Tuesday, 31 May 2016

Nurturing The Brain – Part 9, Blueberries

Astronauts on space missions can be exposed to radiation for long periods of time, which can pose significant dangers to their health. The fact that the administration of blueberry extract has been proposed as a preventive therapy to protect them from harmful radiation is a great indication of just how powerful these fruits might be.

The more blueberries are studied, the more evident it becomes that they are a superfood. Blueberries contain important biologically active compounds, such as polyphenols, phenolic acids, and vitamins, with countless beneficial effects. Within polyphenols, there are many different types of chemicals found in blueberries with great health benefits, such as flavonoids; these include anthocyanins, which are particularly interesting due to their potent antioxidant properties. Among fresh fruits and vegetables, blueberries are the ones that contain the highest concentration of anthocyanins.

Blueberries’ potent antioxidant effects are indeed their most outstanding property. This is important because oxidation in one of the main sources of cellular damage. A process known as oxidative stress can arise from an increase in oxidant factors known as reactive oxygen species. Although they are normal product of cellular metabolism, and quickly neutralized by antioxidant defenses in normal conditions, they may escape neutralization and give rise to oxidative stress. This can have serious consequences, leading to the development of several pathologies, particularly in aged subjects, who are more vulnerable to the effects of oxidative stress.

So, anything that provides an antioxidant effect can help counterbalance the detrimental effects of oxidative stress, as is the case with blueberries, which can be used to boost our endogenous antioxidant defense system. But blueberries’ benefits are not restricted to their antioxidant action; they also have anti-inflammatory, antimutagenic, antihypertensive and hypoglycemic effects, and are even inhibit different types of tumors.

Blueberries confer great cardiovascular protection. Their biologically active molecules can inhibit inflammatory responses in endothelial cells, the cells that form the lining of all blood vessels. This improves endothelial function and prevents the development of vascular diseases. Daily blueberry consumption can improve blood pressure, arterial stiffness, myocardial and coronary performance, and protect the heart against ischemia – the shortage of oxygen and glucose due to restricted blood supply.

The neuroprotective effects of blueberries

The increase in antioxidant defenses that blueberries can provide is relevant not only in vascular disorders, but also in neurodegenerative conditions. Oxidative stress is particularly harmful to the brain because of its higher oxygen demands compared with other tissues, and of the higher exposure to oxidative damage that it entails. In fact, oxidation is the main agent of many age-related and neurodegenerative diseases, giving rise to cognitive and motor impairments and to a decrease in the sensitivity to several neurotransmitters.

Various anthocyanins contained in blueberries are able to cross the blood brain barrier. Those have been detected in the brains of aged rats receiving a long-term blueberry-supplemented diet, specifically in brain regions which are important for learning and memory. Blueberries’ anthocyanins are effective in decreasing oxidative stress in neurons. By counterbalancing oxidative damage, the antioxidant action of blueberries may contribute to a delayed onset of aging signs or even reverse injuries that have already occurred.

An example of the latter is a study that showed that transgenic mice predisposed to the development of Alzheimer’s disease, whose diet was supplemented with blueberry extracts, demonstrated an improvement in neuronal signaling pathways with a neuroprotective effect. In this case, a genetic predisposition to cognitive deficits was counterbalanced through dietary changes, suggesting a direct effect of blueberries on genetic expression. This impressive ability has been further evidenced by studies showing a reduction of the expression of proinflammatory genes in advanced age rats to the levels of young animals, with a corresponding improvement in memory.

Blueberries can also induce an increase in neuronal plasticity and in the generation of new neurons in the hippocampus, having therefore valuable effect in memory and learning mechanisms. This has been verified by studies demonstrating that blueberry supplementation can induce improvements in spatial memory, long-term memory, and in the ability to learn new information in animal models of aging.

The vascular effects of blueberries can also manifest themselves in brain. It has been shown that blueberries are able to prevent cerebral damage induced by ischemia, reducing the neurological deficits and increasing neurogenesis in the affected areas.

Inflammation is another crucial driver of aging and neurodegeneration. Blueberry extracts also have potent anti-inflammatory effects, inducing a significant decrease in the production of proinflammatory molecules. These anti-inflammatory mechanisms can complement their antioxidant action, potentiating their overall neuroprotective effect, and having an anti-neurodegenerative action.

In models of neuronal inflammation, blueberry polyphenols were shown to attenuate learning impairment resulting from neurotoxicity, and to exert anti-inflammatory effects through changes in genetic expression associated with synaptic plasticity, leading to memory improvement and the improvement of cognitive performance in mice.

Most of this data comes from animal studies, but there is also evidence supporting these effects in humans – in a study where elderly subjects received blueberry juice supplementation for 12 weeks, it was shown that there was an improvement in memory tests and in mood. Also, a normalization of glycemic and insulin levels was detected, which can also contribute to a decrease in the levels of inflammatory mediators associated with neurodegenerative diseases.

So, although blueberries’ antioxidant power is their most recognized feature, they can actually be beneficial through many other mechanisms – they can regulate cellular balance by acting on gene expression, signaling pathways, and synaptic plasticity, for example. All these actions can give rise to anti-ageing, anti-inflammatory and antitoxic effects, leading to an improvement in motor and cognitive performance.

Given this broad range of beneficial actions, blueberry extracts promise a multitude of clinical applications, namely in the context of neurological disorders in which oxidative stress, inflammation, and neurodegeneration are associated – Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis… Just to name a few.


Chen, J., Zhao, Y., Tao, X., Zhang, M., & Sun, A. (2015). Protective effect of blueberry anthocyanins in a CCL4-induced liver cell model LWT – Food Science and Technology, 60 (2), 1105-1112 DOI: 10.1016/j.lwt.2014.10.010

Giacalone, M., Di Sacco, F., Traupe, I., Topini, R., Forfori, F., & Giunta, F. (2013). Antioxidant and neuroprotective properties of blueberry polyphenols: a critical review Nutritional Neuroscience, 14 (3), 119-125 DOI: 10.1179/1476830511Y.0000000007

Huang, W., Liu, Y., Wang, J., Wang, X., & Li, C. (2014). Anti-Inflammatory Effect of the Blueberry Anthocyanins Malvidin-3-Glucoside and Malvidin-3-Galactoside in Endothelial Cells Molecules, 19 (8), 12827-12841 DOI: 10.3390/molecules190812827

Huang, W., Zhu, Y., Li, C., Sui, Z., & Min, W. (2016). Effect of Blueberry Anthocyanins Malvidin and Glycosides on the Antioxidant Properties in Endothelial Cells Oxidative Medicine and Cellular Longevity, 2016, 1-10 DOI: 10.1155/2016/1591803

Johnson, S., Figueroa, A., Navaei, N., Wong, A., Kalfon, R., Ormsbee, L., Feresin, R., Elam, M., Hooshmand, S., Payton, M., & Arjmandi, B. (2015). Daily Blueberry Consumption Improves Blood Pressure and Arterial Stiffness in Postmenopausal Women with Pre- and Stage 1-Hypertension: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Journal of the Academy of Nutrition and Dietetics, 115 (3), 369-377 DOI: 10.1016/j.jand.2014.11.001

Krikorian, R., Shidler, M., Nash, T., Kalt, W., Vinqvist-Tymchuk, M., Shukitt-Hale, B., & Joseph, J. (2010). Blueberry Supplementation Improves Memory in Older Adults

Journal of Agricultural and Food Chemistry, 58 (7), 3996-4000 DOI: 10.1021/jf9029332

Pojer, E., Mattivi, F., Johnson, D., & Stockley, C. (2013). The Case for Anthocyanin Consumption to Promote Human Health: A Review Comprehensive Reviews in Food Science and Food Safety, 12 (5), 483-508 DOI: 10.1111/1541-4337.12024

Shukitt-Hale, B., Carey, A., Jenkins, D., Rabin, B., & Joseph, J. (2007). Beneficial effects of fruit extracts on neuronal function and behavior in a rodent model of accelerated aging Neurobiology of Aging, 28 (8), 1187-1194 DOI: 10.1016/j.neurobiolaging.2006.05.031

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Lupus a Tough Disease to Spot, Treat

But experts say scientists are working to unearth genetic causes of autoimmune disorder

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New Test Helps Identify Rare Genetic Diseases in Newborns

'Next-generation gene sequencing' could speed up the time to a diagnosis, study suggests

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Even Kiddie Pools Pose Danger

Vigilance a must around any swimming area, expert says
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Lifestyle May Be Key to Improving ADHD in Kids

Healthier habits related to exercise and diet could help many with the disorder, researcher says

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Sun Protection Comes in Many Forms

Thorough and frequent application of sunblock is crucial, expert says

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Pet Pooch May Help Ease PTSD in Veterans

Dogs also helped reduce depression and loneliness, researchers found

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Asthma Symptoms Can Bloom in Springtime

Follow your care plan to prevent attacks, expert says

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Exploring Zika's Path Through the Placenta

Researchers find the virus can replicate in immune cells

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New Labeling Offers More Protection for Meat Lovers

Warns consumers that mechanically tenderized beef can raise bacteria risk, so more careful cooking needed

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U.S. Officials Confirm Superbug Resistant to All Antibiotics

Pennsylvania case suggests it's almost 'the end of the road' for these drugs

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Fewer Inhaled Steroids May Be OK for Asthmatic Children

Study suggests some kids don't need daily dosing, but one expert worries the strategy might have risks

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Cigarette plain packs to 'go global'

Plain packaging for cigarettes is about to "go global" in a move that will have a "huge impact" on health, the World Health Organization says. via BBC News - Health Read More Here.. Lake forest health and fitness http://ift.tt/1TV3MaF

Relax – your phone probably isn’t going to give you cancer

A study in rats suggests high cellphone radiation exposure is linked to tumours, but the experiment can't tell us much about how we normally use phones via New Scientist - Health Read More Here.. Lake forest health and fitness http://ift.tt/1XbyqQ8

World No Tobacco Day, 31 May 2016: Get ready for plain packaging

30 May 2016 – To mark World No Tobacco Day, WHO is launching a new guide to plain packaging of tobacco products, which gives governments the latest evidence and guidance on implementing the measure. via WHO news Read More Here.. Lake forest health and fitness http://ift.tt/1sIBrtT

India transfusions infect many with HIV

At least 2,234 people in India contract the deadly HIV virus while getting blood transfusions in hospitals in the past 17 months. via BBC News - Health Read More Here.. Lake forest health and fitness http://ift.tt/1TUMri4

Rise in junior doctor applications in Scotland

27% increase in a year to practise north of the border

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Backtrack on plans for full GP surgery weekend opening

Full surgery Sunday service unlikely to be needed, says Hunt

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Hereditary heart and diabetes problems raise risk for children

Third of children have inherited higher levels of cardiometabolic risk

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The power of vaccinating pregnant women

Why they are vital for plugging the "immunisation loophole" via BBC News - Health Read More Here.. Lake forest health and fitness http://ift.tt/1UqRA0f

Experts call for end to ‘systemic neglect’ of lung disease

Deaths due to lung disease unchanged over past decade

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Only quarter of 12-year-olds have all diabetes care checks

Overall diabetes control improving in children and young people

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Care home scandal families' plea to PM

Families of victims of the Winterbourne View scandal write to the prime minister demanding he shuts outdated care home institutions. via BBC News - Health Read More Here.. Lake forest health and fitness http://ift.tt/1spfO1O

Reducing cancer risk more than ‘just a walk in the park’

The science behind headlines claiming physical activity can reduce the risk of 13 types of cancer

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Monday, 30 May 2016

Vaccines might be able to stop Alzheimer’s plaques from forming

The plaques linked to Alzheimer's disease seem to be made by the brain defending itself from attack. Dialling down this defence may stop the disease via New Scientist - Health Read More Here.. Lake forest health and fitness http://ift.tt/22v3GJa

Drop in Google searches reveals success of chickenpox vaccine

It can be difficult to gauge the success of an immunisation programme, but declines in searches for "chickenpox" show they work via New Scientist - Health Read More Here.. Lake forest health and fitness http://ift.tt/1TScgye

How to nap like a pro

Napping isn’t lazy – it’s a smart way to reap the rewards of sleep. Here's the science behind the secrets of the true power nappers via New Scientist - Health Read More Here.. Lake forest health and fitness http://ift.tt/1RFhAjN

VIDEO: Staying still at work 'as bad as smoking'

New data suggests more than half of us only go for a walk at work when we need the toilet. via BBC News - Health Read More Here.. Lake forest health and fitness http://ift.tt/1REuJK3

How the corporate well-being trend can lead to discrimination

To boost health and profits, companies are offering wellness programmes that gather data on staff including steps, calories and even genetic information via New Scientist - Health Read More Here.. Lake forest health and fitness http://ift.tt/1XZiSxK

Sunday, 29 May 2016

How mental health needs sleep – and vice versa

Sleep and mental health are intricately linked, so Russell Foster wants to use sleep for diagnosing and treating troubled brains and minds via New Scientist - Health Read More Here.. Lake forest health and fitness http://ift.tt/1sFPyzW

A Resident’s Reflections from within the American Board of Psychiatry & Neurology (ABPN)

Most residents have a very limited understanding of the American Board of Psychiatry and Neurology (ABPN), and understandably so.

I myself thought of the ABPN as a large, bureaucratic, governmental organization that spent most of its time siphoning money from hapless residents in order to administer board certification examinations. I was therefore surprised, and a bit skeptical, when my chairman asked me if I was interested in a three-month administrative fellowship at the ABPN during my final year of neurology residency. Although I had an interest in administration, I was hesitant because I was unfamiliar with the fellowship’s objectives, because it would be the first year it was offered.

Three weeks before my administrative fellowship was to begin, a thick binder arrived containing a detailed, day-by-day schedule and multiple articles including, 10 Most Common Mistakes Made by Administrators and Understanding Financial Statements of Not-for Profits. I also received three books on self-improvement: Drive, Talent is Overrated, and, ironically, Being Wrong. Reviewing the schedule, I was surprised to see that I would be spending, collectively, almost four weeks traveling (including internationally).

The binder clearly spelled out the objectives of the fellowship. I was expected to learn about the mission and structure of the ABPN as a whole, and in particular the fiduciary responsibilities of the board of directors. I was to have scheduled meetings with the senior staff to appreciate their role in the day-to-day workings of the ABPN. In addition, I was expected to complete a research project, suitable for submission for presentation and publication. Finally, I was to have weekly meetings with Dr. Larry Faulkner, the President and CEO of the ABPN. It would be these weekly meetings that I would find most useful, as they provided perhaps the greatest educational value of the entire fellowship.

About the ABPN

Prior to my arrival at the ABPN, I learned that it had been formed by psychiatrists and neurologists in 1934 in order to distinguish qualified specialists from those offering neurological or psychiatric care without adequate experience or training.

Rather than a large, bureaucratic organization, the ABPN is relatively small. It consists of less than 40 staff, of which only one is a salaried physician (Dr. Faulkner). The ABPN sitting directors essentially volunteer their time. I quickly learned that the ABPN does not have members (unlike the American Academy of Neurology (AAN) or the American Psychiatric Association) and is an organization that is primarily responsible to the American public. Its main mission is to ensure the public that ABPN diplomates are competent to practice neurology and psychiatry. It does this by first certifying candidates who have graduated from accredited residency programs and by developing methods to assess that practicing physicians continuously keep up with the rapid pace of medical advancement. Initial certification for neurologists and psychiatrists now consists of a computer based examination.

Interestingly, the ABPN is also a driving force behind residency education. Recently, the Accreditation Council of Graduate Medical Education (ACGME) decided that it would not accredit additional combined training programs. Instead of dissolving these programs (in which almost 200 residents are currently enrolled), the ABPN decided to review and approve these combined training programs which include neurology-internal medicine and neurology-psychiatry. While the ACGME establishes minimal requirements for neurology and psychiatry residency programs, the ABPN establishes the necessary pre-requisites a resident must have in order to be eligible to become board certified. Often the ACGME follows suit. For example, initially there was no ACGME requirement that a graduating neurology resident see a single critical care patient. The ABPN determined that an intensive care unit (ICU) clinical skill examination (CSE) would be required in order to apply for an initial board certification exam. Shortly thereafter, the ACGME adopted the ICU CSE as a requirement for residency accreditation.

A recent focus of the ABPN is supporting education and research activities of academic faculty. Given the increasing clinical demands on faculty, I noted that the ABPN grants for innovative education projects placed particular emphasis on ensuring that faculty had protected time to complete those activities. The ABPN will shortly begin another grant program to support research on issues relevant to its mission. In both of the ABPN grant programs, awardees are selected by panels of neurologists and psychiatrists that includes members from within the academic community with established expertise in education or research.

Crucial Issue Forums

The ABPN has also begun to host a yearly “Crucial Issue Forum”. These Forums focus on pressing issues central to the fields of neurology and psychiatry and are used to obtain feedback from professional organizations and others on those issues. Experts in the field, including program directors, department chairs, representatives of national professional organizations, residents, and fellows are invited.

The most recent Forum focused on residency education, and included a discussion about whether the process of the CSEs should be modified to produce a more meaningful educational experience. A growing body of literature has suggested that the CSEs are not as effective as they might be. These sentiments were echoed by several residents, including myself. After attending this Forum, it became clear to me how seriously the ABPN took this Forum. Had the attendees of the Forum voted for the ABPN to conduct site visits to monitor the CSEs at every institution, it is likely that we would have site visits. Conversely, if a clear consensus had been to abolish the CSEs, it is likely that they would no longer exist.

My fellowship

A requirement of the fellowship is a research project with the expectation of publication. Several opportunities exist towards this end, including use of the ABPN’s wealth of data on their initial certification examinations, maintenance of certification exam and CSEs. Given my preexisting interest in both headache and education I surveyed adult neurology residency program directors and chief residents to determine their views on the appropriate amount of headache education in neurology residency. The goal of this project was to determine if headache education had significantly increased from a decade ago when a similar survey had been done. I had the opportunity to present the results to the senior staff of the ABPN as well as at the American Headache Society Annual Scientific Meeting in June 2015. The manuscript was accepted for publication in Headache, The Journal of Head and Face Pain.

The most memorable moments of my fellowship were spent in Dr. Faulkner’s office for our weekly 10 o’clock meetings. These ‘one on one’ meetings typically lasted between 1-2 hours. Rarely was there a set agenda. We discussed everything from Dr. Faulkner’s top ten rules for financial investment, to the inexact science of hiring employees. We talked about the slim evidence base behind maintenance of certification (MOC) and the impetus to have an MOC program despite the lack of strong evidence. We explored why continuing medical education (CME) has not met the same opposition as MOC Part IV, despite the fact that CME is the most time intensive component of MOC.

Behind the backdrop of the formal curriculum, readings, and scheduled meetings, a large part of the fellowship consisted of informal education. Every moment of downtime with Dr. Faulkner was an opportunity for me to learn about the process of becoming a successful administrator. While we waited for our flights we would often talk about everything from family to how important it is to take care of oneself physically and mentally. As Dr. Faulkner put it, “If you fall apart, everything falls apart. If you’re not healthy, you won’t be able to fulfill your family, social, or work responsibilities.” He impressed upon me the importance of being on the same page as one’s spouse and family. We discussed the value of doing a few tasks, but doing them well. I understand now that the real value of this unique experience truly lay in the in-depth immersion that I had into all things administrative, from the ABPN, to academic departments, to professional organizations, and even to my family.

Finally, the fellowship gave me the opportunity to meet with some of the most influential leaders in neurology and psychiatry. It was eye-opening to see the work that goes on behind the scenes at organizations like the AAN, APA, and ACGME. Despite their different responsibilities, each of these national organizations and their respective leaders had the singular goal of furthering the fields of neurology and psychiatry through focused initiatives. I began to appreciate the extraordinary effort that went into the large annual professional meetings. I spent a day at the AAN in Minneapolis learning about their different sections and the spectrum of resources they provide for their members. It was humbling to realize that I could probably spend my whole life on the AAN website and still not be able to take advantage of all the resources they have to offer.

In the ABPN I found an organization that not only tried to uphold the standards that make our profession credible, but also an organization that was dedicated towards the advancement of neurology and psychiatry education. In Dr. Faulkner I found a leader who tried to be fair. He cultivated the potential of those around him into a kinetic energy that translated into a collective success. Much of his time was spent advocating for the best interests of neurologists and psychiatrists against those who would like to propose greater physician scrutiny and regulation.

The mounting pressures of lower reimbursement in the setting of higher patient volumes, the oft-repeated mantra of ‘Do more with less’, and the overwhelming paperwork often overshadow our initial motivation to become physicians. More than anything else, my time at the ABPN and my interaction with the leaders in neurology and psychiatry have given me hope and optimism that we can find our way through the pressured maze of bureaucracy and increasing scrutiny to an era where we will be able to provide the best care for our patients while seamlessly documenting the quality of our work. There are multiple initiatives towards this end, not the least of which is the commitment and support of leaders in neurology to the AAN Axon Registry. In summary, my experience at the ABPN taught me that our future is in our hands and that our collective involvement and effort will be crucial to effectuate the outcomes we desire.


ABPN Awards Program. Faculty innovation in education award. American Board of Psychiatry and Neurology website. Accessed December 21, 2015.

Aminoff, MJ. Faulkner RF. (2012). The American Board of Psychiatry and Neurology, Looking Back and Moving Ahead. Arlington, VA: American Psychiatric Publishing.

Kay, Jerald. (1999(. Administrative Mistakes Handbook of Psychiatric Education and Faculty Development. Washington D.C., American Psychiatric Press.

Schuh, L., London, Z., Neel, R., Brock, C., Kissela, B., Schultz, L., & Gelb, D. (2009). Education Research: Bias and poor interrater reliability in evaluating the neurology clinical skills examination Neurology, 73 (11), 904-908 DOI: 10.1212/WNL.0b013e3181b35212

Image via StartupStockPhotos / Pixabay.

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What does ‘natural’ mean? Time to ditch a dangerous concept

The US regulator wants to define "natural" so it can decide which foods can use the label, but the word is also abused by Greens and fans of alternative medicine via New Scientist - Health Read More Here.. Lake forest health and fitness http://ift.tt/1qUhm2r

Can you catch up on missed sleep?

Skipping sleep can hurt both body and mind, but there are ways to make amends via New Scientist - Health Read More Here.. Lake forest health and fitness http://ift.tt/1UlKSbH

Saturday, 28 May 2016

Sixty-ninth World Health Assembly closes

The Sixty-ninth World Health Assembly closed on 28 May 2016 after approving resolutions on WHO’s Framework for Engagement with Non-State Actors; the Sustainable Development Goals; the International Health Regulations. via WHO news Read More Here.. Lake forest health and fitness http://ift.tt/1siqhfB