House Call, MD

by Kelly Erickson, MD 2010 | erickson@myhousecallmd.com

We, at House Call, MD, are big fans of the “snuggle.”  There are few people on this planet who will not benefit in some way from a hug, massage or simple back rub.  A recent New York Times article suggests that we may be on to something (1).  While outright snuggling may create interesting and awkward scenes in the workplace, recent studies are showing that positive interactions involving touch may increase in human performance.

Before we dive into the details of the research on this topic and the science behind them, let’s start with some simple logic: If touch makes us “feel better” and “feeling better” makes us work harder, then it follows that positive or cooperative touch can improve performance.  Seems fairly reasonable to us.  Now on to the science behind the theory.

First, we must show that touching someone is a means of communicating—right?   Some of the most compelling studies regarding the role of touch in communicating emotion are currently being performed at UC Berkeley.  The most recent study sought to show that a wide array of emotions could be conveyed between two complete strangers using only touch.  What is interesting to us is how they conducted their study…

Imagine you are a freshman in college taking a Psychology course and, as part of your grade, you are required to participate in a study currently taking place on campus.  As part of the study you are taken to a small room and blindfolded (and yes, this does sound like the opening scene of a cheesy horror film, but stick with us).  After a minute, an individual enters the room, slaps your wrist, and walks out.  You are then given a list of emotions and asked to identify the emotion the other person was trying to convey to you.  You circle your answer (What would you answer, by the way?), re-blindfold yourself and wait for the next assault.  An individual walks in for the second time, hugs you, and leaves.  You are given the same list of emotions to choose from…etc.

The experiment showed that touch, independent of words, sounds or facial expressions, functions as a distinct means of communicating emotion.  The emotions that were successfully communicated in this study include: anger, fear, disgust, love, gratitude, sympathy, happiness and sadness.  Pretty impressive, right?

You may still be thinking “OK, so how is snuggling supposed to make me perform better?”  This is where the fun comes in.  Michael Kraus of UC Berkeley conducted a study examining the role of “tactile communication” (a.k.a. touching) and its effects on the performance of NBA players (2).  The study hypothesized that players who touched fellow teammates more often throughout a game would be more successful on the court.  They believed that the same would be true for entire teams as well (i.e. the more high-fives and butt pats, the better the team would play).  They watched each individual player in the NBA for an early season game and tallied the number of times the player touched a teammate. “These celebratory touches included fist bumps, high fives, chest bumps, leaping shoulder bumps, chest punches, head slaps, head grabs, low fives, high tens, full hugs, half hugs, and team huddles.”  Can you imagine a bunch of scientists sitting around a television tallying “chest bumps”?  Welcome to the wacky world of UC Berkeley.  After assigning each player a score based on the number of touches throughout the game, the researchers quantified each player’s performance throughout the season in terms of points scored, rebounds gained, successful passes completed, and a number of other parameters that make a player valuable.  The researchers found that the more a player touched his teammates in that early season game, the more successful the player was that season. Teams that had the highest number of positive touches between players were also the most successful teams in the NBA!

According to the study, the Boston Celtics and the Los Angeles Lakers were at the top of the list of the touchiest teams, while the Sacramento Kings and Charlotte Bobcats were the least touchy teams in the league (1).  And the league’s most touchy-feely player?  Kevin Garnett of the Celtics (see photo of picture-worthy hug at left).  While the study showed a correlation between touching and performance, they did not prove that touching causes improved performance.

This observation has been studied in other settings as well.  Tiffany Field, one of the more prolific touch researchers, studied women with prenatal depression.  In the study, they compared participants whose partners gave them a regular massage to a control group in which the subjects got didily-squat (isn’t that sad?).  Guess what they found? Yep, those receiving regular rub-downs reported both a decrease in pain as well as improved relationships with their partners (3).  The same group of researchers studied autistic children and showed that touch therapy (which consisted of 15 minutes of physical contact two times per week for four weeks) was associated with less touch aversion, off-task behavior and stereotypic behavior and improved attention, behavior regulation, social behavior and initiating behavior (4).  Put simply, autistic kids were able to more easily control their behavior (this is one of the biggest challenges of the disease).

What is the science behind these observations?

Lets look at two hormones the body produces in relation to touch: oxytocin and cortisol.

Oxytocin

Oxytocin is the ultimate snuggle hormone.  It is best known for its action in pregnant women and is particularly responsible for milk “let-down” (a.k.a. allowing the milk made in the mammary glands of the breast to move to a “holding chamber” so that when the baby sucks on the nipple, milk is actually released).  Interestingly enough, the very act of suckling causes an increase in release of oxytocin by the pituitary gland (we have no political position regarding that statement.  Use this newfound knowledge at your own risk).  It is a self-perpetuating cycle to make sure babies get the food they need!  In terms of pregnancy, oxytocin also prepares the cervix for the birthing process (“Pitocin”, as oxytocin is called in this setting, is used as a topical gel to move things along and get the baby out faster).

Oxytocin is not only found in pregnant women…no need to feel left out, gentlemen.  Both men and women release oxytocin in relation to touch.  Studies have even found an increase in its release with warm contact on the skin.   Increases in oxytocin levels have been correlated with an increase in trusting behavior and decrease in fear.  It has also shown to be associated with generosity, empathy and even sexual arousal.   All of these emotions contribute to the formation of a bond between individuals.

Cortisol

On the opposite end of the spectrum, cortisol is commonly referred to as the “stress hormone.”  It raises blood pressure, spikes your blood sugar and suppresses the immune system among other things.   The body naturally increases its levels of this hormone in times of stress and anxiety (Remember “fight or flight” from high school biology?  This is a related chemical reaction).  Interestingly, one of the actions of oxytocin is the inhibition of cortisol.  One would think that a peak in cortisol levels in situations like an NBA game would help with performance.   The research, however, shows that it may actually be beneficial to have some level of suppression of cortisol in this scenario.

Therefore, when an NBA player high-fives his fellow teammate, he is triggering a biochemical signal in his teammate’s mind and body that says, “You can trust me.”  Perhaps it is this sense of security that allows players to push themselves physically and out-perform their rivals.  So next time you are on the spot, whether it be before shooting the game-winning free throw or as you sit down to take that final exam, giving the person next to you a motivating high-five will make a lot more sense.  It may be the “secret-weapon” you have been looking for.

Questions? E-mail Kelly: erickson@myhousecallmd.com

References:

1. Carey, B. Evidence That Little Touches Do Mean So Much.  The New York Times.  February 22, 2010.

2. Kraus, M, Huang, C,  and Keltner, D. Running Head: Touch, Cooperation and Performance.

3. Field T, Figueiredo B, Hernandez-Reif M, Diego M, Deeds O, Ascencio A.  Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships. J Bodyw Mov Ther. 2008 Apr;12(2):146-50. Epub 2007 Oct 2.

4. Field, T., Lasko, D., Mundy, P., Henteleff, T., Kabat, S., Talpins, S., Dowling, M. Brief Report: Autistic Children’s Attentiveness and Responsivity Improve After Touch Therapy. Journal of Autism and Developmental Disorders.   Volume 27(3), June 1997, pp 333-338

by Leah Frankel, MS, RD

Hypercholesterolemia (high cholesterol) affects 37.7 million Americans and is a major cause of cardiovascular disease (American Heart Association, 2005). Numerous methods are used to lower cholesterol including change in diet, exercise or use of medications (usually a type of drug called a statin.  You’ve seen them plaguing your primetime TV commercials). However, research suggests that a simple vitamin may actually help improve cholesterol levels.

Niacin, previously referred to as Vitamin B₃, is important in the function of the digestive system, skin, nerves as well as metabolism. The RDI (Recommended Daily Intake) for niacin ranges from 14 mg/day (females 19-70) to 16 mg/day (males 19-70). Food sources of the B vitamin include: dairy, produce, fish, eggs, lean meats, nuts, legumes and enriched breads and cereals.

There are two forms of niacin: nicotinic acid and nicotinamide (no need to memorize these names…they will not be on the test at the end of the article). Both of these forms have the same function when taken in milligram doses. However, when nicotinic acid is taken in gram doses, it works as a cholesterol lowering drug.  The effect of nicotinic acid as a cholesterol-lowering agent was first seen in the middle of the 20^th century when Rudolf Altschul noticed that giving rabbits nicotinic acid caused their cholesterol levels to lower (1). At this time he also discovered that nicotinamide had no effect on lowering cholesterol.

So how does it work? At approximately the same time that nicotinic acid was discovered to lower cholesterol levels, free fatty acids were observed to be precursors of LDL (free fatty acids are converted into LDL and remember that LDL is the bad form of cholesterol.  We outline the different types of cholesterol below). Nicotinic acid was found to lower concentrations of free fatty acids in a matter of minutes, with an increase in free fatty acid levels back to normal levels in approximately an hour. Studies done in rats explained this observation, because nicotinic acid was shown to prevent the release of free fatty acids that were stored as fat (2). Therefore, nicotinic acid is believed to lower cholesterol by preventing fat from being turned into LDL.

The two types of cholesterol we are most familiar with are HDL (high density lipoprotein) and LDL (low density lipoprotein); HDL is commonly known as the “good” cholesterol and LDL as “bad” cholesterol. LDLs are produced by the liver and carry cholesterol and other lipids (fats) from the liver to different areas of the body, like muscles, tissues, organs, and the heart. HDL is produced by the liver to carry cholesterol and other lipids (fats) from tissues and organs back to the liver for recycling or degradation. Once it was determined that high HDL levels would lower the incidence of cardiovascular disease the early findings that nicotinic acid would raise HDL became of some importance. Nicotinic acid has the unique property of modifying each type of cholesterol in a way that is beneficial in reducing the risks of vascular disease. It not only lowers LDL, it raises the concentration of HDL which is unique to nicotinic acid, and very effective in changing your cholesterol mix for the better.

Due to the role of nicotinic acid as an HDL-raising drug, it is now being considered as a complementary drug to be used with statins or other LDL lowering drugs. Nicotinic acid treatment was shown to increase HDL levels by 21% (3). In an earlier trial, when nicotinic acid was given with statins, it was seen that there was an increase in HDL by almost 30%, and a lowering of LDL cholesterol by 25-40%…pretty good if you ask us.  Other studies using nicotinic acid in combination with statins have found that there is a significant clinical benefit because there is a reduction in both coronary artery disease events (i.e. heart attacks) and mortality (i.e. you die). This is thought to be due to the rise in HDL, which is only seen with nicotinic acid.

The biggest problem with the use of nicotinic acid in lowering cholesterol is the side effects. There are two major side effects seen in patients taking nicotinic acid:

1. Flushing (You feel warm and get red in the face.  Imagine passing gas in the middle of a first date – that feeling)

2. Increased uric acid in the blood

A prolonged-release formula of nicotinic acid, also known as extended-release or ER, has been created to help minimize the side effects.

So should we be consuming greater amounts of niacin in our diet to help manage our cholesterol?  The answer for now, is probably not. The tolerable upper limit (what is considered a “safe upper limit”) for niacin is 35 mg/day and as noted above niacin only has a lipid lowering effect when taken in gram doses (10-fold higher than what is safe today).  While consuming extra niacin will probably not lead to healthier cholesterol levels in its current formulation the research between the effects of nicotinic acid and cholesterol levels are promising as pharmaceutical companies are currently creating new forms of nicotinic acid, which will hopefully have less side effects allowing for more extensive use.

Green tea’s medicinal use reaches far back in the history of mankind.  It’s about time someone sorted through all the green tea urban legends, separating the voodoo from the scientifically-proven applications…and that’s exactly what the American Academy of Family Physicians did.  You’ll be amazed to see what they found.

Scientifically-Proven Uses:

1. Cancer: High intake of green tea (i.e. 3-10 cups per day) has been shown to reduce the risk of breast cancer by 20%, the risk of colon cancer by 18%, and the risk of stomach & esophageal cancer by 50%.  Some conflicting evidence exists, however, so the final verdict is still out, but green tea seems to be a promising way to reduce the risk of cancer.

2. Genital & Anal Warts:  Yes, this is (shockingly) true.  Green tea extract in topical cream form (called Veregen) has been proven effective in the treatment of genital and anal warts caused by Human Papillomavirus (HPV).  Research is being done to see if this same compound can be used for the treatment of cervical disease caused by HPV.

3. Stroke: Individuals who consume five or more cups of green tea per day significantly reduce their risk of stroke.

The Voodoo:

1. Weight Loss: Studies looking at weight loss with the consumption of green tea show mixed results, at best.  The weight loss seen in some studies is believed to be related to the caffiene in the tea which increases your metabolism at high doses (which subsequently leads to weight loss).  Other studies have not seen any weight loss with high doses of green tea (i.e. it didn’t work).  We recommend hitting the gym for 30 minutes a day rather than trying to consume over 10 cups of green tea…it seems a bit more reasonable.

2. High Cholesterol & Triglycerides: Studies found that green tea does NOT reduce an individuals cholesterol or triglyceride levels.  Stick to your low cholesterol diet!

There are millions of diets in existence, with new fad approaches to weight loss popping up each month.  From the ever popular South Beach Diet, a high-protein, low-carbohydrate approach, to the very entertaining Cayenne Pepper and Water diet, essentially a starvation diet, it’s hard to sort through the myriad of approaches to weight loss.  Additionally, there is little scientific evidence to support the effectiveness of any of these plans.  Why punish yourself with cayenne pepper water three times a day if it doesn’t even help you lose weight?

This month, the New England Journal of Medicine, one of the most reputable journals in medicine, published the study, “Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates,” to help dieters decode the plethora of diets peppering society.  The study examined 811 overweight adults (people with a Body Mass Index between 25 and 40) who were assigned to 4 different diets.  The participants received regular, personalized diet training during the entire study encouraging diets with less saturated fat, at least 20 g of dietary fiber per day, and low cholesterol.  The four diets studied were classified by the amount of fat, protein, and carbohydrates that each diet consisted of:

1.      Low-Fat, Average Protein: 20% Fat, 15% Protein, 65% Carbohydrates

2.      Low-Fat, High Protein: 20% Fat, 25% Protein, and 55% Carbohydrates

3.      High Fat, Average Protein: 40% Fat, 15% Protein, and 45% Carbohydrates

4.      High-Fat, High Protein: 40% Fat, 25% Protein, and 35% Carbohydrates

The target number of calories consumed per person was calculated as a 750 calorie deficit per day (meaning that if your body consumes 3000 calories per diet, which we call your Basal Metabolic Rate, your target diet would consist of 2250 calories per day).  You’re saying to yourself, “How on earth am I supposed to know what my Basal Metabolic Rate (BMR) is?”  There are a series of formulas that calculate this value for you based on age, height, weight, and amount of exercise you complete each day.  Follow this link to a convenient BMR Calculator (Click on BMR & RMR Calculator…and don’t forget to adjust your caloric need based on your daily physical activity).

After 2 years of monitoring participants weight loss, the study concluded that “reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.” Essentially, it doesn’t matter which diet you choose.  The most important factor in creating a diet is calculating the number of calories your body needs to consume, making sure that the diet you design consists of 750 calories less than your BMR per day. The study found that the majority of weight loss occurred in the first 6 months of the diet (i.e. if you haven’t lost any weight after 6 months, you aren’t on the right diet).  Additionally, all of the diets reduced risk factors for cardiovascular disease and diabetes (a definite bonus).

The Take Home Message: The amount of food you consume is just as important, if not more so, than the types of food your diet consists of.  Whichever diet you choose, be sure to calculate your individual caloric needs based on your age, height, weight, and physical activity and are eating the appropriate number of calories per day based on that number.