Why weight loss experts fail their clients--Part 2

I am a little behind on this post, it's been a busy week!

I wanted to continue with part 2 of a series on why weight loss experts fail their clients. In my first post, just below this one, I described a study looking at brain changes that happen in the presence of depression.

One finding was that the prefrontal cortex, important for memory retention and coordination of complex behaviors, was compromised.

And what are dietitians notorious for doing? Handing over, in a one hour session, a volume of handouts as thick as Tolstoy's War and Peace, full of do's and dont's and calorie counts and exchanges and label reading information. And then they wonder why the client didn't return for a follow up visit.

I will never forget the client who shared with me that he sometimes made two lunches, not because he was hungry for lunch #2, but because he forgot he'd even eaten lunch #1 until he went to put lunch #2's dishes in the sink and encountered remnants from lunch #1.

Yes, it's sometimes that simple. Yet, the dietitian who even takes the time to ask about memory is a rare one.

Reasons for memory issues with depression, in addition to decreased blood flow, include loss of neurons in the hippocampus, another memory center, and low levels of DHA, an omega-3 fatty acid that is an essential component of brain matter.

If those issues are not accounted for and accommodated in a treatment plan, guaranteed your clients are at great risk for dropping out of treatment. Maybe even not remembering appointments they had made, if they actually did want to return.

Another brain center with compromised function with depression is the anterior cingulate, responsible for executive, evaluative, cognitive, and emotional functions, as well as learning and problem solving, error detection, motivation, and emotional modulation.

So if you're a dietitian trying to use the intuitive eating approach and you have a client who can't evaluate how they feel, decide what to do with how they feel, set boundaries in situations that trigger feelings that trigger eating....just how far are you going to get with your approach?

And you know what we do when clients don't do what we think they should? We diagnose them with mental health issues, refer them out, and potentially set them up to be prescribed medication that only exacerbates their metabolic and weight issues.

Just think about it over the weekend. I'll be back next week with a way around this dilemma that may actually help the client to get better and leave the dietitian less frustrated.

Elizabeth Sublette M, Milak MS, Hibbeln JR, Freed PJ, Oquendo MA, Malone KM, Parsey RV, John Mann J. Plasma polyunsaturated fatty acids and regional cerebral glucose metabolism in major depression. Prostaglandins Leukot Essent Fatty Acids. 2009 Jan;80(1):57-64. Epub 2009 Jan 6.

Your brain loves lipoic acid!

I'm primarily a food first, supplements second kind of person. However, lipoic acid is a supplement I love to recommend. It's not something that you can readily find in food, but it does a whole lot of good, especially in the brain.

It can delay and prevent Alzheimer's disease, and dementia, in a variety of ways. It helps to increase acetylcholine levels. Acetylcholine is the neurotransmitter in charge of memory function. It helps to bind free radicals, preventing them from doing damage. It prevents the formation of proteins associated with inflammation.

Not a bad friend, is it?

The amount given in the two studies evaluating lipoic acid's effect on the brain was 600 mg per day.

Lipoic acid is also unique in that it has the ability to make other antioxidants more powerful. The authors of the article reviewed here suggested that in combination with curcumin, EGCG (active ingredient in green tea), and DHA (in fish oil and marine algae), lipoic acid could be a very powerful warrior in the fight against degenerative brain disease.

Hmmmm...anyone for some fish curry, with a green tea chaser?

Maczurek A, Hager K, Kenklies M, Sharman M, Martins R, Engel J, Carlson DA, Münch G. Lipoic acid as an anti-inflammatory and neuroprotective treatment for Alzheimer's disease. Adv Drug Deliv Rev. 2008 Oct-Nov;60(13-14):1463-70. Epub 2008 Jul 4.

A Chinese herb with antidepressant activity

I love Chinese medicine and think there is a lot of potential with its options to treat conditions Western medicine simply doesn't manage very well. It's challenging to share this specialty in an evidence-based blog like this one, because much of the research that is reported, uses terminology that is not meaningful to a Western-trained practitioner like myself. So I was grateful that this group of Chinese researchers took the time to study an aspect of their practice, as well as report on it, in a way that is meaningful and potentially useful to their Western colleagues and friends.

These researchers investigated the activity of xiaobuxin-tang (XBXT), which is a traditional Chinese herb that has been used as an antidepressant in China for centuries. Previously, these researchers discovered that XBXT improves the serotonin balance as well as the behavior of chronically stressed rats with depression. In this particular study, the researchers demonstrated that XBXT stimulates neuron development in the hippocampus, the brain's memory center. (Hippocampal neurons tend to degenerate and die in the throes of depression.) Levels of compounds associated with neuron formation, such as brain-derived neurotropic factor (BDNF), were also increased in the presence of XBXT.

The overall activity of XBXT was compared to that of the antidepressant imipramine.

This little guy here felt so good on XBXT he's still celebrating eight months into the year of the rat!

An L, Zhang YZ, Yu NJ, Liu XM, Zhao N, Yuan L, Chen HX, Li YF. The total flavonoids extracted from Xiaobuxin-Tang up-regulate the decreased hippocampal neurogenesis and neurotrophic molecules expression in chronically stressed rats. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Aug 1;32(6):1484-90.