Just some random thoughts on the neuroscience behind religion. What is religion ? How are our religious beliefs generated? Do we have a center in the brain dedicated to religion (is there a religion center in the brain?) Role of temporal lobe and limbic structures in religion. Some patients with temporal lobe epilepsy are hyperreligious. Does the temporal lobe house the religion center of the brain?
I shall be musing about these thoughts further.
Dr. S
Your brain on yoga: its myths and healing powers
Nitin K. Sethi, MD
Address for Correspondence:
Nitin K. Sethi, MD
Department of Neurology
NYP-Weill Cornell Medical Center
525 East, 68th Street
New York, NY 10021 (U.S.A.)
Email: sethinitinmd@hotmail.com
What is yoga? Yoga literally means union. Union of the self with the inner consciousness is yoga. When one gets skilled in yoga then one can meditate. It is difficult when one tries to meditate for the first time. You close your eyes and the mind is bombarded with thoughts. What happened at work, who said what, things I have to do when I get done with meditation here. Mundane thoughts like these start racing through the mind. In the Bhagavad Gita an ancient Indian text Lord Krishna rightly tells Arjuna “your mind is your best friend but also your worst enemy”. It is indeed very difficult to control the mind, to slow it down and make it calm. In the recent years yoga has gained immense popularity in the west. What is about yoga that is different from traditional exercises like jogging and weight training? Why have so many people incorporated yoga into their hectic schedules? Yoga has been postulated to have dual benefits for the body (exercise) as well as the mind (meditation). What are these benefits of yoga? What is the neuroscience behind meditation? I shall discuss these and other issues briefly in this article.
Before we begin let us briefly talk about different types of yoga. I am in no way an authority on yoga and various yogic postures so I shall keep this short. If you seek further information, there are many books which go over the practice of yoga in great detail. In the Bhagavad Gita, Lord Krishna talks about three kinds of yoga namely karma yoga, bhakti yoga and gyana yoga.
Karma yoga as stated in the Bhagavad Gita means that one should do ones prescribed duties without worrying about the fruits. What does that mean and does that have any relevance to the health of our mind? A lot of stress in our daily lives is due to the attachment to results. We all seek something and strive hard to achieve it. This is especially true in a city like New York where I reside. It is hardly 6 am and the city is on the go. People rushing to work and to appointments, constantly on the move. I personally am of the philosophy that hard work never killed anyone. One should do ones prescribed duties. Like for instance I am a doctor and my duty is to my patients. I need to be there for them and take care of them. Karma yoga teaches us the same, do your prescribed duties, as one cannot remain stagnant. Stagnation or boredom is a big killer. When people get depressed they have what has been referred to as anhedonia. The term means the loss of interest in anything pleasurable. Work can and should be a pleasure. It gives us a reason to get out of our homes, meet new and interesting people, meet up with friends and share a coffee during the lunch break. All this keeps our minds healthy. Man is a social animal and the human brain seeks interaction and I feel thrives on it. What does hurt the mind and through the mind-body connection the health of our bodies in turn, is the desire for results. If I am working hard as a doctor because I want to get rich and famous then I am constantly worrying for the fruits of my endeavors. This attachment to the results leads to stress. Stress which may lead to a nervous breakdown, depression and which has been linked to cardiovascular diseases like heart attacks and cerebrovascular diseases like stroke. The philosophy behind Karma yoga is thus intensely appealing. It does not ask us to renounce life. If you love to party, so party (if indeed that is your prescribed work) but do it without getting attached to the results (I hope I meet someone famous there, someone that will help me in climbing up the social ladder).
Bhakti Yoga the word “bhakti” literally means faith. So what does bhakti yoga mean and is there a relevance to the state of our mental and physical wellness? The way bhakti yoga is described in Indian texts like the Bhagavad Gita is having faith in god. The human brain needs to believe in something. If you are religious you would believe in god (does not matter what your religion is or who is the god you believe in). If you are not religious you may believe in yourself or a close friend. Again bhakti helps the mind in turning inwards. They say faith can move mountains. People have faith and have been able to overcome physical hurdles or go through an intensely draining experience like been diagnosed with cancer.
Gyana Yoga also called Jnana yoga or Dhyana yoga: refers to the yoga of knowledge. In the Gita this yoga refers to seeking the ultimate knowledge and in a way introspection, trying to make a union with the inner self. It also refers to leading a disciplined life in which one remains detached from extraneous sensory objects. In today’s world we are constantly wired. How many times in the space of a day do we check our emails or are talking on the cellphones. The mind just like any other organ of the body needs rest. Needs time to reflect, time to organize its thoughts. Many writers prefer to work in solitude, away from cellphones, televisions sets blaring out the same news and even the Internet.
In a thought-provoking article, Deshmukh talks about the neuroscience behind meditation 1. Deshmukh likens meditation to an art, the art of being serene and alert in the present moment instead of a constant struggle to adapt and change to various external stimuli. As per Deshmukh, when one is meditating there is more efficient management of attentional energy, one may be totally engaged or totally disengaged. During meditation there is a simultaneous, participatory consciousness rather than a dualistic, sequential attentiveness. Thus meditation helps in changing the response of our mind to external stimuli. One can be a part of the external world yet at the same time be detached from its influence. This as Deshmukh points out leads to a natural sense of well-being and spontaneous joy.
Does a meditative mind function better? Does a meditative mind lead to a meditative brain? Meaning do the benefits of meditation on the mind translate into benefits for the brain too. Does regular practice of mediation lead to physiological and neurochemical changes in the brain? Hopefully science shall yield answers to the above questions soon.
Thus there is some evidence though not all scientific suggesting the benefits of yoga for the mind and the brain. That the mind is connected to the body has been emphasized recently. So changes in the milieu of the mind (and brain) affect the body and the reverse is also true. This mind-body connection works both in health and disease. A healthy brain and mind live in a healthy body and vice versa. Is it possible to use this mind-brain connection to promote healing? Can you use the power of the mind to fight cancer of the breast or to overcome a stroke that has left you weak on one side of the body? There is some evidence to suggest in the affirmative. I strongly feel that patients do well when you treat them as a whole, not just the body system that is giving them trouble.
Benefits of yoga for the body
The concept of yoga benefiting the body is far easier to comprehend. The physical aspect of yoga involves various asana (postures or poses). These help in toning the muscles and improving balance and station (posture). Yoga may benefit people suffering from chronic back pain by strengthening the muscles of the back. Patients with Parkinson’s disease or those with mild to moderate Alzheimer’s dementia would likely benefit from some yoga exercise done under proper supervision. This would improve their stiffness as well as balance. I stress the “under proper supervision” part here as some of the advanced postures have the risk of causing injury 2.
Conclusion
Yoga may have the unique capacity to benefit both the mind and the body. Further studies exploring the neuroscience behind yoga shall reveal the secrets behind this ancient science.
References
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Nourishing and nurturing your brain: from the things we eat to the things we do
Nitin K. Sethi, MD
Address for Correspondence:
Nitin K. Sethi, MD
Department of Neurology
NYP-Weill Cornell Medical Center
525 East, 68th Street
New York, NY 10021 (U.S.A.)
Email: sethinitinmd@hotmail.com
The human brain is indeed complex made of millions of small cells called neurons working in close harmony with each other. Its capacity far exceeds that of any supercomputer designed as of yet by man. This fist full of about 1500 grams of tissue is the seat of our emotions, our memory, our senses and serves as the motherboard for all other body systems. This delicate supercomputer of ours is enclosed in a resilient bony skull able to withstand significant trauma. Our brain like our body needs to be nurtured and nourished.
What we eat does to an extent determine the health of our brain. Recently the concept of brain foods has come into vogue. This refers to foods that have been postulated to boost brain power, improve memory and functioning of the brain. So what are these foods that have been postulated to help keep the brain young?
Omega 3- fatty acids: belong to the family of unsaturated fatty acids. The important ones among them include alpha linolenic acid, eicosapentaenoic acid and docosahexaenoic acid. Fatty acids form an important constituent of cell membranes. They thus perform important roles in various cell functions including cell to cell transmission and help maintain stability of cell membranes. A growing body of work has shown the beneficial effects of omega 3-fatty acids in prevention of atherosclerosis. The data showing a beneficial effect of fish oils is more robust for the cardiovascular system while no consisting relationship between fish consumption and stroke reduction has been documented. So while the data may not be robust, it probably makes sense to increase the omega 3-fatty acid content in your diet. I would advise replacing some of the saturated fats with polyunsaturated fatty acids rich in omega -3s like canola oil, walnut and olive oil.
Numerous other foods have been touted to promote brain heath. Some of these include avocado, various legumes (rich source of protein for vegetarians), oatmeal, peas, soybeans (again a good source of protein for vegetarians), wheat germ, fish like tuna, yogurt, brown rice, brussels sprouts and eggs among others. The brain just like any other organ of the human body needs a balanced nutritious diet consisting of the right mix of carbohydrates, proteins, fats, vitamins and minerals.
Role of Ginkgo biloba in enhancing memory: the extract of the Ginkgo leaves has been used for medicinal purposes for years. It contains flavonoid glycosides and terpenoids and is thought to enhance memory and concentration. Studies though have yielded conflicting results. While some studies on patients with Alzheimer’s dementia showed a benefit, others did not and benefits were attributed to a placebo effect. Ginkgo biloba affects the coagulation of blood and can interfere with other anticoagulants like warfarin and aspirin. It might be reasonable for people who have dementia or an early stage of dementia called mild cognitive impairment (MCI) to take Ginkgo biloba. Its use in healthy young adults as a memory enhancer is probably ill advised.
Role of vitamins and minerals in promoting brain health: Vitamins and minerals are also referred to as micronutrients. The body needs them albeit in small amounts for its well being. Vitamins and minerals are involved in diverse cellular functions. Deficiency of certain vitamins has been implicated in causing neurological diseases. Vitamin B1 also called thiamine is a water soluble vitamin. Deficiency of vitamin B1 causes a disease caller Beriberi. It presents clinically as a peripheral neuropathy (the peripheral nerves get involved). Deficiency is commonly seen in alcoholics and those with marginal diets like the elderly. Thiamine deficiency in heavy alcoholics may cause other neuro-psychiatric problems. Wernicke’s encephalopathy and Korsakoff psychosis occur in alcoholics and present clinically with confusion, gait, balance and memory problems. Foods that are rich in vitamin B1 include whole-grain cereals, bread, red meat, legumes, green leafy vegetables and brown rice. I would recommend vitamin B1 supplementation in the elderly and those who drink heavily. Ideally all people who drink a moderate amount on a regular basis should take one multi-vitamin a day.
Vitamin B12 deficiency can occur in people who have pernicious anemia or inflammatory bowel diseases like Crohn’s. Deficiency of B12 also called cyanocobalamine may present with neuropsychiatric manifestations (referred to as megaloblastic madness). It may also cause loss of vision (amblyopia) and weakness of the legs due to involvement of the spinal cord (the spinal cord involvement is referred to as sub-acute combined degeneration of the spinal cord). Meat and meat products like liver, beef, mutton, fish and egg are rich sources of B12. Hence vitamin B12 deficiency occurs mostly in pure vegetarians. In these groups, yes, vitamin B12 indeed does nourish the brain and in fact is vital for it to function normally.
Vitamin E is much in vogue today and has been aggressively touted as an anti-oxidant important for everything from aging gracefully to preventing cancer. Again there is yet no scientific evidence that it indeed does help in all this. Vitamin E deficiency causes ataxia and balance problems (ataxia of vitamin E deficiency). Deficiency occurs in people who for some reason cannot absorb the vitamin from the gut. Wheat germ, vegetable oils, whole grains and nuts are good sources of this vitamin. No one knows what the ideal dose of this vitamin should be. Even giving supratherapeutic doses (mega doses of 1000 IU and above) of vitamin E to patients who had neurodegenerative conditions like Alzheimer’s dementia did not result in any observable benefit.
This is a good time to talk about the role of various anti-oxidants in promoting and maintaining brain health. A variety of anti-oxidants are nowadays been marketed as a visit to any of the health stores shall reveal. These have been touted for their anti-cancerous properties as well as their cardiovascular and cerebrovascular benefits. Among them coenzyme Q10 and alpha lipoic acid are popular. There has been no proven benefit of coenzyme Q 10 when controlled trials have been done in patients with Parkinson’s disease or even in ALS. My personal view is that if someone has a strong family history of Alzheimer’s dementia, Parkinson’s disease or ALS, it may be reasonable to advice supplementation as these preparations are relatively safe with no major side-effects. Studies have shown that when you give them to patient’s who already have an advanced neurodegenerative condition like Parkinson’s disease they seem to be ineffective, no one though knows that if you take these supplements from a young age (before the onset of the disease), would they lessen the chances of developing Parkinson’s disease or dementia in the later life. Meaning do they actually promote brain health? I usually do recommend alpha lipoic acid supplementation in my diabetic patients with neuropathy. In health men and women, I would recommend taking them in moderation as there is no proven benefit.
Role of exercise in promoting brain health: “ The brain too needs to jog everyday” exercise is a natural aphrodisiac for the brain. It promotes the release of endorphins and other feel good neurotransmitters. The benefits of regular exercise in promoting brain heath have been documented repeatedly. Even people who have neurodegenerative conditions like Alzheimer’s dementia and Parkinson’s disease seem to do well if they exercise as compared to those that don’t. These patients are less prone to fall and have improved assessments on care-giver rating scales. My personal belief is that exercise promotes brain healing and improves synaptic transmission. Recently cognitive exercises have come into vogue. Brushing with your left hand (if you right handed), playing mind-games like crossword puzzles and scrabble have been documented in some studies to slow down the progression of dementia and improve memory and concentration. People who are high functioning and use their brain regularly like lawyers and teachers have a lower incidence of developing later life cognitive problems as compared to a construction worker whose job is more manual and does not involve the use of these higher mental functions. “ Use it or lose it!!!”
“ Do not just exercise your body, exercise your brain too”
The mind-brain connection: How to keep your mind healthy
One should not only have a healthy brain but a healthy mind too. Inner peace, calmness, introspection, tranquility are essential qualities that nurture the mind and help to maintain its internal equilibrium. Meditation, been spiritual and doing yoga are ways by which that elusive inner peace can be obtained ensuring a healthy mind as well as brain. One should never forget the healing powers of the mind. Some cancer patients and patients who have had a devastating stroke have been able to overcome their illness and disability due to the healing power of their minds. One should harness this power in a positive direction because the mind can be your best friend as well as your worst enemy. Protect your mind against depression as attacks of major depression make one prone to later life dementia. Have healthy relationships that nurture and nourish your mind.
Someone once rightly said and I quote “ Your mind is your best friend, do not hurt him for whomsoever or whatsoever”.
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” It is declared that the senses are superior but more than the senses the mind is superior but more than the mind the intelligence is superior and more than the intelligence that which is superior is the individual consciousness”
Lord Krishna in the Bhagavad Gita
Stroke is one of the most common neurological conditions. Also called a cerebrovascular accident (CVA), it can have a devastating outcome. Just as you have a heart attack when the blood supply to the heart is compromised due to a clogged artery in the heart, stroke is similarly a brain attack and occurs when the blood supply to the brain gets compromised. The brain is richly supplied by blood vessels and does not tolerate ischemia (reduced blood supply) well.
There are different types of strokes and here I shall enumerate a few of them. Strokes can broadly be categorized under 2 headings:
1) Ischemic strokes ( when blood supply to the brain is compromised eg a clot in the artery supplying the brain shall cause an ischemic stroke).
2) Hemorrhagic strokes ( when a blood vessel in the brain ruptures, hemorrhage occurs into the surrounding brain structures causing a hemorrhagic stroke).
Ischemic strokes can be caused by several different kinds of disease processes and can be further classified either on the basis of the calibre of the blood vessel involved or on the basis of the pathogenic mechanism which caused the stroke.
On the basis of calibre of the blood vessel involved, strokes can be further classified as
1) Large vessel strokes: a big blood vessel in the brain gets blocked. Usually when the doctor refers to a large vessel stroke he means strokes involving large arteries such as the internal carotid artery (ICA), the middle cerebral artery (MCA), anterior cerebral artery (ACA) or the posterior cerebral artery (PCA).
2) Small vessel strokes: a small blood vessel in the brain gets blocked. Usually these are the penetrating arteries of the brain which supply the deeper parts of the brain.
Based on the mechanism/cause of ischemic strokes, we can classify strokes as:
1) Atherothrombotic : the stroke occurs due to atherothrombosis, the same mechanism which causes many of the heart attacks. The blood vessels of the brain become hardened and narrowed due to atherosclerosis: an inflammation of the arteries due to deposition of lipoproteins/fat and cholesterol . This deposition of lipoproteins give rise to what we commonly refer to as plaques. This most commonly occurs in people who have risk factors for both stroke and coronary artery disease namely diabetes, hypertension, high cholesterol, smokers etc.
2) Embolic: here a plaque may break off from its primary site such as the heart and travel up to the brain blocking off a brain vessel. Lots of things can embolize to the brain:
-cholesterol plaques
-fat embolism ( commonly seen after one has a long bone fracture. The long bones like tibia and femur are very rich in bone marrow which is rich in fat. When a fracture occurs rarely the fat may embolize via a blood vessel to the brain.
-air embolism ( strange though it may sound even a bubble of air can embolize to the brain and cause a stroke)
Embolic strokes can be of two types:
1) Cardioembolic : a clot embolizes from the heart to the brain.
2) Artery to artery embolic: a clot embolizes from a larger artery commonly the carotid artery in the neck to a small artery in the brain.
Hemorrhagic strokes: just as ischemic strokes, hemorrhagic strokes can also be of various types. Hemorrhagic strokes are usually classified on the basis of the compartment of the brain into which the bleeding occurs.
1) Bleeding can occur into the substance of the brain itself: this is called as primary intracranial hemorrhage (ICH)
2) Bleeding can occur in the subarachoid space of the brain: this is called sub-arachnoid hemorrhage (SAH). I shall be discussing this under a separate heading.
3) Bleeding can occur in either the epidural or subdural space: this is called epidural hematoma (EDH) and subdural hematoma (SDH) respectively.
Risk factors for stroke/ CVA
There are numerous risk factors for stroke. As both stroke and coronary artery disease involve blood vessels they share some common risk factors.
Risk factors can be divided into: modifiable and non-modifiable risk factors.
1) Non-modifiable risk factors include:
a) Age: strokes are more common in the older age groups. Strokes do occur in the young and even in children and infants but they have diffferent causes.
b) Sex: there is some sex difference in the incidence of strokes.
c) Race: hemorrhagic strokes are more commonly seen in Asians as compared to Caucasians.
d) Genetic causes: if you have a very strong family history of strokes or coronary artery disease ( example your father had a stroke, his father had a stroke and all at a relatively young age then you too have a high risk of having a stroke at some point in your life). Unfortunately the genes which impart this increased risk have still not been clearly delineated, so no one knows just how much is the risk. If bad cholesterol or high blood pressure and diabetes runs in your family and in you then your risk for strokes and heart attacks is increased.
As you may realise the above risk factors are non-modifiable, meaning there is precious little you can do to change them. You cannot stop aging, change your race or sex or modify the genes that you were born with !!! Not at this juncture at least. Maybe in the future science shall advance to the extent that we can modify these bad genes.
Modifiable risk factors:
There are numerous modifiable risk factors for strokes and CAD. I shall list them out as follows:
1) Hypertension: hypertension or high blood pressure (BP) is the number one modifiable risk factor for both strokes and heart attacks. Hypertension has rightly been called the Silent Killer. It usually does not cause any overt symptoms and people are unaware that they have a high blood pressure. At times vague complaints of headache and fatigue may make them seek medical attention where a blood pressure evaluation shall disclose that they are hypertensive. (hypertensive meaning one who has high BP).
2) Diabetes mellitus: diabetes mellitus (DM) too increases the risk of strokes and CAD especially when the blood sugar is uncontrolled and constantly elevated. People who have DM may not know that they have diabetes for a long time as initial signs and symptoms may be subtle. In the setting of uncontrolled blood sugar they may have complaints of polyuria ( too much and too frequent urination), polyphagia ( hungry and always eating, most of the diabetics are obese) and polydipsia ( feeling thirsty all the time). As the disease advances complications of diabetes emerge namely poor wound healing, frequent urinary tract infections, heart attacks, strokes, eye-problems (cataracts and retinal problems leading to impaired vision), nerve problems ( neuropathy) and kidney problems ( renal insufficiency sometimes requiring dialysis).
3) Smoking: people who smoke have a much higher risk of getting a heart attack or a brain attack. The toxins in cigarette smoke damage the lining of the blood vessels in both the heart and the brain. No amount of smoke is good for the heart or the brain. One should quit completely to lower this risk of heart and brain attacks.
4) Sedentary life-style/ lack of exercise: a sedentary life-style also predisposes to strokes and heart attacks. People who are obese especially those with central obesity ( fat around the tummy) have higher risk of strokes and heart attacks.
5) Hypercoaguable states: certain people have factors in their blood which make their blood more coaguable, meaning the blood clots more readily. Examples include patients who have diseases like lupus, sickle cell anemia etc.
6) Dyslipidemia or bad cholesterol: as many of you know there are many types of cholesterol found in our bodies. Not all cholesterol is bad. People who have more bad cholesterol (increased low density lipoproteins, increased very low density lipoproteins) and low levels of good cholesterol (high density lipoproteins) have higher risk of strokes and heart attacks.
Treatment of stroke: before I talk about the treatment of stroke, I rather talk a bit about stroke prevention. Prevention is always better than cure. Stroke prevention involves modification of the risk factors for stroke. Smoking cessation is the key as smoking is an important risk factor for stroke. Smokers get atherosclerosis at an earlier age than non-smokers (their arteries get hardened). Smoking cessation may involve behavioral therapy as well as use of nicotine patches and gums. People who have hypertension should ensure that their hypertension is adequately treated. Nowdays we recommed aiming for blood pressures of 120/70 mm Hg or even less. There are many drugs out there for the effective treatment of high blood pressure. The same is true for diabetics and euglycemia (getting blood sugar as close to normal) is the goal. This may be achieved either by pills (oral hypoglycemic drugs) or with insulin. Recommendations are to reduce Hb A1C (also called glycosylated hemoglobin to below 7). The importance of regular physical exercise cannot be overstated. I would recommned some cardio-vascular exercise like brisk walking or jogging. This is good both for the brain as well as the heart. Diet too plays an important role in stroke and dietary modifications may be one way to reduce your risk for strokes and heart attacks. Eating a diet rich in fish oils, poly unsaturated fatty acids, green leafy vegetables and fruits helps to naturally lower your cholesterol down. Recently the benefits of cooking in olive oil have been emphasised.
Management of an acute stroke:
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