Posted: 21 Dec 2013 08:00 AM PST
THE PSYCHOLOGY BEHIND HOW FESTIVE FOOD AND DRINK MAKE A MONSTER OF YOUR APPETITE.
THE amount of food we can put away on Christmas day is as impressive as it is excessive.
Chocolates and cakes are fair game 24/7. Savoury nibbles are needed shortly after breakfast, to soak up the mid-morning livener.
And then, shockingly soon after lunch and all its trimmings, as soon as someone breaks out the pickled onions, I'm off again.
And so it continues.
One reason we can keep putting it away like this is a phenomenon called sensory specific satiety (SSS). We can have enough of one sort of food, but still have an appetite for something else.
It lies at the root of the expression "pudding stomach".
It is why the trend for small sharing plates is a restaurateur's dream and a slimmer's nightmare.
It is why kids suddenly declare: "I don't like it", while eating a food they definitely like.
The thinking behind SSS is that because humans are omnivores, and we must eat a variety of foods to survive, we evolved this mechanism to keep us from sticking doggedly to our favourite food, and consequently getting ill and/or prematurely popping our clogs.
Marion Hetheringon, professor of biospychology at the University of Leeds, UK, describes the process nicely: "If I'm eating a food like pasta, it will taste good at the beginning.
"Then when I'm halfway through, it doesn't taste quite as good.
"I might add some more sauce to make it taste better, or I might say I'm going to switch to salad now; I've had enough of the pasta."
This happens subconsciously.
In fact, even people with amnesia who not only forget what they've just eaten, but have no idea whether they've eaten at all, still express this mechanism.
Served repeated, identical meals, they will continue to eat them, but they find them increasingly unpleasant.
THE OVERRIDE BUTTON
Adding the sauce in Prof Hetherington's pasta example is an attempt to override SSS.
While SSS happens automatically, we might consciously decide that we want to keep eating the food a little longer and enter into an internal tug-of-war.
It seems that we can foil SSS pretty easily.
One study back in the 1980s found that once people feel satiated from eating red Smarties, if presented with yellow Smarties (which taste and smell identical), they will suddenly get their appetite back.
And more recently, Laurent Brondel at the European Centre for Taste Sciences in Dijon, France, observed that simply introducing a condiment can be enough.
"I gave subjects some french fries," he tells me, "and when they didn't want them any more, I put some ketchup near the french fries, and the subjects started eating them again."
His team did the same with chocolate brownies, and introducing vanilla ice cream led to greater consumption (although, controversially, whipped cream did not).
WHO IS SATISFIED THE MOST QUICKLY?
Babies and young people have exhibited greater SSS in studies.
Brondel says that infants, between weaning and two years of age (after which hedonic and external influences take hold), will choose all the foods they need from a variety put in front of them; they won't simply eat the one food that tastes the best.
"This is a period of diversification, during which they are very sensitive to their internal nutritional state and needs," he adds.
"Children tend to show sensory specific satiety quite strongly," says Prof Hetherington, and therefore, forcing them to finish something they don't want could be detrimental.
"If parents are trying to override internal signals, the child will become more used to environmental signals to determine how much they eat, rather than their own internal signals of hunger and satiety."
Obviously, this is all "within reason" - if, say, there's a purple jelly rabbit on the table, it might not be SSS that's putting the kids off their broccoli.
Much of the work on SSS has involved eating disorders.
"Patients with anorexia show it very strongly," says Prof Hetherington, "whereas people with bulimia show it quite weakly."
But no one knows whether the inflated or decreased SSS are symptoms or causes of these conditions.
A THOROUGHLY MODERN MALAISE
Just as our innate preference for sweet things served us brilliantly in driving us to seek out energy-giving foods back in the good old days before we were surrounded by cheap sweets, SSS also somewhat backfires in the modern world.
With such a wide variety of easily accessible food, and with restaurants offering as many courses as you want, SSS makes overeating pleasurable.
But when you have to eat a certain food every day, no matter how much you like it, long-term SSS can set in.
"There's also a long-term phenomenon called monotony," says Prof Hetherington, "which is different to SSS, but means that by day three, you are not going to fancy turkey again."
On the plus side, if there are only leftovers on offer, you will probably eat less for the next few days.
Perhaps, to speculate wildly, the combined effects of SSS and monotony are what makes it nearly impossible to fashion the turkey into something that tastes delicious in the immediate aftermath of Christmas, no matter how you dress it up.
Have you ever truly succeeded in this task? - Guardian Newsin particular, pain related to ageing and age-related conditions, nerve pain from more modern operations, and cancer treatment.
This sort of chronic pain, which has been recognised as a disease in its own right by the World Health Organisation, is very different from acute pain, which serves either as a warning sign or for adaptive purposes while the body heals itself from damage.
Chronic pain serves no purpose and is now seen as a long-term condition exactly like diabetes or high blood pressure.
It is mainly a diagnosis of exclusion, made after appropriate investigations have ruled out sinister pathology. It is best dealt with in a pain management setting by a pain specialist.
It is a disease that has lifestyle ramifications and is managed by a multitude of combination treatments. There treatments aim not to cure, but instead, to help maintain a good quality of life and function.
Chronic pain can destroy lives, and is a major clinical, social and economic problem.
But above all, persistent pain is a human tragedy.
While quality specialist pain management is available, it is in short supply.
In Malaysia, we are light-years away from giving chronic pain the priority it deserves. Indeed, even in the western world, they are only just starting to invest the funds needed for research into newer treatment options.
In the past, managing pain was by treating it as a symptom, i.e. the patient was subjected to many possible investigations and surgical options.
For example, cervical spondylosis - a degenerative joint condition causing headache and neck pain - would be treated with a spinal fusion or decompression.
Fusing of the spine is used primarily to eliminate the pain caused by abnormal motion of the vertebrae by immobilizing the degenerated vertebrae themselves. However, spinal fusion is also the preferred way to treat most spinal deformities, specifically, scoliosis and kyphosis.
Currently, investigations are targeted at excluding "red flags", i.e. impending nerve damage (cord compression), cancer and spinal cord myelopathy (progressive loss of the proteins covering the spinal cord).
These can be managed symptomatically via certain surgical techniques like a laminectomy, where a portion of the vertebral bone called the lamina is removed.
Failing that, there are various strong medications that can be prescribed to ease the pain.
However, these can, on occasion, lead to tolerance (i.e. needing larger doses), dependence and addiction (particularly with opioids), and intolerable side effects, like fatigue, sleepiness, upset stomaches, and nausea and vomiting.
Pain specialists are always on the lookout for newer treatments with minimal side effects.
One particular treatment that has emerged in recent years is Percutaneous Electrical Nerve Stimulation (PENS).
In the past, acupuncture (western dry needling) and TENS (Transcutaneous Electrical Nerve Stimulation) have been used to effectively treat various forms of arthritic pain.
However, the effects are very transient, and symptoms recur within less than a week.
Top-up treatments have to be given every few weeks in order to regain the benefits.
PENS, TENS AND ACUPUNCTURE
In chronic pain, the affected nerves and muscles are hypersensitive and send incorrect electrical impulses.
The nerves "misbehave" by sending off random electrical messages, which cumulatively gives rise to the sensation of pain, along with causing shortened, tense muscles. (See graphic)
The hypersensitive spot will eventually also affect the surrounding area, causing the sensation of pain to further spread.
This can be readily diagnosed by the bedside, or in the outpatient department, via an ultrasound scan.
PENS is similar in concept to TENS, but instead of placing electrodes on the skin of the affected area, needles are inserted, either around or immediately adjacent to the nerves serving the painful area.
The nerves are then stimulated by passing a low-voltage electrical current through the needles.
PENS is generally reserved for patients who fail to get pain relief from TENS.
PENS differs from electrical acupuncture in that the placement of needles for electrical acupuncture is based on traditional Chinese medicine theories regarding the flow of energy or qi through the body.
In PENS, the needles are located based on the area of pain.
Basically, PENS combines the benefits of acupuncture and TENS.
BECOMING LESS SENSITIVE
The PENS therapy causes a tingling sensation (paraesthesia) in the area of the body associated with the pain. It alters the activity of the peripheral nerve, and reduces and controls the sensation of pain.
The treatment does not destroy the affected nerves, but makes them less sensitive to pain.
A low-voltage electrical current is delivered to the fatty layer just below the surface of the skin close to either a specific nerve, or to all the nerve endings situated in that area.
PENS therapy is used to treat chronic nerve pain, including areas of hypersensitivity, headache and chronic post-surgical pain.
Occasionally, PENS is used as a diagnostic tool.
Even when it does not produce a pain-relieving effect, it can help the pain team find an alternative treatment.
There has been extensive research done on this treatment, and in April, the United Kingdom included it in the National Institute of Clinical Excellence guidelines as part of the treatment for chronic pain.
It is useful in all forms of chronic pain, including non-specific low back pain, occipital headache, post-surgical pain, post-hernia repair and cancer-related pain (from either surgery or radiotherapy).
Its advantages are that it is minimally invasive, avoids the risks and expenses of surgery, and is well tolerated.
Although many more innovative technological treatment options for pain are available, PENS has so far been the most rigorously tested, and a good evidence base has emerged, both with clinical trials and amongst peer reviews and physician use.
Malaysia is the first country to introduce this treatment in South-East Asia.
It should be noted though, that PENS is not meant to be used as a single treatment option, but as part of a wider pain management programme encompassing targeted physiotherapy, medicine optimisation, minimally-invasive injections, and surgery, if indicated.
Dr Maya Nagaratnam is a pain specialist, pioneering PENS therapy in Malaysia, and also a British Medical Acupuncture Society-certified acupuncturist. For more information, e-mail . The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
Posted: 21 Dec 2013 08:00 AM PST
HAPPINESS IS OVERRATED; IT'S BETTER TO BE RIGHT, A STUDY FINDS.
IT IS better to be right than to be happy - at least for one husband on the cutting edge of science.
As part of an unusual experiment, the husband was instructed to "agree with his wife's every opinion and request without complaint", and to continue doing so "even if he believed the female participant was wrong", according to a report on the research that was published on Tuesday by the British Medical Journal.
The husband and wife were helping a trio of doctors test their theory that pride and stubbornness get in the way of good mental health.
In their own medical practices in New Zealand, the doctors had observed patients leading "unnecessarily stressful lives by wanting to be right rather than happy".
They wondered if these patients could just let go of the need to prove to others that they were right, would greater happiness be the result?
Enter the intrepid husband.
Based on the assumption that men would rather be happy than be right, he was told to agree with his wife in all cases.
However, based on the assumption that women would rather be right than be happy, the doctors decided not to tell the wife why her husband was suddenly so agreeable.
Both spouses were asked to rate their quality of life on a scale of one to 10 (with 10 being the happiest) at the start of the experiment and again on Day 6.
It's not clear how long the experiment was intended to last, but it came to an abrupt halt on Day 12.
"By then, the male participant found the female participant to be increasingly critical of everything he did," the researchers reported.
The husband couldn't take it any more, so he made his wife a cup of tea and told her what had been going on.
That led the researchers to terminate the study.
Over the 12 days of the experiment, the husband's quality of life plummeted from a baseline score of 7 all the way down to 3.
The wife started out at 8 and rose to 8.5 by Day 6.
She had no desire to share her quality of life with the researchers on Day 12, according to the report.
Still, the team was able to draw some preliminary conclusions.
"It seems that being right, however, is a cause of happiness, and agreeing with what one disagrees with is a cause of unhappiness," they wrote.
They also noted that "the availability of unbridled power adversely affects the quality of life of those on the receiving end."
The three doctors think they might be on to something, and they wrote that they would like to see the work continue:
"More research is needed to see whether our results hold if it is the male who is always right." - Los Angeles Times/MCT Information Services
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