock/WBUR)

(Photo: WBUR)

Editor’s note: This post contains explicit sexual descriptions.

By Dr. Aline Zoldbrod
Guest contributor

Bill sits in my office, his head in his hands.

“I’m at the age where a lot of my friends are getting married. But I can’t even get up the courage to date. I’m 26, and I’ve got a good job, but I feel like a total freak. My life is stalled. I’m getting more and more isolated and depressed. I just can’t seem to maintain any sexual interest in girls. Hell, I can’t maintain that much interest in a girl in any way. I can’t get turned on. I can’t get an erection. And I’m getting too paranoid to ask any girl out on a date. What if she tells her friends that I can’t perform?”

It turns out that Bill has been watching Internet porn since he was 13. There was not a lot of love or supervision in his family. His dad drank, and his mom was overwhelmed with the stress of taking care of the kids and being the wife of an alcoholic.

For a long time, he masturbated to the porn. In the last few years, he has found himself just watching the porn for hours on end, just clicking his mouse like a zombie, trying new scene after new scene to get enough of a hit to stay aroused, but not even masturbating. Besides work and eating, all he does is stay glued to the screen.

You may have seen the recent film Don Jon, featuring Joseph Gordon-Levitt as Jon, an Internet porn addict whose habit hurts his love life. I see too many Jons in my office — men like Bill.

I can think of plenty of good uses for pornography. I’ve seen it help some of my patients, enrich their lives. And I know that in writing this piece, I’m stepping into a hornet’s nest. Pornography is a very loaded topic, a value-laden one. Many colleagues who are sexologists don’t agree with me, nor do champions of free speech.

From "Don Jon" (Youtube)

From “Don Jon” (YouTube)

But I see a sexual and relational train wreck happening, and I need to speak out. Parents and policy-makers, beware: Something very bad is happening out there with teenagers and pornography. Internet porn has the potential to change some adolescents’ sexual development in a very damaging way: It can ruin or hinder their ability to form sexual relationships.

Here’s the thing: When sex is good, it’s a wonderful part of life. I would hope that even the most conservative among us would wish that when our children grow up, they could have pleasurable sex with a beloved partner.

But if the current trend with teenagers and porn continues, there is going to be a new generation of adults who lost an important step in their sexual development and who have trouble, as young adults and later in life, integrating emotional attachment and love with sexual expression and sexual pleasure. Masters and Johnson did not call sex “the pleasure bond” for nothing.

Dr. Aline Zoldbrod

Dr. Aline Zoldbrod

This is not a new issue. The 60s and 70s saw sexploitation and snuff films, and porn has been traded on the Internet since the 1980s. But films and early porn cost money. Beginning in the 1990s, the amount of free porn exploded; the types of porn available online became ever darker and more insidious; teenagers began accessing it; and now we’re seeing the daunting results.

Recently, a new documentary has come out that illustrates the negative effects that pornography can have on teenage boys. I urge you to watch it here.

Continue reading

Web Glitches Snarl Health Insurance Enrollment In Mass.

BOSTON — Some of the problems plaguing the new federal health insurance website appear to be popping up in Massachusetts.

Jeff Freedner, 57, has had issues re-enrolling in coverage via the new Health Connector website. (Martha Bebinger/WBUR)

Jeff Freedner, 57, has had issues re-enrolling in coverage via the new Health Connector website. (Martha Bebinger/WBUR)

Jeff Freedner has been in Commonwealth Care, the state’s subsidized coverage program, since 2010, and he’s generally happy. But now, as Massachusetts merges with Obamacare, he’s among the roughly 150,000 members who have to enroll all over again, under somewhat different federal rules.

So early last month, the 57-year-old artist sat down at his computer in Hyde Park, and logged on to a new Health Connector website.

“The first time [the website] didn’t work at all,” he said. “The second time I got in but then it went black. The third time I tried logging on… they were doing some kind of maintenance.”

At one point, Freedner couldn’t get past a particular verification page.

“They said I was incarcerated,” he said, shrugging. He’s never been in jail.

At one point trying to navigate the Connector website, Freedner had trouble getting past the incarceration verification. (screenshot)

At one point trying to navigate the Connector website, Freedner had trouble getting past the incarceration verification. (screenshot)

Freedner, who used to design websites, kept trying to complete his application. He had to reset his password several times and may have several applications pending — he’s not sure. He got to the end of one application exactly one month ago.

“It seems like it’s finished, but it’s been a month, right?” Freedner said, raising his eyebrows. “And I haven’t heard anything. No confirmation, nothing.”

Frustrated Massachusetts residents who think they’ll qualify for subsidized health insurance or hope to continue a subsidized plan are posting similar stories to the Connector’s Facebook page. The Connector staff is posting occasional apologies and on Thursday laid out the problems for the agency’s board.

“Things aren’t perfect,” said Scott Devonshire, the Connector’s chief information officer. “Obviously we’re having some issues on the site right now.”

In addition to the glitches like those Freedner mentioned, the state has not been able to process any applications yet, because the federal interface that’s supposed to verify an applicant’s income and some other factors isn’t working.

“Nobody is more frustrated by that than us,” Devonshire said. “We want everyone who comes to the site to have a first-rate experience. So we are literally working around the clock to try to resolve some of these issues.”

The Connector’s $69 million site was built by the same company — CGI — that built the federal website. Connector leaders say the sites are not linked and it doesn’t look like the root problems are the same.

Connector board Chair Glen Shor say he’s focused on fixing the issues in Massachusetts.

“Of course we’re frustrated,” Shor said. “We take this extraordinarily seriously. We’re proud of what we accomplished and we know how much health insurance means to people. So we want the system to go seamlessly and perfectly and we’re working ’round the clock to make that possible.”

The Connector’s call center, where people go for answers to problems with the website, is also on overload. The Connector will almost double the center’s staff for the time being.

The 150,000 or so people caught in this hold-up are supposed to choose a new health plan by the end of December or risk losing their coverage. But the Connector said Thursday that it will extend current coverage through the end of March, in keeping with the open enrollment period for the rest of the country.

There is some embarrassment in Massachusetts that the state’s model health care program is succumbing to problems the federal government and many states that are new to this business are having. Brian Rosman, research director at Health Care for All, says Massachusetts tried to add more layers than most states when it designed a new website to comply with Obamacare.

“That’s turning out to be trickier than [the Connector] realized,” Rosman said.

Even so, says Rosman, outreach teams organized by his group aren’t hearing a lot of concern from residents they remind to re-enroll.

“We’re not hearing panic or we’re hearing modest frustration, sometimes,” he said. “But we hear other people who are getting through right away and filling out their forms and pretty happy with it.”

So maybe this will be a short-term adjustment as Massachusetts merges with the federal requirements of Obamacare. The Connector aims to clear up problems with its website later this month or in early December.

Psychobiotics: Can Stomach Bacteria Change Your Brain?

The plot keeps thickening when it comes to the connection between your gut and your brain.

A new review article links probiotics to changes in mood and mental health, suggesting these “good” bacteria might have potential as a treatment for depression and other psychiatric maladies. In the study, published in the journal Biological Psychiatry, researchers define the term “psychobiotic” as “a live organism that, when ingested in adequate amounts, produces a health benefit in patients suffering from psychiatric illness.”

(diditalbob8/flickr)

(diditalbob8/flickr)

These organisms act on what researchers call the “brain-gut axis,” a biological network connecting the intestinal and endocrine systems to the spinal cord and regions in the brain that process stress, such as the HPA-axis.

Is all this plausible? Perhaps. Ghrelin, known as the “hunger hormone” and produced in the intestines, was recently found to play a role in the development of chronic stress. And stress in turn has been found to alter our microbiota. There’s growing evidence that there’s a special connection between the gut and the brain, and as one MGH psychiatrist said recently: “There is a neural feedback from the gut to the brain so chronic gastrointestinal distress can exacerbate anxiety or depression.”

Thomas Insel, Director of the National Institute of Mental Health, stated last December that how “differences in our microbial world influence the development of brain and behavior will be one of the great frontiers of clinical neuroscience in the next decade.”

Dr. Timothy Dinan of University College Cork in Ireland and the psychobiotic study’s lead author says that although the research conducted on humans is sparse, “the animal studies indicate that certain psychobiotics can change brain chemistry.”

Continue reading

Medical Staff Preps For Code Silver, Or Active Shooter In The Hospital

Earlier this afternoon, police shot and wounded a man armed with a handgun in the Children’s Hospital of Wisconsin, triggering “a lockdown at the hospital,” reports The Chicago Tribune.

Sadly, the incident sounds all too familiar.

Think Newtown. Aurora. Johns Hopkins Hospital. Mass. Eye and Ear Infirmary.

Horrific shooting rampages in public places — even hospitals — are, insanely, becoming more and more common in American life.

So, many Boston hospitals, including biggies like Mass. General, Boston Medical Center, Beth Israel Deaconess Medical Center and Brigham & Women’s, are strongly urging (and in some cases requiring) employees to be prepared for a “Code Silver,” as some are calling it, or, in lay terms, an “active shooter” in the hospital.

Last week, about 1,200 Brigham doctors, nurses and other staff viewed the hospital’s new “Active Shooter Preparedness Training” video, which offers a step-by-step guide on how to handle a hospital shooter.

Ultimately, about 16,000 Brigham employees will see the 10-minute video, created with help from the Boston police department, Boston EMS, and other area hospitals. The shooter video will be part of the hospital’s annual training requirement, said a Brigham spokesman.

Screen shot 2013-11-12 at 9.47.02 AM

One Brigham doctor who saw the video last week said: “It was weird to see our lobby turned into a reenactment of terror,” and added that while the video may or may not help in real life,  “hopefully I won’t have to find out.”

“Shots fired in the hospital — the last sound you’d expect to hear,”  the video narrator says. “An active shooter situation used to be a phrase only used by law enforcement but as these are occuring more frequently, it is something that people in all types of organizations, including hospitals and health care facilities must learn about and prepare for.”

Actually, at the Brigham, this type of emergency is specifically not called a  “Code Silver.” (Everyone knows “Code Blue” from medical dramas, when a patient requires emergency resuscitation or immediate medical attention.) The term “Code Silver” was considered, said Brigham spokesman Tom Langford, but was ultimately tabled.

He explained in an email:

Other hospitals may use code silver, but we specifically chose not to. Here’s why: If there ever were an active shooter and a code was broadcast, only the staff would know what the code means. In an active shooter situation, it is extremely important that patients and visitors also know what’s going on so that they can evacuate the area as quickly as possible. Using a code could put patients and visitors at risk. So we would use a plain English announcement. Something like “There is a life-threatening situation in (location), please move away from the area as quickly as possible.”

Colors vary. MGH, which earlier developed its own shooter training video, deems this kind of emergency “Code Silver-Active Shooter” and BMC calls it a “Code Green.” And, according to the Mass. Hospital Association: “All Massachusetts hospitals are adopting and performing ‘Code Silver’ drills of some type, including some ‘shelter in place’ drills as a result of the Marathon bombing aftermath.”

Why Julie Dropped Her Multi: Tufts Experts Debate Multi-Vitamins

vitamins

I trust Julie Flaherty. She used to be my colleague back in our New York Times days, and never was there a more stalwart or accurate reporter. “Yes!” I said, when I saw that, in her current role as editor of Tufts Nutrition magazine, she had put together a roundtable discussion on the science of multi-vitamins, and posed its experts the widespread question: I’m a fairly healthy adult with a pretty good diet. My doctor said to take a multi-vitamin. Should I?

I stopped taking multi-vitamins more than a year ago because more and more data seemed to suggest they did little or no good, and might even do a bit of harm. But I confess to unease about that decision; doctors keep routinely recommending them, and the silver-haired people in the TV ads look so healthy and happy…I’ll take my cue from Julie, I decided.

The discussion begins with a contrast between two Tufts professors and nutrition researchers, Jeffrey Blumberg and Alice H. Lichtenstein.

Blumberg: I feel there is no harm in taking a multivitamin, and doing so will help fill in the gaps. More than half the American population isn’t consuming the amounts of fruits, vegetables and whole grains that we recommend to help them meet their needs for vitamins and minerals.

Lichtenstein: Your physician’s recommendation is not consistent with current clinical guidelines. There was a very extensive systematic review sponsored by the federal government that was done by the Johns Hopkins Evidence-Based Practice Center that showed no benefit to the general population from a multivitamin.

It’s a rich discussion, worth reading all of, but here are my takeaways: We already get many vitamins from fortified foods. We should think about vitamins in a more individualized way: Which particular ones am I lacking? And mainly, we need to eat better, not expect vitamins to fill in any nutritional gaps. Here’s a memorable quote from nutrition researcher Johanna Dwyer, a professor at Tufts School of Medicine:

Indiscriminate vitamin use is sort of like the use of holy water in the Middle Ages: People thought if you sprinkled it on things, it would ward off all evil. People who take supplements would probably be offended by that, but sometimes if you look at their reasons, they are not more sophisticated than beliefs in the Middle Ages.

Oof. I asked Julie what effect this discussion had on her own multivitamin practices. She emailed: Continue reading