Monday, October 29, 2018

The Cerebellum – Surprising New Findings

The cerebellum is located on the underside of the brain and has been thought to be limited to controlling movement. It has been treated like an afterthought by researchers studying higher brain functions. However, researchers at Washington University School of Medicine in St. Louis say overlooking the cerebellum is a mistake. Their findings, published Oct. 25, 2018 in Neuron, suggest that the cerebellum has a hand in every aspect of higher brain functions -- not just movement, but attention, thinking, planning and decision-making.
"The biggest surprise to me was the discovery that 80 percent of the cerebellum is devoted to the smart stuff," said senior author Nico Dosenbach, MD, PhD, an assistant professor of neurology, occupational therapy and of pediatrics. "Everyone thought the cerebellum was about movement. If your cerebellum is damaged, you can't move smoothly -- your hand jerks around when you try to reach for something. Our research strongly suggests that just as the cerebellum serves as a quality check on movement, it also checks your thoughts as well -- smoothing them out, correcting them, perfecting things."
Dosenbach is a founding member of the Midnight Scan Club, a group of Washington University neuroscientists who have taken turns in an MRI scanner late at night, scanning their own brains for hours to generate a massive amount of high-quality data for their research. A previous analysis of Midnight Scan Club data showed that a kind of brain scan called functional connectivity MRI can reliably detect fundamental differences in how individual brains are wired.
Postdoctoral researcher and first author Scott Marek, PhD, decided to apply a similar analysis to the cerebellum. In the better-known cerebral cortex -- the crumpled outer layer of the brain -- wiring maps have been drawn that connect distant areas into networks that govern vision, attention, language and movement. But nobody knew how the cerebellum is organized in individuals, partly because a quirk of MRI technology means that data obtained from the underside of the brain tend to be low quality. In the Midnight Scan Club dataset, however, Marek had access to more than 10 hours of scans on each of 10 people, enough to take a serious look at the cerebellum.
Using the cortex's networks as a template, Marek could identify the networks in the cerebellum. Notably, the sensory networks are missing -- vision, hearing and touch -- and only 20 percent of the cerebellum is devoted to movement, roughly the same amount as in the cerebral cortex. The remaining 80 percent is occupied by networks involved in higher-order cognition: the attention network; the default network, which has to do with daydreaming, recalling memories and just idly thinking; and two networks that oversee executive functions such as decision-making and planning.
"The executive function networks are way overrepresented in the cerebellum," Marek said. "Our whole understanding of the cerebellum needs to shift away from it being involved in motor control to it being more involved in general control of higher-level cognition."
The researchers measured the timing of brain activity and found that the cerebellum was consistently the last step in neurologic circuits. Signals were received through sensory systems and processed in intermediate networks in the cerebral cortex before being sent to the cerebellum. There, the researchers surmise, the signals undergo final quality checks before the output is sent back to the cerebral cortex for implementation.
"If you think of an assembly line, the cerebellum is the person at the end who inspects the car and says, 'This one is good; we'll sell it,' or 'This one has a dent; we have to go back and repair it,'" Dosenbach said. "It's where all your thoughts and actions get refined and quality controlled."
People with damage to their cerebellum are known to become uncoordinated, with an unsteady gait, slurred speech and difficulty with fine motor tasks such as eating. The cerebellum also is quite sensitive to alcohol, which is one of the reasons why people who have had too many drinks stumble around. But the new data may help explain why someone who is inebriated also shows poor judgment. Just as a person staggers drunkenly because his or her compromised cerebellum is unable to perform the customary quality checks on motor function, alcohol-fueled bad decisions might also reflect a breakdown of quality control over executive functions.
Marek also performed individualized network analyses on the 10 people in the data set. He found that while brain functions are arranged in roughly the same pattern in everyone's cerebellum, there is enough individual variation to distinguish brain scans performed on any two participants. The researchers are now investigating whether such individual differences in cerebellar networks correlate with intelligence, behavior, personality traits such as adaptability, or psychiatric conditions., Dosenbach said: There are four times as many neurons in the cerebellum as in the cerebral cortex, so if you're leaving out the cerebellum, you've already shot yourself in the foot before you started. The promise of imaging the whole human brain at once is to understand how it all works together. You can't see how the whole circuit works together when you're missing a major piece of it."
This article comes from an October 25th post from the website Science Daily. Materials provided are from the Washington University School of Medicine
The take -home message from these findings are - treat your brain with great care!  Avoid head injuries in sports; don’t let your kids play tackle football. Headers in soccer can also be dangerous.  Treat alcohol and other drugs with caution.  Do some exercise – it stimulates the production of new brain cells.  Getting adequate sleep helps the brain, as do self-calming practices such as meditation. Eating a plant based diet low in salt will prevent obesity and high blood pressure, which will favor brain health. Your brain makes you, you.  Have a lot of respect for yourself, as well as others!
Sadja Greenwood, MD, MPH   leave me a message





Monday, October 15, 2018

The Health Risks of Alcohol

On August 24, 2018, the Lancet published a paper based on a study from the University of Washington,concluding that there is no safe level of drinking alcohol. The Lancet is a renowned English and international medical journal.  The study shows that in 2016, nearly 3 million deaths globally were attributed to alcohol use, including 12 percent of deaths in males between the ages of 15 and 49.

"The health risks associated with alcohol are massive," said Dr. Emmanuela Gakidou of the Institute for Health Metrics and Evaluation at the University of Washington and the senior author of the study. "Our findings are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer, and cardiovascular problems. Zero alcohol consumption minimizes the overall risk of health loss." Gakidou is a professor of health metrics sciences at the UW School of Medicine, and of global health at the UW School of Public Health.
The study does not distinguish between beer, wine, and hard liquor due to a lack of evidence when estimating the disease burden, Gakidou said. However, researchers used data on all alcohol-related deaths generally and related health outcomes to determine their conclusions.
Alcohol use patterns vary widely by country and by sex, the average consumption per drinker, and the attributable disease burden. Globally, more than 2 billion people were current drinkers in 2016; 63% were male.  Alcohol use was less in countries with large numbers of Muslims, as Islam forbids and discourages drinking.  
The study looked at deaths and overall poor health attributable to alcohol for 23 health outcomes, such as communicable and non-communicable diseases and injuries, including:
  • Cardiovascular diseases: atrial fibrillation and flutter, hemorrhagic stroke, ischemic stroke, hypertensive heart disease, ischemic heart disease, and alcoholic cardiomyopathy;
  • Cancers: breast, colorectal, liver, esophageal, larynx, lip and oral cavity, and nasal;
  • Other non-communicable diseases: cirrhosis of the liver due to alcohol use, diabetes, epilepsy, pancreatitis, and alcohol use disorders;
  • Communicable diseases: lower respiratory infections and tuberculosis;
  • Intentional injuries: interpersonal violence and self-harm;
  • Unintentional injuries: exposure to mechanical forces; poisonings; fire, heat, and hot substances; drowning; and other unintentional injuries; and
  • Transportation-related injuries.
"We now understand that alcohol is one of the major causes of death in the world today," said Lancet Editor Richard Horton. " We need to act urgently to prevent these millions of deaths. The myth that one or two drinks a day are good for you is just that -- a myth. This study shatters that myth."
The take home message from this study is complicated.  Companies providing beer, wine and hard liquor are enormously large and powerful, permeating the world of sports, dining and agriculture. Cutting down on alcohol use means resisting pressures from many directions – advertising, friends, social events, and habits.  If you want to abstain, and can go 3-4 days without alcohol, you are probably not seriously addicted and can make the shift. You may decide to have a single drink on special occasions, such as your birthday, but be sober at other events.   If you have been a regular drinker and have great difficulty abstaining a day or two, you should see your doctor to discuss the possible use of temporary drugs to help you through the transition to sobriety.  In either case, you should start going to AA meetings, both for help and to meet other non-drinkers.  You will get a sponsor who will help your transition.  Don’t worry if you don’t believe in a God – the group itself, or nature, can function as your higher power.  
Sadja Greenwood, MD, MPH    back issues on this blog






Monday, October 8, 2018

Are Sugar-Free Chemicals Affecting Your Gut?

According to a new paper by researchers at Ben-Gurion University in Israel and Nanyang Technological University in Singapore, FDA-approved artificial sweeteners and sport supplements were found to be toxic to digestive gut microbes. The  study looked at the relative toxicity of six artificial sweeteners (aspartame, sucralose, saccharine, neotame, advantame, and acesulfame potassium-k) and 10 sport supplements containing these artificial sweeteners. The bacteria found in the digestive system became toxic when exposed to concentrations of only one mg./ml. of the artificial sweeteners.  The researchers modified  bioluminescent E. coli bacteria, which luminesce when they detect toxicants and act as a sensing model representative of the complex microbial system,.  They stated: "This is further evidence that consumption of artificial sweeteners adversely affects gut microbial activity which can cause a wide range of health issues."
Artificial sweeteners are used in countless food products and soft drinks with reduced sugar content. Many people consume this added ingredient without their knowledge. Moreover, artificial sweeteners have been identified as emerging environmental pollutants, and can be found in drinking and surface water, and groundwater aquifers. According to the researchers - "The results of this study might help in understanding the relative toxicity of artificial sweeteners and the potential of negative effects on the gut microbial community as well as the environment. Furthermore, the tested bioluminescent bacterial panel can potentially be used for detecting artificial sweeteners in the environment.”
Diet Coke, Diet Pepsi, Sprite Zero and other sports drinks contain aspartame and acesulfame potassium as artificial sweeteners, along with other ingredients for flavoring. Splenda is sucralose.  
As you are aware, your gut microbes play a large role in your digestive health, your weight and the strength of your immune system.  They thrive on a diet with lots of fiber from vegetables and fruits.  This recent study, published in the journal Molecules, can be toxic to these important bacteria.  
What are your alternatives for a thirst-quenching drink that will not harm your gut and allow you to avoid sugar?  Slice an organic orange, other fruit or cucumber into a glass bottle of water and sip from it during the day.  Add mint and other herbs.  Drink plain coffee and a variety of teas, Sweeten with small amounts of stevia (this plant derived sweetener may not be safe for the kidneys with excessive use, but is considered safe as ordinarily used.)  Yacon syrup, derived from a plant grown in the Andes, is another recently popular sweetener.  It has not been extensively studied, but should probably be used sparingly.  The syrup can cause abdominal pains, nausea, bloating and diarrhea when taken in doses greater than two teaspoons a day.  You can retrain your taste buds to prefer unsweetened foods.  If you order or make a fruit smoothie, use a permanent straw – not a disposable plastic one.  Try a few raisins and nuts for a treat.  

Let’s celebrate Indigenous Peoples Day.  

Sadja Greenwood, MD. MPH