Friday, January 16, 2015

The Physiological Benefits Of Laughter

theater_masksAs regular readers are well aware, over the past year, I have been exploring the use of stand-up comedy in communicating about the science of obesity to anyone who cares to listen.

While preparing for this new venture included working with professional comedians, taking improv classes, and, yes, impromptu appearances at local “open-stages”, I have also delved into the (sometimes rather serious) literature on the science of comedy and laughter.

Indeed, as one may suspect, there is indeed a rather large and growing body of scientific literature on humor, comedy and laughter – including its physiological and psychological effects, its therapeutic use (in everything from depression and chronic pain to cancer and obesity), and as a communication tool for health professionals.

Anyone interested in this topic, may wish to refer to a recent article by Dexter Louie and colleagues from the University of California, Harvard Medical School and the Joslin Diabetes Centre on laughter as a tool for lifestyle medicine that recently appeared in the American Journal of Lifestyle Medicine (btw – a term that I really don’t like).

The article begins with a brief discussion of the three preeminent theories (out of over 100 competing ideas) of why we laugh, which are summarized as follows (the examples are mine):

1. Release theory, which argues that laughter is the physical manifestation of repressed desires and motivations (which explains potty jokes).

2. Superiority theory, which posits that laughter is a means of increasing one’s self-esteem at the expense of others (which is probably why most people laugh at fat jokes).

3. Incongruity theory, which states that humor is created by a sense of incongruity between two or more objects within a joke (e.g. an obesity doctor making jokes about obesity doctors).

The article then goes on to briefly review the physiological effects of laughter, whereby it makes a clear distinction between spontaneous and and self-induced laughter:

“The former refers to “genuine” or unforced laughter, often in response to a stimulus, whereas the latter describes laughter that is simulated de novo. Spontaneous laughter is often associated with positive mood, whereas simulated laughter is primarily physical and is not necessarily associated with positive emotions or feelings. Neuroimaging suggests that different neural pathways are used in these 2 forms of laughter.”

The researchers review a range of studies documenting the positive effects of spontaneous laughter on stress hormones, endorphins, immune response, pain tolerance, anxiety as well as studies showing that the cardiovascular response to a good laugh are virtually identical to those elicited by a bout of physical exercise (exercise physiologists take note!).

Despite these promising findings, the authors are also quick to point out that,

“There is great potential for future research in laughter. Randomized controlled large-scale trials are needed to further elucidate the physiologic effects of laughter.”

In the second part of the article, the authors discuss whether or not physicians should use humor as a tool to induce therapeutic laughter?

“Of course, health is a serious and often grave matter, and humor delivered at inappropriate times can be devastating, insensitive, and crass……Within the bounds of appropriateness, however, both humor and laughter can be beneficial. For one, laughter shared between the provider and patient conveys a measure of trust and light-heartedness. Furthermore, humor can improve communication, as a joke can signal a transition in the conversation from the serious to more benign topics.”

The authors even have suggestions on how to address the issue of laughter in clinical practice:

“Providers can ask, “What has made you laugh recently?” or “How often do you laugh?” Inquiring about laughter opens the door to light heartedness and also could lead to counseling on laughter and sharing the latest research with the patient. More important, it allows the provider to determine what the patient finds funny, thereby allowing the provider to tailor recommendations to better fit the patient’s needs and preferences. This also contains the potential to deepen the therapeutic relationship between patient and provider. Put together with a more structured approach, the health care provider could consider prescribing laughter to patients.”

And here is what a laughter prescription could look like (directly borrowed from exercise prescriptions):

(F) Frequency: once a week
(I) Intensity: belly laughing
(T) Time: 30 minutes

(T) Type: your favorite sit-com

While much remains to be studied in terms of the therapeutic use of laughter (e.g. spontaneous vs. self-induced, individual vs. group laughter, dose-response relationships, laughter yoga, etc.), as the authors point out, there is an increasing body of evidence pointing to potential benefits for health and well-being.

Or, as the authors put it,

“With no downsides, side-effects, or risks, perhaps it is time to consider laughter seriously.”

@DrSharma
Edmonton, AB

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Friday, December 12, 2014

Prevalence and Treatment of Depression In Canada

sharma-obesity-mental-health1Depression can be a significant factor both in the development of obesity and as an important barrier to its treatment.

Now a paper by Sabrina Wong and colleagues from the University of British Columbia, in a paper published in CMAJ open, present data on the prevalence and treatment of depression in Canadian primary care practices.

The authors analysed electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, of over 300,000 patients who had at least one encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012.

Of these, 14% had a diagnosis of depression.

Women with a BMI greater than 30 were about 20% more likely to also have depression than women with a BMI below 25. No such relationship was noted in men.

Overall, 25% of individuals with a diagnosis of depression also had at least one other chronic condition as well as about 50% more doctor visits than individuals without depression.

Clearly, depression is a common problem in primary care and weight management in patients (particularly women) presenting with this problem needs to be addressed (not least because many of the medications often used to manage depression may well be part of the problem).

@DrSharma
Edmonton, AB

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Wednesday, December 10, 2014

Introducing Sadly The Line-Dancing Owl

Sadly The Line Dancing Owl

Sadly The Line Dancing Owl

Yesterday, I posted about my daughter Linnie von Sky’s 2nd children’s book Pom Pom A Flightless Bully Tale, that is now available here.

Today, I would like to introduce you to Sadly The Line-Dancing Owl, who one morning wakes up with a dark cloud over his head.

Learn how Sadly in the end overcomes his sadness and how he finds the help he needs to be his happy self again. 

After tackling immigration and bullying, Linnie turns her attention to depression – in a children’s book that she admits is somewhat autobiographical,

“Depression is REAL and it SUCKS…at least it sucked the living daylight out of me and consumes too many people I love.”

Along for the ride is the incredibly talented Ashley O’Mara as the new illustrator.  Ashley is a Vancouverite, Emily Carr Graduate, Bird Lover (she draws the cutest darn chickens I’ve ever seen) and like Linnie, knows a thing or two about how much depression hurts.  

Please consider supporting Linnie’s fundraising campaign by pre-ordering your personal copy(ies) of Sadly The Line-Dancing Owl, which will again be 100% made in Canada.

To learn more about Sadly and how you can support this venture, please take a minute to visit Linnie’s Indiegogo page.

@DrSharma
Edmonton, AB

 

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Tuesday, December 9, 2014

Pom Pom A Flightless Bully Tale Takes Flight

Pom Pom A flightless bully tale coverToday’s post is to announce the arrival of my daughter Linnie von Sky’s second children’s book, “Pom Pom A Flightless Bully Tale“, that hundreds of you helped fund by pre-ordering your copy(ies) about 12 months ago – your books are in the mail and should be there in time for the Holidays (a big THANK YOU from me for your support!).

To those of you, who are new to these pages, Pom Pom is the story of the slightly rotund little penguin Pomeroy Paulus Jr III., who simply hates it when people call him “Pom Pom”.  Like any boy his age he’s busy trying to impress ‘the birds’, particularly one bird: Pia. Pomeroy dreams of a pair of orange swim trunks; the ones that Pete, Pucker and Piper own. The same ones Pia said she loved. There’s just one little hiccup. The antAmart doesn’t carry them in his size.

The story tells of how mom helps Pomeroy get his own pair of orange swim trunks and how Pia saves the day when she steps up and puts bullies in their place.

Here is what Linnie had to say about the reason for writing this book in an interview with Lindsay william-Ross for VancityBuzz:

“When you talk about bullying you have to talk about how much it hurts. Kids understand that,” says von Sky, who hopes her stories ignite conversations. Of “Pom Pom,” von Sky remarks: “I think it’s an encouragement to talk about emotions. What triggers certain actions, what makes somebody want to hurt someone else. Are they hurting?”

For von Sky, whose protagonist in “Pom Pom” is picked on because of his size, the pain of bullying in the story echoes the passion she first tapped into working with the Canadian Obesity Network. “Weight bullying happens to be the one thing I’m extremely allergic to,” affirms von Sky.

For any of you  who would like to order your own copy of this delightful little children’s book about bullying, friendship, respect, sadness, empathy, standing up for friends, antarctica, penguins & above all, love (for ages 3 and up) – click here.

@DrSharma
Edmonton, AB

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Monday, December 1, 2014

Are Sedentary Moms Promoting Childhood Obesity?

Edward Archer, PhD, University of Alabama Birmingham

Edward Archer, PhD, University of Alabama Birmingham

Last week, Edward Archer from the University of Alabama at Birmingham (UAB), published a paper in the Mayo Clinic Proceedings (to much media fanfare), suggesting that the primary driver of childhood obesity is the shifting of nutrient energy to fetal adipose tissue as a result of increased maternal energy availability paired with decreased maternal energy expenditure, resulting in fetal pancreatic b-cell and adipocyte hyperplasia – a theory, which Edwards labels the “maternal resource hypothesis”.

The primary process for these changes, as readers of these pages will have read before, is through epigenetic modification of DNA, which, together with other non-genetic modes of transmission including learned behaviours and environmental exposures (socioenvironmental evolution), leads to “phenotypic evolution”, which Edward describes as,

“…a unidirectional, progressive alteration in ontogeny that is propagated over multiple successive generations and may be quantified as the change over time in the population mean for the trait under examination (eg, height and obesity).”

Since the beginning of the 20th century, socioevironmental factors have significantly altered the energy balance equation for humans

“Socioenvironmental evolution has altered the evolution of human energy metabolism by inducing substantial decrements in EE imposed by daily life while improving both the quality and the quantity of nutrient-energy availability.”

“For example, as thermoneutral environments became ubiquitous, the energy cost of thermoregulation declined, and improved sanitation (eg, clean water and safer food) and vaccinations decreased the energy cost of supporting parasites (eg, fleas) and resisting pathogens (eg, communicable diseases and diarrheal infections).”

Over the past century, these developments have led to profound phenotypic changes including,

“progressive and cumulative increases in height, body stature and mass, birthweight, organ mass, head circumference, fat mass/adiposity as well as decreases in the age at which adolescents attain sexual maturity…”

Archer goes on to describe some of the many factors that may have changed in the past century, whereby, he singles out sedentariness as one of the key drivers of these developments (not surprising given Archer’s background in exercise science).

Thus, although one could perhaps make very similar arguments for any number of factor that may have changed in the past century to, in turn, affect insulin resistance and ultimately energy partitioning (change in diet, sleep deprivation, increasing maternal age, endocrine disruptors, antibiotic use, gut microbiota, medication use and many other factors I ca think of), Archer chooses to elevate sedentariness to being the main culprit.

While this may or may not be the full story, it does not change the thrust of the paper, which implies that we need to look for the key drivers of childhood obesity in the changes to the maternal-fetal (and early childhood) environment that have put us on this self-perpetuating unidirectional cycle of phenotypic evolution.

Ergo, the solution lies in focussing on the health behaviours (again, Archer emphasizes the role of physical activity) of moms.

While Archer largely focusses on maternal transmission, we should perhaps not forget that there is now some also evidence implicating a role for epigenetic modification and intergenerational transmission through paternal DNA – yes, dads are getting older and more sedentary too (not to mention fatter).

I do however agree with Edward, that this line of thinking may well have important implications for how we approach this epidemic.

For one,

“…the acknowledgment that obesity is the result of non-genetic evolutionary forces and not gluttony and sloth may help to alter the moralizing and demoralizing social and scientific discourse that pervades both public and clinical settings.”

Secondly,

“Future research may be most productive if funding is directed away from naive examinations of energy balance per se and redirected to investigations of interventions that alter the competitive strategies of various tissues.”

Thirdly,

“From the standpoint of the clinician, accurate patient phenotyping (inclusive of family obstetric history and metabolic profiling) may allow the targeting of women most likely to be a part of populations that have evolved beyond the metabolic tipping point and therefore require significant preconception intervention.”

While none of this may be easier or more feasible than other current efforts, they may well point us in a different direction than conventional theories about what is driving childhood obesity.

@DrSharma
Calgary, AB

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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