2 2 7 J U N E 2 0 1 0body+mindhealthYOUR

The phrase “mind-body con-nection” has many connota-tions. For some, it’s short-hand for New Age quackery.For others, it’s a source of

hope and a way to reconcile their spiri-tual life with modern science.

For Tor D Wager, it’s just another dayat the office.

Dr Wager is a professor of psychol-ogy at the University of Colorado. Hisspeciality is neuroscience and brainimaging, but his passion is the placeboeffect —a phenomenon that has un-dergone a resurgence in recent years.Much of this attention is a result of thekind of brain imaging Dr Wager does,and he is a leading figure in the newgeneration of placebo researchers.

Dr Wager, 35, was raised in ChristianScience, a religion mostly known for itsaversion to medical treatment. Hisfamily was not strict about it, however;he recalls an incident from his child-hood that could have served as a har-binger for his career.

As a baby, he says, he came downwith a rash, and after much prayer hismother took him to a doctor, fearingscarlet fever. “The doctor said, ‘Here’s acream, rub it on there,’ and it wentaway,” Dr Wager said.

So did his mother’s distress. Herpulse probably slowed, he says now,and her breathing relaxed — just the ef-fect a placebo may have on a terrifiedpatient.

Increasingly, placebo effects are be-ing viewed as real and tangible, if mys-terious. In various surveys, 45 to 85 percent of American and European practi-tioners say they have used placebos inclinical practice, and 96 per cent of aca-demic physicians in the United Statessay they think placebos have therapeu-tic effects.

Even so, many scientists mistrustthem. “When I started graduate schoolI felt like it was kind of taboo to studythe placebo,” Dr Wager said. The re-search at the time was spotty at best,“and then there were whole sections ofsociety that were ready to jump on thatand say, ‘Oh, look how powerful themind is!’ ”

But placebo research has gained re-spectability in recent years, thankslargely to the work of Dr FabrizioBenedetti, an Italian neuroscientistwidely seen as the patriarch of the field.Dr Benedetti argues that there is not asingle placebo effect, but many.

One common effect involves the as-sumption that a particular pill is re-sponsible for easing pain or discomfortthat is actually subsiding naturally. An-other is classic Pavlovian conditioning,in which a patient is so accustomed tofeeling better after a shot that it worksno matter what is in it. Another is therelief a patient like Dr Wager’s mother

feels when a doctor offers a concretesolution.

As a graduate student at the Univer-sity of Michigan, Dr Wager used imag-ing to watch emotions in the brain. Itwas fascinating work, he says, but emo-tions are hard to define with precisionand he wanted to do something thatcould help patients. So he decided tolook at placebos in a clinical setting. In2001, he joined forces with Dr Robert MRose, a University of Texas scientist

who had done pioneering studies ofstress in Vietnam War veterans, and agroup of respected researchers calledthe Network on Mind-Body Interac-tions.

Within a few years, Dr Wager’s namewas at the top of a ground-breakingstudy in the journal Science that usedfunctional magnetic resonance imag-ing—a specialised scan that measureschanges in blood flow—to link specificbrain activation to people experiencing

a placebo effect (in this case rubbingunmedicated cream on a burn). Sincethen, he has written roughly a dozenscientific papers on placebo effects, in-cluding a 2007 study linking pain-re-lated effects to parts of the brain thatprocess opium or heroin (which mayhelp explain why many placebos aretemporary). “Wager is a person whohas to convince himself of something,”Dr Rose said.“He doesn’t buy it becausesomeone else does it. He is a sceptic.

But once he buys it, boy, is he dogged.” When Dr Wager isn’t writing about

placebos, he is defending the tools heuses to study them. Many critics areskeptical of functional MRI, and Dr Wa-ger says that at first he was, too.

At the recent conference of the Organization for Human Brain Map-ping, Dr Wager gave a presentationabout placebos to a full house of scien-tists. But his laboratory at the University of Colorado also shared ar-cane new statistics for reading brainscans. Such attention to detail, he said,is the only way to convince sceptics.

Until recently, the government andthe drug industry have been hesitant tofinance studies of placebo effects.

“Companies who are developingnew treatments like to think that actu-ally their new treatment works wellenough to do better than just the powerof positive thinking,” said Dr Helen SMayberg, a neurologist at Emory Uni-versity nown for her work with func-tional MRI in patients with depression.She quickly added that placebo effectswere very different from positive think-ing.

Drug trials sometimes start witheveryone getting a placebo; those whorecover are then weeded out. Whileperhaps strengthening the results, thisdoes not help researchers understandwhy people in the first group got better.

That persistent question — whysome people are more responsive toplacebos than others — has long frus-trated scientists. “There’s decades of re-search that has more or less failed,” DrWager said. “New methods are going tolet us get a lot more out of it.”

Solving the mystery would poten-tially unlock whole new areas for ther-apy. Dr Wager recently attended ameeting sponsored by the National In-stitutes of Health about enlisting multi-ple institutions in an effort to under-stand placebos. Several drugcompanies were present; some havebegun their own research into the mystery.

Dr Wager (who receives financingfrom the National Science Foundationand the Michael J Fox Foundation) saysdrug companies were cautious aboutbringing too much attention to place-bos, but recognised a potential for bet-ter therapies.

But for him it is tied to his childhoodreligion and the way he sees the world.“What is the placebo effect?” he asked.“It’s not some weird magical thing thatjust kind of happened out of the blue.”

“I think it’s connected to systemsthat generate emotional responses,” hecontinued. “It’s a window into ways inwhich psychological factors can affectbrain and body factors that are relatedto health.” ◆

—NYT

Which calcium supplements you should take

ISHI KHOSLA is aformer senior nutritionistat Escorts. She heads theCentre of Dietary Counselling and alsoruns a health food store.She feels that for complete well-being,one should integratephysical, mental and spiritual health. According to her: “To behealthy should be the ultimate goal for all.”

DIETDIARY

The ClaimA craving for ice is a sign of anemia

The FactsFatigue and weakness are the familiarsymptoms of the blood disorderanaemia, which afflicts millions ofAmericans. But a fixation for ice?

Oddly enough, in recent years, crav-ings for ice have emerged in the medicalliterature as a puzzling and increasinglydocumented sign of anaemia, espe-cially its most common form, iron defi-ciency anaemia. Scientists don’t fullyunderstand the link, but some suspectthat compulsive consumption of ice —called pagophagia — relieves inflam-mation in the mouth brought on by irondeficiencies.

In extreme cases, people with undi-agnosed anaemia and pagophagia havebeen known to go through multiplebags or trays of ice in a single day; theproblem usually clears up after treat-ment with iron supplements. Anotherwell-known anaemia, sickle cell, cannotbe treated with these supplements.

Studies at Northwestern Universityhave shown that ice cravings area acommon side effect of a popular type ofweight-loss surgery. The procedure,known as Roux-en-Y (pronouncedROO-on-why), involves bypassing thepart of the intestine where iron andother minerals are most easily ab-sorbed; about a third of patients de-velop a deficiency of iron or vitaminB12. One case was described in theMayo Clinic Proceedings in 2008, involv-ing a 33-year-old woman who had un-dergone bypass surgery.

“The patient’s husband frequentlyobserved her in the middle of the nightwith her head in the freezer eating thefrost off the ice-maker,” the reportstated. “This craving resolved aftertransfusion and iron administration.”

The Bottom LineAbnormal cravings for ice can be a signof anaemia. ◆

—NYT

The placebo effectStudies show that placebo effects could be real and tangible � ERIK VANCE

Calcium is a critical nutrient for many bodily functions and getting enough calcium reduces the risk of osteoporosis later in life

Before you head to the chemist, takea critical look at your diet, especiallyyour intake of dairy products. In ur-

ban westernised diets, dairy foods are themajor sources of dietary calcium. Withoutthem, it may be difficult to reach the rec-ommended intake for calcium. Peoplewho exclude dairy products for the fear ofheart disease, obesity, are vegans or thosewith a milk allergy, must choose foodscarefully to find rich calcium sources.

Calcium sources vary widely in theirbio-availability — the proportion of a sub-stance capable of being absorbed andavailable for use or storage. Although sev-eral sources of natural calcium are knownand labels are required to list the per centdaily value for calcium, they do not indi-cate how much of that calcium the bodywill absorb. For example, half a cup ofspinach contains about 120 milligrams ofcalcium, but the body absorbs only fiveper cent of that calcium.

Intake recommendations are thereforebased on the “mix of sources” in the typi-cal diet of a country. Many cultures man-age on much lower intakes because theydo not consume the food that deplete cal-cium or reduce its absorption. Vegetariansmay, in fact, need less calcium than meateaters. If you are considering non-dairy

foods as your sole source of calcium, how-ever, refer to the table which shows theamount of certain foods needed to pro-vide the calcium available from one cup ofmilk.

Even with adequate calcium in yourdiet, if you are pregnant, elderly, a smoker,menopausal or have family history of os-teoporosis, you may still need to investi-

gate the supplement. Calcium deficien-cies are common in chronic dieters,women who have undergone hysterec-tomy, alcoholics, and people who areanorexic/bulimic. Constituents of foodlike fibre, oxalates (spinach, rhubarb, al-monds, chocolates), phytates (found inwheat bran) and alcohol limit absorptionof calcium. Excessive intakes of certainnutrients like protein, vitamin A andsodium also inhibit calcium absorption.Many common medicines includingantacids, steroids, diuretics interfere withcalcium metabolism.

Again there is variety of choices: cal-cium carbonate, calcium citrate, calciumlactate, calcium phosphate, coral calcium.The absorption of calcium from most sup-plements is about equal, roughly 30 percent. The calcium citrate malate is ab-sorbed a little better at 35 per cent, how-ever, a typical calcium citrate malatetablet has less calcium than a tablet of an-other type such as calcium carbonate. Cal-cium carbonate is usually the most con-centrated per tablet, so taking fewer pillsper day will supply enough. It may be agood idea to keep changing the type in or-der to derive the maximum benefits.

You also need to get plenty of vitaminD, either through exposure to sunlight, in

fortified milk, or as a part of a supplement(many calcium supplements have addedvitamin D). Vitamin D is important for theabsorption of the calcium.

There is no substitute to eating right.However, many people do not consumethe recommended amounts of calcium (4servings of calcium rich foods/day).Health professionals must promote dietand exercise patterns that promote opti-mal calcium levels.

Take 5:■ Avoid consuming iron supplements

with calcium, as it interferes with ironabsorption.

■ Calcium supplements should not betaken with any medication that has to betaken on an empty stomach.

■ For maximum absorption, drink 1- 1½cups of water with each tablet and havethem between meals.

■ Supplements must be consumed underprofessional supervision. Excessive cal-cium intake can cause constipation, in-testinal bloating, excess flatulence andkidney stones.

■ It is important to take adequate levels ofnutrients including vitamin D, phos-phorus, zinc, manganese, magnesium,and boron, together with exercise. ◆

Foods that provide the calcium equivalentof one cup of milk

Beans pinto 6 1/3 cupsBeans, red 7 cupsBeans, white 2 ½ cups Broccoli 2 ½ cupsBrussels sprouts 4 cupsCabbage, Chinese 1 cups Cabbage, green 3 cupsCalcium fortified juices 150 mlCauliflower 4 cupsKale 1 ¾ cupsKohlrabi 3 ½ cupsMustard green 1 1/3 cupsRadish 4 ½ cups Rutabaga 2 ¼ cupsSesame seeds, no hulls 300 gSoy milk unfortified 30 cups Spinach 7 ¾ cupsTofu, calcium set ½ cups Turnip greens 1 cups Watercress 3 ½ cups

Breaking the

ice code

45 TO 85 PER CENT OF AMERICAN AND EUROPEAN PRACTITIONERS SAY THEY HAVE USED PLACEBOS IN CLINICAL PRACTICE, AND 96 PER CENT

OF ACADEMIC PHYSICIANS IN THE UNITED STATES SAY THEY THINK PLACEBOS HAVE THERAPEUTIC EFFECTS

PHOTOS: THINKSTOCK