EMOTIONS AND DISEASE
Two of the most compelling features of the last twenty years have been dramatic achievements in the laboratory and striking advances in biomedical technology. Together, they have literally extended the frontiers of the mind by embodying emotions in the biology of the brain more successfully than ever before and by creating the possibility of identifying the intricate interconnections between brain-based emotions and the functioning of the neuroendocrine and immune systems. Spectacular developments in laboratory science and visualization technology have been essential components of the explosive development of neuroscience, a field which has quickly become one of the most respected, exciting and actively pursued in medicine.
67"> Within the neurosciences an area variously called "psychoneuroimmunology" and "neuroimmunomodulation"
68"> has recently emerged which seems on the verge of tracing the pathways between emotions and disease whose connections had long been glimpsed in clinical contexts by physicians ranging from Galen to Freud and from Maimonides to Alexander.
by Esther M. Sternberg, M.DESTHER M. STERNBERG M.D. is internationally recognized for her discoveries in brain-immune interactions and the effects of the brain's stress response on health: the science of the mind-body interaction. A dynamic speaker, recognized by her peers as a spokesperson for the field, she translates complex scientific subjects in a highly accessible manner, with a combination of academic credibility, passion for science and compassion as a physician.
Esther M. Sternberg, M.D. is the Chief of the Section on Neuroendocrine Immunology and Behavior at the National Institute of Mental Health; Director of the Integrative Neural Immune Program, NIMH/NIH; and Co-Chair of the NIH Intramural Program on Research in Women Health, National Institutes of Health, Bethesda, MD
The notions that stress can make you sick or believing could make you well have been embedded in the popular culture for thousands of years, but only recently have scientists and physicians had the tools to prove that these ideas are real. In ancient Greece, people visited Temples to Asclepius, the Greek God of Healing, to be cured with prayers, music, sleep, dreams, healthy diet, pure water, exercise, and socializing with family and friends. These temples were always built at the tops of hills overlooking the sea, near a fresh water source, and had gently sloping ramps that even the lame could climb.
In this article I will briefly describe some of what we have learned in recent years about the role of the stress response in autoimmune diseases like rheumatoid arthritis, how stress can worsen disease, and how understanding the cross-talk between the brain and the immune system can help us structure our lives to help us heal.
Of course, stress alone does not cause autoimmune diseases like arthritis, and removing stress alone does not cure arthritis. But relaxation can help one=s body to heal and to respond to the advanced medications that have been developed in recent years to treat such diseases.
Many genes--over 20 different ones, each with small effect--contribute to susceptibility to inflammatory arthritis. A blunting of the brain hormonal stress response is also an important contributor to development of autoimmune diseases. The reason for this is that cortisol, the potent anti-inflammatory hormone that is released from the adrenal glands in response to stress, is also released after exposure to inflammatory triggers.
In normal circumstances cortisol keeps the immune system in check, preventing inflammation from going out of control. In many patients with autoimmune diseases, this cortisol response and the cascade of brain hormones that stimulates its release are impaired, so there is no shutoff valve to end inflammation when it is no longer needed. In other patients, the cortisol response may be intact but immune cells are resistant to the anti-inflammatory effects of cortisol due to abnormalities in the cortisol receptor. In both circumstances, inflammation goes on unchecked without the dampening effect of the body own cortisol.
Conversely, chronic stress, like that experienced by chronic caregivers of Alzheimer=s patients, is associated with elevated levels of cortisol which keep the immune system in a sluggish state, predisposing to infection. Such persons are more prone to more severe viral infections, have lower take-rate of vaccines, and have prolonged wound healing--all functions dependent on an intact immune response.
Salubrious activities like meditation, prayer, sleep, exercise, healthy life style and social support--many of those activities that the ancient Greeks practiced in their temples to Asclepius--tend to reduce the stress response and prevent the negative effects of cortisol on the immune system.
Krista Tippett
Esther Sternberg is a scientist's scientist. She is wary of the commercialized self-help industry and of unsubstantiated claims for alternative methods of healing. Until she began to do the research she describes in this program, she shared her profession's modern bias that emotions — such as the gamut of "feelings" we associate with stress — are distinct and perhaps altogether separate from physical health. Without measurable and logical proof of their direct connection to disease or healing, such a correlation could not be taken seriously.
But in recent years, parallel to her colleagues in many other disciplines, Esther Sternberg underwent a period of scientific and personal discovery. While dying of cancer, Esther Sternberg's mother urged her daughter to ask not only whether stress can make us sick, but whether "loving" and "believing" can help us to live well. Esther Sternberg began to pose these questions for herself when she became exhausted and simultaneously developed a form of arthritis, a disease she studies. Here, she tells part of her personal story and some of the fascinating history of medicine she traced for the book she ultimately wrote: The Balance Within: The Science Connecting Health and Emotions.
Sternberg insists that we'll always need different "languages" to discuss medical fact and emotional realities. And yet she rediscovered that for a thousand years "the balance of the four humours" — blood, yellow and black bile, and phlegm — was a central principle of medical teaching. These were visible secretions and therefore could be taken as windows into the workings of the body. Vestiges of these concepts, Sternberg points out, are buried in words we still use to describe emotional types: sanguine, melancholy, phlegmatic, choleric. Modern scientists are now on the cusp of a new world of understanding, she says, because they now know genes, hormones, and neurotransmitters to be as real and measurable as blood and bile. They know that what we call feelings — both physical and emotional — are caused by myriad biochemical connections.
This conversation leaves me with a helpful and unexpected appreciation of the positive function of the human stress response. It is as old as time, part of our body's in-built capacity to guide us in new environments and protect us from danger. Stress does not make us sick, per se. But prolonged stress sets off a cascade of reactions that can leave us with overstimulated or suppressed immune systems. Memory and perception add to those physiological effects. Knowing such details, we can concretely understand when we need to avail ourselves of medical care and when and how we can help to heal ourselves. Such an approach is at the core of integrative medicine, an approach to health care that is growing across this country and which we've explored in previous programs.
There is a healing paradox in the Esther Sternberg's perspective. Science — with its insistence on what can be seen and measured — took us away from our ancient intuition about the connection between health and emotions. But science now is bringing us back. Esther Sternberg's insights validate the experience of prolonged stress so many of us know. They evoke the full meaning of the phrase, "feeling sick." She even suggests a notion contrary to our culture of constant productivity: that vacations are not luxuries but physical necessities. So, too, are practices that calm and renew our emotions and our spirits together.
Can stress make us sick? Can places of peace, prayer, meditation, rest, music, and friendship help us to live well? Each of us must answer these questions in the context of our lives, with our particular histories and our physical and spiritual details. But what interesting times we're living in when physicians and scientists begin to ask such questions along with us.
The brain and the immune system continuously signal each other, often along the same pathways, which may explain how state of mind influences health
Cross Communication
Both systems also rely on chemical mediators for communication. Electrical signals along nerve pathways, for instance, are converted to chemical signals at the synapses between neurons. The chemical messengers produced by immune cells communicate not only with other parts of the immune system but also with the brain and nerves. Chemicals released by nerve cells can act as signals to immune cells. Hormones from the body travel to the brain in the bloodstream, and the brain itself makes hormones. Indeed, the brain is perhaps the most prolific endocrine organ in the body and produces many hormones that act both on the brain and on tissues throughout the body.
A key hormone shared by the central nervous and immune systems is corticotropin-releasing hormone (CRH); produced in the hypothalamus and several other brain regions, it unites the stress and immune responses. The hypothalamus releases CRH into a specialized bloodstream circuit that conveys the hormone to the pituitary gland, which lies just beneath the brain. CRH causes the pituitary to release adrenocorticotropin hormone (ACTH) into the bloodstream, which stimulates the adrenal glands to produce cortisol, the best-known stress hormone.
Cortisol is a steroid hormone that increases the rate and strength of heart contractions, sensitizes blood vessels to the actions of norepinephrine (an adrenalinelike hormone) and affects many metabolic functions — actions that help the body meet a stressful situation. In addition, cortisol is a potent immunoregulator and anti-inflammatory agent. It plays a crucial role in preventing the immune system from overreacting to injuries and damaging tissues. Furthermore, cortisol inhibits the release of CRH by the hypothalamus — which keeps this component of the stress response under control. Thus, CRH and cortisol directly link the body's brain-regulated stress response and its immune response.
CRH-secreting neurons of the hypothalamus send fibers to regions in the brain stem that help to regulate the sympathetic nervous system, as well as to another brain stem area called the locus ceruleus. The sympathetic nervous system, which mobilizes the body during stress, also innervates immune organs, such as the thymus, lymph nodes and spleen, and helps to control inflammatory responses throughout the body. Stimulation of the locus ceruleus leads to behavioral arousal, fear and enhanced vigilance.
Perhaps even more important for the induction of fear-related behaviors is the amygdala, where inputs from the sensory regions of the brain are charged as stressful or not. CRH-secreting neurons in the central nucleus of the amygdale send fibers to the hypothalamus, the locus ceruleus, and to other parts of the brain stem. These CRH secreting neurons are targets of messengers released by immune cells during an immune response. By recruiting the CRH-secreting neurons, the immune signals not only activate cortisol-mediated restraint of the immune response but also induce behaviors that assist in recovery from illness or injury. CRH-secreting neurons also have connections with hypothalamic regions that regulate food intake and reproductive behavior. In addition, other hormonal and nerve systems — such as the thyroid, growth and female sex hormones, and the sympathomedullary pathways (connections of the sympathetic nervous system and medulla) — influence interactions between the brain and the immune system.
CRH and Depression
Although the role of the stress response in inflammatory disease in humans is more difficult to prove, there is growing evidence that a wide variety of such diseases are associated with impairment of the HPA axis and lower levels of CRH secretion, which ultimately results in a hyperactive immune system. Furthermore, patients with a mood disorder called atypical depression also have a blunted stress response and impaired CRH function, which leads to lethargy, fatigue, increased sleep and increased eating that often results in weight gain.
Patients with other illnesses characterized by lethargy and fatigue, such as chronic fatigue syndrome, fibromyalgia and seasonal affective disorder (SAD), exhibit features of both depression and a hyperactive immune system. A person with chronic fatigue syndrome classically manifests debilitating lethargy or fatigue lasting six months or longer with no demonstrable medical cause, as well as feverishness, aches in joints and muscles, allergic symptoms and higher levels of antibodies to a variety of viral antigens (including Epstein-Barr virus).
Patients with fibromyalgia suffer from muscle aches, joint pains and sleep abnormalities, symptoms similar to early, mild rheumatoid arthritis. Both these illnesses are associated with a fatigue like that in atypical depression. SAD, which usually occurs in winter, is typified by lethargy, fatigue, increased food intake and increased sleep, symptoms similar to those of atypical depression.
A deficiency of CRH could contribute to lethargy in patients with chronic fatigue syndrome. Injection of CRH into these patients causes a delayed and blunted ACTH secretion by the HPA axis. That same response is also seen in patients whose hypothalamus has been injured or who have a tumor. Also, fatigue and hyperactivity of the immune response are associated with cortisol deficiency, which occurs when CRH secretion decreases. The hormone levels and responses in patients with fatigue syndromes suggest — but do not prove — that their HPA axis functions are impaired, resulting in a decrease in CRH and cortisol secretion and an increase in immune system activity. Together these findings indicate that human illness characterized by fatigue and hyperimmunity could possibly be treated by drugs that mimic CRH actions in the brain.
In contrast, the classic form of depression, melancholia, is actually not a state of inactivation and suppression of thought and feeling; rather it presents as an organized state of anxiety. The anxiety of melancholia is chiefly about the self. Melancholic patients feel impoverished and defective and often express hopelessness about the prospects for their unworthy selves in either love or work. The anxious hyperarousal of melancholic patients also manifests as a pervasive sense of vulnerability.
Melancholic patients also show behavioral alterations suggestive of physiological hyperarousal. They characteristically suffer from insomnia (usually early-morning awakening) and experience inhibition of eating, sexual activity and menstruation. One of the most widely found biological abnormalities in patients with melancholia is that of sustained hypersecretion of cortisol.
Many studies have been conducted on patients with major depression to determine whether the excessive level of cortisol associated with depression correlates with suppressed immune responses. Some have found a correlation between hypercortisolism and immunosuppression; others have not. Because depression can have a variety of mental and biochemical causes, only some depressed patients may be immunosuppressed.
The excessive secretion of cortisol in melancholic patients is predominantly the result of hypersecretion of CRH, caused by a defect in or above the hypothalamus. Thus, the clinical and biochemical manifestations of melancholia reflect a generalized stress response that has escaped the usual counterregulation, remaining stuck in the "on" position.
The effects of tricyclic antidepressant drugs on components of the stress response support the concept that melancholia is associated with a chronic stress response. In rats, regular, but not acute, administration of the tricyclic antidepressant imipramine significantly lowers the levels of CRH precursors in the hypothalamus. Imipramine given for two months to healthy people with normal cortisol levels causes a gradual and sustained decrease in CRH secretion and other HPA axis functions, indicating that down-regulation of important components of the stress response is an intrinsic effect of imipramine.
Depression is also associated with inflammatory disease. About 20 percent of patients with rheumatoid arthritis develop clinical depression. A questionnaire commonly used by clinicians to diagnose depression contains about a dozen questions that are almost always answered affirmatively by patients with arthritis.
In the past, the association between an inflammatory disease and stress was considered by doctors to be secondary to the chronic pain and debilitation of the disease. The recent discovery of the common underpinning of the immune and stress responses may provide an explanation of why a patient can be susceptible to both inflammatory disease and depression. The hormonal dysregulation that underlies both inflammatory disease and depression can lead to either illness, depending on whether the perturbing stimulus is pro-inflammatory or psychologically stressful. That may explain why the waxing and waning of depression in arthritic patients does not always coincide with inflammatory flare-ups.
The popular belief that stress exacerbates inflammatory illness and that relaxation or removal of stress ameliorates it may indeed have a basis in fact. The interactions of the stress and immune systems and the hormonal responses they have in common could explain how conscious attempts to tone down responsivity to stress could affect immune responses.
Practice Relaxation and Stress Reduction
Relaxation techniques are immune-enhancers. A positive mental attitude makes a big difference in how the body fights disease. Creative visualization establishes belief and optimism. Biofeedback or massage therapy to reduce stress.
Get Enough Sleep
I can't emphasize enough how sleep is really a basic foundation of immunity. Two people can follow the same exact program, but if one is getting insufficient sleep -- and for most Americans, that means less than eight hours a night -- they will have reduced immunity against disease.
Incorporate Mind/Body - Spirituality into Your Wellness
Whether it's organized religion, prayer, meditation, or mind-body approaches such as yoga or tai chi, your mind and spirit are in communication with your immune system. Having a rounded spiritual sense and positive outlook on life can enhance immunity.
"The time I have spent in prayer has been of great transcendental importance in my life. I deeply value all the prayers I've received from friends, family and all my students!"
Pat
Get on your knees
Faith may make you healthier. People who attended religious services once a week or more have been shown to have lower levels of interleukin-6, an immune-system protein linked to some autoimmune diseases, cancer, and heart disease, than non-churchgoers.
Their immune response may be related to increased social contacts, which lower stress. Or prayer may elicit the relaxation response, a reaction that is exactly opposite to the fight-or-flight response we have to stress.
Deeply established habits can be altered; energy released. The expectation of improvement is a major factor in healing. Hope and trust are constellated and this has an immediate soothing and calming effect on the bodymind system. Release of endorphins. Importance and effect of prayer in these situations. Placebo effect. Conversely, for example, telling someone they haven't long to live may kill them or accelerate the process of degeneration. One of the most important channels for the flow of feeling is touch. The way parents touch and hold their baby can establish positive or negative neural circuitry that lasts a lifetime, laying a foundation of trust or fear.
“Prayer saves lives,” says Harold Koenig, director of Duke Medical Center's Program on Religion, Aging and Health. "We're not talking about miracles or some type of supernatural phenomena. We're just looking at basic social, psychological and physiological parameters. That’s all."
Koenig has found religious faith reduces stress, anxiety and depression, and that achieving serenity means lower adrenalin and in turn the enhancement of the immune system to fight infections, cancer, heart disease, stroke and stomach and bowel problems.
Research has confirmed the clinical benefits of religious belief, prayer and meditation, and so has our common sense, though molecular biologists are still trying to make that link between 'thought' and the biochemical malfunctions of disease.
Robert Felix, author of The Partners Within, ( http://www.partnerswithin.com ) has been educating on the healing power of prayer and meditation to overcome destructive emotions for the last decade. We interviewed him to get his perspective.
Q: How does this work, changing emotional circuitry with meditation?
Felix: The current studies focused on the amygdala -
a little almond-shaped center located deep in the brain. It has been shown to be involved with the negative emotions such as fear, anger, anxiety and depression. This emotional center needs to be modulated by the prefrontal cortex.
Q: What happens if it isn't modulated?
Felix: Well, then negative emotions can snowball into destructive behavior patterns. Typically, the psychiatric community treats these poor states of mental health with neuroplastic drugs such as serotonin uptake inhibitors (Prozac, Zoloft, etc.) with mixed success.
Q: I certainly know people for whom this hasn't been the answer. So you think there's a more successful way?
Felix: These studies have suggested that meditation strengthens the connections between the prefrontal cortex and the amygdala. They said, "Inhibitory signals from the prefrontal cortex appear to rein in the amygdala like a good yank on a kite string. The stronger or more numerous those "stop firing!" signals, the stronger the inhibition."
Q: So that's the mind-body connection! But does that mean we can do it ourselves?
Felix: Yes, and I tell you how in my book. Prof. Richard Davidson of the University of Wisconsin concluded, "It appears the inhibitory signal reaching the amygdala can be modulated voluntarily."
Q: And what happens when we learn how to modulate it ourselves?
Felix: We can get happier and more productive! The research also found that “the plasticity of connections between the thinking and feeling regions of the brain casts d
oubt on the belief that each of us has a "set point" for happiness, and that neither a Powerball win nor a Sept. 11 tragedy budges it for long." If those connections can be strengthened in a lasting way, then we can shift that point.
Q: What does that mean exactly?
Felix: It means we can increase our capacity for happiness, fulfillment and for actualizing our own unique human and higher powers.
by Alfred C. W. Davis MBA, M.Div.
Emotional Intelligence Part 1 Daniel Goleman tells us in his book Emotional Intelligence that the human being has two distinctively different brains: "one that feels and one that thinks". The emotional/rational dichotomy approximates the folk distinction between "heart" and "head". These two minds operate in tight harmony intertwining their two different ways of knowing to guide us through the world. The emotional brain is made up of the amygdala and the limbic system, whereas the thinking brain consists of the cortex and the neocortex. The workings of the amygdala and its interplay with the neocortex are at the heart of emotional intelligence.
If we were all emotional brain and no neocortex, we would become overwhelmed with the sensory input and we would be unable to make wise decisions. But, if were all neocortex and no emotional brain, we would be cold heartless computers. The key to intelligent functioning is the balance and interaction of these two brains, as opposed to the suppression of one or the other.
The way that the brain functions is that sensory data goes to the thalamus and then across a single synapse first to the amygdala, before the same signal is sent separately to the neocortex. Sometimes fight or flight is needed for protection even before the logical mind is accessed. However, if the input to the amygdala triggers an emotional memory before the thinking brain has a chance to modify the feeling, a person can become overwhelmed with emotions. Since childhood experiences are stored in the amygdala in rough, wordless blueprints for emotional life, this precognitive emotion can trigger reactions before there is full confirming evidence from the neocortex.
In most cases, the same sensory data is sent to the neocortex shortly after the amygdala has received it. The prefrontal lobes of the neocortex act as a damper switch for the amygdala. Emotional hijacking or swamping happens when the emotional response bypasses the neocortical processes that usually keep the emotional response in balance. The key "off" switch for distressing emotion seems to be the left prefrontal neocortex lobe. If the amygdala acts as an emergency trigger, the left prefrontal lobe acts as a switch for controlling disturbing emotions. The prefrontal lobes store facts, analyze information, organize actions and orchestrate reactions. In this way, the prefrontal lobes play an executive role in the managing of emotions. The thinking brain therefore guides the moment-to-moment decisions and the emotional brain informs those decisions. For example, the thinking brain recognizes the face as a cousin and the emotional brain adds that you don't really like the person.
It is important here to point out the difference between the right prefrontal lobe and the left prefrontal lobe. The right prefrontal lobe is seen as the seat of negative thinking such as fear and aggression. Another way of thinking about it is that the right prefrontal lobe is the home of the "glass half empty" thinking. It takes the negative emotion and cognitively processes it in a way that the negativity increases. On the other hand, the left prefrontal lobe keeps emotions in check, even inhibiting the right prefrontal lobe. In short, the left prefrontal lobe seems to be part of a neural circuit that can switch off, or at least dampen down all but the strongest negative surges of emotion. The "glass half full" thinking connects with what I call the thinking of "agape love" in the left prefrontal lobe where the thinking is open, constructive, expansive and positive. Hope and positive thinking in the left prefrontal lobe help overcome overwhelming anxiety, a defeatist attitude and depression in the face of difficult challenges. While emotion is needed to be human, the left prefrontal lobe thinking enables the breakdown of a formidable task into smaller, manageable pieces so that coping is possible. Agape love involves the intellect found in the left prefrontal lobe because it is a choice of the will that manages impulses, helps control Self and maximizes relationships with others.
When it comes to managing emotions, there are two main categories: a) arousal emotions and b) emotions that slow down or suppress. Emotions that arouse include: anger and anxiety. These emotions need to be managed by soothing and calming. On the other hand, emotions that slow down include: depression and sadness. These emotions need activity and stimulation. It is the thinking of the left prefrontal lobe that modifies these emotions which enables the response to be emotionally intelligent.
The processes of emotional intelligence include:
First, the intra-personal skills that enable the person to form an accurate picture of oneπs self, access oneπs own feelings and draw upon the emotions to guide behaviour, and
Second, the inter-personal skills that provide the ability to understand other people and to discern, respond appropriately to moods, temperaments, motivations and desires of other people.
Emotional intelligence combines the following steps;
1) Intra-personal abilities:
a) Knowing one's own emotions – self awareness or recognizing a feeling as it happens.
b) Controlling one's own emotions – the capacity to control and soothe one's self so that feelings can be responded to appropriately.
c) Managing one's own emotions - the capacity to marshal emotions in the service of a goal.
2) Inter–personal abilities:
a) Empathy – the capacity to listen to and be attuned to another person.
b) Relate – the capacity to interact with others smoothly by co-ordinating moods and dealing effectively with the other person's emotions.
c) Optimism – the capacity to live out of the creative, co-operative, positive approach of "how" to make things happen.
The intra-personal emotional intelligence is needed first before moving to the inter-personal emotional intelligence. As you will see in the following examples, the principles of agape love are integral to the practice of emotional intelligence.
Humans have a wonderful ability to expect positive events in the future, even when there is no shred of evidence to support them. One of the key components of resilience is optimism. Though there is data to show that there is a genetic contribution to optimism, it is also a psychological attribute that can flow from life experiences as well as attitude that can be developed. Though the motivational coaches who tell us that putting on a happy face will make you happy and optimistic are probably overstating the truth! A lack of optimism is often a sign of clinical depression so learning more about it, is not just an academic exercise.
New research just published in the journal Nature indicates that there are two regions of the brain linked to optimism.
The team from New York University and University College, London, says that the act of imagining a positive future event, for example winning an award or receiving a large sum of money, activates two brain areas: the amygdala and the rostral anterior cingulated cortex (rACC). The finding ties in with earlier studies that suggested that these brain regions malfunction in depression. (1,2)
The investigators first measured how optimistic 15 volunteers were using a standard questionnaire. They were then scanned using functional magnetic resonance imaging (fMRI) while reflecting on one of a number of potential scenarios.
In one part of the trial, subjects followed specific instructions to recall a negative event in the past, such a funeral that they had attended in the past five years. In another experiment they had to imagine what it would be like to be involved in a car crash in the near future. At other points in the study subjects had to reflect on positive events such as winning an award in the past or receiving a large sum of money in the future.
Reflecting on both past and future events activated the amygdala and the rACC regions of the brain. However, positive events, and particularly those imagined in the future, generated a significantly larger response in these regions than reflecting on negative events.
When imagining happy events, the more pessimistic subjects in the trial had less activation of these brain areas than their optimistic counterparts when imagining happy events.
For some time now, many researchers have assumed that the amygdala and rACC are only involved in negative thoughts and negative reactions, but this research indicates that they have an important role in signaling cheerful thoughts. And, what is more, these are also regions of the brain that have been implicated in depression. Previous research has suggested that patients with depression have decreased nerve signaling and fewer cells in the rACC and amygdala.
Is this why people with depression find it so hard to generate positive thoughts?
This is important work that will likely have a great many practical applications.
“Children are born optimists and we slowly educate them out of their heresy.”
--Louise Imogen Guiney (American-born English Poet, 1861-1920)
“Although the world is full of suffering, it is full also of the overcoming of it.”
--Helen Keller (American Blind and Deaf Swedenborgian Philosopher, 1880-1968)
“No man is so old as not to think he can live one year more.”
--Marcus Tullius Cicero (Roman Political Figure and Orator, c.106-43 B.C.E.)
"The way to become happy
Is to think
And to feel
That the very best is yet to come.”
--Sri Chinmoy (a.k.a. Chinmoy Kumar Ghose, Indian Philosopher and Spiritual Teacher, 1931-2007)
Oprah Winfrey is saying goodbye to burgers inspired by Quantum Wellness book and Canadian motivational speaker Eckhart Tollet
As well as already demonstrating that the diet does actually work in reducing seizures, the UK clinical trials aim to establish the exact mechanism by which the diet works. The research is being undertaken by Great Ormond Street Hospital (GOSH) together with the Institute of Child Health (ICH), the National Centre for Young People with Epilepsy (NCYPE) and the Central Middlesex Hospital. GOSH experts also believe it is not known which of the two ways of giving the diet are better. Up to 120 children (aged two to sixteen) will be recruited on the study. The study will examine if there is actually any difference between the diets by randomising half of the children to each diet. Click onto 
Although high in fat, meals on the ketogenic diet can be extremely tasty if well prepared and some parents have conjured up some very inventive recipes to make the diet as palatable as possible. The exact dietary composition will depend on which type of ketogenic diet a child is following, and on their individual prescription. A typical breakfast on the classical diet might include double cream, egg, butter and a small portion of fruit or vegetable, whereas more starchy carbohydrate would be allowed on the MCT diet, for example a small serving of cereal or bread. However, the special MCT supplement is needed with each meal on the MCT diet - this can be mixed into milk or food. Lunch and dinner might include a protein source, such as meat, fish or cheese, a serving of vegetable or fruit, and fat in the form of butter, double cream, oil or mayonnaise, or the MCT supplement if on the MCT diet. Snacks can be included if these suited a child's eating pattern. The portion sizes will be individualised for each child, however do tend to look smaller than normal, as fat provides more calories per gram than carbohydrate or protein.
