A new post on the "You Must Be Hungry" blog at Psychology Today looked at the relationship between eating disorders and autoimmune diseases, as well as potential treatments in the form of probiotics (healthy bacteria, like the kind in yogurt). Writes author Shelia Himmel:

Enter NuBiome, a company founded in 2009 to develop therapies, including probiotics (beneficial bacteria) that interfere with disease-causing bacteria found in the gastrointestinal tract, focusing on autoimmune conditions. The company founders all have seen or had family members who got sick with autoimmune diseases. That includes bulimia and anorexia.

"The paradigm's got to change," said Brian Lue, a NuBiome researcher. In a paper he delivered recently, Lue explained how people used to think that stomach ulcers were caused by stress and dietary choices.

...Lue explains, "A normal person with a normal immune system may have a rare event in their intestine and this changes the way the normal bacteria in their gut die and break up into fragments. Their immune system then finds a specific piece of the bacteria that looks like a piece of the insulation on their nerves. Now, when the immune cells find that piece of insulation on the nerves, bad things start to happen. The body's immune system turns against nerve insulation because it "thinks" that they are foreign bits of bacteria. In the process it ends up destroying its own tissue because it confuses body tissue with that of the bacteria. This is what an autoimmune disease is. In the case of multiple sclerosis, the insulation on the nerves is attacked by the person's own immune system."

How does all this relate to eating disorders?

Lue refers to a 2005 paper in the Proceedings of the National Academy of Sciences by Serguei Fetissov, who identified specific antibodies in people with anorexia and bulimia nervosa. These antibodies disrupted the normal hormonal systems of the brain, particularly the part of the brain that is responsible for appetite control and the stress response.

Lue writes, "This seems to correlate with the changes in eating habits that defines bulimia and anorexia. The authors of the study suggested that the autoimmune response could be triggered by pieces of several types of bacteria in the gut mimicking the brain hormones. Pieces of H. pylori, the stomach ulcer bacteria, and E. coli are some of the likely suspects."

I'm a long way from saying that yogurt is some magical cure-all for eating disorders (though I do loves me some yogurt), but the research is interesting.

I had previously downloaded the 2005 Fetissov paper that Himmel mentioned in her blog post, titled "Autoantibodies against neuropeptides are associated with psychological traits in eating disorders," and re-read it for this post. The researchers knew from previous research that people with AN and BN had antibodies to α-melanocyte stimulating hormone (Fetissov et al, 2002), known as auto-antibodies because they were antibodies against "self" proteins, and the authors of the 2005 study note that:

melanocortin peptides involved in appetite control and the stress response. In this work, we studied the relevance of such [auto-antibodies] to AN and BN. In addition to previously identified neuropeptide autoAbs, the current study revealed the presence of [auto-antibodies] reacting with oxytocin (OT) or vasopressin (VP) in both patients and controls.

Which is interesting, when you look at the roles of both oxytocin and vasopressin and consider that difficulties with social relationships and stress, respectively, are pretty common in eating disorders. What is also interesting from this study are the differences in auto-antibody levels in AN and BN. In AN, higher levels of auto-antibodies were correlated with higher scores on the Eating Disorder Inventory-2 (meaning higher levels of ED psychopathology), while in BN the opposite was true: higher levels of auto-antibodies meant lower levels of ED psychopathology, and vice versa. (If I'm reading the statistics wrong, please someone let me know- it's been a long time since I had to puzzle through dense biostatistics jargon.) What this difference ultimately means is beyond me, although I hope more research will look into the subject.

At the end of Himmel's blog post, she mentioned that a NuBiome researcher asked about her daughter's (who had anorexia and bulimia) childhood exposure to antibiotics, and Himmel recalled that her daughter had frequent doses of antibiotics. Granted, so did I, for frequent lung infections aggravated by asthma that left me with a 10-pack-a-day smoker's cough at the age of 6. However, antibiotics were peddled like candy when I was younger, and furthermore, EDs existed long before penicillin. Nor was I able to find any research indicating a link between antibiotics and the onset of eating disorders.

Still, the research is interesting and thought-provoking, and I'm curious to see more. I'm also getting a strange urge to hit the dairy case, so if you'll excuse me...

In the continuing debate on health care, we hear a lot of terms thrown around, terms like "death panels" and "public option" and "pre-existing condition." I am all too familiar with these terms (especially the third one), as well as one other term that has been increasingly used as our country tries to figure out what the bleepity bleep to do about health care. That term? Personal responsibility.

An op-ed piece in Newsweek by Jeneen Interlandi addressed this idea head-on.

If I develop diabetes or cancer or cardiovascular disease, I will undoubtedly add to the nation's health-care burden. But my behavior is only one in a host of factors that will determine whether any or all of those conditions eventually befall me. In fact, a rapidly growing body of evidence indicates that how much education, income, and social status people have, what's advertised on the billboards or sold in the stores around them, and how clean the air they breathe and streets they walk on are kept, have as much to do with their health as diet, exercise, and doctor's appointments. "It's the context of people's lives that determines their health," says a recent World Health Organization report on health disparities. "So blaming individuals for poor health or crediting them for good health is inappropriate."

Now, I'm not anti-personal responsibility. I'm not saying that this is a green light to velcro ourselves to the couch and eat Ho-Hos all day. But "choosing health" isn't as straightforward as it might seem. How can you eat properly when many major cities have large food deserts? When it's not safe to play outside? When there isn't a good place to play even if it was?

Nor do we have good ways to accurately measure "responsibility." As long as you're not a smoker and your weight is in the "normal" range, congratulations, you're "healthy" and "responsible."

Writes Interlandi:

Consider the most oft-cited source of our national health-care woes: type II diabetes, triggered by obesity. My food choices alone should make me a prime candidate for both. But I am 5'3" and I have never weighed more than [redacted] lbs. I'd like to take credit for showing restraint at the pastry shop, but the truth is, I have no restraint. What I do have is a lightning-quick metabolism acquired through a twist of genetic fate. In fact, twists of genetic fate have a significant influence on who develops not only diabetes but a range of chronic diseases...

...Of course none of this information will stop people from blaming the less healthy among us. When we say that people fall ill because they eat too much, drink too much, work too much, or don't sleep enough we are also saying that by not doing those things we can avoid the same fate. Blaming the individual gives us a sense of control over an uncertain future. It's also easier than contemplating our own mortality.

Benjamin Franklin said that the only certainties in life are death and taxes. Well, Mr. Franklin, illness is almost certainly a third, and we're just going to have to live with that. Prevention is good, but people are always going to get sick. Blaming the sick isn't going to make them any healthier.

I read a thought-provoking piece in the NY Times Magazine called "Are your friends making you fat?" I've been finding the idea of networks and social networks both interesting and compelling, and I wrote about it quite a bit at my job this spring. Information and infectious diseases do flow through networks of people. The math to determine exactly how they spread, and at what rate, is rather atrocious but also really fun. (I have an MPH in epidemiology- it's sort of a career hazard.)

Where I first learned this idea was in a seminar course on STDs, and a study of a syphilis outbreak in Baltimore in the 1980s. Basically, researchers used known patterns of drug use since syphilis was typically transmitted during a sex for drugs exchange. People might not always remember their partners, but they typically remembered where they got high. With this information, healthcare workers could narrow down the number of people who needed testing. The problem with translating these types of studies into non-infectious diseases is this: networks don't tell us whether the disease is a virus or bacteria, or even how the disease is transmitted. There can definitely be clues about transmission in these networks, but rarely are there specific answers. Rather, we find associations.

Which is why I find the idea of "social contagion" rather troubling. Certainly we affect each other's habits and lifestyles. I don't doubt that. But I'm not convinced from these studies that simply being friends with a fat person is going to make me fat.

An anorexic friend can't make you anorexic. An anorexic parent can't make you anorexic (though the whammy hits from both the genetic and environmental side, for double the trouble). A black friend isn't going to make me tan better- though I wouldn't mind if they helped me burn just a bit less. A tall friend isn't going to make me taller.

I've made friends with many people who also struggle with eating disorders and other mental health issues. If you just looked at my Facebook page, you might start to think that hanging around these people may have caused my eating disorder. Or maybe that I even caused theirs. We have an association (ie, interest in eating disorder advocacy), but that says nothing about cause.

Do we see trends of behaviors passing between friends and family? Absolutely. Can these have both positive and negative effects? Absolutely. But talk of causation, especially for something as complexly regulated as body weight, seems rather premature.

Although malnutrition and eating disorders go hand-in-hand, EDs aren't the only conditions that are frequently accompanied by malnutrition. Cancer is, too, with up to 87% of cancer patients becoming malnourished at some point during treatment.

A new study looks at the relationship between malnutrition and the psychological distress experienced by cancer patients. The 213 cancer patients were taking part in a nutrition rehabilitation program, and were asked to rate their psychological distress on a scale of 0 (no distress) to 10 (high distress). Researchers found a significant correlation between malnutrition and distress: the higher the distress, the greater the malnutrition.

"Our data suggest that nutrition status may contribute to the level of distress in patients with cancer," Dr Amdouni says. "Evaluation of the nutrition status should be included in the evaluation of distress experienced by these patients."

The connection between malnutrition and psychological distress in cancer patients seems somewhat obvious, and lots of people are (hopefully) going to coax the cancer patient into eating and improving their nutritional status, which will then improve their psychological distress.

So why is the same thing so controverisal and seemingly unorthodox among ED patients? Why is it that people don't flat-out say: of course you're depressed and feel like crap. You're not eating properly! Instead, hours of therapy and thousands of dollars are spent trying to make you feel better in the hopes that you might eat. Of course, one meal isn't a cure. One meal won't make you feel better.

Brain tumor or brain disease, nutrition is important.

Is the name of my thesis that is done done DONE.

And here, for your reading pleasure, is the introduction.*

Out of Africa
The end of 2003 became the rainy season that wasn’t, plunging Kenya and other East African countries into drought. Crops were in danger. Drinking water was in danger. Where water used to be everywhere, women were now forced to walk long distances, often twice daily, to get fresh water. So they began to store the water in any kind of container they could find, to save their aching feet from the twice-daily walk to fetch water for drinking, cooking, and cleaning.

What they didn’t know—what they couldn’t have known—was that an invisible danger in those containers would set off a series of events whose effects would be felt thousands of miles away. The pools of water that collected in the nooks and crannies of the seemingly empty containers—as well as the stored water itself—was the perfect breeding ground for Aedes aegypti mosquitoes. These mosquitoes have evolved to live alongside humans, taking advantage of environmental quirks that come with Homo sapiens. They can breed in mere teacups of water, and their eggs can survive long after the water is gone. Aedes aegypti can spend their entire lives in houses and huts, never once venturing outside. Their meal of choice is human blood. “These are cosmopolitan animals,” said entomologist Kathleen Walker of the University of Arizona. “They’ve hooked [their] life styles on people.”

The close relationship between Aedes aegypti and humans was also utilized by viruses. They, too, have adapted and evolved. Diseases like dengue and yellow fever exist in a perpetual cycle between humans and mosquitoes. So, too, does an unusual disease with an even more unusual name: Chikungunya. Known in research circles as “Chik,” the virus has probably been around for centuries, transferred to person to person by Aedes aegypti. Most people in the US had never heard of the disease and it might have remained a tropical curiosity if not for the drought.

With plenty of containers and water for breeding, and ready access to human blood for food, the Aedes aegypti population skyrocketed. And at least one of these mosquitoes was infected with Chikungunya, buzzing from victim to unknowing victim and injecting the virus. In the beginning of 2004, hundreds of rural Kenyans reported headache, fever, and rash, as well as excruciating joint pain. This pain, the characteristic symptom of Chikungunya, is so severe that victims bend over, unable to stand. Indeed, it gives the disease its name: “Chikungunya” translates from Swahili as “that which bends over.” Fingers, wrists, knees and ankles swell, leaving limbs gnarled for weeks. The joint pain finally caught the attention of public health officials, who sent blood samples to advanced laboratories for more testing. Lab tests showed an outbreak of Chikungunya in Kenya.

An outbreak of Chikungunya in Kenya—indeed, anywhere in East Africa—is hardly a noteworthy event. This is the region where the virus likely evolved, so it makes sense that it would show up on its own front porch. Yet the outbreak that began in 2004 in Kenya soon left Africa and began a journey eastward, traveling in a large arc in the countries around the Indian Ocean. The total number of people infected with Chikungunya since 2004 is approaching four million, and cases have been reported in Malaysia, Taiwan, and Australia. And the virus shows no sign of stopping.

The Chikungunya virus was first discovered from a febrile woman in 1957, in modern-day Tanzania. By comparing the genes of the Chikungunya virus to those of closely related viruses, virologists knew that the virus had been circulating in east Africa for several hundred years. Perhaps it went unnoticed because the virus was confused with many of the other diseases circulating in tropical Africa. Indeed, the joint pain characteristic of Chikungunya can easily be mistaken as a symptom of dengue fever, another mosquito-borne disease endemic to Africa. And in impoverished countries such as Kenya, Uganda, and Tanzania, modern diagnostic equipment usually isn’t available to distinguish the different viruses causing the same symptoms.

For most of the virus’ history, Chikungunya would flicker in and out of sight, causing small, localized outbreaks. Once a person has been infected with Chikungunya, they are essentially immune for life. When the virus ran out of people to infect, it moved on to other remote areas of East Africa, leaving as suddenly as it had arrived. Up until 1962, Chikungunya had been known to exist only within Africa. Beginning in the 1960s, however, Chikungunya began to move, both around Africa and around the globe. India and Indonesia recorded outbreaks of Chikungunya in the 1960s and 1970s. Both Aedes aegypti and the closely related Asian tiger mosquito (Aedes albopictus) had always lived in those areas. As populations increased, and more of these people moved to urban areas, outbreaks grew larger. The virus could multiply rapidly with large numbers of people in very high concentrations, easily jumping from person to person. And the virus’s carrier, Aedes aegypti, could live just as easily in an apartment complex as in a hut in a dusty village.

Because Chikungunya infections require both mosquitoes and humans, treating both populations is necessary to stop current outbreaks and prevent future ones. Controlling mosquito populations has long been an effective way to combat infectious diseases such as yellow fever, dengue, and malaria, as well as Chikungunya. Given the cost-effective use of chemical insecticides, most countries combating Chikungunya have focused on reducing the number of both Aedes aegypti and Asian tiger mosquitoes.

This is so important because no medications exist to fight the virus once a person has become infected. Chikungunya is a virus, so antibiotics—which only kill bacteria—won’t help. And the development of antiviral medications is still in its infancy. Existing antiviral medications can only treat either the influenza virus or HIV. Treatment remains supportive: plenty of fluids, rest, and anti-inflammatory pain medications, such as Tylenol or Advil, as necessary. A person must then wait for the virus to run its course.

Currently, no vaccine exists to protect a person from becoming infected with Chikungunya. The US Army Medical Research Institute on Infectious Disease (USAMRIID) had been working on a vaccine back in the 1970s, but progress stalled and the project was abandoned. The gravity and scale of the current outbreaks has prompted scientists at USAMRIID to resume work on the project, though an effective vaccine is years in the future. The vaccine is still not ready for animal or human trials. If it passes this stage, then scientists must jump the hurdles of production. Many American pharmaceutical industries are not interested in developing treatments or vaccines for what they see as “Third World” diseases. To them, the Third World is a separate entity, a place far away that is dramatically different than the US. To Chikungunya, a person in Texas is the same as a person in Nairobi.

As the virus began traveling, it appeared in areas where no one was immune, and would strike again. Viruses like Chikungunya “replicate very quickly and spread through the population very fast,” said Ann Powers, director of the Alphavirus Labs at the Centers for Disease Control and Prevention. Because of this, she says, the virus rapidly runs out of people to infect, and the epidemic comes to a halt.

For example, Chikungunya existed in Kenya throughout 2004 and 2005 in cycles, striking and disappearing as groups of people became immune. But Chikungunya had no sooner burned through possible victims in Kenya that it began a slow trek eastward. Traveling east out of Africa, the virus first hit the idyllic Indian Ocean islands of the Comoros, the Seychelles, and Mauritius. The presence of Chikungunya in these French protectorates, popular vacation destinations made French virologists look closely at this disease. More than a full year after the first cases of Chikungunya were diagnosed in Kenya, the international community finally began fighting the disease in earnest. Why the delay? “Of course you have people dying of disease—that’s just what people do in Africa,” said Walker. “Any time you have tropical disease in developed country, it’s easier to get people’s attention.”

*This is copyright by ME, so don't go snatching it. The writing gods will give you bad juju for the rest of your life, and besides- it's not nice. Ask and ye shall receive. Take and I shall smite you.

I was in Boston over the weekend for a conference (a bit of a last-minute deal), and my last day there, I woke up feeling utterly terrible. In fact, terrible doesn't even come close to describing it. That I had a 7-hour train ride back home didn't make things seem any better.

The past few days have been terrible. Aches and pains, hacking cough, stuffy nose, and exhaustion. Take yesterday. I woke up at 10 am, slept from 12:30 to 3pm, then again from 5pm to 7:15pm, and was back asleep at 10pm. I was, however, up bright and early this morning at 7:45.

I'm feeling much better than yesterday, which means the moral of the story is that when your body tells you to rest, you really should try and listen. I actually laid on the couch most of Monday afternoon, watching DVDs and crap TV because my cough was too bad to sleep. Even thinking about exercising has been too exhausting to consider, and probably will be for the next week or so.

This makes me feel quite guilty. That I'm lazy. That being sick is no excuse for "getting off my game." I've gotten more rational and realisitic lately to understand that 100% of my usual wasn't going to happen while falling over with the flu. Yet I have reading for class tomorrow (a whole book!) that's 300 pages long, and I'm only 100 pages into it. This is also for the professor who yelled at me for coming to class yesterday because I was sick, so go figure.

My diet for the past week (when you combine the traveling and the illness) has consisted largely of take out. Yes, again, the guilt. For spending the money. For being too lazy to cook. For eating crap. I know it's what I need to do. I know this very well. I just wish I could make peace with it.

I have to go back to the health clinic in an hour for a re-check. They were really concerned about my lung capacity, which was 2/3 of normal. I'm feeling much better than before, but the cough is still nasty. My abs feel like they've been smacked with a baseball bat. Kind of in this fashion:



We shall see what turns up.

Fat is now considered "contagious."

Why do I ever doubt the creativity of obesity researchers? They really have it going on.

Apparently, a new study showed that if you have fat friends, you're going to get fat, too.

The chances of a person "developing obesity"* increased 57% if a friend was obese, 40% if a sibling was, and 37% if a spouse was.

This is now more likely to determine your weight than genetics, the researchers say.

"We were stunned to find that friends who are hundreds of miles away have just as much impact on a person's weight status as friends who are right next door," said co-author James Fowler of the University of California, San Diego.

Researchers think it's more than just people with similar eating and exercise habits hanging out together. Instead, it may be that having relatives and friends who become obese changes one's idea of what is an acceptable weight.

So let me get this straight here: many of my friends I've met through this blog. Most of them, I've never seen pictures of. Therefore, I'm more likely to weigh what they do because they determine what an acceptable body weight is.

Here's a novel idea for you: what if we through out all preconceptions of an "acceptable weight"? What if an acceptable weight was whatever your own DNA told you to be at? What if we stopped asking stupid questions that could only yield stupid answers?

However, the researchers did caution severing friendships with obese people. Even the globe-trotting man with almost untreatable TB was not advised to ditch his wife. She was there in her little mask with him during interviews. No one said, "Get divorced." Or "Don't see each other." Wearing a mask is advisable, certainly. So what? Now you're supposed to wire your mouth shut around friends who have "unacceptable" weights?

I'm sorry, but if my friend found my weight unacceptable, I'd ditch them long before they could ditch me.

But wait: there's more.

"If you're just a little bit heavy and everyone around you is quite heavier, you will feel good when you look in a mirror," said Dr. David Katz, director of Yale University's Prevention Research Center.

Yep. Judge your self-worth based on your weight. Damn, don't I know where that leads. So their "new" proposal is to focus on getting whole groups of people to lose weight.

And damn, don't I know where that leads, too.

There is a little part that makes sense. It reminds me of pro-anorexia. Of the group fasts, of the posting of "thinspiration", of the cognitive reinforcement of the need to lose weight. And from that standpoint, it makes at least a tad of sense. It's really cognitive behavioral therapy, given in a effed up way.

The irony is that the "ideal" figure out there is so thin or so muscular that it's completely unattainable. Look at a magazine, feel fat. Look at a friend, feel thin. So what the hell are you supposed to do?

Stop looking at others for figuring out how you're supposed to look. That's the underlying assumption of this study. That you look to others to decide how and what you're supposed to be. Imagine telling an African-American with primarily white friends that they need to lighten their skin because they look "too dark" around them. Or a tall basketball player to lop a couple of inches off their legs because they look too tall against other people.

We would never say it 1) because it's rude and degrading and 2) because it's not true! Prejudice against fat people has the same name as prejudice against any other group of people: bigotry.

And now I've just proven that stupidity is far more contagious than obesity ever will be. Quad erat demonstratum.

*An asinine term if ever there was one. It's not a disease. You don't "develop" blonde hair or blue eyes or a hairy chest. In fact, it's not even a decent term.