Brain Biofeedback

Random Health Thoughts

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It's been so long since I've blogged on my brain biofeedback treatments, it almost feels like I'm not doing them. But I am. I continue trucking along, each session a 3-minute assessment, 5-minute HRV screen aka deep breathing in rhythm with heart rate going up and down, three neurofeedback screens of 3 minutes each bowling, maze, sailboats racing on three day-glo seas SMIRB for 5-10 minutes (writing out one’s ruminating thoughts), and 5 minutes of reading philosophy material online.

Since I began laser therapy for my painful muscles injured way back in 2000, my heart rate has droppede, despite continuing high stress. Turns out, that drop could be because the deep, penetrative laser on my neck affects the cerebrospinal fluid, increasing its flow. Better flow = brain working better. (Though why I see the brain effect mostly on my heart rate, I don’t know.) We’re finally seeing the beat rate in the low 100s. Mind you, my GP took it and my blood pressure with his fancy, automatic machine and declared 118 high. I almost choked. When it was in the 120s or 130s, it got little attention, but now it's high?! Doctors are weird.

Seriously though, my GP is a good guy, and he took the time to commiserate with me about the suckage of being diabetic again. He encouraged me to feel that since I normalized my blood sugar once, I could do it again. I am only 3kg away from where I achieved it last time. I suppose. My athletic therapist and other professionals treating me all expressed surprise I was diabetic again because my weight doesn't compute with having type II diabetes (I'm not big enough). It strengthens in my mind that my brain injury is responsible. I may have the gene, but under normal circumstances, I would still need lots more poundage on me to trigger it. And I'm not that bad an eater. My fatigue is my biggest enemy. How can I cook my own meals when I don't have the energy, when my muscles refuse to obey me from central fatigue not fatigue from working hard and activating muscle cells is an act of will so intense there are too many days I just don't have it? How do I remain healthy on prepared foods?

One strategy I'd forgotten (or was so zonked I couldn't even do it) is to add frozen veg to prepared food, frozen or takeout, to bulk it up so that feel satiated.

On the plus side, my appetite has been normalizing after LORETA neurofeedback. It was returning to normal even with gamma enhancement. But I think the LORETA accelerated that process, and spontaneous healing of my appetite is continuing. (After biofeedback treatments are over, spontaneous healing continues, at least it did and is for me. It's like the treatments kickstart a cascading effect of regeneration.)

Anyway, though it should be easy, I don't know how I'll lose such a tiny amount of weight, but with doctors and therapists having faith in me, I feel a tiny glimmer of hope that I will.

Health

How Do You Know if You’re Malnourished When Fat?

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I was watching ABC’s Extreme Makeover: Weight Loss  Edition (link has annoying video with audio ad) last night and heard the medical specialist inform the 456-lb woman that she was malnourished. I wondered: how did they assess malnutrition? How do we know if we’re malnourished, even when fat? So I asked my resident nutrition guru. Here is his answer.

As I discovered when reading through research articles and perusing Judy Taylor’s medical records for my book Lifeliner, Judy underwent many kinds of analyses of her body composition and assessments of her nutritional state at the behest of her doctor, my resident nutrition guru. After years of conducting such tests and reading the literature, my resident nutrition guru, aka Jeej, realised that they do not predict outcomes well and  that the best way to assess a person’s nutritional status is through Subjective Global Assessment, a method that he developed and that independent scientific research supports. The Assessment involves four questions:

  1. Are the bowels normal?
  2. Does the person eat a normal diet?
  3. Is the person of normal weight and neither losing nor gaining?
  4. Does the person have normal energy?

If the answer is yes to all four questions, then the person is not malnourished. Doing blood tests and body scans will not give a superior or even as good an answer as this assessment, although scans and tests sure are sexier and feel like real medicine.

But, I asked, what does normal mean?

Normal Bowels

Normal bowels are ones without diseases like Crohn’s or without resections or do not have ostomies. In other words, a not normal bowel is a bowel with severe problems that muck up a person’s ability to absorb nutrients or even digest food. Spastic bowel (irritable bowel) or lactose intolerance, as painful as they are, are normal, in this sense anyway.

Normal Diet

A normal diet includes all the food groups. One that skips fruits and vegetables is not normal. So eat them!

Normal Weight

It’s interesting watching old movies. Everyone is skinnier yet fatter. Women weren’t sticks; men weren’t pumped muscles. Yet they were healthy and energetic. I wondered: why do muscles look so different now, look plumper and more defined, when decades ago people had to be stronger because daily living required more physical work and some jobs required more strength or the same strength as they do now? Marbling. That was the answer I got.  Today, people have more  fat in their muscles, which plumps the muscles up. Think of top Alberta steak. It’s value comes from the fat that marbles the muscle so that during cooking, the fat liquifies and keeps the meat moist. Well, humans are nicely marbled too today, way more than in decades part, because of what they eat. Our diet has changed that much apparently.

I believe this change in the look of muscles and, concurrently, our average size, has changed our perception of what is normal. Some people think I look normal weight, but given my genetic heritage and my midriff circumference, I’m not. I’m too big. I bet when I reach my normal weight, I’ll be getting comments on how skinny I am. But if I was put back in time, I would fit right in with the general population.

Today, researchers consider that normal weight is best measured by stomach circumference. Men need to have stomachs <102 cm (40 in) in circumference and women <88cm (35 in), and the waist-hip ratio must also be <0.9 for men and <0.85 for women in order to be considered normal weight.

Although gaining weight is the central preoccupation and problem of North Americans, losing weight when not trying (i.e., with no change in diet, exercise, or lifestyle) is also not good, and going below a certain weight for your height leads to bad nutritional status too.

Normal Energy

Sometimes I wonder what is normal energy. Sometimes I feel like people of my parents’ generation had more energy than healthy people today do … or maybe that generation just didn’t whine about things but got on with it. In any case, you must differentiate between low energy caused by disease or injury and low energy caused by nutritional deficiencies. Many things can cause your energy levels to drop, like a chronic illness or recovering from an injury or surgery. It’s the unexplained changes from your normal energy levels that may signal malnutrition, assuming you’ve ruled out disease or syndromes.

So I asked: is it worth testing any nutrients? Yes. Three. Vitamin D. Iron. And Vitamin B12 in certain populations.

Vitamin D

This vitamin is important for bone strength and does affect energy levels. Briefly and simply, if you have too little Vitamin D, then your parathyroid hormone will shrink your bones, leading to osteoporosis. If you have too much, then the parathyroid will stop making bone, also not good. The levels of Vitamin D that lead to one or the other are not far apart. Tis a fine balance. Vitamin D supplementation will prevent the former from happening, but now that the Ontario provincial government is making people pay, how will you be able to afford a sufficient number of tests to know when you’re in balance and are keeping in balance? Well, there is one caveat: weight-bearing exercise or obesity, both of which stress the bones, will cause bone to continue to be created even if Vitamin D levels are high enough to shut off the parathyroid. If a person is using weight and gravity to stress the bones, then the real problem is in ensuring you’re taking enough supplementation to avoid a too-low level. However, there is now controversy over what that level is. Only time, unfortunately, will tell who is right.

Iron

We have known for decades that too little iron leads to anemia. Ferritin is a good indicator of iron deficiency, which is fairly common among young women. Too much iron will change your skin colour, among other problems. If you’re having energy problems, this is an obvious test to do.

Vitamin B12

Recent research shows that in the elderly — people older than about seventy years of age — low B12 can lead to cognitive decline. Apparently, the elderly metabolize this vitamin differently than the general adult population. I didn’t understand the science behind how eating normal amounts of B12 can lead to this decline in the over-seventy set, but suffice to say that researchers discovered that supplementing the diet with B12 in the elderly led to significant improvements in cognitive performance. In short, old people’s brains work better when given B12.

Vegetarians and vegans should also be tested for B12 as the best sources of this vitamin are from meat or lots of micro-organisms in water (I wouldn’t want to have the latter, my stomach less so!). The body stores this vitamin for five years, so if you’ve been eating a meat-free diet for that number of years or longer, then it’s probably time to be tested.

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Please note: this is for informational purposes only and does not constitute advice of any sort nor can I give personalized advice. Also note that cholesterol and glucose tests are not involved in nutritional status and continue to be important tests regardless of nutritional status.

Health

The Core of The GI Diet by Gallop: The Glycemic Index

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Aside from my rebellious first impressions of The GI Diet by Rick Gallop, I have to admit that this book does one thing very well: makes the glycemic index intelligible and practical.

Dr David Jenkins* at the University of Toronto developed the glycemic index as a way to measure how a particular food affects glucose levels in the blood and its attendant insulin response. Huh? Basically, a food will either make your blood sugar skyrocket or not. Those that do are bad bad bad for you. Those foods cause your pancreas to pump out large doses of insulin rapidly that suck up the blood sugar and then stuff the excess into your fat cells. The sugar becomes stored fuel, not used fuel. Gallop calls them red light foods. Those foods that cause your blood sugar to soar quickly but not too quickly, Gallop calls yellow light foods, like the amber light at an intersection that warns you to look before proceeding. In this case, think do you really want to eat this, is the transient pleasure worth the rise in blood sugar and all that will lead to, primarily weight gain and blood glucose results your GP will tsk tsk over? Then there are foods that cause a slow, long-lasting rise and fall of blood sugar like a slow, warm wave that washes over you langurously. Those foods Gallop calls green light foods because you can eat as much as you want when you want — within reason of course. Because the blood sugar rises slowly, it’s used as fuel for the body as you go about your life; there is no excess the body sees as storage potential and thus you don’t grow your fat cells. (Gallop explains it differently: red light foods give you a sugar high then a sugar low that leads you to look for more to eat, and that’s how you get fat.)

Gallop makes the index even more understandable by creating a small table of basic, everyday foods that you can eat but in strict moderation if you want to lose weight. My only gripe with this table is you got to remember the page it’s on and to keep looking at it else you’ll forget that no, it’s not 2 slices of bread at a meal but 1 that you can eat. What would’ve been nice is a pull-out card listing these foods that you could stick on your fridge or bread box where it’s always visible.

Gallop makes his traffic light analogy even more followable by listing at the back almost every food in colour-coded columns under category headings so that it’s easy to find out if what you want to eat is green lighted. And right at the beginning where he talks about starting Phase I of the GI Diet, the weight loss phase, he lists them under breakfast, lunch, dinner, and snack, which makes it even easier when starting this diet.

Some people think it’s easy to follow a GI diet cause you just eat more fibre. I’ve had one rather obese person say she doesn’t need to get the book because she eats healthy, no white bread, no white sugar. Uh huh. Clearly, losing weight and keeping it off is more than just switching one’s bread to whole wheat. First off, in Canada, whole wheat does not mean whole grain, and only whole grains give you the complete nutrition and fibre content of the wheat. Also, did you know that how the wheat is milled will change its glycemic index rating? If it’s milled the conventional way it’ll cause a much faster, higher blood sugar rise than if it’s stoneground.

I was in the mood for a sandwich the other day — a no-no as a sandwich is 2 slices and I’m supposed to have only 1 slice per meal, but what the hey, I was in the mood, and a Herbivore sandwich for me is 2 meals anyway. So I went there, and as she was preparing my yummy, huge sandwich, I noticed all these goodies. Several used spelt flour, so being mindful of what Gallop had said about stoneground wheat only, I asked, “Is the spelt flour you use stoneground?” I got a blank look, the kind that screams I’ve never heard that question before. She asked someone in back; that person said she had no idea but now was so intrigued just had to find out. Several minutes later, she replied, it’s stoneground. Whoo hoo! I bought a chocolate chip “cookie.” Yum, yum, yum. OK the bananas in it were not the most GI friendly but the flour was as were the rest of the ingredients, so I figured I was good. I continued to lose weight after indulging in that anyway.

The problems I had with converting my diet to The GI Diet were in finding the kinds of crackers and breads and snacks I could eat. I discovered that many so-called high-fibre breads and crackers were not, despite what the labels said. I would buy a package of what I thought was the good stuff, take it home, compare the fibre grams in it to what Gallop said it should be and find it sadly lacking. I finally wrote down the nutritional requirements to take with me to the store and spent hours poring over labels. As Jane Haddam is so fond of saying in her Demarkian mysteries, it made my head hurt. I would say it took me about a half dozen trips plus a couple by my mother to the grocery store for me to finally get my snacks and breads in order.

Gallop recommends Wasa brand crispbreads; the store clerk told me they fly off the shelves. I don’t know why. They made my gums hurt (and I’ve never had problems with seeds before), feel like sawdust, and taste so-so. Back to the cracker aisle. I had the added problem of trying to find an organic product as I prefer my diet to be as close to 100% organic as possible, at least at home anyway. I finally settled on Holland Organic and Ryvita. The latter is not organic, and the former, after I did the math, I realised didn’t have enough fibre in it. Ryvita seemed very familiar to me. Turns out my maternal grandmother insisted on my mother keeping it in stock for her. It’s a lot tastier than Wasa, and my gums are OK too. But the Holland cracker is absolutely terrific with cream cheese and strawberry jam. So I may treat myself to those every once in awhile.

Bread was a bear to find. First off, I guess I’m fussy. I like slightly sweet — sweet from the grain, not sugar — chewy, flavourful whole wheat bread. I tried multigrain, and although it’s OK, I much prefer whole wheat. Plus multigrain breads are not all made the same. Most don’t have enough fibre in them. Then I had to figure out which whole wheat was stoneground. What a pain in the you-know-what. Most breads don’t list that on the label. I had to go surfing their websites and, in the end, just go in to the wholesale-retail outlet and ask. The St John’s Bakery Integral and Red Fife breads are made with stoneground flour. They’re pretty darn good too. Tough to keep to the 1-slice-per-meal rule.

And lastly, I hadn’t eaten protein bars before but after reading and rereading Gallop’s 3 meals, 3 snacks plan of green-light foods for weight loss, I decided that would be the easiest way to fulfill at least 1 snack requirement. Ha! I went to 3 different stores, stood in front of 3 different protein bar aisles, compared the nutrition labels of all these bars to what Gallop recommends, and wanted to give up right then and there. Too much fat, not enough protein, too much sugar, way too many calories, ingredients that sound like a pharmacy aisle, ingredients that make me gag, not organic. The ones I settled on were closest to his requirements but were too caloric and had too much fat. And then my mother remembered that my father Dr. Khursheed Jeejeebhoy works with a woman who has developed an entire line of low-calorie, low-fat protein bars that triathletes love. The Simply Bar. And they exceed Gallop’s recommendations too. So now I got my snacks sorted.

Next, his fat rules.

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*I worked in Dr. Jenkins lab one summer as a student. It was nice to work with human diets for a change instead of rats, and I may actually have been there when he was developing the glycemic index. I remember being fascinated with his work and regretting that I spent such a short time there. Most summers I worked in Dr. Harvey Anderson’s nutrition labs at the other end of the building and learnt a lot from his staff.

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Related Articles:

Type 2 Diabetes Plays Gotcha

First Impressions of The GI Diet by Rick Gallop

The Three-Month Type 2 Diabetes Followup

The GI Diet: Could I Stick it in the Long Run?

News

Is Mohamed Mahjoub Starving Himself? Jeejeebhoy Answers in the Toronto Star

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My father Dr. Khursheed N. Jeejeebhoy “retired” a few years ago; his last grant for research at the University of Toronto had run its course, and, after 40 years of filling in tedious grant applications, he felt it was time to say no more. Yet his expertise is still in demand, mostly around the world. I still am amused when thinking of the story of Canadian doctors heading down to the big hospitals in the US looking for expert help on TPN and receiving puzzled looks as the Americans said to them you have the TPN big guy in your own backyard, what’re you doing down here? Why the University of Toronto and every hospital in Toronto aren’t picking his brains and demanding he teach residents in TPN and nutrition is beyond me (one group of residents were even forbidden from going over to St Mike’s to learn from him), but it’s heartening to see the Toronto Star know who to turn to when looking for an answer to the question of how a terrorist on a hunger strike will fare. Is Mohamed Mahjoub technically starving himself as his doctor claims? Jeejeebhoy answers:

Starvation occurs when the body can no longer protect the brain and heart from malnutrition, he said.

Our body is designed so that other body parts, especially fat stores and the skeletal muscles, give themselves up to keep the brain and heart fed. The fat stores go first, Jeejeebhoy said, as your body converts these into carbohydrates to sustain life. Then the muscles are tapped as an energy source. (Joseph Hall, The Toronto Star, 16 October 2009)

To read the rest of his answer on Mahjoub’s hunger strike, check out the Second Opinion article in the GTA section.

Lifeliner

Diabetic in Sweden Reads Lifeliner and Helps His Feet

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It’s been too long since my last blog post, but my mind was totally blank about topic possibilities this morning. And then I got an e-mail from my Swedish friend Britt Lindqvist, and my eyes popped.

I met Lindqvist through the research I did for my book Lifeliner. Those of you who have read the book will recognize her name. She told me a great story that started last summer when she sent a copy of Lifeliner to her friend. She wrote:

“As being a diabetic for quite [a] long time he had got trouble with his feet. When he read about all your father’s strain to help Judy, he became very interested when he read that your father gave Judy Chrome [chromium], because of the trouble with her feet. He also felt as if he had cotton under his feet.”

He immediately went out and bought chromium. And do you know, his feet got better! As she wrote, “You can imagine how happy he is!”

I can, but what I can’t imagine is how a book about Judy Taylor and the development of TPN (total parenteral nutrition) would have such an impact on the physical health of a man half a world away in the here and now. But then that’s what Judy did during her lifetime.

It gets better.

He was so thrilled with how chromium improved his health that he mentioned it to his female doctor, a specialist in diabetes. Now, I knew that my father’s 30-year-old discovery of the role of chromium in diabetes was still barely explored, but I had thought most specialists would be aware of it by now. Apparently not. Some research flies through doctors’ offices everywhere, especially when touted by marketing-savvy researchers and hospitals, while some obviously plods its way through. This Swedish doctor had not heard of the role of chromium in diabetes, was very interested when informed by her patient (that’s a good doctor, one who listens and is not afraid to learn from her patients), and is now discussing it with her colleagues. On top of all that, the friend knows a professor who is also interested in this information and is discussing it with his colleagues. This diabetic has got the chromium ball rolling in Sweden. Given how Sweden was the centre of research into artificial feeding back when my father started his work, it would not surprise me if this ball leapfrogs them ahead of the world in treating diabetes.

I wonder though if Canadian diabetes’ specialists know about chromium and have incorporated that knowledge into their treatment protocols. And I wonder why, when the news of my father’s discovery hit the media back in the 1970s, they didn’t immediately leap onto it, especially as Canada birthed the famous Banting and Best. Well, it’s probably the same reason why a Canadian living in Ontario recently had the Mayo Clinic refer her to my father for treatment of her disease. Amazing that, eh? A renowned American clinic still regards him highly while the local teaching hospital has been busy trying to put him out to pasture, and the University of Toronto already kicked him out as being too old (once he’d finished his last grant — they didn’t want to lose that money).

If Canadian specialists and researchers were, as a group, happy to learn from, encourage, and tout the findings of their highly successful colleagues, then all specialists around the world would by now know much more about chromium and its role in diabetes — you would even be able to easily find an entry on chromium in the Banting and Best Diabetes Centre, an Extra Departmental Unit of the Faculty of Medicine at the University of Toronto. And Lindqvist’s friend would not have had to suffer from cotton wool feet for so long.

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Update: Wikipedia has a good general article on chromium and one on chromium deficiency. It’s interesting that the trivalent form of chromium is safe, whereas hexavalent chromium is toxic. One thing the article on chromium deficiency missed mentioning, as Dr. Jeejeebhoy pointed out, is that with the aging body, chromium falls and may account for the glucose intolerance of the older person. Also increased insulin levels as found in diabetics increase chromium loss from the body and depletes body chromium.

Personal

A Lactose Rant: Goat’s Milk vs. Cow’s Milk

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The Oprah Show was interesting today, looking at the Blue Zones — places where centenarians thrive in good health — and Dr. Mehmet Oz, Oprah’s medical guru, served as the guide for the show. Dr. Oz, with his partner, also writes a column for The Toronto Star, talking a lot about nutrition. He’s a cardiac surgeon; still, for a surgeon most of his expert opinions aren’t too off the mark. But the one he spouted today was the same old BS that I’ve heard on talk shows, read in newspapers, and heard people pontificate on too many times. And I’m getting mighty sick of it. He said the lactose intolerant should drink goat’s milk. Just hearing it makes me want to run screaming for the Buscopan.*

What a load of crap, I yelled at the TV. And why do I hear it over and over?

My father Dr. Khursheed Jeejeebhoy is a top nutritional researcher and was one of the first to recognize lactose-intolerance back in the 1960s and to evaluate methods for measuring intestinal lactase (one day I’ll tell the story behind that study!). So when I developed stomach pains after we moved to Canada, he knew immediately it was lactose intolerance even though no one here had ever heard of it here. And when I became intimately acquainted with my English Aunt’s bathroom, he knew the culprit: goat’s milk.

My Aunt started breeding goats to help rid her daughter of asthma, and so every time we visited her, goat’s milk and goat meat were regularly on the menu. I remember the first time we visited her after she started breeding goats, she poured glasses of fresh milk all around for us kids; I hesitated to drink the milk because I’d come to associate milk from Western animals as dangerous to my peace of mind. But she encouraged me. Well, it wasn’t too long before I broke the speed barrier to get to the bathroom. Too bad for everyone that there was only one in the house. Cow’s milk was bad enough; goat’s milk was lethal! Thereafter, I inspected my Aunt’s cooking closer and closer for hidden signs of goat’s milk — she’d toss it in anything, even my favourite baked treats, and then forget that she had — because even when I was sure it wasn’t there, my stomach would quickly let me know otherwise. So when all these experts talk about how goat’s milk is more digestible for the lactose intolerant, I think what a crock of shit.

Here are the lactose figures:

Cow’s milk ranges from a low of 4.66 to 5.15, depending on breed, with the common Holstein having 4.93 on average. Goats, on the other hand, again depending on breed, range from 4.54 to 6.4, with Saanens about on par with Holsteins, although some Holsteins have tested for much lower levels at 3.51. Goats, as you can see, can easily have more lactose than cows, or at best the same amount.

So next time some dingbat, even disguised as an expert, tells you oh yeah, goat’s milk is fine, don’t believe them for a second.

As for Dr. Oz’s contention that the fat in goat’s milk may be more digestible because of its smaller globule size, dairy research scientists at an international symposium on goat’s milk back in 1980 debunked that myth and posited the much more logical suggestion that

“Nearly 20% of fatty acids in goat milk fat are in the category of short and medium chain length (4 to 12 carbons). Cow milk fat contains only 10 to 20% of fatty acids of this category. This difference may contribute to more rapid digestion of goat milk fat since lipases [enzymes that break up fat] attack ester linkages of such fatty acids more readily than they do those of longer chains.”

It’s interesting to note that Dr. Jeejeebhoy made major nutritional breakthroughs in Total Parenteral Nutrition (TPN) for Judy Taylor because he included animal science literature in his regular reading. That’s why he didn’t fall into the big goat milk myth.

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*Buscopan was a tiny little miracle pill my parents would give me to ease stomach cramps from lactose intolerance, as I couldn’t always avoid milk, being as no one else believed in lactose intolerance and asserted that I needed to drink my milk.