This Isn’t a Nutrition Blog…Or the Fat Addiction

I don’t want to turn this into a nutrition blog, but I find some of the recent studies coming out on the science very interesting.  The evidence that there is an epidemic of obesity in our country is overwhelming.  And, more and more evidence is accumulating that dieting is not the answer.  It’s going to take more than just telling people to eat better and exercise more.

One aspect of nutrition that has probably been under-appreciated is the interaction of nutrition and neuroscience.  Well, thanks to a new study published in Nature Neuroscience, that may not be the case much longer.

Addiction to certain drugs, like cocaine and heroin, are accompanied by changes in the level of specific neurotransmitter receptors in the brain.  In a process called negative feedback, as the neurotransmitter level increases, the number and sensitivity of its receptors decrease.

The neurotransmitter most closely associated with addictions is dopamine.  Dopamine is active in the “reward” or “pleasure” centers in the brain.  One of these reward centers is called the striatum.  The authors showed that in rats exposed to chronic high fat foods, the level of the dopamine receptor D2 in the striatum is decreased.  That means that it would take even more fatty food to get the same pleasure response.  In other words, this is the first clear evidence that fatty foods are addictive.

From a neurosurgical perspective, this is very interesting.  Neurosurgeons are able to modulate brain activity in specific regions of the brain by implanting electrical stimulators.  Current surgical techniques for the treatment of obesity (called bariatric surgery) are principally performed by general surgeons.  Procedures including gastric bypass, banding, stomach stapling, and others are accompanied by severe side effects.  They also carry risks of vitamin deficiencies.  Furthermore, although there are many successful outcomes from the surgery, there are failures as well.  A deep brain stimulator could be a very attractive alternative.

First Principles

Medicine is so complicated.  Even if you narrow it down to a specific specialty like neurosurgery, there is so much to know.  There are myriad neurosurgery textbooks.  Perhaps the most definitive is Youman’s, a mere four volumes of 1500 pages each.

You need to be able to manage a lot of information for many professions.  In order to do this, organization is critical.  But it can be done, and it is done by many.

Amongst the volumes of information available, some facts are more important than others.  I like to call the most important things “First Principles.”  Every concept, every dilemma, every problem facing a surgeon should be framed according to the appropriate First Principles.

Frequently, the First Principles are clearly defined.  In the field of medicine, the First Principles were described 2,000 years ago by Hippocrates.  When a physician addresses a patient, these principles are reviewed and guide subsequent actions.

This is the art of medicine: it lies in recognizing the key features of a situation and then identifying the appropriate First Principles to apply in the management.

Here are some of the first principles:

1. First, do no harm.
2. The needs of the patient come first.  (But not the wants of the patient.)
3. Apply your skills and abilities for the healing of the sick and afflicted to the best of your abilities.
4. Maintain personal standards in line with upholding the nobility of the profession.