Dr. Amen's Boost Brain, Get the Bod You Want

Heard of Dr. Amen? His main premise is this: your brain is your integration station -- boost your brain function and your body will look better too. His latest book, Change Your Brain, Change Your Body, was just published. Just took his test to assess my brain. His counsel: eat the foods and take the supplements that we're taking in the Gottfried Cleanse (from N-acetyl-cysteine to amino acids plus fish oil and SAM-e).

Dr. Daniel Amen MD is a psychiatrist and has published 24 books, so chances are you have heard of him. Here's an excerpt:

Most people throughout the world... care more about their faces, their boobs, their bellies, their butts, and their abs than they do their brains. But it is your brain that is the key to having the face, the breasts, the belly, the butt, the abs, and the overall health you have always wanted; and it is brain dysfunction, in large part, that ruins our bodies and causes premature aging.
It is your brain that decides to get you out of bed in the morning to exercise, to give you a stronger, leaner body, or to cause you to hit the snooze button and procrastinate your workout. It is your brain that pushes you away from the table telling you that you have had enough, and that gives you permission to have the second bowl of Rocky Road ice cream, making you look and feel like a blob. It is your brain  that manages the stress in your life and relaxes you so that you look vibrant, or, when left unchecked, sends stress signals to the rest of your body and wrinkles your skin. And it is your brain that turns away cigarettes, caffeine, and alcohol, helping you look and feel healthy, or that gives you permission to smoke, have that third cup of coffee, or to drink that third glass of wine, thus making every system in your body look and feel older.
Your brain is the command and control center of your body. If you want a better body, the first place to always start is by having a better brain.

While he's a bit bombastic, I like it so far. Check your brain health with his questionnaire right here.

Disengage from Inner Critic (Radio Station KFKD)

Geneen Roth features this key step as pivotal in healing your relationship to food. Her text from Chapter 10 of her new book, which I've briefly excerpted below, is brilliant. Does any of this sound familiar?

The biggest obstacle to any kind of transformation is the voice that tells you it's impossible. It says: 

You've always been like this, you'll always be like this, what's the point. No one ever really changes. Might as well eat. By the way, have you taken a look at your arms recently? And what were you thinking when you wore those pants today? Have you noticed the rolls cascading over your pants? And excuse me, did you forget to put on makeup today or is that what you look like when it's already on? That hair. Those thighs. Why do you even bother? Did you just say what I think you said to your boss? Who are you, Queen of the Universe? How many times do you have to fall flat on your face before you learn to keep your mouth shut?

Anne Lamott calls it Radio Station KFKD. Less lyrical people (like Sigmond Freud) call it the superego, the internalized parent, the inner critic. I call it The Voice. 

You talk to yourself like that from the time you awaken until you close your eyes at night without one teeny thought about the cruelty factor; you've become inured to the insults. And therein lies the pickle: The Voice feels and sounds so much like you that you believe it is you. 

The Voice usurps your strength, passion and energy -- and turns them against you. Its unique way of blending objective truth - that you've gained weight - with moral judgment - that therefore you are a complete loser - leaves you feeling defeated and weak, which then leaves you susceptible to latching on to the next quick fix or miracle cure. Anything to stop feeling so desperate.


When you disengage from The Voice, you have access to yourself and everything The Voice supposedly offers: clarity and intelligence and true discernment.

-- Geneen Roth

As I said, brilliant. An exercise Geneen suggests is to start naming The Voice when you hear it in your head, and to write down the exact statements your Voice makes. This is a very effective means of starting your disengagement. Read her book for more juice and guidance.

Higher TSH Associated with Weight Gain

Here is a good review of a study showing that higher thyroid stimulating hormone (TSH, the most sensitive indicator of thyroid function) is associated with weight gain, and the increase is linear. Optimum TSH is < 2.5.

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD

March 25, 2008 — Modest increases of thyroid-stimulating hormone (TSH) within the reference range may be associated with weight gain, according to the results of a large, community-based study reported in the March 24 issue of the Archives of Internal Medicine.

"Overt hypothyroidism and hyperthyroidism may be associated with weight gain and loss," write Caroline S. Fox, MD, MPH, from the National Heart, Lung, and Blood Institute's Framingham Heart Study in Framingham, Massachusetts, and colleagues. "We assessed whether variations in thyroid function within the reference (physiologic) range are associated with body weight."

This study included 2407 participants in the Framingham Offspring Study who attended 2 consecutive routine examinations, were not receiving thyroid hormone therapy, and had baseline serum thyrotropin (TSH) concentrations of 0.5 to 5.0 mIU/L and follow-up concentrations of 0.5 to 10.0 mIU/L. During 3.5 years of follow-up, the relationship of baseline TSH concentrations with body weight and body weight change was determined.

From the lowest to highest TSH concentration quartiles at baseline, adjusted mean weight increased progressively from 64.5 to 70.2 kg in women (P < .001 for trend) and from 82.8 (lowest quartile) to 85.6 kg (highest quartile) in men (P = .007 for trend). Mean body weight increased by 1.5 ± 5.6 kg in women and 1.0 ± 5.0 kg in men during 3.5 years of follow-up.

Although baseline TSH concentrations were not associated with weight change during follow-up, an increase in TSH concentration at follow-up was positively associated with weight gain in women
(0.5 - 2.3 kg across increasing quartiles of TSH concentration change; P < .001 for trend) and men (0.4 - 1.3 kg across quartiles of TSH concentration change; P = .007 for trend).

"Thyroid function (as assessed by serum TSH concentration) within the reference range is associated with body weight in both sexes," the study authors write. "Our findings raise the possibility that modest increases in serum TSH concentrations within the reference range may be associated with weight gain."

Limitations of the study include observational design precluding determination of causality; lack of measurement of free thyroxine levels; sample nearly entirely white, with possible lack of generalizability to other ethnic groups; and inability to account for other covariates known to be associated with body weight and weight change, including diet and physical activity.

"The identification of change in thyroid function as a risk factor for weight gain might help guide research into the identification, prevention, and treatment of individuals at risk for the development of excess adiposity," the study authors write. "Confirmation of our findings in other samples is warranted, and in particular more longitudinal studies are warranted."

The National Heart, Lung, and Blood Institute's Framingham Heart Study supported this study. Two of the study authors have been supported by the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. The other study authors have disclosed no relevant financial relationships.

In an accompanying editorial, Roy E. Weiss, MD, PhD, and Rebecca L. Brown, MD, from the University of Chicago Medical Center in Chicago, Illinois, address potential mechanisms linking thyroid function and obesity.

"Assuming preservation of tissue responsiveness to thyroid hormone levels, the absence of reciprocal changes in T3 and T4 levels suggests a central modification of the HPT [hypothalamic-pituitary-thyroid] axis in obesity," Drs. Weiss and Brown write. "Elucidation of the mechanisms by which obesity alters the HPT axis may give clues to the other metabolic abnormalities seen in this condition. There is no evidence at this time to advocate lowering serum TSH concentrations to treat obesity."

Drs. Weiss and Brown have disclosed no relevant financial relationships.

Arch Intern Med. 2008;168:568-569, 587-592.

Clinical Context

In the United States, the prevalence of obesity is rising. Obesity is associated with the increased risk for diabetes, vascular disease, all-cause mortality, and cancer. Known predictors of obesity and weight gain include a low level of physical activity, increased energy intake, parity, smoking cessation, inflammation, depression, and genetic factors. It has been recognized that thyroid dysfunction is a cause of weight change. Studies have suggested that variation in thyroid function within the reference range may be related to weight change.

The aim of this study was to determine whether variations in thyroid function are associated with body weight.

Study Highlights

• From the Framingham Offspring Study, participants (n = 2407) who attended 2 consecutive routine examinations, were not receiving thyroid hormone therapy, and had baseline serum TSH concentrations of 0.5 to 5.0 mIU/L and follow-up concentrations of 0.5 to 10.0 mIU/L were included in this study.
• The prevalence of obesity at baseline was 14.3%, and the mean baseline serum TSH concentration was 1.91 mIU/L in women and 1.70 mIU/L in men.
• Baseline TSH concentrations were related to body weight and change in body weight during 3.5 years of follow-up.
• Results revealed that at baseline, adjusted mean weight increased progressively from 64.5 to 70.2 kg in the lowest to the highest TSH concentration quartiles in women (P < .001 for trend) and from 82.8 (lowest quartile) to 85.6 kg (highest quartile) in men (P = .007 for trend).
• Baseline TSH concentrations were not associated with weight change during follow-up.
• During 3.5 years of follow-up, mean (SD) body weight increased by 1.5 (5.6) kg in women and 1.0 (5.0) kg in men.
• Weight increased by 1.9 kg per every 1-unit increase in log TSH concentration (P < .001) in women and by 1.0 kg per every 1-unit increase in log TSH concentration (P = .007) in men.
• An increase in TSH concentration at follow-up was positively associated with weight gain in women (0.5 - 2.3 kg across increasing quartiles of TSH concentration change; P < .001 for trend) and men (0.4 - 1.3 kg across quartiles of TSH concentration change; P = .007 for trend).
• Limitations to this study included the observational design of the study; lack of measurement of free thyroxine levels; sample nearly entirely white, with possible lack of generalizability to other ethnic groups; and inability to account for other covariates that may affect body weight, such as diet and physical activity.

Pearls for Practice

• Risk factors leading to obesity include low level of physical activity, increased energy intake, parity, smoking cessation, inflammation, depression, and genetic factors.
• Thyroid function within the reference range is associated with body weight in both sexes, suggesting that modest increases in serum TSH concentrations within the reference range may be associated with weight gain.

Food Addiction = Disease: Stages & Consequences

I'm going to draw heavily again from Kay Sheppard's book on food addiction along with my professional and personal experience to lay out for you the stages and consequences of the disease of food addiction. It's when we look at food addiction as a bad habit that needs to be changed by sheer force of will that we get into trouble - we fail inevitably and then the roller coaster of despair, anxiety, depression, mood swings and self-loathing begins.

The conventional medical world has been slow to see the connection between food addiction and obesity, or food addiction and anorexia and/or bulemia. The link is obvious to me, although the classic criteria of food addiction have not made it into the conventional bible of such problems: Our Diagnostic and Statistical Manual of Mental Disorders. However, if you look under "Bulemia," you'll find there is tremendous overlap with food addiction.

Kay Sheppard states that the path of food addiction is one of ups, downs and many side trips. I happened to own my food addiction relatively early in the process, mostly because I had the blessing to care for many women who were food addicts who recovered through an abstinent eating plan and 12-step. I had never seen people maintain a healthy weight as these women, and it intrigued me.

Kay talks about how young food addicts have more interest in food than their peers, who can often take it or leave it. She recommends a careful assessment of past behavior and attitudes as they relate to food to reveal addiction. Below is a list of symptoms taken directly from her book.

Stage I: Preoccupation with Food
Food addicts spend an "inordinate amount of time seeking, talking about, and involving" himself or herself with food. Movies = popcorn, Holidays = special food (e.g., my mom's yummy Yorkshire Pudding for Christmas, latkes for Hannukhah) ; "the food addict sees life in relationship to the next opportunity to eat."

Other facets of Stage I: Sneaking food and/or stealing food & money; discomfort in no-food situations; keeping secrets; concern about weight; self-loathing; and eating after others stop.

Stage II: Loss of Control and Attempts to Control
Kay describes this next phase as loss of control over the amount of food consumed and over behavior. Life becomes unmanageable. This leads to many attempted diets: Weight Watchers, Jenny Craig, Fat Flush, Nutrisystem, etc.

Other features? Self-deception; making excuses; lethargy, irritability and depression.

Stage III: Final Stages -- Efforts to Control Binging Fail Repeatedly.
This includes over-exercising, use of laxatives or diuretics, and cycles of failure may become more frequent.

Eventually there is a withdrawal phase of greater isolation and "numbing out" in food - with loss of interest in family, friends and other pursuits, work and family problems, emotional , physical, moral and mental deterioration, neglect of good nutrition, food is the main source of security, panic: obsession and compulsion take over, and then, in time, complete defeat.

Medical consequences of food addiction are legion: high blood pressure, pre-diabetes or diabetes (adrenal fatigue helps hasten this regardless of weight), high cholesterol and cardiovascular disease (our #1 killer in the US), and cancer. There are also lesser known conditions such as gallbladder disease, hepatic steatosis, lung impairment, hormonal imbalances (especially estrogen dominance and adrenal fatigue), obstetric complications, gout, joint dysfunction, etc.

The emotional and psychological effects may be even worse: bulemia, depression, anxiety, guilt, poor self-esteem, shame and self-contempt.

Fortunately, there is a solution. Kay's book is a great start along with joining a 12-step program such as Overeaters Anonymous or Food Addicts. If you are suffering and want to heal, call today or show up at a meeting.