Two Charles Loloma Rings

Study: Putting Feelings Into Words

Affect Labeling Disrupts Amygdala Activity in Response to Affective Stimuli

Matthew D. Lieberman,

Naomi I. Eisenberger,

Molly J. Crockett,

Sabrina M. Tom,

Jennifer H. Pfeifer and

Baldwin M. Way

University of California, Los Angeles

Abstract

Putting feelings into words (affect labeling) has long been thought to help manage negative emotional experiences; however, the mechanisms by which affect labeling produces this benefit remain largely unknown. Recent neuroimaging studies suggest a possible neurocognitive pathway for this process, but methodological limitations of previous studies have prevented strong inferences from being drawn. A functional magnetic resonance imaging study of affect labeling was conducted to remedy these limitations. The results indicated that affect labeling, relative to other forms of encoding, diminished the response of the amygdala and other limbic regions to negative emotional images. Additionally, affect labeling produced increased activity in a single brain region, right ventrolateral prefrontal cortex (RVLPFC). Finally, RVLPFC and amygdala activity during affect labeling were inversely correlated, a relationship that was mediated by activity in medial prefrontal cortex (MPFC). These results suggest that affect labeling may diminish emotional reactivity along a pathway from RVLPFC to MPFC to the amygdala.

Address correspondence to Matthew Lieberman, Department of Psychology, Franz Hall, University of California, Los Angeles, Los Angeles, CA 90095–1563, e-mail: lieber@ucla.edu

From Brain Pickings Weekly: An Antidote to the Age of Anxiety: AlanWatts on Happiness and How to Live with Presence

by Maria Popova

Wisdom on overcoming the greatest human frustration from the pioneer of Eastern philosophy in the West.

“How we spend our days is, of course, how we spend our lives,” Annie Dillard wrote in her timeless reflection on presence over productivity — a timely antidote to the central anxiety of our productivity-obsessed age. Indeed, my own New Year’s resolution has been to stop measuring my days by degree of productivity and start experiencing them by degree of presence. But what, exactly, makes that possible?

This concept of presence is rooted in Eastern notions of mindfulness — the ability to go through life with crystalline awareness and fully inhabit our experience — largely popularized in the West by British philosopher and writer Alan Watts (January 6, 1915–November 16, 1973), who also gave us this fantastic meditation on the life of purpose. In the altogether excellent 1951 volume The Wisdom of Insecurity: A Message for an Age of Anxiety (public library), Watts argues that the root of our human frustration and daily anxiety is our tendency to live for the future, which is an abstraction. He writes:

"If to enjoy even an enjoyable present we must have the assurance of a happy future, we are “crying for the moon.” We have no such assurance. The best predictions are still matters of probability rather than certainty, and to the best of our knowledge every one of us is going to suffer and die. If, then, we cannot live happily without an assured future, we are certainly not adapted to living in a finite world where, despite the best plans, accidents will happen, and where death comes at the end."

What keeps us from happiness, Watts argues, is our inability to fully inhabit the present:

The “primary consciousness,” the basic mind which knows reality rather than ideas about it, does not know the future. It lives completely in the present, and perceives nothing more than what is at this moment. The ingenious brain, however, looks at that part of present experience called memory, and by studying it is able to make predictions. These predictions are, relatively, so accurate and reliable (e.g., “everyone will die”) that the future assumes a high degree of reality — so high that the present loses its value.

But the future is still not here, and cannot become a part of experienced reality until it is present. Since what we know of the future is made up of purely abstract and logical elements — inferences, guesses, deductions — it cannot be eaten, felt, smelled, seen, heard, or otherwise enjoyed. To pursue it is to pursue a constantly retreating phantom, and the faster you chase it, the faster it runs ahead. This is why all the affairs of civilization are rushed, why hardly anyone enjoys what he has, and is forever seeking more and more. Happiness, then, will consist, not of solid and substantial realities, but of such abstract and superficial things as promises, hopes, and assurances.

Watts argues that our primary mode of relinquishing presence is by leaving the body and retreating into the mind — that ever-calculating, self-evaluating, seething cauldron of thoughts, predictions, anxieties, judgments, and incessant meta-experiences about experience itself. Writing more than half a century before our age of computers, touch-screens, and the quantified self, Watts admonishes:

The brainy modern loves not matter but measures, no solids but surfaces.

The working inhabitants of a modern city are people who live inside a machine to be batted around by its wheels. They spend their days in activities which largely boil down to counting and measuring, living in a world of rationalized abstraction which has little relation to or harmony with the great biological rhythms and processes. As a matter of fact, mental activities of this kind can now be done far more efficiently by machines than by men — so much so that in a not too distant future the human brain may be an obsolete mechanism for logical calculation. Already the human computer is widely displaced by mechanical and electrical computers of far greater speed and efficiency. If, then, man’s principal asset and value is his brain and his ability to calculate, he will become an unsaleable commodity in an era when the mechanical operation of reasoning can be done more effectively by machines.

If we are to continue to live for the future, and to make the chief work of the mind prediction and calculation, man must eventually become a parasitic appendage to a mass of clockwork.

To be sure, Watts doesn’t dismiss the mind as a worthless or fundamentally perilous human faculty. Rather, he insists that it if we let its unconscious wisdom unfold unhampered — like, for instance, what takes place during the “incubation” stage of unconscious processing in the creative process — it is our ally rather than our despot. It is only when we try to control it and turn it against itself that problems arise:

Working rightly, the brain is the highest form of “instinctual wisdom.” Thus it should work like the homing instinct of pigeons and the formation of the fetus in the womb — without verbalizing the process or knowing “how” it does it. The self-conscious brain, like the self-conscious heart, is a disorder, and manifests itself in the acute feeling of separation between “I” and my experience. The brain can only assume its proper behavior when consciousness is doing what it is designed for: not writhing and whirling to get out of present experience, but being effortlessly aware of it.

And yet the brain does writhe and whirl, producing our great human insecurity and existential anxiety amidst a universe of constant flux. (For, as Henry Miller memorably put it, “It is almost banal to say so yet it needs to be stressed continually: all is creation, all is change, all is flux, all is metamorphosis.”) Paradoxically, recognizing that the experience of presence is the only experience is also a reminder that our “I” doesn’t exist beyond this present moment, that there is no permanent, static, and immutable “self” which can grant us any degree of security and certainty for the future — and yet we continue to grasp for precisely that assurance of the future, which remains an abstraction. 

Our only chance for awakening from this vicious cycle, Watts argues, is bringing full awareness to our present experience — something very different from judging it, evaluating it, or measuring it up against some arbitrary or abstract ideal. He writes:

There is a contradiction in wanting to be perfectly secure in a universe whose very nature is momentariness and fluidity. But the contradiction lies a little deeper than the mere conflict between the desire for security and the fact of change. If I want to be secure, that is, protected from the flux of life, I am wanting to be separate from life. Yet it is this very sense of separateness which makes me feel insecure. To be secure means to isolate and fortify the “I,” but it is just the feeling of being an isolated “I” which makes me feel lonely and afraid. In other words, the more security I can get, the more I shall want.

To put it still more plainly: the desire for security and the feeling of insecurity are the same thing. To hold your breath is to lose your breath. A society based on the quest for security is nothing but a breath-retention contest in which everyone is as taut as a drum and as purple as a beet.

He takes especial issue with the very notion of self-improvement — something particularly prominent in the season of New Year’s resolutions — and admonishes against the implication at its root:

I can only think seriously of trying to live up to an ideal, to improve myself, if I am split in two pieces. There must be a good “I” who is going to improve the bad “me.” “I,” who has the best intentions, will go to work on wayward “me,” and the tussle between the two will very much stress the difference between them. Consequently “I” will feel more separate than ever, and so merely increase the lonely and cut-off feelings which make “me” behave so badly.

Happiness, he argues, isn’t a matter of improving our experience, or even merely confronting it, but remaining present with it in the fullest possible sense:

To stand face to face with insecurity is still not to understand it. To understand it, you must not face it but be it. It is like the Persian story of the sage who came to the door of Heaven and knocked. From within the voice of God asked, “Who is there” and the sage answered, “It is I.” “In this House,” replied the voice, “there is no room for thee and me.” So the sage went away, and spent many years pondering over this answer in deep meditation. Returning a second time, the voice asked the same question, and again the sage answered, “It is I.” The door remained closed. After some years he returned for the third time, and, at his knocking, the voice once more demanded, “Who is there?” And the sage cried, “It is thyself!” The door was opened.

We don’t actually realize that there is no security, Watts asserts, until we confront the myth of fixed selfhood and recognize that the solid “I” doesn’t exist — something modern psychology has termed “the self illusion”. And yet that is incredibly hard to do, for in the very act of this realization there is a realizing self. Watts illustrates this paradox beautifully:

While you are watching this present experience, are you aware of someone watching it? Can you find, in addition to the experience itself, an experiencer? Can you, at the same time, read this sentence and think about yourself reading it? You will find that, to think about yourself reading it, you must for a brief second stop reading. The first experience is reading. The second experience is the thought, “I am reading.” Can you find any thinker, who is thinking the thought, I am reading?” In other words, when present experience is the thought, “I am reading,” can you think about yourself thinking this thought?

Once again, you must stop thinking just, “I am reading.” You pass to a third experience, which is the thought, “I am thinking that I am reading.” Do not let the rapidity with which these thoughts can change deceive you into the feeling that you think them all at once.

In each present experience you were only aware of that experience. You were never aware of being aware. You were never able to separate the thinker from the thought, the knower from the known. All you ever found was a new thought, a new experience.

What makes us unable to live with pure awareness, Watts points out, is the ball and chain of our memory and our warped relationship with time:

The notion of a separate thinker, of an “I” distinct from the experience, comes from memory and from the rapidity with which thought changes. It is like whirling a burning stick to give the illusion of a continuous circle of fire. If you imagine that memory is a direct knowledge of the past rather than a present experience, you get the illusion of knowing the past and the present at the same time. This suggests that there is something in you distinct from both the past and the present experiences. You reason, “I know this present experience, and it is different from that past experience. If I can compare the two, and notice that experience has changed, I must be something constant and apart.”

But, as a matter of fact, you cannot compare this present experience with a past experience. You can only compare it with a memory of the past, which is a part of the present experience. When you see clearly that memory is a form of present experience, it will be obvious that trying to separate yourself from this experience is as impossible as trying to make your teeth bite themselves.

To understand this is to realize that life is entirely momentary, that there is neither permanence nor security, and that there is no “I” which can be protected.

And therein lies the crux of our human struggle:

The real reason why human life can be so utterly exasperating and frustrating is not because there are facts called death, pain, fear, or hunger. The madness of the thing is that when such facts are present, we circle, buzz, writhe, and whirl, trying to get the “I” out of the experience. We pretend that we are amoebas, and try to protect ourselves from life by splitting in two. Sanity, wholeness, and integration lie in the realization that we are not divided, that man and his present experience are one, and that no separate “I” or mind can be found.

To understand music, you must listen to it. But so long as you are thinking, “I am listening to this music,” you are not listening.

The Wisdom of Insecurity is immeasurably wonderful — existentially necessary, even — in its entirety, and one of those books bound to stay with you for a lifetime.

From Brain Pickings Weekly: Why Haters Hate: Kierkegaard Explains thePsychology of Bullying and Online Trolling in 1847

Celebrated as the first true existentialist philosopher, Danish writer and thinker Søren Kierkegaard (May 5, 1813–November 11, 1855) may have only lived a short life, but it was a deep one and its impact radiated widely outward, far across the centuries and disciplines and schools of thought. He was also among the multitude of famous writers who benefited from keeping a diary and nowhere does his paradoxical blend of melancholy and idealism, of despair about the human condition and optimism about the purpose of life, shine more brilliantly than in The Diary of Søren Kierkegaard (public library) – a compendium of Kierkegaard's frequently intense, always astoundingly thoughtful reflections on everything from happiness and melancholy to writing and literature to self-doubt and public opinion.

In an immeasurably insightful entry from 1847, 34-year-old Kierkegaard observes a pervasive pathology of our fallible humanity, explaining the same basic psychology that lurks behind contemporary phenomena like bullying, trolling, and the general assaults of the web's self-appointed critics, colloquially and rather appropriately known as haters.

Kierkegaard writes:

"There is a form of envy of which I frequently have seen examples, in which an individual tries to obtain something by bullying. If, for instance, I enter a place where many are gathered, it often happens that one or another right away takes up arms against me by beginning to laugh; presumably he feels that he is being a tool of public opinion. But lo and behold, if I then make a casual remark to him, that same person becomes infinitely pliable and obliging. Essentially it shows that he regards me as something great, maybe even greater than I am: but if he can't be admitted as a participant in my greatness, at least he will laugh at me. But as soon as he becomes a participant, as it were, he brags about my greatness."

That is what comes of living in a petty community.

It is unlikely that Kierkegaard was aware of what would become known as the Benjamin Franklin Effect – the Founding Father formulated his famous reverse-psychology trick for handling haters – and yet he goes on to relay an anecdote that embodies it perfectly. He recounts coming upon three young men outside his gate who, upon seeing him, "began to grin and altogether initiated the whole gamut of insolence." As he approached them, Kierkegaard noticed that they were smoking cigars and turned to one of them, asking for a light. Suddenly, the men's attitude took a dramatic U-turn – the seemingly simple exchange had provided precisely that invitation for participation in greatness:

"Instantly, all three doffed their hats and it would seem I had done them a service by asking for a light. Ergo: the same people would be happy to cry bravo for me if I merely addressed a friendly, let alone, flattering word to them; as it is, they cry pereat [he shall perish!] and are defiant... All it amounts to is play-acting. But how invaluably interesting to have one's knowledge of human psychology enriched in this way."

The Diary of Søren Kierkegaard may be short in both pages and lifetime covered, but it is a treasure trove of equally penetrating insights into the human experience. Complement it with Kierkegaard on our greatest source of unhappiness, then visit Anne Lamott's brilliant modern manifesto for handling haters.

Icons From the Age of Anxiety : Ebola: Landmark Outbreak in Dallas,Texas, USA

Ebola has broken out in the heart of the city I live in. As you might imagine it's an especially fearsome contagious disease for someone with OCD or other anxiety disorders. And for those "neurotypical" persons suffering recurrent rumination filled with irrational fear and loathing -- welcome to a bitter taste of the OCD experience. Anyway, without being overly alarmist, at the bottom of this post is some official information regarding disinfectants that some in Dallas may find helpful in the uncertain days ahead...

Nurses at a nationwide convention in Las Vegas staged a "die in" to dramatize the USA's lack of medical preparation and training for an Ebola outbreak. "It's not 'if,' but  'when'," they said. A Nevada healthcare official stated that such an Ebola outbreak was "extremely unlikely" to occur any time soon in the USA, and so, he was far more concerned about the spread of venereal disease in Sin City. The very next day, the nurses were proven correct on all counts when a Liberian visitor brought the contagion to Dallas.

Officials held news conferences and officials reassured the public that they were confident that they could halt any Ebola outbreak in its tracks. While they stressed that only close direct contact with "bodily fluids" from the afflicted could transmit the disease -- and thus it was "low risk" for the public. The hazmat suits worn by clean-up crews soon suggested otherwise -- that the virus could indeed linger in the environment and be very contagious.

Although told to quarantine themselves for a "wait and watch" self-monitoring period of 21 days, the family defied this request, showed an alarming lack of personal responsibility, and sent at least one "high risk" child, and possibly more, into public schools the following day. The need to socialize is a human trait that is hard to override long-term -- but this was the very next day.

Then, unfortunately, an intensive care nurse treating the Liberian patient came down with the virus, even though she was wearing protective gear. Once again, those demonstrating nurses in Las Vegas were proven correct in their warnings. A "break in protocol" was cited as the reason for the new case -- but no one has yet explained exactly what this "break" was. The apartment at the new Lakewood area location in Dallas was isolated and special cleaning crews were sent in. The nurse sought treatment and went into quarantine at the hospital within 90 minutes of being symptomatic.

The Dallas nurse's pet dog was also quarantined (at another location) as all mammals may act as carriers for the deadly disease. The pet dog of a case in Spain (another nurse) was recently euthanized as a public health precaution, despite pleas from the pet-loving public. It has not been explained how or even if such pets can be monitored with test for symptoms.

Hazmat crews arrived once again to disinfect the second apartment, and police are guarding it to make sure no one enters the building. TV news crews are still lingering around the site after several days, possibly to film "location shots" for their news updates. Ebola factoid flyers were issued to homeowners in the area in an attempt to ease fears. Only one "high risk" contact with the nurse was identified, and that person is also being monitored.

Chlorine Bleach: A Trusted Ally in the Battle against Ebola

By the Water Quality and Health Council, October 10, 2014

A group of San Diego women with close ties to the West African nation of Liberia is raising funds to help fight the Ebola outbreak in that country. Their chosen weapon:  buckets of bleach.  In a recent video, Deborah Lindholm, the founder of the group, Foundation for Women, describes life today in Liberia:  “There are no handshakes, no touching, no hugging; there is just complete and utter fear in Liberia right now…There are buckets of bleach all over the streets in Liberia and the people in Liberia and in the surrounding areas that have been affected by Ebola understand that if they keep their hands clean they can kill off the virus.”

Hand washing is an extremely important component of infection control as germs picked up on the hands are readily transferred to the eyes, mouth and nose by touching.  

Keeping all settings clean—homes, healthcare settings, schools and workplaces—is another critical factor in infection control because it helps prevent hands becoming re-contaminated between hand washings.

Thousands of gallons of concentrated chlorine bleach and other critical equipment are loaded into the cargo hold of an airplane destined for Sierra Leone, September, 2014. 

World Vision and the American Chemistry Council coordinated the humanitarian airlift to help fight Ebola.  Chlorine bleach was donated by Olin Corporation; domestic transportation services for bleach were donated by CSX Corporation and the Buffalo and Pittsburgh Railroad; bleach bottling services were donated by The James Austin Company.

Using Bleach to Destroy Ebola on Surfaces

According to the World Health Organization (WHO), “The Ebola virus can be eliminated relatively easily from surfaces using heat, alcohol-based products, and sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder) at appropriate concentrations.” 

The Ebola virus can live on inanimate surfaces, especially those that are soiled with blood or other body fluids from infected people.  In the later stages of Ebola, when patients experience internal and external bleeding, they may vomit blood or have bloody diarrhea, all potential sources of infection for those around them.

WHO recommends surfaces or objects contaminated with blood, other body fluids, secretions or excretions from Ebola patients be cleaned and disinfected as quickly as possible. 

The following information on bleach use against Ebola is based on a September, 2014 WHO guidance document:

As soon as possible after a spill of bodily fluids, clean the affected surface with a standard hospital detergent; then apply disinfectant.  This order of operations helps prevent the disinfectant becoming inactivated by organic matter on surfaces.

A 0.5% chlorine solution or a solution containing 5,000 parts per million free available chlorine is an effective surface disinfectant against Ebola.  

To prepare such a solution from liquid chlorine bleach or solid calcium hypochlorite, follow the directions in Examples I and II below.  Note that chlorine solutions have a limited shelf life, and should be prepared fresh daily.

Wastes, such as feces, urine, vomit and liquid waste from washing can be disposed of in the sanitary sewer or pit latrine with no further treatment.  WHO provides detailed guidance on Waste Management Procedures.

Don’t use bleach for everything: If an uninfected person is splashed with the bodily fluid of an infected person, as soon as possible wash the affected skin surface with soap and water.  

If a mucous membrane is exposed to infected bodily fluid, as soon as possible irrigate with copious amounts of water or an eyewash solution, not with chlorine solutions or other disinfectants.

 Bleach:  A Trusted Ally

In the rapidly unfolding saga of the West African Ebola outbreak, the critical role of surface disinfection is highlighted repeatedly by public health professionals along with public education, isolation and quarantine, contact tracing, good hygiene and personal responsibility.  

From sanitizing healthcare environments used for Ebola patient care, to airplanes used for international travel, to homes formerly inhabited by Ebola patients, chlorine bleach proves time and again to be a trusted ally in the raging battle against Ebola.

For further information on Ebola, please see the Centers for Disease Control and Prevention website and our article Ebola:  What You Should Know.

Notes:

1. Disinfectants are defined by EPA as either hospital or general use types. Disinfectants destroy or irreversibly inactivate infectious fungi and bacteria, but not necessarily their spores.

2. Chlorine solutions of various concentrations are also recommended for machine-laundering contaminated linens, decontaminating equipment such as goggles and visors and even body bags containing Ebola victims.

In contrast to the above advice, a journalist covering the devastating West African Ebola outbreak, rather than using just soap and water, keeps a bucket of 0.5% bleach solution in her own apartment to disinfect her hands when she comes inside.

Here is the West African Ebola journalist's own caption for her photograph of her personal chlorine cleansing solution.

In the Blogs: Fixing the Broken Mental Health System

By Lloyd I. Sederer, MD, and Steven S. Sharfstein, MD

Martin was 20 years old when he was arrested for the second time. Responding to auditory hallucinations, his aggressive behaviors endangered people on the street and in his apartment building. 

While incarcerated at Rikers Island (New York City's now infamous jail, where thousands of others with serious mental illness reside), he received antipsychotic medication. When released, however, he discontinued the medication and became ill again, reoffended and ended up with a lengthy stay at an upstate prison. Life there fostered survival-based antisocial behaviors that would make community reintegration even more problematic upon release.

Louise developed schizophrenia at age 18. Her illness progressed. She refused mental health treatment, became disruptive at home, and was hospitalized on a general hospital psychiatric unit. 

After discharge she refused treatment and began living on the streets, moving from shelter to shelter. By the time she was 35 years old, she suffered from severe hypertension, uncontrolled diabetes, and emphysema. 

She would visit a local emergency room once or twice a month. Sometimes she was hospitalized for either medical or psychiatric care; exposure to the elements and her lack of self-care were taking their toll. She looked 20 years older than her age and was at high risk for more illness and an early death.

Frank had been a successful attorney until he experienced a severe episode of clinical depression at age 45. He was reluctant to seek mental health treatment, without which his primary care physician and family believed his career could not last. 

They were right: He was unable to work and went on disability. After seven more years of severe depression and feeling hopeless about his future, he hung himself in the basement of his home. 

One of the great public health challenges in America today is that of untreated and poorly treated serious mental illness. 

Millions of Americans, and their families, lack access to or receive poor quality care -- the hallmarks of a broken mental health system. 

Jails and prisons have become principal places where many people with chronic mental illness arrive in the absence of alternatives. Many homeless individuals suffer from untreated serious mental, addictive, and chronic physical health problems resulting in great suffering as well as great strain on medical services and state medical assistance budgets. Because of stigma, or an inability to know that they are ill, or troubling experiences with mental health services they do not seek or follow through with treatment.

The legal, medical, and social service safety net for people with serious mental disorders has become so frayed that it often seems non-existent. What should be done?

Access to humane mental health and substance use treatment must be provided in local, community-based treatment settings, not jails or prisons, nursing homes, shelters, or long-term hospitals. 

The mental health 'system', such as it is, needs to be re-engineered to deliver alternatives to inpatient care such as intensive community treatment teams and crisis services. Court-mandated outpatient and inpatient treatment should be available for those so ill they are at risk to 'die with their rights on.'

Patients and families must come first, not the convenience of providers and payers. Patients do best, especially with chronic conditions, when they are informed, supported, and held responsible for their lives and health, which calls for a genuine partnership among, patients, families, and clinicians . 

Treatment must be comprehensive and continuous to control any chronic disease; for mental and addictive disorders that means psychotherapy, skill building, and rehabilitation services; wellness management; and medications. Nothing less is sufficient -- or works.

The fields of psychiatry and mental health have many evidence-based practices for people with serious mental illness. There is robust scientific evidence that case management, including health coaches and peer counselors, reduces the use of emergency acute services by people with serious mental illness and improves their lives. 

Existing Federal privacy laws also need to be better understood and updated so that families can do what they want more than anything, to help loved ones get the care that will save their lives and enable a quality existence in the community. 

Programs diverting individuals from jails and prisons, including specialized mental health and drug courts should be the rule, not the exception. Families, as well, can serve as the early warning system for signs of a member's recurring symptoms and early relapse.

The Helping Families in Mental Health Crisis Act (HR 3717, 113th Congress), a bipartisan bill introduced by Congressman Timothy Murphy, Ph.D. (R-Pennsylvania and a trained psychologist), offers needed, overdue direction for reforming mental health care. 

The time to pass this legislation is now so that we can repair a broken system and deliver opportunities for healing and recovery for tens of millions of people in this country.

It has been said that measure of a society is its humane attention to the sick and vulnerable. When real reform, transformation, comes to mental health and addiction services we will meet that moral and ethical standard -- and we will be able to serve so many in need.

In the Blogs: The Secret to Heart Health Is Avoiding Sugar

By Marcelle Pick, OB-GYN N.P. 

We all know that heart disease is the number one killer of women and the leading cause of death worldwide. One in three women die each year from this disease, more than all forms of cancer combined. 

For decades we believed saturated and trans fats were the primary offenders for heart disease, until now. Sugar, not fat, is the culprit, and this is shifting our whole philosophy on cardiovascular health.

In a report published this past spring, the Journal of the American Medical Association (JAMA) linked excess sugar intake to a dramatic increase in cardiovascular disease and mortality rates. The association also linked sugar intake to all sorts of health hazards, such as cancer, dementia, and Type 2 diabetes.

It isn't often that an entire medical consensus changes, and it has certainly created quite a stir. But it actually isn't bad news. It's important to understand the root causes of life-threatening diseases and implement effective strategies and treatment plans to save lives.

Sugar is delicious and satisfying. In fact, I'd be hard pressed to find one of my patients who doesn't have a love affair with chocolate. But sugar wreaks havoc in our bodies when consumed in large quantities over long periods of time. A diet high in sugar contributes to obesity, which is linked to many problems such as insulin resistance, kidney disease, hypertension, rheumatoid arthritis, asthma, and a multitude of harmful diseases related to inflammation.

Here are some not-so-sweet statistics:

Subjects with the highest sugar intake had a 400 percent higher risk of heart attack, according to the JAMA study.

The risk of heart attack nearly triples when 25 percent or more of our daily calories come from sugar.

The risk of dying from cardiovascular disease directly correlates to consuming 12 ounces per day, seven days a week, of a sugar-sweetened beverage.

Given the statistics, we know we should cut back on sugar. But that's not as easy as it sounds, because sugar is hidden in just about everything we eat. It goes by many names, including dextrose, high fructose corn syrup, malt syrup, glucose, sucrose, and evaporated cane juice, just to name a few.

It's found on more food labels than you would believe -- fruit drinks, yogurts, ready-to-eat cereals, even ketchup and salad dressings. Foods labeled "low fat" are especially deceptive. While the fat may be reduced, the sugar is increased to make up for lost flavor. Just look at low-fat salad dressings and try to find one with no sugar; it's almost impossible.

To make matters worse, sugar is highly addictive both biochemically and emotionally. The more we eat it, the heavier the impact, not only on our body -- including our hearts -- but also our brains. When the brain is continually overloaded with refined sugar, it essentially re-wires the mind, creating a dependency much like a drug addiction.

It can be hard to kick the sugar habit, even if we are aware of what we are eating because sugar is addictive, and both our bodies and our minds come to rely on it. Nicole Avena, a neuroscientist at Princeton University, has shown in numerous lab experiments that overeating palatable foods (like sugar) can produce changes in the brain and behavior that resemble addiction.

Mood-enhancing neurotransmitters such as serotonin and endorphins are released when we eat sugar, sending positive messages through our bodies, which helps lower our anxiety, making us feel more calm and relaxed. Sugar beckons us, but the more sugar we consume, the more we want. Even artificial sweeteners without calories trick our brain into wanting that sweet flavor.

We love sugar, but it's a very tough love. Chronic stress is also a key factor when it comes to sugar cravings. Patients tell me every day how difficult it is to balance work, home life, and self-care. Taking care of our families while trying to manage a career, put nutritious meals on the table, get enough exercise, the right amount of sleep, and tend to our health, is not easy.

When we are tired or unhappy, where do we turn? To sugar -- a relationship that feels almost seductive. There is definitely a correlation between a lack of joy and a craving for sugar, so it's very important to find wholesome sweetness in your life on a daily basis, no matter how small.

So with all of this information, how do we improve our odds against one of the many life-threatening conditions deriving from excessive sugar? For a long time, the use of statin drugs as a solution to heart disease was advised. 

But we knew in our practice, the real solution was right in our kitchens. Changing our diets can have a huge impact on our hearts, and our risk factors. It's important to eat organic, locally grown, seasonal fruits and vegetables, and consume low-fat, lean meats and fish.

Staying away from processed, refined foods, trans fats, and foods laden with sodium is critical. Limiting alcohol, which contains lots of sugar, is equally important. Eating several small meals throughout the day that contain protein can help keep blood sugar levels stabilized, reducing cravings. Adding dietary supplements can also help round-out nutrient deficiencies that often accompany diets teeming with sugar-overload.

The American Heart Association recommends women consume no more than 6 teaspoons, or 30 grams, of sugar each day. Men should have no more than 9 teaspoons, or 45 grams per day. 

Unfortunately, studies show the average American consumes nearly 140 pounds of sugar in a year, so we have a long way to go. The JAMA report may have changed a long-held belief system, but we can successfully learn to take small steps each day to achieve better heart -- and overall -- health.

The recommendation from the AHA may be too high, as the best option may be to avoid it completely, as to date, we have little to show us it has benefit to the body, just the palate.