Monthly Archives: April 2009

Should the medical establishment regulate psychotherapy?

Therapist and client

Betty Draper (January Jones) with her therapist on Mad Men

Source: Hatch

When someone with a serious mental illness – schizophrenia, bipolar disorder — takes pharmaceutical drugs for their condition, we’re obviously talking about medicine and the medical profession. Drugs affect the physiology of the body, and drug use needs to be monitored by someone who’s been to medical school. But what if you see a talk therapist because you’re unhappy with your relationship or feeling low after losing your job? Should that be under the control of the medical establishment?

This issue – should psychotherapy be treated as a health profession and regulated by the government — is currently under debate in the UK. Advocates on both sides of the argument are talking past each other. Their reasoning appeals to their constituencies, but the two sides are unwilling or unable to consider a compromise.

The Health Professions Council: New rules for therapists

The Health Professions Council (HPC) is a UK regulatory agency set up to “protect the public.” If a “health professional” does not meet certain standards, HPC can put them out of practice. Currently the HPC regulates 13 professions, including podiatrists, physical therapists, and radiographers.

Last summer HPC announced its intention to regulate psychotherapists and counselors. This comes at a time when there is a high demand in the UK for psychotherapy. The economic recession has increased the number of individuals seeking help. Both doctors and patients regard therapy as safer and more effective than antidepressants and tranquillizers when it comes to anxiety and depression. The National Health Service is training an additional 3,600 therapists at a cost of $261 million a year.
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The Pepsi challenge: How beliefs affect what you taste

Got Taste?

Taste — so essential to our very survival — is a complex experience. It’s influenced by many things: our past experiences, the associations we make with specific foods, advertising, brand loyalties, cultural and ethnic preferences, price. If we think of taste as something objective, determined exclusively by our taste buds, we’re underestimating it.

Pepsi challenge

Image source: Wikipedia

Researchers have experimented with many of the subjective influences on taste. For example, Coke is rated higher in taste when people drink from a cup with the Coke logo. Beer preferences disappear if the brand labels are removed. Bitter coffee tastes less bitter if you repeatedly tell consumers that it’s not bitter. This last one is from a study called “Cognitive Effects of Deceptive Advertising.”

One of my favorite examples is a study on wine tasting. Volunteers tasted what they thought were five different wines, priced at $5, $10, $35, $45 and $90 a bottle. All 20 volunteers reported that the more expensive the wine, the more they liked the taste. Little did they know: The experiment only used three different wines. The $90 wine, for example, was also presented as the $10 wine. The tasters’ brains were hooked up to functional MRIs during this wine tasting. One significant and discouraging finding in this experiment: A part of the brain that notices the pleasantness of an experience becomes more active when we believe something costs more.

These studies are of great interest to food and beverage manufacturers and their advertising agencies. Coke still outsells Pepsi, despite losing the Pepsi challenge. One study in particular probed taste preferences at a fundamental level: Our personal values and the cultural symbols that represent those values.
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This is your brain on sugar — and sugar substitutes

Got Taste?

There’s no question that artificial sweeteners have fewer calories than sugar, but does using a sugar substitute lower the total number of calories we consume? Research indicates we might actually eat more.

Currently there are five sugar substitutes approved for use in the U.S. They compete with each other not only to provide a sense of sweetness, but to do so without leaving a detectable or unpleasant aftertaste.

Saccharin (SweetN’ Low) has always been known for its bitter or metallic aftertaste. Food processors try to minimize this by combining it with other sweeteners.

Acesulfame potassium or acesulfame K (Sunett) also has a bitter aftertaste at high concentrations.

Aspartame (NutraSweet, Equal) tastes odd to some people. It’s said to have a “watery” aftertaste.

Neotame is chemically similar to aspartame and reportedly does not leave an aftertaste, perhaps because it takes much less of it to create a sense of sweetness. Aspartame is 180 times sweeter than sugar. Neotame is 8,000 to 13,000 times sweeter.

 Sucrose and sucralose

Image source: Feingold Association

And then there’s sucralose (Splenda, SucraPlus). Sucralose is made from sugar. In a process called chlorination, three of the hydroxyl groups (OH) in the sugar molecule (sucrose) are replaced with chlorine (Cl) atoms. Sucralose is 600 times as sweet as sugar, twice as sweet as saccharin, and 3.3 times as sweet as aspartame. This means, of course, that you need less of it to get the same amount of sweetness. As far as I know, it has no aftertaste.

By itself, sucralose has no calories. The nutritional information on a packet of Splenda says that one gram has zero calories. That’s not quite true. The FDA allows manufacturers to list zero calories if there are fewer than five. Splenda needs to be “bulked up” with dextrose and maltodextrin, which adds 3.75 calories per gram.

Splenda

Image source: Aimee’s Adventures

Splenda used to advertise with the tagline “Made from sugar, so it tastes like sugar.” Technically this is true. They were sued, however, by the manufacturer of Equal, who argued that the statement was misleading. The case was settled out of court, but when Equal took up the same battle in France, Splenda lost. The Sugar Association complained to the FTC that “Splenda is not a natural product. It is not cultivated or grown and it does not occur in nature.” In advertising, Splenda now says it “starts with sugar, tastes like sugar, but is not sugar.”
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Grapefruit and the Pill

Got Taste?

Contraceptive pillsIn my last post I described a story that appeared in The Lancet: A woman with many risk factors for a life-threatening blood clot developed a clot, a deep vein thrombosis (DVT). In addition to her many risk factors, she had been eating grapefruit for the previous three days. Here’s how the media covered the story.

The most responsible headlines

I collected the available news stories on this incident from Google News in early April. All but one featured grapefruit, which is, after all, the only thing that makes this story newsworthy. Here are the most responsible headlines:

“Grapefruit, birth control pill interaction may have caused weird blood clot case” (The Canadian Press)

“Grapefruit May Have Raised Blood Clot Risk in Unusual Case” (Medical News Today)

“Grapefruit Breakfast Shares Blame in Leg Thrombosis” (Modern Medicine)

“Hunt for DVT Cause Reveals Link to Grapefruit” (Medpage Today)

“All things in moderation” (phillyBurbs.com)

The Canadian Press, which did follow-up interviews, and Forbes.com had the best coverage. Forbes had an unfortunate headline: “Grapefruit-Heavy Diet Helped Spur Dangerous Clot.” The diet wasn’t grapefruit heavy. As I’ve mentioned before, journalists are often not allowed to write their own headlines. The subhead was much better: “The fruit, combined with contraceptive pill and a genetic mutation, almost cost woman her leg, doctors say.”
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"Killer" grapefruit?

Got Taste?

A few months ago, in a post on medical journalism, I noted: “The unstated assumption … is that ‘scaring the bejesus out of people’ is a recognized journalistic practice when it comes to health news.” This post describes a medical case in which grapefruit played a minor role. The next post illustrates how the media turned this innocent, everyday item into an object of fear.

Grapefruit

Image source: J. Tome

The British medical journal The Lancet recently published the case report of a 42-year old woman who developed pain in her low back, left buttock, and left leg after a 90-minute car trip. The next day, when her leg had turned purple, she went to an emergency room. She was light headed, short of breath, and had difficulty walking. Her medications included Levothyroxine (Synthroid) for low thyroid levels and birth control pills, the estrogen/progestin combination type.

On examination, the woman was found to have a blood clot in her leg, a deep-vein thrombosis (DVT) that extended from her hip to her calf. What makes this story of interest to physicians is not the diagnosis, which was obvious, but the etiology: What caused this woman to have a DVT?
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The taste advantage

Got Taste?

Can being a supertaster – or a nontaster – affect your health? There are no studies that monitor the health statistics of supertasters from childhood to old age. So there’s no definitive scientific evidence. Most pronouncements on how taste sensitivity could affect health seem to be common sense.

Supertasters dislike bitter foods, including many vegetables and some fruits. Fruits and vegetables contain cancer preventing ingredients, which supertasters may miss out on. On the other hand, supertasters are less fond of sugar, fats, and salt than nontasters. This means they’re more likely to maintain a normal weight, which in turn can decrease their chances of heart disease, high blood pressure, and diabetes. Here are the details.

Fruits, vegetables, phytochemicals, flavonoids, and naringin

Fruits and vegetables

Image source: SteadyHealth.com

Plants contain chemical compounds called phytochemicals. These are non-essential nutrients – we can live without them – but they appear to play a role in preventing disease. People who eat diets rich in plants seem to have lower rates of cancer and heart disease, the major causes of death in modern times.

Flavonoids, an important phytochemical found in fruits, vegetables, chocolate, tea, and wine, have an antioxidant effect in the body. They end up neutralizing potentially damaging free radicals. An interesting side note: While flavonoids act like typical antioxidants in a test tube, that’s not what happens in the body. Our bodies see flavonoids as foreign objects and try to eliminate them. This is what creates the increased antioxidant capacity of the blood.
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Do we taste fat?

Got Taste?

The flavors that make good food taste delicious are dissolved in fat. Scientists used to think that when we ate fat, we tasted these dissolved flavors and that fat itself was tasteless. We now know that’s not quite true. But the efforts involved in isolating the “taste” of fat are considerable.

What do you “sense” when you eat fat?

To answer the question “Do we taste fat?” we first need to isolate taste from the other senses. Fats have a very distinctive texture. They have a thickness, called viscosity, and a slipperiness, called lubricity. If Jack Sprat would eat no fat, it could be because he disliked the slimy texture.

When a taste researcher asks a subject if a certain food “tastes” like fat, the subject could be detecting the texture. “Fat molecules literally press against the taste buds, producing a tactile sensation that’s interpreted by the brain as viscous, slippery or greasy.”

Fats also have an odor. Even monkeys can smell cream. As with most complex flavors, when you pinch your nose, it’s more difficult to detect fats.
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Why do we love high-fat foods?

Got Taste?

There are at least two reasons we love high-fat foods: Fats can make any food taste better and it’s in our interest, genetically, to prefer foods that the body needs.

Flavor enhancement

Most of us don’t consume our fats straight. We don’t sit down with a bottle of olive oil and eat it by the spoonful. And when did you last eat a pat of butter without first applying it to a roll or baked potato? The secret weapon of fat is its ability to interact with other foods and make them taste better.

The most interesting and tasty flavors – animal, vegetable, or dessert — are fat soluble. We prefer marbled beef to lean beef because the most enticing flavors that characterize meat have dissolved into the fat and are stored there. Fat not only carries the taste of the food it’s mixed with. It also carries the smells. The more fat in a meal, the more aroma, and aroma plays an important role in our ability to sense flavor. Without aromas, there are only the five basic tastes: sweet, sour, salty, bitter, savory. Flavor is something much more complex and subtle.
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Are you a supertaster: DNA testing

Got Taste?

In the last two posts I’ve discussed counting the taste bud containers (papillae) on your tongue or using a bitter test strip to determine taste sensitivity. There’s one more option: genetic testing. A DNA analysis will reveal whether you’ve inherited the dominant gene for bitter taste sensitivity from both parents. If you have, there’s a high probability you’ll experience food and drink with the taste buds of a supertaster.

An analysis of your genes will not only tell you about inherited traits, like bitter taste perception and earwax type, but about your ancestry and your risk for certain diseases. Do-it-yourself genetic testing is now available on the Internet. You simply send a test tube full of saliva to a lab and the results are sent directly to you, the customer. There’s controversy in the medical profession about whether this is an advisable practice. Is it wise to absorb confusing and potentially disturbing medical information on your own or should a physician/genetics counselor spoon feed you the results?

What your genes tell you (for a price)

Test tube for genetic testing

Image source: Newsweek

Currently there are three high-profile, do-it-yourself DNA-testing companies: deCODEme, Navigenics, and 23andMe.

deCODEme will calculate your “genetic risk” for bitter taste perception, but only as part of their complete scan. Price: $985.

Navigenics position themselves above the fray of the merely curious. They pride themselves on testing only for conditions that are actionable, for example, can you delay onset of a disease or benefit from early detection. They also limit testing to conditions where quality research shows a definitive link between genetic findings and disease. An additional constraint is that the condition must be “medically relevant.” You could make a case that bitter taste perception, which influences what we eat, is relevant to heart disease and diabetes, but the quality research is scarce. The price tag for Navigenics’ premium genetic test, the Health Compass, is $2499.

23andMe is a Silicon Valley start-up that’s received a lot of good publicity, like being the number one 2008 Invention of the Year in Time Magazine. For $399 the company will read 500,000+ locations in your genome and return the data to your computer. They provide research information on 100+ diseases, conditions, and traits. One of those traits is bitter taste perception.
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