A New Way to Control Stressful Emotions

The simple act of talking to yourself by using your own name, rather than thinking of yourself as ‘I’, may help you control difficult or painful emotions more easily.  Studies done at Michigan State University and the University of Michigan, and published online in Scientific Reports in July, 2017, have shown that such third person self-talk may constitute a  relatively effortless form of self-control. 

Here’s an example – Robin is feeling angry and hurt after and argument with a former friend.  Her ordinary thinking would have involved inchoate feelings that, put into words, would revolve around the pronoun  ‘I’ – I’m so mad at her – she was horrible to me – I’m feeling sick about what happened – I’m going to give her a piece of my mind tomorrow etc. 

However, if Robin has trained herself to talk to herself in the third person, she might ask “I see that Robin is very upset.  How can I help her understand what happened?  How can I help her feel better about this?  What’s my advice to her?”  Robin is giving advice to herself as she would to a friend.  This technique helps Robin gain a tiny bit of psychological distance from her experience , which can be helpful in regulating her emotions.

The researchers on this study, which was funded by the National Institutes of Health and the John Templeton Foundation, carried out two experiments to test the hypothesis that third person thinking would help with stress.  Participants – mainly healthy young men and women – viewed neutral and then disturbing images and reacted to the images in both the first and third person while their brain activity was monitored by an electroencephalograph.  When reacting to a frightening image, their emotional brain activity decreased almost immediately when they referred to themselves in the third person.  The researchers found that using the third person was no more effortful than using first person self-talk in terms of effort related brain activity.

In the second experiment, participants reflected on painful experiences from their past, using first and third person languages while their brain activity was measured using functional magnetic resonance imaging.  When they used third person self-talk, their brains showed less activity in a region commonly implicated in reflecting on painful emotional experiences.  Again, third person self-talk required no more effort-related brain activity than using first person.

University of Michigan psychology professor Ethan Kross, who directs the Emotion and Self-Control Lab, had this to say about the studies:  “What’s really exciting here is that the brain data from these two complimentary experiments suggest that third person self-talk may constitute a relatively effortless form of emotional regulation.  If this ends up being true – we won’t know until more research is done – there are lots of important implications these findings have for our basic understanding of how self-control works, and for how to help people control their emotions in daily life.”   The research teams are continuing to explore how third person self-talk compares to other emotion regulation strategies.

I’ve been trying out self-talk since reading about these studies, often silently, as I experience painful emotions.   It’s interesting to call yourself by your own name, and give yourself soothing and practical advice.  I have found that I can achieve balance with less despair or upset.  Give it a try! 

Sadja Greenwood, MD, MPH  past issues on this blog

Osteoporosis and Yogurt

A recent study from Trinity College in Dublin, Ireland is the largest observational study to date of bone measurements in older men and women and dairy intake.  After taking into account traditional risk factors for bone strength or frailty, the researchers found that increased yogurt intake was associated with higher hip bone density and a significantly reduced risk of osteoporosis in older Irish men and women. 

The study analyzed a wide ranged of factors that could contribute to bone strength or weakness, such as BMI, kidney function, physical activity or inactivity, servings of milk or cheese, calcium and vitamin D supplements, smoking, and alcohol use. After adjusting for these factors, total hip and femoral neck bone density in women were 3.1 – 3.9% higher among those with the highest yogurt intakes compared to the lowest.  In men, the biomarker of bone breakdown was 9.5% lower in those with the highest yogurt intakes compared to the lowest – showing reduced bone turnover.  Vitamin D supplements were also associated with significantly reduced risk in both men and women.

Lead author of the study and research fellow at the Centre for Medical Gerontology, Trinity, Dr Eamon Laird said: "Yogurt is a rich source of different bone promoting nutrients and thus our findings in some ways are not surprising. The data suggest that improving yogurt intakes could be a strategy for maintaining bone health but it needs verification through future research as it is observational."

Dr Miriam Casey, senior investigator of this study and Consultant Physician at St James's Hospital Dublin said: "The results demonstrate a significant association of bone health and frailty with a relatively simple and cheap food product. What is now needed is verification of these observations from randomized controlled trials as we still don't understand the exact mechanisms which could be due to the benefits of micro-biota or the macro and micro nutrient composition of the yogurt."

The study included 1,057 women and 763 men who underwent a bone-mineral-density (BMD) assessment and 2,624 women and 1,290 men who had their physical function measured. Yogurt consumption information was obtained from a questionnaire and categorized as never, 2-3 times per week and more than one serving per day.

The Irish study did not look at the type of yogurt eaten, and whether it was sweetened or unsweetened.  However, it is wise to consider the fat and sugar content of the yogurt you eat if you are planning to increase your intake.  A study done by Kaiser Permanente researchers suggests that women with breast cancer should avoid high-fat dairy foods, which may contain more estrogen from the cows’ milk fat.  Avoiding too much sugar in your diet, a smart move for all of us, may mean that you find ways to enjoy plain yogurt with fruit, or eat it as they do in India, with spicy lentils (dal).

Previous studies on milk intake and osteoporosis have shown mixed results in terms of fractures and bone density.  One study showed benefits from both milk and yogurt in the diet.  This is the first large study to show that yogurt may be more beneficial than other dairy products.

Sadja Greenwood,  MD, MPH

The Benefits of Mind-Body Interventions – Take a deep breath and read!

Mind-body interventions (MBIs) such as mindfulness, yoga, Tai Chi, Qigong, the relaxation response, and breath regulation were studied by researchers in Coventry University in England and Radboud University in the Netherlands.  They looked at published studies that examined changes in gene expression in MBIs  and explored how these changes are related to health.  They found and analyzed 18 relevant studies ,  including 848 participants, publishing their findings in Frontiers in Immunology, June, 2017.  

Overall, the studies indicated that MBI practices are associated with a pattern in the molecular changes that happen in the body, and how these changes may benefit our mental and physical health.  Research on stress and inflammation has looked at nuclear factor kappa B (NF-kB), which is produced when stress activates the sympathetic nervous system (fright/flight/fight).  NF-kB translates stress into inflammation.  Lower activity of NF-kB  suggests reduced inflammation. 

While acute inflammation is a short-lived adaptive response that enables the immune system to fight injury or infections, chronic inflammation is maladaptive because it persists when there is no actual threat to the body.  According to the study, it is associated with increased risk for some types of cancer, neurodegenerative diseases, asthma, arthritis, cardiovascular diseases, and psychiatric disorders such as depression and posttraumatic stress. 

The study found that people who practice MBIs have been found to have a decrease in the production of pro-inflammatory gene expression.  The authors caution that the studies they looked at did not have control groups and measured the MBI interventions for varying amounts of time.  More exacting research is needed. 

However, the researchers were encouraged by the results they found.  Lead investigator Ivana Buric from the Brain, Belief and Behavior Lab at Coventry University said “Millions of People around the world already enjoy the health benefits of mind-body interventions like yoga or meditation, but what they perhaps don’t realize is that these benefits begin at a molecular level and can change the way our genetic code goes about its business.  These activities are leaving what we call a molecular signature in our cells, which reverses the effect that stress or anxiety would have on our body by changing how our genes are expressed. Put simply, MBIs cause the brain to steer our DNA processes along a path that improves our wellbeing.  More needs to be done to understand these effects in greater depth, for example how they compare with other healthy interventions like exercise or nutrition.  But this is an important foundation to build on to help future researchers explore the benefits of increasingly poplar mind-body activities.”

Here is West Marin we are fortunate to have great classes in yoga, Tai Chi, Qigong and meditation.  I have found a computer class called Mindfulness Daily with Jack Kornfield and Tara Brach from Soundstrue, which is helping me.   There’s something for everyone. 

Sadja Greenwood, MD, MPH

All About Olive Oil and Your Brain

Researchers from the Lewis Katz School of Medicine at Temple University (Philadelphia) have identified a specific ingredient in extra-virgin olive oil (EVOO) that protects against cognitive decline.  In a study published online in the Annals of Clinical and Translational Neurology, June 21^st, 2017, researchers found that  EVOO protects memory and learning ability by reducing the formation of classic markers of Alzheimer’s disease in the brain – amyloid-beta plaques and neurofibrillary tangles.  The Temple team, led by Dr.Practico, identified the mechanisms by which EVOO is effective: “We found that olive oil reduces brain inflammation but most importantly activates a process known as autophagy.” Autophagy is the process by which cells break down and clear out intracellular debris and toxins, such as amyloid plaques and tau tangles.

"Brain cells from mice fed diets enriched with extra-virgin olive oil had higher levels of autophagy and reduced levels of amyloid plaques and phosphorylated tau," Dr. Praticò said. Phosphorylated tau is responsible for neurofibrillary tangles, which are suspected of contributing to the nerve cell dysfunction in the brain that is responsible for Alzheimer's memory symptoms.

Previous studies have suggested that the widespread use of extra-virgin olive oil in the diets of people living in the Mediterranean areas is largely responsible for the many health benefits linked to the Mediterranean diet. "The thinking is that extra-virgin olive oil is better than fruits and vegetables alone, and as a monounsaturated vegetable fat it is healthier than saturated animal fats," according to Dr. Praticò.

The Mediterranean diet, as you probably know, consists of primarily plant-based foods such as vegetables and fruits, whole grains, legumes and nuts.  Butter is replaced by olive oil.  Herbs and spices flavor foods, so that less salt is used.  Red meat is limited to no more than a few times a month, while fish and poultry are eaten at least twice a week.  Red wine is used in moderation if desired (not to exceed one glass for women, two for men).  In previous studies, this diet has been associated with a decrease in high blood pressure, heart attack and stroke, and intestinal polyps. 

In order to investigate the relationship between extra-virgin olive oil and dementia, Dr. Praticò and colleagues used a well-established Alzheimer's disease mouse model. Known as a triple transgenic model, the animals develop three key characteristics of the disease: memory impairment, amyloid plagues, and neurofibrillary tangles. The researchers divided the animals into two groups, one that received a chow diet enriched with extra-virgin olive oil and one that received the regular chow diet without it. The olive oil was introduced into the diet when the mice were six months old, before symptoms of Alzheimer's disease begin to emerge in the animal model.

In overall appearance, there was no difference between the two groups of animals. However, at age 9 months and 12 months, mice on the extra virgin olive oil-enriched diet performed significantly better on tests designed to evaluate working memory, spatial memory, and learning abilities. Studies of brain tissue from both groups of mice revealed dramatic differences in nerve cell appearance and function.

"One thing that stood out immediately was synaptic integrity," Dr. Praticò said. The integrity of the connections between neurons, known as synapses, were preserved in animals on the extra-virgin olive oil diet. In addition, compared to mice on a regular diet, brain cells from animals in the olive oil group showed a dramatic increase in nerve cell autophagy activation, which was ultimately responsible for the reduction in levels of amyloid plaques and phosphorylated tau.

"This is an exciting finding for us," explained Dr. Praticò. "Thanks to the autophagy activation, memory and synaptic integrity were preserved, and the pathological effects in animals otherwise destined to develop Alzheimer's disease were significantly reduced. This is a very important discovery, since we suspect that a reduction in autophagy marks the beginning of Alzheimer's disease."

Dr. Praticò and colleagues plan next to investigate the effects of introducing extra-virgin olive oil into the diet of the same mice at 12 months of age, when they have already developed plaques and tangles. "Usually when a patient sees a doctor for suspected symptoms of dementia, the disease is already present," Dr. Praticò added. "We want to know whether olive oil added at a later time point in the diet can stop or reverse the disease."

Sadja Greenwood, MD, MPH