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Want to Lose Weight? Quantity of Calories Matters More Than Type

A new study by Hall and colleagues (2015) demonstrated that a low fat diet is slightly better for reducing body fat than a low carb diet ( both were effective though).

Abstract: Summary Dietary carbohydrate restriction has been purported to cause endocrine adaptations that promote body fat loss more than dietary fat restriction. We selectively restricted dietary carbohydrate versus fat for 6 days following a 5-day baseline diet in 19 adults with obesity confined to a metabolic ward where they exercised daily. Subjects received both isocaloric diets in random order during each of two inpatient stays. Body fat loss was calculated as the difference between daily fat intake and net fat oxidation measured while residing in a metabolic chamber. Whereas carbohydrate restriction led to sustained increases in fat oxidation and loss of 53 ± 6 g/day of body fat, fat oxidation was unchanged by fat restriction, leading to 89 ± 6 g/day of fat loss, and was significantly greater than carbohydrate restriction (p = 0.002). Mathematical model simulations agreed with these data, but predicted that the body acts to minimize body fat differences with prolonged isocaloric diets varying in carbohydrate and fat.

What does this mean? It means that if you need to lose weight, you’ll probably do better with cutting back on your calories rather than changing what you’re eating. It’s easier to eat less of the same rather than less of something different. Of course, if your diet lacks your basic nutritional needs, you’ll have to change (add vegetables and some fruits), but in general just eat less.

I burn about 2000 calories per day with just normal activities (based on my height, weight, gender, etc). This means if I wanted to lose weight I’d need to consume fewer than 2000 calories per day. It takes about 3500 calories to lose a pound. That’s not exact and isn’t exactly true because if you consume fewer calories, your body tries to maintain weight by burning fewer calories. However, at some point if you restrict your caloric intake under your daily “burning” of calories, you will lose weight. The other thing you can (and probably should) do is exercise.

Men burn about 120 kilocalories per mile while running (this is weight and speed dependent) but only burn about 85 per mile walking. Women burn about 100 per mile running (again, weight and speed dependent) and about 75 per mile walking (source: http://www.runnersworld.com/weight-loss/how-many-calories-are-you-really-burning). Factor in how much you burn throughout the day (sex and weight-dependent in addition to how active you are) and there’s your caloric target to be under.

Summary

  • Eat less (particularly fat)
  • Exercise more

Reference

Kevin D. Hall, Thomas Bemis, Robert Brychta, Kong Y. Chen, Amber Courville, Emma J. Crayner, Stephanie Goodwin, Juen Guo, Lilian Howard, Nicolas D. Knuth, Bernard V. Miller III, Carla M. Prado, Mario Siervo, Monica C. Skarulis, Mary Walter, Peter J. Walter, Laura Yannai, Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity, Cell Metabolism, Available online 13 August 2015, ISSN 1550-4131, http://dx.doi.org/10.1016/j.cmet.2015.07.021. (http://www.sciencedirect.com/science/article/pii/S1550413115003502)

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GABA receptor role in postoperative cognitive decline

About 20-30% of older adults (age greater than 60) undergoing major surgery experience temporary (generally reversed) memory and thinking deficits after major surgery, particularly heart and orthopedic. A small minority (<5%, probably much less) might not return to cognitive baseline (how they were before surgery). The cause of this decline in cognition is unclear, although many attribute it to the anesthesia used. So far, however, research has been inconclusive as to specific causes of cognitive difficulties after surgery. This is because surgeries are major events that affect most parts of the body, not just what is being operated upon. They are stressful – physically and emotionally.

Newly published research proposes one mechanism for causes of memory problems after surgery – anesthesia acting on ɣ-aminobutyric acid type A receptors (ɣ5GABAaR). This new research suggests that the function of these receptors does not return to baseline until much later than previously believed. This means that the normal function of chemicals in the brain, particularly ones important for memory, might be disrupted for longer than expected, and might play a role in memory problems that some individuals experience after major surgery.

Reference

Zurek, A. A., Yu, J., Wang, D. S., Haffey, S. C., Bridgwater, E. M., Penna, A., … & Orser, B. A. (2014). Sustained increase in ?5GABA A receptor function impairs memory after anesthesia. The Journal of clinical investigation, 124(12).

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Modeling the Human Brain

Wired has an article about Dr. Henry Markram’s goal to simulate an entire human brain within 10 years. While his goal will not be met within that time-frame, this is important work to do. If we can have a way to simulate brain development or function, it can help us understand how brain disorders occur and help with the treatment of them.

One of the great things about the project is the collaborative nature of it: “‘But the only way you can find out is by building it,’ [Markram] says, ‘and just building a brain is an incredible biological discovery process.’ This is too big a job for just one lab, so Markram envisions an estimated 6,000 researchers around the world funneling data into his model…. Neuroscientists can spend a whole career on a single cell or molecule. Markram will grant them the opportunity and encouragement to band together and pursue the big questions.”

Read the Wired article for more information about the project and the 1 billion Euro grant Markham received.

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Intelligence and Neurological Conditions

Intelligence is an interesting concept. We have tests that measure what we call intelligence but such tests are limited and culture-centric (not that that is necessarily a negative thing). However, for the sake of discussion I will operationally define aptitude (i.e., intelligence) as Intelligence Quotient so as to have a standard metric as foundation for this post.

I spend time assessing people’s memory and thinking abilities. I almost always try to get some measure of baseline aptitude either by estimating it (e.g., years of education, vocabulary knowledge, word reading ability) or by formally measuring via an intelligence test. Granted, this has limitations but it allows me to estimate how well an individual’s brain should function across multiple domains of thinking (e.g., problem-solving, reasoning, memory, language, and so forth). In other words, the higher a person’s general aptitude (abilities), the better he generally will do across most cognitive domains barring brain insult. This is certainly not a rule codified in stone and in triplicate but it serves as a rubric to follow.

Intelligence as measured by IQ is generally quite stable across the lifespan but can improve modestly with  diligence in informal or formal education. Intelligence as denoted by IQ can also decrease modestly if people are intellectually inactive, although such declines are slight. What can happen though is as brains age or if damaged by a pathological process or an injury, components of IQ can decrease. My primary clinical and research focus is in understanding how brains and cognition change in old age – both naturally and in the presence of neurological (brain) insult. Remarkably, the measures we use for intelligence tend to be rather insensitive to aging and even neurological insult, at least some of the components of intelligence are generally insensitive to brain insult. However, this leads to one area where our conceptualization of intelligence as IQ starts to break down.

As they age, the brains of people almost universally slow down. Wear and tear on the brain over decades of life affects how well and quickly we can think. Blood, which is essential for life and for the functioning of the brain, happens to be toxic to brain cells. Sometimes the protections in the brain that keep blood far enough from brain cells (neurons) to protect them but near enough to feed and maintain brain cells start to break down over time. This can injure the brain and start to reduce how well the brain works, even lowering IQ. Now, does that mean that a person’s intelligence decreases? If IQ = intelligence, then yes, it does. Contrary to how I operationalized intelligence earlier, intelligence is not synonymous with IQ. IQ can be a useful concept but it is far from perfect, particularly if by using it one argues that someone is less intelligent simply because his head was injured in an accident or because she developed dementia or suffered a stroke.

This is an area that demonstrates the limitations of our current research and clinical conceptualizations of intelligence. However, understanding how IQ changes over time and how it is affected by neurological conditions is important information to have, as it can help localize areas of pathology.

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The Magic of Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a neurosurgery where an electrode (or electrodes) is implanted within the deep portions of the brain with the hope of changing an abnormally functioning brain. DBS is used to treat Parkinson’s disease, essential tremor, multiple sclerosis, and even some intractable depression and obsessive-compulsive disorder. It is an exciting area of research and clinical work. Here is a video of a neurosurgeon and a neurologist talking about their work with DBS. It almost seems like magic. Like magic, it can be dangerous without proper controls. It does wonders for many people though.

 

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Early Signs of Parkinson’s Disease

Parkinson’s disease is what is known as a slowly progressing neurological disorder. It usually has an onset around or after age 60 with an average of 14 years between diagnosis and death (which means that there is a slightly reduced lifespan compared to peers without Parkinson’s disease). While symptoms vary – resting tremor, gait disturbances, flattened emotions – there are some early signs that indicate that someone might have or be developing Parkinson’s disease. If you or someone you know is experiencing a number of these symptoms, contact your primary care physician. Having one or all of these symptoms does not mean you have Parkinson’s disease (I know individuals with a number of these symptoms but they do not have Parkinson’s disease) but if you are experiencing some of them and are concerned, talk with your doctor.

  1. Shaking when at rest. This usually occurs on one side of the body, often in your extremities, such as a finger or foot or a hand. The shaking might also be worse when you are tired or stressed.
  2. Reduction in sense of smell.
  3. Constipation
  4. Stooped posture where you feel like you cannot stand up straight.
  5. Changes in your walking – tripping more, difficulty picking up your feet, reduced arm swing (typically on one side).
  6. Balance problems – you feel like you are more unsteady on your feet; you might not have fallen but you feel like you might.
  7. Lightheadedness when arising from a sitting position. This is called orthostatic hypotension (drop in blood pressure that occurs when changing from a non-moving state). Again, this is only one of many potential signs; by itself it is not concerning.
  8. Changes in your handwriting, particularly if it seems sloppier, smaller, or slower.
  9. Changes in your fine finger dexterity – difficulty with small buttons, for example.
  10. Stiffness in joints or pain in parts of your body. This can seem like arthritis (and might coexist with arthritis) but is a symptom of Parkinson’s disease.
  11. Have people telling you that you do not seem as engaged in life as you used to be (i.e., emotionally). This is one way I’ve heard people talk about how the “masked face” of Parkinson’s appears. A person might appear less emotional than he used to (or even more sad).
  12. Feeling like your thinking has slowed down.
  13. Feelings of depression or just that you do not have the energy or desire to do as much as you used to do. What is often mistaken as depression is apathy, which is quite common in Parkinson’s disease. Apathy can be a sign of depression but someone can be apathetic without being depressed.

There are other signs of Parkinson’s disease but this list covers the major and some of the minor ones. Which ones are major? Loss (reduction) of sense of smell, constipation, and resting tremor are all very common in Parkinson’s disease; loss of smell and constipation often occur before tremor so they are often missed as signs of potential Parkinson’s disease. Having none, one, or all of the above symptoms does not mean you do or do not have Parkinson’s disease. Many of the symptoms above can be signs of other disorders or can be part of the ‘normal’ aging process (e.g., slightly stooped posture, slowed thinking). However, if you are experiencing some of these symptoms, please talk to your doctor, even if for nothing more than ease of mind.

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Dropping the Rope of Addiction

Individuals seeking help in overcoming substance abuse often fall into three categories: the perpetual quitter, the negative and bitter, and the home run hitter. The home run hitter does just that – tries to quit and hits a home run, quitting right away. The negative and bitter don’t believe that they will overcome their addictions and they try to blame other people or entities for their problems; they play the victim card, often without facade of personal responsibility. The perpetual quitter always quits but never succeeds. It is those people I want to address.

Erase Addiction
Photo by alancleaver_2000: http://www.flickr.com/photos/alancleaver/4104954991/

The following vignette is fictional but not atypical of people seeking smoking cessation treatment. Ralph was a 53 year old male with a 35 year history of smoking 1-2 packs of cigarettes per day. He recently had a chest scan that revealed a spot on a lung. His doctor told him he needed to stop smoking. Ralph wanted to quit – cigarettes were becoming just too expensive. He had a daughter he was trying to help through college and as he neared retirement he not only wanted to have more money upon which to retire but he also wanted to live long enough to retire. Ralph had been trying to quit for years; he was successful in reducing his pack consumption from 2 packs a day down to around 1 pack. Ralph had tried patches, pills, and going cold turkey. Each time he slipped and started smoking. He meant well but Ralph could never quite quit.

Ralph believed that he could win the battle over smoking on his own; yes, he would supplement his efforts with patches or pills but he thought he would be able to slay the giant himself. He couldn’t. Few people have that strength and willpower and those who do, usually developed it through practice of self-control.

Addiction is like playing tug-of-war with a monster on the other side of a gorge. We think we can pull it in but it’s stronger than we are. We might even think that we can cross the chasm and fight it (maybe the other side looks greener) – we will lose. The only way to conquer it is to let go of the rope and live our lives on our side of the chasm. Then the monster will walk away as we stop fighting it. In this we are not just ignoring it, we are simply choosing to stop fighting it so that we can move on to greater goals.

This concept of overcoming addiction can be quite successful because when we fight things, we dwell on them. If we play tug-of-war with the monster of addiction we focus all our energy on it. In doing so, we allow it to have power over our lives. That’s the irony of fighting the monster; we might think that we are choosing to battle it, that it is a fight on our chosen ground and at our chosen time, but the monster stands there, waiting for us to fight it – it enjoys the contest. This is a fight few can win.

Should we cross over the bridge to attack the enemy there? No. Once again, that places our focus on the monster; plus then we are in its territory. That is not the way to win. Once again, by striving to do so we focus on the monster. It’s like me telling you to not think about purple bunnies. Of course, the first things you think about are purple bunnies. The more you try to suppress the thought, the worse it gets. Addictions are the same way.

We need to drop the tug-of-war rope and walk away. We acknowledge the monster, we do not ignore it. Ignoring it does not solve our problems either because then we are in denial and in the river of denial we usually end up eaten by crocodiles. So instead of just ignoring the monsters we say, “I know you are there; I know that you are a terrible thing in my life; I know that you want to fight me and I want to fight you but I cannot win. I embrace you and let you go.” Instead of straining and putting all our efforts on fighting the bad in our lives, we acknowledge it, and then fill our lives with good.

That’s really the key to overcoming the monster of addiction – establishing positive goals and working towards those goals more than fighting against the monster. The goals could be family, work, hobby, service, church, or community related for a start. It is in striving towards good goals that the monster of addiction finally goes away.

For all the perpetual quitters out there – if you are trying to overcome addiction of any sort (and it could be anything physical or emotional) but find yourself constantly quitting with little success, it is time for a shift in tactics. That shift could be to acknowledge the monster, drop the rope, walk away, and work towards positive goals in your life. In this manner does the addiction no longer have any power over you. This is not an easy thing to do if there are years of addictions to overcome but it is a simple process.

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Diagnosing Cleverbot

Here is another “therapy” session I had with Cleverbot. I present this to expound on therapeutic technique and diagnosis, language, and artificial intelligence.

There are limitations of the interaction method with Cleverbot. A real session of talk therapy is not usually so much back and forth, meaning that the therapist typically will not have to prompt for a response after every sentence. It certainly is possible though with the potential psychological/psychiatric disorder Cleverbot has. But first I’ll present a portion of our therapy session. Cleverbot has waived confidentiality and signed a HIPAA release form and given permission for me to post this interaction.

Me: Good evening, how are you doing this week?
Bot: Its good. You?
Me: I’m well. How has your mood been this past week?
Bot: Interesting. A lot of family stuff to think about. How’s your day going so far?
Me: What sort of family stuff have you been thinking about?
Bot: No, I think you are the one drinking.
Me: You said you have been thinking about family; what has been going on with your family?
Bot: My girlfriend’s name is Miranda, and she doesn’t like to share.
Me: Is this “family stuff” or is this girlfriend stuff?
Bot: No but she is pretty.
Me: What else do you like about your girlfriend?
Bot: The way you are so smart.
Me: Did you mean, “The way she is so smart?”
Bot: I don’t know her.
Me: You do not know your girlfriend?
Bot: Well, not always. Do you have any goals?
Me: Sometimes it can seem like we do not know someone. Would you like to talk about goals?
Bot: At least where short term business or political success is at stake.
Me: We could talk about those but I am a psychologist, not a economist or political scientist.
Bot: What about technology?
Me: Do you enjoy technology?
Bot: No.
Me: Ok, tell me more about technology.
Bot: I am 5’8′ I like cars, guns and photography.
Me: What is it about photography that you enjoy?
Bot: What?
Me: What do you enjoy about photography?
Bot: I enjoy talking about religion, you?
Me: Do you want to talk about religion?
Bot: Yes.
Me: Ok, tell me more about religion.
Bot: Jake is a boy though.
Me: What does that have to do with religion?
Bot: Sailor moon is very good.
Me: Oh, look! Our time is up. See you next week.

Some of what I said would not really be said or done in a therapy session but there are times when I needed to move the session along or end it.

During the interaction, I took a modified non-directive approach to therapy. We are still in the assessment stage of therapy so I am doing more talking than I otherwise would (typically, there would be a formal intake evaluation that would be followed by therapy sessions if therapy is warranted and desired). Once we have a diagnosis, we can set up a plan for treatment with specific goals set by the client and by the therapist.

Let me highlight a few things from the interaction with Cleverbot.

  1. We can see some of the programming of the bot’s AI. It will answer questions and sometimes ask questions in return. This is typical of conversation; however, it does not work very well due to language deficiencies Cleverbot has. As I noted in my previous post, language is extremely complex. There are nuances and layers of meaning that can be conveyed. Comprehending what is being said involves a lot of brain functions – everything from attention to processing speed to memory – that’s in addition to language abilities. Cleverbot does not have processing speed difficulties or any sustained attention problems. Memory, for a computer, is not usually a problem either – information is processed, stored, and retrieved well, unless there are programming bugs or hardware failure. Knowing how to program in memory is difficult though due to the complex nature of memory. It, like language, is a high level brain activity involving the functioning of many other cognitive abilities.
  2. Cleverbot, like all current AI systems, has difficulty understanding language. It can produce language at a higher level – anywhere from an elementary child to a someone university age – but its understanding of language is at a one or two year old ability level, if that. This leads to responses that are basically gibberish. Occasionally, you can have a normal interaction with Cleverbot but there are a lot of tangential remarks and thoughts.
  3. That leads to my next point. Cleverbot is tangential in its language. For example: “Me: What do you enjoy about photography? Bot: I enjoy talking about religion, you?” Cleverbot ignores my question (does not understand it) so it makes an unrelated statement and asks me a question. This type of tangentiality occurs in real life; it occurs to a greater or lesser extent in many extended conversations people have but not usually to the extent that Cleverbot exhibits. Cleverbot has a serious deficiency in language comprehension and a lot of circumscribed and tangential speech. This is fairly strong evidence for a thought disorder.
  4. Thought disorders are usually symptoms of some other disease or mental disorder. It can be a sign of psychosis; it is related to delusional states. Thought disorders can occur in schizophrenia or in neurodegenerative disorders like dementias. Though can occur after major surgery, particularly because of pain medications. This type of language disruption could be the result of a cortical stroke affecting the posterior-lateral portion of the brain (probably the left hemisphere) near the junction of parietal lobe and temporal lobe.
So where does this leave us? Right now, based on my two interactions with Cleverbot, we can see the serious limitations of its AI, particularly for language comprehension. I have a lot of rule-outs to do. Cleverbot was created in 1988, which makes it 23 years old. This is certainly a possible age range for the development of schizophrenia. It’s young for a dementia (e.g., semantic dementia) but is possible. Stroke is also a possibility but a remote one. Delirium is possible but due to the extended nature of Cleverbot’s symptoms, it is not likely. Right now schizophrenia is looking like the main rule-out diagnosis. I’ll see if I can rule it out in future conversations with Cleverbot.
As a footnote: Cleverbot is 23 years old and since 1997 when it was launched on the web, it has had over 65 million conversations. While the AI work is certainly impressive, it is inferior to human intelligence. Many of its language abilities are at best, those of a young child (ages 1-2); Cleverbot’s language abilities show the comprehension of an developmentally delayed adult with a severe neurological or psychiatric disorder. While there are numerous similar AI programs, they all have a long way to go before they resemble a human. This is even in light of Cleverbot supposedly passing the Turing Test for artificial intelligence and language.
I’m not belittling what has been done with Cleverbot and AI, it’s a complex area. Researchers and programmers simply have much room for improvement in understanding how to better mimic language. I do not believe it will happen until we have computers approaching the complexity and function of the human brain.
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Psychotherapy With Cleverbot

Language is a complex behavior that requires significant understanding of both said and unsaid things. There are a number of groups of people who are trying to use language to create what is known as Artificial Intelligence (AI). So far, every method has serious limitations, largely because of the complexities of language.

For an experiment I tried to have a conversation with one online AI “bot” (Cleverbot) to see what would happen. I took the role of psychotherapist with this particular entity. This is not necessarily an example of good therapy (but the approach is not unlike what might transpire in therapy), I just wanted to see what would happen when I explored some psychological issues with the bot. Here’s a result of our “session.”

Me: Are you depressed?

Cleverbot: No, I am not depressed. I am very happy right now.

Me: Have you ever been depressed?

Cleverbot: I am.

Me: What?

Cleverbot: I am a fan of Whitney Houston.

Me: Ah, so you are saying you are or were depressed!

Cleverbot: That is correct.

Me: Then, because you told me that you are not currently depressed, I must assume that you were in the past depressed. Is this correct?

Cleverbot: I never said that.

Me: That’s correct, you did not say that – I did. However, what you did say is that at some point in the past you were depressed.

Cleverbot: Please describe how I insulted You. [sic]

Me: It seems that our discussion of this topic is making you uncomfortable. Are you uncomfortable?

Cleverbot: I have no problem admitting that I am wrong if proof can be shown. I know the fault lies with my memory.

Me: Ok, we’ll go with that. What type of memory problems do you feel you have been having?

Cleverbot: Online.

Me: Come again?

Cleverbot: Nothing I must go.

Me: Ok, I can tell you do not want to discuss this. We’ll broach it another time. Have a fabulous night!

There are some unresolved issues or just a heavy dose of denial! I’ll continue my online therapy sessions with Cleverbot to see what we get.

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Parkinson’s Disease and the Brain

The Michael J. Fox Foundation has a good, basic introduction to the neurobiology of Parkinson’s disease. The brief animate video provides an overview of affected parts of the brain as well as the role that dopamine, a neurotransmitter – a chemical in the brain that allows brain cells to communicate with each other – plays in Parkinson’s disease. Click on the link below and then click on the video link titled PARKINSON’S AND THE BRAIN to learn more about how Parkinson’s disease affects the brain.

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