24 comments

  1. Dr. Eenfeldt,

    Have you given much thought to what causes some people to stick to your dietary recommendations, others to not be able to, or even experience initial success, then drop out?

    Because I believe the most important study in medicine, in my opinion, explains this well.

    Ann Childers, MD, a paleo-practitioner and adult and child psychiatrist tweeted to me the other day that she was impressed with a series of comments I left on your site in the agave post, and pointedly pointed out that most physicians aren't familiar with the ACE Study.

    In a nutshell, the ACE study was started by a top obesity researcher at Kaiser Permanente, and he noticed his most successful patients were dropping out of treatment. Upon interviewing them, he found a recurring theme of childhood trauma of various types, both overt and abandonment/neglect.

    I wonder if one of the reasons Sweden is leading the world right now in adopting a rational eating plan isn't because Sweden was the the first country to ban corporal punishment of children.

    OK, that's speculation, but it's a reasonable hypothesis worth looking into.

    On the other hand, America, particularly the southern United States where child striking is still allowed in school and spanking is widespread practice along with other corporal punishment methods and stern child raising techniques generally, have very high obesity rates that are worsening.

    You're a scientist in terms of your thinking and an MD by training.

    Will you please take a look at the longest running, largest study in the world on the effects of adverse childhood experience on children?

    The correlations between these and subsequent mental, emotional, physical, social, and economic problems are profound. In some cases, there are in the thousands of percent range.

    I truly do believe this is the single most important study so far not just in terms of medicine but civilisation. And it certainly, absolutely, categorically does have some major bearing on the obesity epidemic.

    There are two main ways this works, in my opinion.

    Important, but probably less important, is how chronic elevated adrenal hormones such as cortisol raise insulin and leptin resistance. This is easy enough to understand, and you've posted yourself on the links between cortisol and insulin resistance.

    At the same time, there is an even deeper way these traumatic experiences (including lack of early attachment) effect people:

    People are so caught up (limbic system controlling higher-order functioning) in relieving the negative emotional effects of their past experiences, self-medicating them, that they can't follow dietary instructions or consistently give attention to food quality. They find they don't care, when their traumatic memories get triggered, often subconsciously.

    These are the same reasons why addictions such as smoking, alcohol, drugs, extreme promiscuity, aggression, and even suicidal behaviour (an attempt to escape emotion and trauma) and so on, are so strongly associated in people with a high-ACE score.

    The associations are profound, and this is a large scale study. Surely the fact that an obesity researcher's work morphed into the largest study in the world in the burgeoning field of looking into childhood trauma's effects should have some interest to obesity researchers and clinicians.

    That just stands to reason, doesn't it?

    In the long series of comments I placed on the agave post (in reply to another commenter there who said she always gave into her cravings as if something just took over her), I mentioned some self-treatments (can also be done with a therapist) that have been clinically proven to lower cortisol dramatically, and also help people with stress disorders such as PTSD. Some of these techniques, such as iRest yoga nidra and mindful meditation, are so effective they are working their way into the western world, treating everyone from combat veterans to workers in hospitals' ER rooms to the general public.

    They are grabbing hold of much of the western world's wellness consciousness.

    Lowering people's sense of stress and physiological factors of stress like cortisol can make following a diet or any other healthy behaviour change much easier.

    Will you take a look at this and consider writing on it sometime? I feel that obesity-interested doctors should be taking a look at the links between trauma (including abandonment/neglect) and obesity, which is being demonstrated in study after study.

    Yes, back in the day, even traumatised children couldn't eat much sugar, so they stayed lean and instead engaged in crime, alcoholism, or what have you. But now traumatised people have a wider array of unhealthy behaviors to choose from: many choose McDonald's, potato chips, and boxed macaroni and cheese.

    Notice that obesity is largely a disease of poverty, and that children in poverty suffer greater rates of childhood trauma.

    Here's an excerpt of a speech Dr. Vincent Felitti gave on the ACE study, and it's good. I feel you should also listen to a full version of his presentation, which is also available on the site.

    And by all means, delve into the study itself.
     
     
    P.S. It's good to be right about macronutrients and so on, but what does that matter if only a small fraction of people can consistently follow your advice? Understanding the ACE Study gives you both a much greater understanding of and compassion for your fellow human beings; and also the key to help them follow your health advice, and improve their lives generally.

    Reply: #7
  2. When I use "your" in the above comment, I am referring not just to Dr. Eenfeldt, but to everyone in the health field where patients/clients following through on recommendations is of importance.
  3. And the comic? Yes it was funny. ;)
  4. Patrick
    Lol. This Delbert comic joke was funny. Not only is bread the problem, it's the wheat that makes bread the problem.
  5. Dana
    Christoph: It may be a chicken-and-egg argument.

    The southern United States has always been a poor region, but never so poor as in the years immediately following the American Civil War. What followed was a pellagra epidemic that, as far as I know, affected nearly everyone. On top of that you have a former slave population in those states which was, once freed, subjected to "Jim Crow" laws which limited black people's access to decent jobs and therefore decent food.

    I have reason to believe that poor nutrition leads to violent and otherwise antisocial behavior. Those poorly nourished who become parents then default to raising their children in violent and antisocial ways. The children too are poorly nourished, and then on top of that they live in an antagonistic, punitive environment. Double whammy.

    And this doesn't even take into account the *multi-generational* effects of severe malnutrition in one generation--the aftereffects are passed down to the children through epigenetics. I suspect this is where a lot of the so-called "inbred" people down South really came from. It wasn't cousin marriage, it was a lack of niacin in the grandparents!

    This is not just an abstraction to me. I'm a Southerner, now living in Ohio. I am not here for the weather.

    But really in any poor region you will see poorly nourished people, and it doesn't matter if they get enough calories when food quality overall is poor. There may still be abuse in their lives but it doesn't necessarily come from the parents--witness the atmosphere in which American Indians on reservations must live, facing political hostility on all sides. I'm sure many of them are quite loving parents but the odds are stacked against them.

  6. Diane
    Thanks for posting this Christoph. I had not heard of the ACE Study but I've now looked it up and it is very interesting and makes so many things make sense.

    Do you know of a good place to look for ways to help people with high ACE scores make positive changes in their lives to improve their life chances?

  7. bernardo
    Hi Christoph, I have a few things to share about what you wrote, according to my own experience and observation:

    1 - I used to have a very emotional relationship with food so I consider myself someone that falls into the category of people that wouldn't be able to stick to the diet, but low carb makes it easy, it's not a diet, you are not going to get back to your "normal" eating after you loose some weight, even though you will be pressured by society to do so. There are many reasons why someone drops off the diet, social pressure being a huge one. Like with any other addiction, you can't make exceptions or you risk getting back to the cycle.

    2 - It's really hard to mesure what is traumatic experience and how it affects eating and vice-versa. I didn't have any traumatic incident in my life (well not extremely traumatic), but I still developed this compulsive relatioship with food (or maybe just carbs), again, it's a cycle, it feeds on itself (no pun intended) and it's hard to know where it begins and where it ends, but I kept it under control for good with LCHF.

    3 - Today's children are the least beaten in all history, and still they develop obesity and diabetes like never before.

    So, those are a few points I'd like to make based on my experience. I don't know details of the study, but I think evaluating people in such subjective matters can be confusing and open to many interpretations/manipulations. I'd rather have people really trying an LCHF diet without all the social pressure to eat carbs (which might occur in the future) and then if it really doesn't work for some reason, try to find other possibilities. I would bet that it would be a minority, yes, that will always exist.

  8. Christoph: It may be a chicken-and-egg argument.

    Yes, I couldn't agree more, Dana. In highly-complex systems, whether biological or social, there are reinforcing cascades. Some are good, some not so good.

    Thanks for posting this Christoph. I had not heard of the ACE Study but I've now looked it up and it is very interesting and makes so many things make sense.

    Thanks so much to you too, Diana, for your comment especially the part I bolded. It is so important and you put your finger right on it.

    Do you know of a good place to look for ways to help people with high ACE scores make positive changes in their lives to improve their life chances?

    This is something I've had the unfortunate necessity of having to address myself. But I do believe a combination of my love of research combined with finally understanding the root causes of many (most) of my difficulties in many areas, has led me into some very helpful directions.

    Not only have they been helping me a lot, there's good science that they do, objectively, lower cortisol levels, feelings of trauma, etc.

    One thing I'll say though, is my experience and the experience of at least one other trauma survivor that I know (a woman named Michele Rosenthal who has a podcast series, a couple blogs on this topic, lectures on it, etc.) is that combining different approaches seems to work exponentially better than just doing one approach.

    She's observed that in several different people, and that was my personal experience and revelation --- before I'd ever heard of her.

    In the middle link above, which I'll repost here, I mention some of the most useful approaches that I found transformative. There are six consecutive comments in all where I talk about this, partly in the context of diet/obesity to hopefully one day get the attention of luminaries in this field (and because it's really important to it), but also helping with many if not most life problems.

    Essentially, they're some stress reduction and also some specific trauma therapy techniques (potentially very powerful for many). I'm not claiming originality; rather I'm pointing out the relationship between overcoming trauma, building stress reduction into one's life, and how this can positively impact physical not just emotional issues: 1. partly due to reduced stress hormones; 2. perhaps even more, because of increased ability to make healthy lifestyle changes due to not needing to self-medicate to handle negative emotions.

    I hope some of this is of value, Diana.

  9. 3 - Today's children are the least beaten in all history, and still they develop obesity and diabetes like never before.

    Children are developing mental problems at an unprecedented rate.

    The ACE study doesn't just look at child hitting. Children used to be raised by their parents.

    Now they are sent off to daycares, preschools, and the like. They don't form good early attachments. This is devastating to children's emotional development.

    While I object to hitting children on moral grounds as well as based on the increasing mountain of psychological data showing that this is harmful to them, I am mindful that we evolved in a stressful environment with life and death on the line through various mechanisms, including tribal warfare.

    However.

    These stresses were then soothed by parents in most cases. Nowadays, children are away from their primary caregiver for a long, long time, beginning quite early and going to adulthood.

    Further, in a state of nature, children were raised mostly by adults with some children around. Now, children are raised by their peers.

    Are their peers mature?

    Their peers don't even include older children for the most part! They're raised in a 25-35:1 child:adult ratio, with the adult in question being a (perhaps well-meaning) civil servant drawing a paycheque, not a parent.

    Finally, getting back to diet itself, the dietary options available has changed. We all acknowledge that. I'm not saying that stressed children become fat adults eating a healthy natural diet became obese (anymore than they got addicted to heroin and crystal meth and porn in 9,000 BC). They probably were more aggressive, depressed, became unstable, found it harder to form solid relationships and achieve social status, self-harmed possibly, etc. But they didn't have the raw materials around them in enough quantity to become fat.

    Now they do, and they do.

  10. Also what do children get if they're very upset? Time-outs.

    They need time-ins. This video very good at communicating a good understanding the stress lack of a proper relationship with a primary (not a bunch of perhaps nice people working shifts at an institution) relationship with a carer is to a mammal, particularly a primate, and in particular a child.

    Abandonment and neglect are categorically adverse childhood experiences.

    We're left alone far too often during our formative years. Now factor in bottle feeding instead of breast feeding, the Internet, two-working-parent families needed to pay high tax rates, an explosion in divorces and/or single-parent families, etc., etc., and it's a nightmare for healthy child development. Children are suffering for it all throughout the west.

  11. I didn't have any traumatic incident in my life (well not extremely traumatic)

    Well good.

    Although the adverse childhood experiences study in particular doesn't so much look at "incidents" as "categories". And several of those categories are not necessarily what we would consider the most horrific, intentional forms of abuse (some are).

    I am not saying this is the case for you because I don't know you, but as a general rule, as a survival strategy (and probably a self-esteem protection society), most people who had less than great idealise their parents and childhoods.

    You see this often in extreme cases where parents did the most horrific things. But this trend also holds true for other less extreme situations. And ACEs don't all have to be intentional, by any means.

    There is an ideal of child rearing and there is reality. For most people, it's less than the ideal, and the degree varies greatly. All I can say is that the ACE scores (and similar studies, but this is the biggest) show phenomenal correlation, sometimes to the few thousand percent range. There's something important going on there.

    But of course, it's possible to go through a lot of trauma and come out totally OK, and it's possible to have a great, non-violent childhood with parents who were attentive and good role models and become an axe-murderer, but that's not the way you'd want to bet if you were an actuary.

    I'm glad your childhood was decent, and I mean that. ;)

    Afterthought: this is a matter of degree too. People's ability to adhere to healthy lifestyle choices is not black or white. The degree of trauma received and the child's innate genetic resilience are going to have a big part to play, as well as the current social and physical environment.

    But the ACE score correlates very strongly with good/bad outcomes — which is why it's a shame adverse childhood experiences have been mostly ignored in obesity and other physical-illness prevention and treatment.

  12. What an incredibly interesting discussion. While I have no doubt that childhood experiences do definitely affect our ability to effect permanent changes as adults, I am also currently studying the role that amino acids play, not only with mental health, but with our ability to tenaciously stick to dietary changes.

    Anyone else noticing that the brain chemicals created from amino acids seem to have a profound effect on behaviour, especially allowing people to relax and stop obsessive behaviours which include anorexia, bulimia and overeating? I have noticed this in my own clients.

    This may also have a causative relationship with to behaviours in low income areas, where quality animal protein may be considered a occasional luxury, rather than a daily part of the diet.

    Interesting stuff.

  13. Anyone else noticing that the brain chemicals created from amino acids seem to have a profound effect on behaviour

    Yes, I'm sure, and also important, what causes differing expressions of neurotransmitters aside from dietary intake? It most certainly includes the environment and experience. The brain is also an electrical system with language and visual observations impacting the chemistry. Psychiatry overemphasises the chemistry in my opinion (easier and more profitable to sell a drug than help someone overcome trauma), and downplays life experience.

    It's undoubtedly both, but experience is huge. You can take an unhappy suicidal person and offer them $10,000. Chances are good that they will find something fun to do before the end, right? So it can't JUST be chemistry.

    Barb, this video and also this one will provide a great background understanding of negative effects of stressful childhoods, and gets a little into the biochemistry resulting from experiences.

    But you're probably right that chemistry can help with cravings (although I don't know as much about amino-acids treatment per se except anecdotally). In fact, that has to be right. Chemistry's a big factor. But I'd be willing to bet there's a certain fraction of the traumatised population that wouldn't even be able to keep up with swallowing amino acid tablets, much less more difficult permanent changes in lifestyle.

  14. Barb, you might find this video equally interesting because it gets more into the biochemistry. Also, the first 11 minutes 30 seconds is an excellent summary of how every branch of medicine is greatly affected by patients' adverse childhood experiences ... even if the practitioners don't realise it (since, as Ann Childers said, most doctors are unaware): Child Maltreatment and Brain Consequences presented by David McCollum, MD.
  15. Bruce Berry
    Christoph;
    "They're raised in a 25-35:1 child:adult ratio, with the adult in question ...not a parent."
    I can tell you that this is a profound statement, and that very few recognize and understand the fact that our society has children raising each other. They receive almost no meaningful exposure to different aged people, and no time to develop meaningful relationships with parents and grandparents. Their sports and leisure is highly directed and adult mediated on the other hand. It is as if we are wilfully abandoning or sabotaging every chance for them to develop normally. I think it fair to say that for members of our species, functioning within in a culture is a core survival trait. We go further out on a dangerous limb even as we saw away behind us.
    Reply: #16
  16. Hear, hear, Bruce. You put it better than I.
  17. Diane
    Thank you Christoph for all the links. You have given me a whole new avenue of possibilities to explore. I had more than my fair share of ACE's and I still struggle to overcome the effects. I have made progress over the years and have quit smoking and alcohol and improved my general health and wellbeing by changing my diet to low carb paleo also.

    Some really important factors in making changes and improvements is believing that change is possible, believing that you deserve better and being totally committed to working at changing and improving your life. People who have suffered childhood trauma struggle with this and it is very hard for them to make it to this first rung on the ladder of change. I don't think I would have made it as far as I have without love, support and guidance from other people and from counsellors and therapists. I would add this to the list of ways to overcome trauma, at number 1. Get help and support, find people you can trust to support you and keep on finding and getting the support you need for as long as you need it.

    I still suffer from an anxiety disorder and so I am going to try some of your suggestions for meditation, relaxation and hypnosis to help with this.

    Another source of support in my healing and self change process has been reading books and listening to positive thinking audio by Louise Hay (also an ACE survivor)

    Replies: #18, #19
  18. Some really important factors in making changes and improvements is believing that change is possible, believing that you deserve better and being totally committed to working at changing and improving your life.

    Your whole comment (not just the parts I've quoted) is not only very perceptive (and accurate, I believe), it's very touching, Diana.

    I would add this [therapy with a licensed therapist] to the list of ways to overcome trauma, at number 1.

    I agree it's ideal when circumstance, funding exist, and you can find good ones. That said, those aren't the case for everybody and the methods I've shared are very very economical, can be done virtually anywhere at any time, and can also be used in conjunction with therapy. I see them as core practices one could maintain for a lifetime (whether traumatised in early life or not) and be better off for them.

    I'm not religious, but good enough for Buddha, good enough for me. ;)

    find people you can trust to support you and keep on finding and getting the support you need for as long as you need it

    Hugs, dern tootin.

    I still suffer from an anxiety disorder and so I am going to try some of your suggestions for meditation, relaxation and hypnosis to help with this.

    These helped me a lot. Yoga nidra (by my experience and also one study I've read) is the most effective technique I know of to reduce cortisol levels (and the study shows it works really well from the first session). Mindfulness meditation is more widely known and is also extremely good. As I and Michele Rosenthal and countless others have discovered, combining techniques seems to work best.

    For a technique that you can do by yourself that is similar in some ways to EMDR (but adds touch, not just eye movements), you can try Havening, here explained on the Dr. Oz show by Britain's most famous hypnotherapist and a friend of the inventor of Havening, Ron Ruden, MD, PhD. I believe you can also buy Havening videos from either Paul McKenna or Ron Ruden's Havening.org site (the former is probably less expensive if you just want the self-Havening version, the latter is more for therapists ... but really, the self-Havening techique is simple and is given in the link above).

    I think hypnotherapy is awesome, and you may want to start with some relaxation ones because, well, relaxation. :P

    I do think cognitive hypnotherapy can be very powerful, but remember that my experience is it works a lot better once stress is reduced, rather than starting with ambitious activity-focused suggestions right off the bat. That said, integrating these types of hypnotherapy sessions with the more purely stress reduction and trauma-focused therapies is probably OK.

    TRE, mentioned in the other comments, is good too, but I'm less aware of science to back it up, although the theory makes sense and it's being practised more around the world. Can't hurt, anyway.

    Here are some free yoga nidra audios to get you started. I like Albert Sellaman's two ones with music a lot, but they're all good.

    There are a lot of mindfulness meditation MP3s (such as from yoga instructors, university wellness departments, etc., and the aforementioned Albert Sellaman, who isn't a swami, but seems a pretty nice bloke) available online.

    A lot of this will probably be redundant, but just in case.

    Oh, and I dug up a link to a Tension and Trauma Releasing Exercises video in case you want to get physical. It's more advanced, in that sense, but it's interesting.

  19. You prompted another thought, Diane, by mentioning Louise L. Hay.

    I've no doubt she's a fine lady, but you know, as a guy, I found her a little hard to relate to. ;-)

    One person I did relate to a lot is the author of How to Win Friends and Influence People, one of the most famous self-help books of all time. But Dale Carnegie's lesser-known book How to Stop Worrying and Start Living is far better in my opinion (and in that of many others': if you read the reviews on Amazon or wherever, they're glowing despite — and maybe partly because of — this book being classic).

    Unlike Think and Grow Rich, pretty much everything by Tony Robbins, and most books in the self-help genre, it doesn't suck. It's based on sound philosophy (including some of my favourite Stoics like Epictetus), psychology (e.g., Carl Rogers), and timeless wisdom from religion (I'm not religious, but there are some nuggets in there), plus the authors' extensive experience in teaching practical courses on exactly this topic to many people for several years.

    It's less "technique-y"; in fact, there's no technique at all. However if you like positive reading and good ideas about managing stress, it's the single best book I can think of. The only one that's in it's league that I've ever read is Neil Fiore's The Now Habit, which is quite similar in some ways.

    Here's an audio of How to Stop Worrying and Start Living on YouTube (it's long, but there's no rush ... listen to 15 minutes and see if you want to keep listening over the coming weeks and months until you're done), and most book stores should carry it as an inexpensive paperback. You might need to order it in, possibly, if you prefer a written book, but it's also on Kindle.

    Video2mp3.net will let you download any YouTube videos as audios, but I'm not sure what the copyright status is of the aforementioned uploaded file. It's been online there for a year so far. I am sure if you did like it, it can be purchased somewhere as either an MP3 or a CD.

    OK, in total this is a lot of information to explore, but I think it's good info. No hurry with any of it. Take your time.

    For what it's worth, a schedule that worked for me in the past was listen to whatever audiobook I want whenever, TRE and Havening once a month each, Yoga nidra and mindful meditation once a week each, and hypnotherapy on any day I wasn't doing one of the former.

    But any other combination could work too (and if you had a formal therapy session scheduled for a given day, say, you could certainly count that as therapy/relaxation/meditation for the day!).

    Good luck with everything.

  20. Diane
    Thanks again Christoph - lots of stuff for me to explore! :)
  21. Michelle
    Great info Christoph; lots to read, watch and digest.

    Mindfulness is my new buzz word.

  22. Haha love Dilbert! But seriously, I know many people like this who take their love for bread to a whole other level...and then wonder why they aren't losing weight!
  23. I think that taking bread, you can still lose weight. But it will definitely be harder to do so, that's all..

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