Wednesday, October 17, 2012
You don't hear much about light pollution. And when you do, it's usually a story about wildlife or greenhouse gases or stargazing. That's about to change.
Recent research has drawn a connection between dim light exposure at night and depression. The investigators found that light, comparable to the levels of light pollution surrounding cities, not only triggered depression in animal models but also increased specific inflammatory molecules in the hippocampus, a part of the brain involved in mood disorders. When the inflammatory molecules were blocked, the depression lifted.
We have known for some time that inflammation is associated with many diseases. In fact, it seems as if it is an essential condition for most of them. A Who's Who of inflammatory illnesses would number over 100 and include Alzheimer's, atherosclerosis, arthritis, Parkinson's, cancer and mood disorders. The connection with mood disorders was first appreciated when depression was found to be more prevalent in those with inflammatory disorders than in the general population.
So the medical community has targeted anything that causes chronic inflammation as something to nip in the bud. The big players here have been stress, Western diet (high in fat and processed foods), and sedentary lifestyle. Now we may have to add light at night (LAN).
This shouldn't come as a complete surprise. We evolved in an environment that alternated between light and dark. Over tens of thousands of years, this was an environmental constant. In this setting, our cells developed a kind of clock that is organized on a daily (circadian) pattern. Disrupt that rhythm and the trouble begins.
In the 100 years that widespread use of electric bulbs has become the norm, our genome has not adapted. Genetic change does not occur that rapidly. We are still wired for darkness at night, and artificial light disrupts our circadian rhythms. A growing body of research suggests that artificial light at night increases the risk for a variety of diseases including obesity and certain cancers.
If you think about some of the most common symptoms of depression, this story makes more sense. Circadian cycles, sleep, hunger-satiety, and memory are typically altered in depression. People with depression describe difficulty sleeping or excessive sleep. They often relate that their "clock is off." They complain of a loss of appetite or an inability to stop eating. Depression's capacity to impair memory is so profound that depressives have been misdiagnosed as suffering from dementia, a memory disorder.
The brain centers that control these functions (hunger-satiety, circadian cycles-sleep, memory) are located in the hypothalamus. Bingo! That's the part of the brain adversely affected by light at night, according to the recent research.
Over the past century there has been a dramatic increase in the incidence of depression, sleep disorders and obesity. This new data suggest that at least part of this increase could be due to the ever-growing exposure to light at night.
Imagine if we were to discover that light plays a major role in the obesity epidemic. I can see the headline now: "My Nightlight Made Me Fat."
So how might you respond to these findings?
Does your bedroom look like a NASA control room when you turn off the lights? Does your phone, TV, cable, computer, fax, printer, smoke alarm, etc. emit light? Do your curtains eliminate all light from outside?
For once, we may want to be in the dark.
We all want to change something. Most of us have tried and had either fleeting success or chalked up a failure. Why is it so hard?
The way we think about change is the problem. In this arena (unlike most), we think too much. We usually think our way to keeping things exactly as they are.
There's always a good reason we do the things we set out to change. On some level, these things -- whether food or drink or drugs -- work. They may cause all sorts of problems, but there's a reason we keep doing them, and it's not laziness or lack of willpower. They soothe us in some fundamental way, no matter how transiently.
Our mind has devised this maladaptive solution and has hijacked our better sense in an attempt to protect us. It is dedicated to preventing the loss of this behavior and made anxious by even the idea of such change. For this reason, most thinking about change has been sabotaged from within.
Change is about doing, not thinking.
There are three big mistakes people make that doom their attempts from the get-go. Avoid these and you're off to a great start.
Mistake #1: It's not something you want to change, it's someone else's agenda.
This may prove more complicated than it seems. Let me give you an example.
Harry's wife wants him to lose weight. His doctor has informed him that he's developing a pre-diabetic condition that puts him at risk for all sorts of bad things. Harry believes that enjoying life means eating and drinking to your heart's content. To curb these appetites is to create a life not worth living.
In this setting, it's highly unlikely that Harry will change. However, let's say Harry really loves his wife and that she is terrified of losing him. He wants to "be there" for her. He wants to feel like a good husband. He is distressed that he is the cause of her anxiety. It is more powerful to see himself as a good partner than to enjoy the pleasures of a glutton. Now, change has become his agenda.
Mistake #2: The change you want to make is not a behavior.
Let's stick with Harry. So Harry decides that what he really needs to do is lose weight (fine) and therefore defines weight as his thing to change (not fine).
The choice of what we're going to change is the most important factor for success. It must be a simple behavior, not a broad goal. Hopefully the chosen behavior will move you toward a broad goal.
If weight-loss is desired and diet the approach, then an example of an appropriate change would be to eliminate bread. This can be done on a day-by-day basis. The goal each day is to have no bread that day. This sits much more comfortably in our minds than the resolution that we will never again have bread.
Another essential component here is the ease with which we can measure success. You go without bread today, you succeeded. Success is not months or years down the road when you tip the scales at some magical number. And there is nothing like this one-day accomplishment to make something feel controllable. Success breeds success.
Mistake #3: You will adopt the change behavior most of the time.
Choice is the enemy. Good old Harry figures, "hey, I've been eating a ton of bread every day, if I don't eat bread most days, it will be a big step in the right direction."
As soon as the option to eat bread sometimes is on the table (so to speak), you'll fail. Every time you sit down to eat, you will play the "do I eat bread this time" game. It's as if you decide to wrestle with the decision to change this behavior several times a day. There will always be a rationale for why it's ok to eat bread "this" time. And you will feel worse after allowing yourself to do it. Such feelings make you feel weak and erode confidence that you have the power to change.
100 percent is easier than 90 percent
I know this sounds upside down, but it's not. No matter what you're trying to eliminate -- bread, gluten, TV, alcohol, pot -- I believe you will succeed much more of the time when it's all or nothing.
I'd say "good luck," but it's not about luck. It's about making it really small, getting out of your own way, and creating some successes.
Saturday, September 22, 2012
Monday, September 10, 2012
The 1981 Raymond Carver short story collection "What We're Talking About When We're Talking About Love" masterfully showed us that everyone has a different conception of love. At the end of the eponymous story Carver seems to suggest that while we may struggle to put into words what love is, it's worth the effort, even if we fail.
I think a similar effort should be made with the contemporary practice of "cleansing", a term used here to cover a broad spectrum of behaviors (from colonics to detox diets/drinks) defined by an attempt at purification or elimination of undesirable material from our bodies.
Why make such an exploration?
A Google search on "health cleanses" draws 4 million 430 thousand entries. Clearly this is on a lot of people's minds. And the mind is my focus. The cleansing phenomenon is driven by a perception of self as dirty. Dirt, like love, means different things to different people.
The etymology of dirt (the dirt on dirt, so to speak) is telling. In Olde English "dritan" was a verb meaning to defecate. Middle English coined the noun "drit" for excrement. Over the years the i and the r swopped places giving us "dirt". So it's not a stretch to see where the idea that if there's a place in us that needs cleaning, it must be that final pathway of our feces, the colon.
Our bodies turn food into feces. But we take in more than food. We take in ideas and experiences that are also "metabolized" in the sense that they are broken down and mined for useful material that we store in our memory and use in a variety of ways. They may be nourishing in that they provide a sense of wellbeing or the belief that we're a good person. Alternatively, some ideas and experiences give us mental indigestion. They tamper with our sense of our selves as decent. They make us feel dirty.
We all carry around an idea of what we should be. The distance (in our own estimation) between this ideal and where we actually live, defines how we feel about our self. Traditionally such self-evaluation was based largely on how we felt we were measuring up in our relationships as a spouse or son or mother or neighbor or citizen or religious community member.
Because the distance between our ideal self and actual self is so often a painfully large expanse littered with regret, every culture has had its way of addressing the feelings of being guilty, dirty, impure. We want to "come clean", to start over. Confession, prayer, fasts, sweathouses, service, and yes, now, colonics, all fit into this category.
So how did we get here?
The traditional roles mentioned remain powerful. But a new metric for assessing how we measure up has taken root. Now the moral meter appears to be our bodies, our diet and exercise. What do you weigh? How much red meat? Did you really have pizza last night? How often are you exercising? What is your cholesterol? How many cocktails? Are you flossing? Did you get your annual checkup or colonoscopy (not colonic!) or mammogram or Pap smear?
Don't get me wrong. We should take care of ourselves. But obsessing about our bodies will not replace the cleansing feelings that come from caring for others.
Our culture is attempting to substitute diets and detoxs for self-exploration and the hard plodding work of accepting what can't change and trying to change what can, for the better. As Raymond Carver said about love, it's worth the effort, even if we fail.
Monday, September 3, 2012
Cleanliness may be next to godliness, but it also may do us in. A growing body of data suggests that a wide range of ills, from allergies and asthma to inflammatory bowel disease, may be the consequence of our fetish for clean.
A quick look at the shelves of pharmacies and supermarkets speaks volumes to the priorities of a culture. The aisles of cleaning products continue to metastasize claiming more space and new frontiers. The territory in need of a good scrub now ranges from our garage to our gut, from our teeth to our toilet. Whether it’s the surface of our kitchen counter or the surface of our face, cleaner is not just better but safer.
A kind of homeland security mentality has invaded the cosmos of clean. The axis of evil here is bacteria and all bacteria are bad. But nothing could be further from the truth. We can’t live without bacteria. The bottom line: we are part bacteria.
Our bowels are a perfect example. There are way more bacterial cells living in our gut than the total number of our own cells in our entire body. We are, so to speak, colonized. These gut microbes turn out to be incredibly important. Anyone who has been on antibiotics, which kill many of these bacteria, can attest to the stomach misery caused by upsetting the balance of these little lodgers. Growing evidence suggests that a reduced diversity of these bugs is with inflammatory bowel disease, metabolic syndrome (prediabetes) and obesity. So why would you want to “clean” a colon?
Decreased exposure to the bacterial world has been cited as a cause of the explosion in childhood allergic conditions. For instance the rate of peanut allergies in children more than tripled between 1997 and 2008. Children living in urban centers are twice as likely to have peanut and shellfish allergies compared to kids in rural areas. 5.9 million children in the US under the age of 18 (1 in 13) have a potentially life-threatening food allergy. An allergic reaction to food sends an American to the ER every 3 minutes.
When a species develops an allergy to its food, that species is in trouble.
The explanatory theory for this phenomenon is called the Hygiene Hypothesis. Without the exposure to bacteria that we experienced historically and that our bodies evolved to cohabitate with, our immune systems go haywire. We develop hyperactive immune reactions to all sorts of things, i.e. we develop allergies and autoimmune disorders.
So how did we get here?
Let’s start with the new improved soaps, the antibacterial soaps. Studies have demonstrated that they provide no greater protection from contamination. In fact, they appear to be associated with an increased frequency of fevers, and upper respiratory tract symptoms. Apparently, these agents are non-specific killers. They knock out both the invading pathogenic bacteria that cause illness and the friendly “flora” or usual bacterial tenants. The problem here is that our bacterial flora actually provide protection from many invading bacterial bad guys, preventing them from finding a niche in our bodies.
Don’t get me wrong. Hand washing is good. Just do it with regular soap. Interestingly, good old-fashioned soap does not seem to kill off the non-pathogenic bacterial flora and is therefore ironically more effective in preventing contamination.
Another pervasive culprit is the “wipe”. What a great name, with its double-barreled implication of total elimination of the enemy (“wipe out”) and ease of victory (with a mere “wipe down”).
The “magic bullet” in antibacterial wipes is some form of the antibiotic called Triclosan. And it seems to be everywhere. Surfaces in food-processing plants, chopping boards, and refrigerator shelves are impregnated with this titan of the microbial battle. But in any confrontation between humans and bacteria we win pyrrhic victories only.
The bacteria have seen our ante and raised the bet. Not only have bacteria developed a resistance to Triclosan, there are now strains that eat it. As you might imagine, all this Triclosan finds its way into our waste grounds, sewers and water supply. In these fertile domains, the bacterial number has not diminished. In fact there has been an increase in the bacterial populations that are resistant to prescription antibiotics.
Any story of this kind would be incomplete without mentioning the bonfire of resistant bacteria steadily stoked by the misuse of antibiotics. This includes prescribing them for every sniffle (most of which are viral and therefore unaffected by antibiotics) and their pervasive use in the animals we consume. 75% of all antibiotics are used in the service of promoting growth in livestock.
Let me close with a plea for a dirtier world, a relinquishing of the desire for a squeaky clean colon. We are not dirty. We may feel dirty, but we do not need cleansing. There is a difference between guilt and contamination. It can be difficult not to fall prey to the idea of a Spring Cleaning of our bodies, a return to some innocent beginning.
We know the hard work of how to clean up our lives. Attempting to sterilize the environment or our bodies won't do it.
And when it comes to dangerous bacteria, we must cultivate the good bacterial part of us to survive them. Diversity is a good thing in man and microbe.
Tuesday, August 7, 2012
James Holmes went to the movies and shot 142 people. Wade Page entered a Sikh temple and gunned down 9 citizens. 31,513 people were killed by firearms in 2010 in the United States. (1) It remains remarkably easy to obtain firearms in most states.
One man, Richard Reid, boarded flight 63 from Paris to Miami on December 22, 2001 with plastic explosives in his shoe. The fuse failed to ignite. Reid is serving a life sentence in a supermax prison that houses the most dangerous prisoners in the federal system. All airline passengers since Reid’s attempt must remove their shoes so they can be scanned for bombs.
How do we make sense of the different responses?
To put the question another way, how do we compare the association of shoes with bombs vs. the association of firearms with mortality? What would the equivalent of the new transportation safety regulations be for guns?
Is this simply a matter of the relative impotence of the shoe lobby compared to the gun lobby?
A brief review of the statistics lends some clarity to this uniquely American situation.
Firearms are one of the top 10 causes of death in the US. (1) In a 2003 World Health Organization study, the US was compared to 20 other high-income countries (Australia, Austria, Canada, Czech Republic, Finland, France, Germany, Hungary, Iceland, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Slovenia, Spain, Sweden, Scotland, and the United Kingdom). The US population at that time was 290.8 million and the combined population of the other countries was 563.5 million. There were 29,791 firearm deaths in the US that year and a total of 7,653 firearm deaths in the other 20 countries. (2)
We Americans are not more violent. But American violence is often lethal violence. And there is one reason for this fact; access to guns. We humans are an emotional lot, prone to impulsive behavior. Most violence is impulsive and the consequences limited by what’s at hand.
Another set of statistics helps frame a rational approach to gun legislation. Firearm deaths fall into three categories, suicides, homicides, and accidents. Most people are unaware of the fact that suicides represent the largest category, followed by homicides. (1)
It is fair to say that the majority of individuals who commit suicide are mentally ill or temporarily out of their minds. Most suicide deaths are accomplished with firearms. Between 2003 and 2007, an average of 46 Americans committed suicide with guns each day. (3)
Studies attempting to explain why some regions have higher suicide rates repeatedly find a strong significant positive association between gun ownership and rates of suicide. (4) Simply put, states with more guns have more suicides.
Public health concerns legitimately include gun control.
Similarly, preventable accidents fall under the purview of public health. Many fatal firearm accidents occur in children. In the U.S., children between the ages of 5 and 14 are 11 times more likely to be killed accidentally by a gun compared with the same aged children in other developed countries. (5) If we can perfect the child-proof medicine bottle, we should be able to protect children from guns.
It took one shoe to change the way Americans travel.
What will it take to change our way with guns?
1. U.S. Department of Health and Human Services, CDC, National Center for Health Statistics, National Vital Statistics Reports Jan 11 2012 Vol.60, 4
2. Richardson EG, Hemenway D, J Trauma 2011 Jan; 70 (1):283-43
3. Hemenway D. Amer J Lifestyle Med 2011 5:502
4. Miller M, Lippman S, Azrael D, Hemenway D. Household firearm ownership and rates of suicide across the 50 U.S. states J Trauma. 2007;62:1029-1035
5. Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm fatality: comparing the United States with other high-income countries, 2003 J Trauma. Doi: 10.1097/TA.
Friday, August 3, 2012
The world’s most widely used pick-me-up reduces your risk of neurodegeneration, depression, cancer and cardiovascular disease, and that’s just the beginning of the story. Yes, I’m talking about that legal, over-the-counter beverage now available every other block. You know, brain juice, brew, liquid energy, morning mud, rocket fuel, wakey juice.
It may even be an ingredient in that fountain of youth we’re still searching for. According to a recent study in the New England Journal of Medicine, coffee lowered all-cause mortality by over 10% after 13 years of follow-up. (1)
Before I summarize the remarkable medicinal properties this plant-based beverage has recently been shown to possess, let me flag the potential negative effects. They are few in number and undoubtedly the positive dwarfs the negative. However if you happen to suffer from one of these conditions, you might want to consult your doctor before changing your coffee consumption.
Coffee can increase blood pressure and intraocular pressure (a potential concern if you have glaucoma), make the anxious more anxious, and worsen tremors and insomnia. (2) There, that’s it. Makes you wonder why it’s gotten such bad press in the past.
While it is true that caffeine transiently increases blood pressure, it appears that when consumed in coffee, the increase is small and offset by protective effects. For instance, coffee beans are rich in antioxidants that decrease LDL and markers of inflammation (3-8). Inflammation occurs early in the development of cardiovascular disease and is most commonly triggered by a sedentary lifestyle, stress, and processed foods.
Overall coffee appears remarkably heart friendly. It has been shown to substantially decrease the risk for coronary heart disease (4) and as little as 2 cups per day decreases the risk of heart failure. (9)
Recent research has demonstrated coffee’s capacity to protect the brain as well. Investigators found that 1-6 cups per day reduce the risk for stroke by 17% (3) A well designed Swedish study followed female coffee drinkers for an average of 10 years and found a 22%-25% reduction on stroke risk. (11)
Well that’s great you say, but can it help me loose weight? Yes, indeed. By decreasing glucose absorption, coffee can facilitate weight loss, especially when combined with other measures. (15) It also improves glucose metabolism and insulin sensitivity, thereby decreasing one’s risk for Type 2 Diabetes. (12-14)
Coffee also appears to provide protection from a number of cancers through its antimutagenic and antioxidant effects. (16,18) Studies suggest different quantities are necessary to affect different cancers; prostate cancer – 6 cups/day (17), estrogen receptor-negative breast cancer - > 5 cups/day (21), endometrial cancer - > 4 cups/day (16)
When it comes to protecting your brain, studies have shown coffee to be a potent agent. Recent investigation demonstrated a protective effect in subjects with mild cognitive impairment, a condition that usually progresses to dementia. Those who consumed 3-5 cups of coffee per day attained blood caffeine levels of > 1200 ng/ml showed no progression of their condition during the 2 to 4 years of follow-up. (22)
Coffee drinkers also appear to be at lower risk for Parkinson’s disease. Recent research presented at annual meeting of the American Academy of Neurology demonstrated that as little as 3 cups of coffee per day may block the formation of Lewy bodies, an early diagnostic sign of the development of Parkinson disease. (23)
The other remarkable brain benefit relates to mood.
Just last year researchers found that women who consumed 2 to 3 cups of coffee per day lowered their risk for depression by 15% compared to women who drank less than 1 cup per week. And more coffee afforded more protection. Those drinking 4 or more cups per day lowered their risk by 20%. (24) The investigators speculated that this antidepressant effect stemmed from coffee’s antioxidant and anti-inflammatory qualities. (25-27)
If all that isn’t a sufficiently broad spectrum to convince you that coffee might be the most exciting “new” gun in medicine’s armamentarium, the list goes on.
What type of pathology remains? “Can it fight infection?” you ask. Yes, and not just any wimpy intruder. Coffee has also proven itself a potent force against one of the scariest bacteria, methicillin-resistant Staphylococcus aureus, known as MRSA. The mechanism of this effect remains a mystery. However, subjects reduced the likelihood of having MRSA in their nasal airways by almost 50% by drinking coffee regularly, regardless of quantity. (28)
So bottoms up.
For once a simple pleasure is the perfect prescription.
1. Freedman ND, Park Y, Abnet CC, et al. Association of coffee drinking with total and cause-specific mortality. N Engl J Med. 2012;366:1891-1904
2. Pasquale L. Program and abstracts of the American Glaucoma Society 22nd Annual Meeting; March 1-4, 2012; New York, New York. Abstracts 23 and 83.
3. Larsson SC, Orsini N. Coffee consumption and risk of stroke: a dose-response meta-analysis of prospective studies. Am J Epidemiol. 2011;174:993-1001.
4. Wu JN, Ho SC, Zhou C, et al. Coffee consumption and risk of coronary heart diseases: a meta-analysis of 21 prospective cohort studies. Int J Cardiol. 2009;137:216-225.
5. Natella F, Nardini M, Belelli F, et al. Coffee drinking induces incorporation of phenolic acids into LDL and increases the resistance of LDL to ex vivo oxidation in humans. Am J Clin Nutr. 2007;86:604-609.
6. Gómez-Ruiz JA, Leake DS, Ames JM. In vitro antioxidant activity of coffee compounds and their metabolites. J Agric Food Chem. 2007;55:6962-6969.
7. Nardini M, D'Aquino M, Tomassi G, et al. Inhibition of human low-density lipoprotein oxidation by caffeic acid and other hydroxycinnamic acid derivatives. Radic Biol Med. 1995;19:541-552.
8. Montagnana M, Favaloro EJ, Lippi G. Coffee intake and cardiovascular disease: virtue does not take center stage. Semin Thromb Hemost. 2012;38:164-177.
9. Mostofsky E, Rice MS, Levitan EB, Mittleman MA. Habitual coffee consumption and risk of heart failure: a dose response meta-analysis. Circ Heart Fail. 2012;DOI:10.1161/CIRCHEARTFAILURE.112.967299.
10. Larsson SC, Orsini N. Coffee consumption and risk of stroke: a dose-response meta-analysis of prospective studies. Am J Epidemiol. 2011;174:993-1001.
11. Larsson SC, Virtamo J, Wolk A. Coffee consumption and risk of stroke in women. Stroke. 2011;42:908-912.
12. Huxley R, Lee CM, Barzi F, et al. Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis. Arch Intern Med. 2009;169:2053-2063.
13. Sartorelli DS, Fagherazzi G, Balkau B, et al. Differential effects of coffee on the risk of type 2 diabetes according to meal consumption in a French cohort of women: the E3N/EPIC cohort study. Am J Clin Nutr. 2010;91:1002-112.
14. Floegel A, Pischon T, Bermann MM, et al. Coffee consumption and risk of chronic disease in the European Prospective Investigation into Cancer and Nutrition (EPIC)–Germany study. Am J Clin Nutr. 2012;95:901-908
15. Vinson JA, Burnham B, Nagendran MV, et al. Randomized double-blind placebo-controlled crossover study to evaluate the efficacy and safety of a green coffee bean extract in overweight subjects. Program and abstracts of the 243rd American Chemical Society National Meeting and Exposition; March 25-29, 2012; San Diego, California. Abstract 92.
16. Je Y, Hankison SE, Tworoger SS, et al. A prospective cohort study of coffee consumption and risk of endometrial cancer over a 26-year follow-up. Cancer Epidemiol Biomarkers Prev. 2011;20:1-9.
17. Wilson KM, Kasperzyk JL, Rider JR, et al. Coffee consumption and prostate cancer risk and progression in the Health Professionals Follow-up Study. J Natl Cancer Inst. 2011;8;103:876-884.
18. Turati F, Galeone C, La Vecchia C, et al. Coffee and cancers of the upper digestive and respiratory tracts: meta-analyses of observational studies. Ann Oncol. 2011;22:536-544.
19. Galeone C, Tavani A, Pelucchi C, et al. Coffee and tea intake and risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomarkers Prev. 2010;19:1723-1736.
20. Song F, Qureshi AA, Han J. Increased caffeine intake is associated with reduced risk of Basal cell carcinoma of the skin. Cancer Res. 2012;72:3282-3289.
21. Li J, Seibold P, Chang-Claude J, et al. Coffee consumption modifies risk of estrogen-receptor negative breast cancer. Breast Cancer Res. 2011;13:R49.
22. Cao C, Loewenstein DA, Lin X, et al. High blood caffeine levels in MCI linked to lack of progression to dementia. J Alzheimer Dis. 2012;30:559-572.
23. Ross W, Duda J, Abbott R, et al. Association of coffee caffeine consumption with brain Lewy pathology in the Honolulu-Asia Aging Study. Program and abstracts of the 64th Annual Meeting of the American Academy of Neurology; April 21-28, 2012; New Orleans, Louisiana. Abstract #S42.005.
24. Lucas M, Mirzaei F, Pan A, et al. Coffee, caffeine, and risk of depression among women. Arch Intern Med. 2011;171:1571-1578.
25. Pasco JA, Nicholson GC, Williams LJ, et al. Association of high-sensitivity C-reactive protein with de novo major depression. Br J Psychiatry. 2010;197:372-377.
26. Ng F, Berk M, Dean O, Bush AI. Oxidative stress in psychiatric disorders: evidence base and therapeutic implications. Int J Neuropsychopharmacol. 2008;11:851-876.
27. O'Connor A. Coffee drinking linked to less depression in women. New York Times. February 13, 2012. http://well.blogs.nytimes.com/2011/09/26/coffee-drinking-linked-to-less-depression-in-women/ Accessed January 11, 2012.
28. Matheson EM, Mainous AG, Everett CJ, King DE. Tea and coffee consumption and MRSA nasal carriage. Ann Fam Med. 2011;9:299-304.