News flash: the gut and brain are connected!

The obvious scatological humor will be left alone. Guys, you know what I mean. (Girls who were outnumbered by your brothers, you too.)

I started to blog this article because the forehead-smacking tone of the revelation that the gut might relate to the brain was a bit too much for me. On closer examination, it looks like the misplaced drama is the writer’s, not the scientists’.

One of the places where serotonin is released is in the gut, where it helps digest proteins. That’s the most obvious “duh” moment here. Moreover, as those of us who remember our embryology know, the inter-relationships and constant correspondence between neurology and gut, gut and immunity, immunity and endocrine system, endocrine and neurological system are all too intense and interlocked for words.

Most studies make brutally clear that these so-called systems are medically treated as separate and distinct, but our bodies never got that memo. It’s all the same system, as far as the body is concerned.

Much of this researcher’s recent work focuses on neurology of the gut — enteric neurology. It’s a real thing now. His prior work focused on the biological environment in the gut, or the intestinal microbiota.

// START Word geek goes wild:
Sometimes, I just love medical terminology for the way it rolls, hops, and bounces off the tongue. Enteric neurology. Intestinal microbiota. Hypothalamic-pituitary-adrenal axis.

Maybe that last one doesn’t work so well.
// END Word geeking.

If you can stand the medical and chemical jargon, it’s worth looking into some of his work. It’s probably not a stretch to call it prescient, in that it is likely to lay the foundations for our emerging understanding of the gut as a more complex and self-managing, yet interlocked, set of systems than we’ve ever imagined before.

I can’t find the original science article, just this unsatisfactory and superficial overview. It says that intestinal microbiota affect the person’s mood and feelings, and that it’s possible to deliver specific probiotics (like yogurt species, naturally-fermented cole slaw, certain cheeses and the like) in order to have a specific benefit to the neurological system.

If you were an empiricist, like me, it would sound like “eating good, living food leads to better mental health,” which healers have been saying for millenia. But far be it from me to steal such well-researched thunder.

Link list:

Science Daily article:
A Gut-Full of Probiotics for Your Neurological Well-Being

Credentials of lead researcher, Prof. Lyte:
Mark Lyte, Ph.D., M.S., MT (ASCP)

Wikipedia’s digest (sic) of the enteric nervous system (this seems basically congruent with the uber-geeky medical studies I looked at on the subject, so I accept it as a decent primer):
Enteric Nervous System

Couldn’t find a good overview that didn’t involve more dead rodents than I could, er, stomach.

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Proportional monocytes and CRPS, translated

Today’s translation from medspeak to English: Inflammatory white blood cells and inflammatory nerve cells, in relation to CRPS.

Elevated blood levels of inflammatory monocytes (CD14+ CD16+ ) in patients with complex regional pain syndrome

Here’s what the jargon means.
// ed. note: my comments and clarifications are picked out by those two slashes and the contraction for “editorial notation.”

One important factor in CRPS is inflammation that starts in the nerves. Microglia and astrocytes, which are the inflammatory and immune cells of the nervous system, get active enough to cause worse pain by themselves.

That’s a sparking astrocyte. Pretty, eh?

// ed. note:  The inflammatory and immune responses are mixed blessings throughout the body.  An immune response is uncomfortable; think about the last time you had the flu — sucked, huh?  An inflammatory response can cause pain due solely to the inflammation, like with some kinds of arthritis.  So, for the microglia and astrocytes to make pain worse is not a surprise, since that’s what immune response and inflammation can do anywhere.

One type of immune cells normally floating in your blood, called monocytes, can get into the brain and spinal cord and turn themselves into the nervous system’s immune cells, microglia. The added level of inflammatory/immune response leads to more pain.

// ed. note: Again, not as strange as it sounds.  The body’s living cells all contain complete DNA, and they are designed to be both helpful and appropriate; heart cells transplanted into muscles become muscle cells, and muscle cells transplanted in the heart become very much like heart cells.  So, for this type of small white blood cells to turn into microglia is reasonable.

These are microglia in various active states.

// ed. note: The inflammatory response releases cytokines.  Cytokines are the chemical widgets, produced in inflammation, that serve as the chemical messengers running around the cells screaming that the sky is falling.  Some cytokines increase inflammatory pain, some cytokines reduce it.

This study looked for particular kinds of inflammatory monocytes in the blood, to test the assumption that higher levels of these particular types of monocytes (which can then turn into microglia, making the inflammation and pain worse, etc.) are related specifically to CRPS.

Now here’s the fun part.  The basic blood-borne indicators of inflammation and illness were no different in those with CRPS than in normal people. That’s why conventional lab results, like “complete” blood counts, come back normal for us.  However, the proportion of the particular types of monocytes associated with CRPS, were significantly higher in those with CRPS.  The type of cytokine that reduces inflammatory pain, was also significantly lower in people with CRPS.

That means the inflammatory process screws us coming and going, and screws specifically us, the people with CRPS, in ways that can be checked in a lab.

OK, GTK.

These are sensible scientists: they state that they don’t know if the monocyte proportions changed before or after the onset of CRPS, or both before and after.  If before, it might indicate a predisposition to CRPS, in which case surgeries and accidents have to be handled with specific care for antioxidant therapy and aggressive pain control. If after, it might be relevant in figuring out how things are going and if what the doc is doing works.

Also, some drug company could make a staggering fortune off of new meds that mess with this process. They actually mention that at the end of the article, which means someone has to fund their work.

// ed. note: Be fair. We have a profit-based health care system driven by enormous corporations that are traded on the stock exchange, and the Sarbanes-Oxley laws mean that their first obligation is to their shareholders. Not patients. Not customers. But shareholders.

Conventional medicine has to come back to profitability.  There are more direct ways to address these immune and inflammatory issues by existing means, which could be further developed, but they don’t sustain the pharma industry’s usual annual returns of 20-40% — a rate of stock profitability matched only by oil companies.

… On your pain.

If you have something to say about that, you can contact your political representatives here: http://www.usa.gov/Contact/Elected.shtml

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Hemingway: How courage and depression go together

This article is well-intended, but egregiously judgmental and woefully ignorant:

http://www.npr.org/2011/07/02/137540700/after-50-years-remembering-hemingways-farewell

If it weren’t for the inane babble puzzling over why Hemingway lived so intensely, this line would be the Winner of The Most Fatuous Statement award: 
“…in January 1961 he told his wife, Mary, that he could no longer write a single good sentence. And Hemingway would only settle for great ones.”
It wasn’t a question of settling for less than great, it was a question of how important it is to fulfill your purpose and dig some meaning out of life, even amid the unbearable. That purpose and meaning was taken from him, under the mistaken guise of treatment. 
Hemingway got electroshock therapy for his depression; a common side effect is to knock out your language abilities and cognition, sometimes for months and sometimes forever. The one thing that made his life endurable — writing like himself — was taken from him. 
Depressed people have more courage and determination than their non-depressed cohorts. Studies are finally being funded that verify this (which I’ll dig up later. Feel free to nudge me with a comment.) 
Think about that next time you curl your lip over suicide. It’s not about courage. It’s about unbearable pain and a degree of mental crippling that puts a valid life out of reach. 

Waiting and working at it until things improve is a reasonable thing to do: Hemingway waited and worked at it for  40 years, though with so little real hope for treatment. Talk about courage! It’s unthinkable how much courage he brought to bear on his life. His intensity and wild behavior were directly related to making his life bearable — and his work more compelling. Check his quoted remarks on that subject. What’s between the lines is breathtaking. 


The article’s remark about suicidal lineage is true, but poorly understood. A suicide in the family has the powerful effect of making suicide less unthinkable. There is often a genetic tweak associated with it, but that’s not all there is. The thing to know now is, we are not our predecessors; we can do more. Far more. 

Hemingway died before we developed SSRIs, SNRIs, and a tremendously improved understanding of neurochemistry, behavior, nutrition and psychodynamics. We have more options now. Lots more. Waiting and working at it is a real success path now. 
Be good to your depressed friends. You probably have no idea what they’re capable of, when they can be well again. Help them persist. 
It’s the most important thing to do: persist. A valid and bearable life is a reasonable thing to hold out for. Only death bars the door to healing. Things will change. 
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Stem cell research is really whizzing along

Pluripotent stem cells (that is, the kind that could be turned into many different types of tissue) were successfully grown from urine:

http://f1000.com/11427957?key=khstst6kwbn437f

This is a little weird even for me, but intriguing as hell.

It’s normal for a tiny number of cells from the draining parts of the urinary system to wash away in urine. Throwing off very many is not healthy. However, given a tiny number of healthy cells, they managed to tweak the epithelial cells (the cells that form the “skin” of a space) of the renal system into being able to turn into a variety of other cells, including nerve cells that could grow and connect to other nerve cells.

Caveat emptor: manufactured stem cells are not like Mother made. There is always something they do that’s not in the original specification.

This article makes the point, at the end, that this is a starting point and that the stem cells it produces, and the differentiated (that is, specialized) cells that grow from them, really need to be evaluated before those of us who need new nerves (or kidneys, or whatevers) should start to cheer and break out the champagne.

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Neuroscientists map a "new" target to wipe pain away

This article discusses the role of the peptide CDB3 in modulating the specific calcium channel signals that transmit chronic pain:

http://www.sciencedaily.com/releases/2011/06/110605132425.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

This article says it’s a “novel” peptide, but last I heard, CDB3 was a cannabinoid, one of a couple hundred constituents derived from a medicinal plant cultivated for thousands of years, being researched by the likes of Prof. Robert Malamede in Colorado… For, among other things, specific & benign interference in calcium-channel signaling in pain pathways.

Let’s keep our signals clear, even if we want to muddle pain’s signals.

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Why premature birth shouldn’t be iatrogenic

I’m delighted to get my hands on an article about a study done by a nurse. Prof. Sullivan, RN and her team say, “Effects of premature birth can reach into adulthood.”

http://www.sciencedaily.com/releases/2011/06/110615171408.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

Do you know why this is, logically, a candidate for the Department of the Blitheringly Obvious?

It has to do with fetal development. In a healthy pregnancy (that is, most of them), labor starts when the fetus’s lungs — the last thing to finish developing — are done. Then the fetus signals the mother’s body, and labor begins.

The neurological system and heart are getting the finishing touches in those last few weeks, too. The final stages of fetal development are extremely important, and ever more so as it gets harder and costlier to get care in this country.

Why does getting care matter? Aren’t preemies a lot easier to deliver?

They pop out faster, yes. They also tend to need time in the neonatal ICU.

But wait, there’s more.

This article goes on to say that premature babies tend to have lifelong problems with — you guessed it — heart, lungs, and neurology. Neurological issues that consistently show up relate to coordination; learning (especially math); memory; and, most worryingly, hypothalamic-pituitary adrenal (HPA) axis problems — which messes up the body’s ability to regulate weight, growth, anxiety, sleep, and mood; it’s a major factor in CRPS, MS, and other constitutional illnesses.

These people are far more likely to require extra care and attention from parents, school, doctors, nurses, and therapists of both body and mind, _throughout_their_lives_ — or at least, as Prof. Sullivan has shown, to the age of 21. More data to follow, as the study continues.

This is why I find “elective c-sections”, which are often done at 37 weeks just to avoid the final stage of pregnancy, so appalling. They combine the drawbacks and long-term effects of prematurity with those of nonvaginal delivery and abdominal surgery. A full house, you might say.

Back to this article, which focuses on people who were born 21 years ago, when prematurity was not optional.

She states that these personalities tend to be more driven and success-oriented. On the one hand, that could be the cortisol talking (remember the lack of regulation? These people have higher than normal cortisol levels.) On the other, these are all people who have had a higher than average level of care, attention and structure in their young lives, and that tends to produce these characteristics anyway. When young people internalize the message that there are a lot of capable adults who really care what happens to them, they don’t see failure as anything but learning how not to do it next time. And that’s a setup for success.

Having explicated her stated finding, I have to say that she did not, nor did I read anything here about how she measured these personality characteristics. In short, it’s possible she was looking for ways to make everyone feel better about the learning disabilities and systemic issues.

And that, frankly, is one of the common characteristics of nurse studies that tend to lessen the respect they otherwise deserve: nurses who achieve worldly success don’t get there without being good at making decision-makers feel good.

I looked for the text of the study at her site, but no luck. I’ll look on PubMed once I’m off this handheld. I’d like to clear up that last gratuitous silliness, if I can.

* Can’t find it on PubMed. It was published very recently, so it might be worth checking back.

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Acupuncture helps where conventional medicine can’t even diagnose

A valid diagnosis is necessary to getting appropriate alopathic (that is, conventional Western) medical care. (This is why “House” is such a popular show: there’s a lot of inherent drama in wrong diagnoses, because they can lead to chaos, suffering and hideous deaths.) Unfortunately, fully 20% of those who seek ongoing care don’t get one.

No pressure.

The Chinese were developing diagnostic strategies before my British Isles ancestors were even sure how babies were made, so I view this intensely patronizing, very cagy terminology with a jaundiced eye, but the study itself looks pretty good:

http://www.sciencedaily.com/releases/2011/05/110530080513.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

As well as dramatic improvements in function and well-being, it’s interesting to note that these patients made changes in their daily lives, because they felt their acupuncturists really cared (and probably because they knew what they were talking about.)

Do you have any idea how hard it is to persuade people to change the way they eat, move, sleep? Most people would rather put up with hideous suffering and tons of needless ill-health rather than change the pattern of their days. It’s incredibly hard to make those changes, and speaking as someone who has had to change all that and more, I’m still not sure why it’s so staggeringly hard.

But these practitioners of a well-structured form of acupuncture did it, and did it consistently.

— Or rather, their patients did, given the combination of good info and perceptible support. Now THAT’s a therapeutic relationship.

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Curing the incurable: type 1 diabetes in mice, with 78% success rate

Next Big Future: Gene therapy reverses type 1 diabetes in mice with 78% success rate

Intriguing approach: providing gene therapy to both protect and rebuild the Islets of Langerhans, which means blocking the T cells from the islet cells without compromising them otherwise.

For an early trial of a complex therapy, this is rather brilliant and very promising. Of course, humans are not mice, but type 1 diabetes is generally type 1 diabetes – or something very similar.

Next up: a cure for CRPS, Alzheimer’s, and AIDS. Hey, it could happen.

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Thinking with your body, thinking with your mind

I’m too jetlagged to do this justice, but it’s an intriguing look at the way we solve 3-D problems with, and without, using our hands to work out solutions.

http://www.sciencedaily.com/releases/2011/06/110602111448.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily%2Fmind_brain+%28ScienceDaily%3A+Mind+%26+Brain+News%29

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News flash: Dementia is confusing & doctors should communicate

I can’t resist candidates for the Dept. of the Blith. Obv.: Many geriatric patients receive an incorrect dementia diagnosis. 

The final diagnosis was determined by postmortem autopsies examining structures and changes in the brain, which are pretty definitive.

Most dementias are currently incurable, and only some can even be managed. So why does this matter?
Two reasons: the clinical and the academic — which is ultimately clinical, too. 
Firstly — and I’m speaking as someone who has skirted dementia myself — if anything can be done to mitigate this hideous state, it should be done. Correct diagnosis improves your chances of getting appropriate care. 
Secondly, incorrect diagnoses screw up the data. How can we evolve our understanding, improve diagnostic criteria, develop more effective treatment, and work on actual cures, if we aren’t clear about what we’re working with and how it plays out?
What’s lovely and touching about this is, the researchers truly believed that correct diagnoses were much more common, and that the communications between the neurology department and the geriatric psychiatry clinic were better than they were … and that they changed their stance dramatically in response to their findings. 
Knowing how cautiously physician researchers normally phrase recommendations, and how neutral and respectful Swedes prefer to be, the researcher’s closing remarks sound like a passionate cry from the heart. It’s really moving. 
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