
Toxic positivity; body roundness index; drug delivery to brain: Upstate Medical University's HealthLink on Air for Sunday, Jan. 19, 2025
Psychologist Holly Vanderhoff, PhD, defines toxic positivity and how it differs from a healthy positive outlook. Exercise physiologist Carol Sames, PhD, rethinks the body mass index by explaining the new body roundness index. Neurosurgeon Satish Krishnamurthy, MD, discusses the challenges of delivering medication to the brain.
Transcript
[00:00:00] Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a psychologist explains the difference between healthy and toxic positivity.
[00:00:07] Holly Vanderhoff, PhD: "...Where it can cross a line, and sometimes that line is very fine, is where folks really start to try to pursue that positive outlook no matter what they're actually really feeling, or what's actually happening in their lives.
[00:00:20] Host Amber Smith: An exercise physiologist tells about the body roundness index.
[00:00:24] Carol Sames, PhD: "...The reason that people are liking this BRI is that you can look at maybe how fat is distributed because you're getting this waist measurement..."
[00:00:34] Host Amber Smith: And a neurosurgeon discusses drug delivery to the brain.
[00:00:38] Satish Krishnamurthy: "...There are multiple mechanisms that protect us. And one of the most important ones is what is called a blood-brain barrier..."
[00:00:45] Host Amber Smith: All that, along with a visit from The Healing Muse, right after the news.
This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, how the body roundness index is more accurate than the body mass index. Then, a neurosurgeon discusses how medication can be delivered to the brain. But first, what you can do if you're pressured to always look on the bright side.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
Keeping a positive outlook can be good, but positivity can become unhealthy if it becomes toxic. For help understanding toxic positivity, I'm talking with Holly Vanderhoff. She's a clinical psychologist and associate professor of psychiatry and behavioral sciences at Upstate.
Welcome back to "HealthLink on Air," Dr. Vanderhoff.
[00:01:48] Holly Vanderhoff, PhD: Thanks so much for having me.
[00:01:50] Host Amber Smith: Is there a fine line between healthy positivity and toxic positivity?
[00:01:55] Holly Vanderhoff, PhD: Yeah, there sure can be. I don't think there's one definition, but we would think of healthy positivity as a person's ability to hold a realistic, healthy degree of optimism to meet life challenges with some open energy, maybe even the sense that "I'm capable of meeting life challenges, even if I go through hard things." And I think a lot of us would assume things like optimism and even feelings of gratitude and awareness of what's really good about life are part of a healthy positivity.
And we know, and it's beyond me to review all this research here, but we know that kind of an outlook can be really helpful to folks and even is associated with things like improved outcomes when someone has a medical or health problem, and in all sorts of ways it can be beneficial.
Where it can cross a line, and sometimes that line is very fine, is where folks really start to try to pursue that positive outlook no matter what they're actually really feeling, or what's actually happening in their lives. And so there can be a very fine line there that many of us cross.
[00:02:59] Host Amber Smith: So what makes positivity toxic? Can you define toxic positivity, give some examples?
[00:03:06] Holly Vanderhoff, PhD: Sure. And I should say too, this is not a formal diagnosis, so we can't really talk about symptoms the way we would talk about symptoms of depression or COVID, but toxic becoming the idea that in spite of what we're intending by being positive, we're actually maybe creating harm to ourselves or harm to other people.
And so one version of toxic positivity might seem to be that it's the insistence on feeling good, feeling optimistic, feeling cheerful, no matter what life circumstances we're actually facing. And really even no matter what feelings we're really having. So someone who is behaving in a way that's kind of toxically positive might choose to ignore their own difficult feelings, their painful feelings. If they're interacting with someone who's going through something hard, it might feel almost intolerable to them to kind of sit with that person's difficulties. And instead, they might insist on looking on the bright side or looking at everything in a way where there's a life lesson to be gleaned, or something good could come out of pain.
And so the toxic positivity mindset, I think, is that insistence on positivity even in the face of things that are not inherently positive.
[00:04:14] Host Amber Smith: So are toxic positive people born, or do they become toxic over time?
[00:04:21] Holly Vanderhoff, PhD: There's a whole raft of research showing that our tendencies to be, at baseline, kind of optimistic or more pessimistic, that there's strong genetic factors that influence that. And then certainly our family environment or whatever environment we grow up in can amplify that or even help tone it down a bit, depending on our experiences. So I would say there's good reason to think the disposition toward feeling optimistic or feeling positive is kind of inborn.
At the same time, what we're talking about with toxic positivity, I think, is very much something that we can absorb from our culture and from our environment.
And so, where this shows up, we could go as far back as the founding documents for the United States has the right and the entitlement to pursue happiness as part of the bedrock of how our country was formed. Western culture really prizes things like independence, taking personal responsibility for our successes, for how we're feeling, and tells us kind of "If you want it, you can have it. You just have to work hard for it."
And so, something I didn't say earlier about the toxic positivity mindset is this idea that if you're going through anything painful or difficult, you can and should try to get rid of that, right? That if you just worked hard enough, or you try the right strategies, you can develop a more positive outlook and therefore have all the benefits of positivity.
So I think culturally, this has been with us for a long time, I think much more recently with the rise of a corporate wellness culture, right? Which will say to us, again, if you do these five stress management strategies, you can be really happy, and life's going to be really great for you.
And even on social media. I'm not on much social media, but what little I use, I scroll it, and it's one meme after another of "live, laugh, love," "hashtag blessed," "hashtag best life," "positive vibes only." And even to things that are, I think, even more insidious: "Everything that's happening to you right now is a result of the choices you've made." There's books like "The Secret," which is an old idea that if you want something, you can kind of think or speak it into an existence by asking the universe for it, and it will come to you. And if you don't have the things you want, maybe it's because you haven't tried hard enough to have them.
And more recently there's, I don't know if anyone's familiar with this, but there's something called the Lucky Girl syndrome, which is another reinvention of this same old idea online, where if I just expect good things to happen to me, if I act like a lucky girl in the world, great lucky things happen to me all the time.
So we are flooded with messages that painful feelings like anger, sadness, anxiety, those are bad, and we should get rid of them. Not only that, we have the power to get rid of them if we really want to, and then we're going to live the good life. So that's the part, to me, that's toxic, and that's the part that I think we are really handed by our culture more than biology.
[00:07:06] Host Amber Smith: So if you feel like you're an optimistic person to begin with, how do you know if you're becoming toxic with your positivity?
[00:07:16] Holly Vanderhoff, PhD: This is such a good question, and I want to say, if you discover this about yourself, welcome. It's a huge club of us who are in that club.
I think it's easier to see if we think about how we interact with others around us, right? So if I have a good friend who comes to me and is struggling, she's maybe got a problem with her family or her job. And if my first instinct is I need to help my friend, right, I need to cheer her up, I start encouraging her to look on the bright side. I start encouraging her to think about how much worse this really could be. I start immediately encouraging her to think about all the great life lessons or the good things that might come out of this painful experience for her.
That, probably for most of us, that will probably have the impact of pushing her further away, right? We only have to think about how do we want to be treated or taken up if we're having difficulties.
Personally, I, and I think a lot of people, I'd like someone to listen a bit, right? Maybe be empathic, help me work through some of my feelings. Those beliefs, right, those states of thinking, "Hmm, maybe things really could be worse," or "Maybe there is meaning in this that I need to think about," or "Eventually, I might even be happy that this painful thing happened. I might be able to grow from it." Most of us will get there eventually, right? But I think those are attitudes we have to kind of live our way toward. It never, for me, anyway, and for most of us, I don't think, is it ever going to come from someone next to me saying, "You just need to look on the bright side, right? You need to forget those negative feelings."
So if you're someone very well intentioned, but someone who tends to do that to other people, it's probably easiest to see in those relationships that you have.
If you encourage people to -- it's so easy, right? -- especially as a parent, it's so easy to start to want your kids to kind of be happy and in a good mood all the time and to treat their negative moods as a problem that you have to solve, or they should get busy solving right away, so you are comfortable as a parent.
Just being very mindful, right, of those interactions with others, and are we sending messages that we can't, or won't, tolerate their pain?
[00:09:13] Host Amber Smith: This is Upstate's "HealthLink" on Air," with your host, Amber Smith.
I'm talking with clinical psychologist Holly Vanderhoff about toxic positivity.
What impact can toxic positivity have on romantic relationships?
[00:09:27] Holly Vanderhoff, PhD: I think it's maybe the impact it can have on almost any close, intimate relationship, which is to create isolation and alienation from the person, right? So in your romantic relationship, at least in our culture, that's usually your primary relationship. It's the person you go to when you're having difficulties.
If that person is only ever going to encourage you to suppress your difficult feelings and focus on the positive, or they get busy with a solution when maybe what you want is a little bit of support in listening, you're going to have greater distance between you rather than greater closeness.
If you're with someone who tends to do that, it can be really helpful upfront to say, "I'm going through a hard time. What I really need from you right now is just to listen." Like, "Shut up and listen to me," you know? "And don't just tell me it's going to be fine, but I really need you to just kind of listen and be there for me right now." And most people are really responsive to that.
[00:10:19] Host Amber Smith: So for somebody who maybe sees themself in some of this that we're talking about, and they want to change their ways, they don't want to be toxic positive anymore, what do you say to them?
How can you go about changing your ways?
[00:10:32] Holly Vanderhoff, PhD: Again, I would say, yes, you are in a huge club of people, right? Many, many of us are like this. So you don't need to develop a lot of shame about it or worry that it's one more problem you should solve.
But if you do want to change this about yourself, it might be good to stay mindful of the times when you feel this urge to fix other people's problems, or with yourself, right? You feel this urge. You notice you're angry about something, you get right on the task of getting rid of that anger so that you're not in a bad mood. You've got to be very mindful of the urge you have to flip pain into positivity, and then you just choose to do something maybe even slightly more neutral, right? You don't have to go all in on, "That's the worst thing ever, and you should be angry the rest of your life," right? But just something a bit more neutral with yourself or with other people. This takes, I think, time, like any habit, right? It can become a habit to be this positive problem solver, but if with some time and some mindful effort, you can start to, I think, respond in a way that is probably better caretaking of other people around you, and certainly better self-care, than just telling yourself, say, to get over something quickly, or you should feel grateful, or you should feel optimistic, when you just really don't.
[00:11:40] Host Amber Smith: Any advice for dealing with someone who has a toxic positivity personality?
Say they're a family member or a boss or a coworker that you really can't avoid. How do you cope with this sort of personality?
[00:11:53] Holly Vanderhoff, PhD: That can be really, really difficult, right? And I think, again, it colludes with our own idea that, "Gee, I really probably should be more positive." So we can always feel this strange sense of anxiety and almost guilt or shame if we're with someone who's super-positive all the time.
But if you are kind of dealing with that, especially if it's in a close relationship, and you can't really avoid it, in the closer personal relationships, if it's really a problem, I might sit down with that person and try to talk it through a bit. Not in the middle of a time when you are in crisis, but just to say, "You know, I don't know if you realize this, but this is often how you react to me if I'm having a rough day. And I know you mean well. I know, Honey, you want me to feel better, and I really appreciate that about you. But sometimes when you tell me to just look on the bright side, or you try to solve the problem immediately, that actually makes it harder for me to feel OK."
You're probably not going to have a conversation like that with your boss or with a coworker. And so I think when it's in a less personal relationship, but more formal, it could still be helpful to say, "Oh, I hear you. Thanks for that." And if you feel comfortable, saying, "I'm not sure I'm in that place yet, to think about the life lessons here."
And if nothing else works, a fair amount of avoidance can go a long way. That won't be the person you should go to if you're having a rough time. It just probably won't be particularly helpful for you. So there's a little self-protection there. And I think, again, permission, because we can kind of think this way on the inside too, permission to say to ourselves, "It's OK if I'm kind of down today. I don't have to resolve this quickly just because there's a really cheerful person next to me insisting that I do."
[00:13:25] Host Amber Smith: Well, let's look at kind of the flip side. Is there such a thing as toxic negativity or even healthy negativity?
I mean, there's some people that sort of have a bit of a negative outlook on life, right?
[00:13:37] Holly Vanderhoff, PhD: Yes, that's true. And I think that what's really interesting, again, there's so many areas of research in this field, but there's some interesting research showing that people who are going through difficult medical or physical health problems, if they have a negative attitude, their outcomes are no worse than people who have a more positive outlook. It's just they're a little more subjectively miserable the whole time. There's not necessarily anything catastrophic about having a negative outlook; it's just not going to feel as pleasant.
And so I guess your question is, can negativity be healthy, and can it also become toxic itself?
The healthy version of negativity, I would argue, is the ability to feel things like anger or sadness or anxiety and fear and sit with them appropriately and take the energy that might come from them to address whatever issues they're creating some of those feelings. If I just insist to myself I need to be positive, I don't get the benefit of the energy that, for instance, anger can bring to me to solve a problem. There are all kinds of ways that sitting with what we might call negativity is appropriate. If I have a realistic outlook on a situation, and it's a bit pessimistic because it's realistic, things may not go my way, this bad thing really does seem to be happening in my life, adopting an optimistic attitude is probably not going to help me through that situation as much as appraising it realistically and then getting down to the business I need to get down to.
What I would say is a toxic negativity is something like ruminating excessively on how the bad thing could happen, right? People who feel very prone to just playing out the worst-case scenarios all the time or ruminating about things that have happened in the past and can't seem to let go of something that's difficult or painful. You can get very stuck in that kind of a negative outlook, and I don't think people do that on purpose. I don't think sometimes they're even conscious of it, but it can, I think, create more anxiety and frustration, and it can start to blind the person to the areas of their lives that really are either going pretty well or maybe even going really well, or the positive outcomes that could happen.
So if you find yourself really stuck in rumination or worrying about the future, your head's almost never in the present, right, we're almost always in the past, or we're almost always in the future, that can be a sign to just tap the brakes a little bit and see if you can come back to something more neutral.
[00:15:56] Host Amber Smith: Is there a danger in people who try to suppress negative feelings? If they're feeling sad, and they just try to make themselves positive. Is there bad side effects to doing that?
[00:16:07] Holly Vanderhoff, PhD: You might think, "Well, what's the harm?" Maybe you'll feel better if you just try hard enough. But we do know from many different areas of research and psychology that you pay a price when you try hard to suppress negative feelings, especially if they're very intense.
And studies have been done showing people who are engaged in a physical activity, their physical endurance is worse if they're also, somewhere in that experiment, made to feel upset or angry, and they're told to suppress it while they're doing the exercise. Physical endurance is worse.
This is an extreme example, but there's research on women who are trying to leave abusive relationships, physically violent relationships, abusive relationships, and that if they work hard to suppress their feelings of concern or anger or fear, and they work to be more optimistic or forgiving of their partners, they're actually, over time, at greater risk of further abuse, and they're also at greater risk of depression and even suicide attempt down the line. So here's an example where trying to suppress your fear or your anger can actually have a real cost, right?
We know from working with folks who are diagnosed with depressive disorders or anxiety or, especially, post-traumatic stress disorder, the last thing you want to do for someone who's experiencing say, PTSD, is encourage them to suppress their feelings. The primary treatments for some of those disorders are exposure to the difficult, painful feelings, working through them a little differently than we might on our own. But paradoxically, the more we're helping someone to acknowledge and work with their difficult feelings, the more likely they are to eventually find relief and feel positive or at least feel better in a more genuine way.
So insisting that someone just kind of suppress their negative feelings in the service of being positive, it's not just annoying. You can actually have a real impact on the person if they take it up that way.
[00:18:01] Host Amber Smith: So we talked about sort of this culture here, or the pressure, to be positive all the time. I wonder if that's an American thing? Do other cultures have this same sort of fascination with keeping positive?
[00:18:14] Holly Vanderhoff, PhD: I'm not an expert in this area, but I think until very recently, the answer would be it's really a Western culture and particularly something in the U.S., right?
It seems to be a particular issue here. In this, I'm going to speak very, very broadly, but in more Eastern cultures, the idea that you are independently responsible for your feelings and your outcomes, there's much more of a collectivistic sense of identity. And outcomes depend on a network, your community. No one person's happiness matters quite as much, right, as the good of the community. Again, I'm speaking very broadly here, and even things like self-esteem are described and defined differently. In the U.S., we might think of "I feel really good about myself and my accomplishments and my abilities." And there's some evidence that in Eastern cultures, self-esteem is built much more around "Am I meeting the obligations of my family, of my larger community? How well am I functioning as a community member?" And so there's a more diffuse sense of responsibility for any one thing.
Again, this is not my area, so I don't want to say anything definitive about that, but I do think that there's something kind of baked into that Western culture "pull yourself up by the bootstraps, and if you're not, you are the problem" attitude, right? There are ways that that's great, of course, and there are ways I think that it really trips us up.
[00:19:30] Host Amber Smith: Well, this has been very interesting, and I thank you. I appreciate you making time for this interview, Dr. Vanderhoff.
[00:19:35] Holly Vanderhoff, PhD: Absolutely. Thank you so much for having me.
[00:19:38] Host Amber Smith: My guest has been clinical psychologist Holly Vanderhoff, an associate professor of psychiatry and behavioral sciences at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."
Rethinking the body mass index, next on Upstate's "HealthLink on Air."
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
The body mass index has been criticized as too general and inaccurate. Now doctors are considering the body roundness index. Here to explain is exercise physiologist Carol Sames. She's also an associate professor of physical therapy education at Upstate.
Welcome back to "HealthLink on Air," Dr. Sames.
[00:20:22] Carol Sames, PhD: Thanks so much, Amber. Glad to be here.
[00:20:24] Host Amber Smith: Now, before we get into the body roundness index, what is the body mass index, or BMI, that people may have heard of?
[00:20:32] Carol Sames, PhD: Well, it's just an index that was created back in the 1830s by a Belgian mathematician. And he created it because he wanted to try to calculate the average Caucasian man.
[00:20:46] Host Amber Smith: OK, so it really doesn't apply to everyone.
[00:20:50] Carol Sames, PhD: No, it doesn't.
[00:20:52] Host Amber Smith: So the purpose was just to be able to gauge people's weight, or what?
[00:20:59] Carol Sames, PhD: Well, to figure out what was average, and then from that, clearly, to identify what was not average in terms of height and weight. it really didn't have any significance.
But in the 1970s, a physiologist termed the body mass index as that term, because before then it wasn't known as a body mass index. And then this physiologist said, "Hey, I wonder if we could use it in looking at population health?" And so he started to do some research and of course it was done on Caucasian males, and it really didn't become popular until some of the research demonstrated that there could be an association with some negative health.
[00:21:44] Host Amber Smith: The body mass index, as it is now, can it be used for women or non-Caucasian people, or does it work for tall people and short people the same?
[00:21:55] Carol Sames, PhD: Well, that's the problem, because it was originally developed and tested on Caucasian males, so it wasn't ever designed for health screening. It doesn't take into account any racial, ethnic, age, sex, gender diversity differences, so that's a big problem.
And then the other big problem is that weight in and of itself, doesn't necessarily tell us about the composition of that weight. Really, the negative health outcomes are associated with fat, sometimes called adipose tissue, not muscle mass, so if we can't differentiate in somebody, you could have somebody who is very muscular and ends up with a higher BMI because they weigh more on the scale, but they're very muscular, so if you actually looked at their percentage of body fat, it's low. But they could get categorized as having a high BMI, which then might set off triggers, like say I am trying to apply for health insurance or life insurance. I mean, it's got some negative consequences there. They're two major inherent issues with BMI.
[00:23:05] Host Amber Smith: So does a high BMI correlate with other health metrics -- blood pressure or blood work or anything?
[00:23:11] Carol Sames, PhD: The answer is possibly yes and maybe no. So if we just take BMI as a number, and we don't look at the individual person, there could be a lot of error there.
Again, we could have somebody who's incredibly muscular, right? Or we could have somebody who maybe has body fat that they store more in their hips and thighs and buttock area, and that distribution of fat mass generally doesn't have all of the adverse consequences as fat mass that's more in the stomach area. It's called visceral fat, and that does have some negative health consequences.
So BMI is not differentiating where that fat is stored. So I say yes and no because if we know the person, and we can observe the person, and we could see their BMI, and maybe look at their waist and their hip measurements, we could see how their fat is distributed. If we looked at maybe some blood work, then maybe yes, we could say it is correlated. But just on an individual, person by person, there's a lot of variability involved there.
Well, what can you tell us about the new metric, the BRI, the body roundness index?The BRI is quite interesting and, again, also created by a mathematician. And this one came out in 2013, and what it involves is height and waist measurement, so it's not looking at weight; it's looking at waist measurement. There are some calculators that will also put in a hip measurement, too, but her original one was just height and waist. And the reason that people are liking this BRI is that you can look at maybe how fat is distributed because you're getting this waist measurement.
So as waists get larger, that's telling me that I have more storage of fat in my stomach, abdominal area, and again, that fat, that type of what we call central body fat has been demonstrated to be associated with some negative health outcomes, so the development of Type 2 diabetes, hypertension, metabolic syndrome, stroke, cardiovascular disease, poor lipid profile or our cholesterol profile, than fat that's stored in my buttocks and my thighs and my hips. So there is a difference in that fat.
[00:25:35] Host Amber Smith: So with the BRI, the weight doesn't matter, then. They don't even calculate weight.
[00:25:40] Carol Sames, PhD: Correct. They're not even using weight at all.
[00:25:44] Host Amber Smith: So are medical offices using this yet?
[00:25:48] Carol Sames, PhD: Well, it's interesting because in June of 2023, the American Medical Association suggested that BMI has many limitations, especially, again, at the individual level, and that other measurements of health risk could be better potentially or used in conjunction with BMI, such as waist circumference, this BRI, or actually looking at body composition or measuring that abdominal fat. So they're saying there's some issues with BMI, but to say that I've gone to my doctor, and they've done a BRI, that has not happened.
And I think the medical community tends to be a little slow to change, and there's so much research on BMI, and there's not as much on BRI, because it's newer.
[00:26:33] Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with exercise physiologist Dr. Carol Sames, who's an associate professor of physical therapy education at Upstate.
How can people calculate their own BRI?
[00:26:50] Carol Sames, PhD: If you Google and go to "BRI calculator," you can get a calculator that just plugs those numbers in. It's a pretty complicated math equation. So you just can plug in your height and waist, and it will spit out a number for
you.
[00:27:05] Host Amber Smith: So you need to have a measuring tape to measure your waist?
[00:27:08] Carol Sames, PhD: Yes.
[00:27:10] Host Amber Smith: You need to get an accurate height.
[00:27:12] Carol Sames, PhD: Yes. Correct.
[00:27:14] Host Amber Smith: When we talk about measuring the waist, so people don't get confused and measure their hips instead, is there an easy way to explain how to get a proper waist measurement?
[00:27:24] Carol Sames, PhD: A waist measurement should be above the pelvis, like your hip bones. So you actually want to be above that like up, and that's where you want to measure your natural waist. Usually that involves your belly button. For most people, it should involve the belly button. It should come across there.
Because for hips, you actually want to go across the biggest part, so we're really talking around the biggest part of your butt and around. So usually, for most people, that's almost down like where your pubis is, when you come around from the butt. That's going to be a little bit lower. But waist should be above your hip bones.
[00:28:02] Host Amber Smith: So what is
a healthy score?
[00:28:05] Carol Sames, PhD: Because there's not a whole lot of research done with BRI, the estimate of what they would consider a good score is somewhere between 3.5 to 5.5. But again, because this is a newer index, the data is not there on a huge population level yet, so at least that's the estimate we have now, about 3.5 to 5.5.
[00:28:30] Host Amber Smith: So do we know yet what a high score means if you're above 5.5 or if you're below 3.5?
[00:28:39] Carol Sames, PhD: What the research has at least indicated so far is that if you have a score above 7 that is associated with higher early mortality, also mortality from certain cancers, heart disease. They're what has been demonstrated so far.
And then, a lower score is considered below 3 So a lot of times people think, "Well, a lower score would be better." And that's not true, and that's also not true with BMI. When you get low BMI scores, that can be very concerning, again, because you see a higher mortality with those lower scores, and a lot of the individuals that have those lower scores tend to be adults that are 65 and older, and that can occur because of malnutrition, just losing muscle mass or inactivity. And with older adults, we know that sarcopenia is a process that results in us losing muscle mass, and that means we get weaker. And then that means we have less power, so getting out of a chair, going upstairs, those activities require power.
And this occurs as we get older, even if I'm very physically active. Now, the amount of loss is less, but it occurs. It's a physiological process. And so, as you start to lose muscle mass, then that is going to clearly impact my ability to function, whether it just be doing things around the house, like activities of daily living. It also increases my risk of fear of falls and then falls. And they're certainly things we want to avoid as we get older. So, having a low BMI and a low BRI is not necessarily healthy and probably, again, at the individual level needs to be investigated.
[00:30:29] Host Amber Smith: So for someone whose BRI is not around 5-ish or 5 or 6 say they want to reduce it to that or increase it to that, what is the best strategy for that?
[00:30:42] Carol Sames, PhD: So the first thing I would say is you always want to go to your doctor, right? You really do need to know, "Where are my blood values here? Are my lipids starting to increase? What is my fasting blood sugar?" Those kinds of things.
But after that, if a person has not been active. Activity is just such a wonderful thing. And not just activity, but something that involves strength training, and it doesn't have to involve weights. You've got a body, and that body can move, and you can increase strength just by using your body and a wall or a chair.
And then something that is continuous. So something like walking, something that is just a continuous activity. Because what that's going to do is it's going to increase your muscle mass, which certainly then is a good thing, and it can help to reduce fat mass.
One of the things we don't realize is that as we get older, fat actually starts to go into our muscle. It infiltrates the muscle, and so the muscle clearly is not as strong. And when we start to have fat in muscle, that also causes a cascade of other issues. So being active, and again, any activity, for any amount of time, is always better than nothing.
And then, I always think it's good to investigate, "What is my nutritional status?" In many cases, people can keep a diary, but there are times when maybe I'd want to have a discussion with my physician about, "Should I go see a registered dietitian somebody that can help me?" Maybe as I look at my nutrition, I don't have enough protein, and I'm going to need protein to increase muscle. Or maybe I'm not drinking enough water, right? All those things that can occur. Or maybe I have a lot of really fast, broken-down carbohydrates; I'm eating more processed types of foods.
Sleep: How am I sleeping? When we don't have consistent, good sleep, we get an increase in inflammation. And the problem with inflammation is it affects all body systems. So, am I sleeping regularly? Am I getting enough sleep for myself? And, again, that's where a visit to the physician could be helpful.
What about chronic stress? All of us are dealing with different stressors. Is it something that is impacting my health? Because that can also cause me to deposit more of that bad abdominal fat. Chronic stress, lack of sleep, even in the presence of me being active, so there's a lot of different things. It's not just one choice I make, it's really more a number of choices that I choose to make.
[00:33:07] Host Amber Smith: Since we're talking about the abdominal fat, I thought you were going to say, abdominal exercises -- sit-ups and planks and other things like that. Will those help? Will those help a person slim down so that their number is better?
[00:33:21] Carol Sames, PhD: So again, it's always going to depend on how much energy I'm taking in, right? But you can't spot-reduce. I wish we could. I wish that we could do lots of sit-ups and planks, and miraculously, my waist gets smaller.
But generally speaking, in terms of losing fat, we lose it in the reverse of where we gained it. So if you gained more of your weight in your stomach area first, that's going to be the last place that it generally will come off.
It would be great if spot reduction worked, but it doesn't.
What sometimes people do is, if they do start to do a lot of core exercises, they may notice that they feel taut or stronger, and that's the muscle there, but that doesn't necessarily mean that I've lost the fat mass that is there, but it's still good. Core exercises are really important. You need to have a strong core in order to have strong arms and legs.
[00:34:10] Host Amber Smith: Well, Dr. Sames thank you so much for taking time to tell us about the body roundness index.
[00:34:15] Carol Sames, PhD: My pleasure.
[00:34:16] Host Amber Smith: My guest has been Carol Sames. She's an exercise physiologist and associate professor of physical therapy education at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."
Next on Upstate's "HealthLink on Air," delivering drugs to the brain.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
When cancer spreads to the brain, it is notoriously difficult to treat because the blood-brain barrier limits the delivery of therapeutic agents to the brain. Here to talk about how to optimize drug delivery in these situations is Dr. Satish Krishnamurthy. He's a professor of neurosurgery at Upstate.
Welcome back to "HealthLink on Air," Dr. Krishnamurthy.
[00:34:59] Satish Krishnamurthy: Thank you so much, Amber. I'm looking forward to this.
[00:35:02] Host Amber Smith: Well, before we get into it, can you please describe what the blood-brain barrier is?
[00:35:09] Satish Krishnamurthy: That's a very, very important question. A blood-brain barrier is like our walls and the front door of our house.
So the brain needs protected space, in the sense that the chemicals that affect the brain and the nerve transmission signals, as well as the environment that is protected, the temperature control, all needs to be perfect because the brain is very important for survival. If you can't think properly, whether you're in the jungle or in the ocean, you're going to be dead.
So brain function needs to be protected very closely. And in order to protect this, there are multiple mechanisms that protect us. And one of the most important ones is what is called a blood-brain barrier.
Blood-brain barrier prevents chemicals that we ingest in terms of food or other things that we inhale, either intentionally or unintentionally. These things get into the blood. And if everything that gets into the blood gets into the brain, then there'll be a problem with the brain, the functioning, the ability to protect, the ability to think, the ability to discern, all of that.
Therefore, biology has devised this blood-brain barrier, where substances in the blood don't get into the brain very easily. However, when you're treating brain disorders, you need to give medications to relieve the problem. For example, in this particular instance, if you have a tumor, you need to treat the tumor using a medication. And the medications taken either by mouth or given through infusion into the vein do not always get to the tumor in adequate concentrations to kill the tumor cells.
So blood-brain barrier becomes a very important barrier to delivering the drugs. So what protects us also prevents chemicals that we use to treat tumors not get in.
[00:37:11] Host Amber Smith: So it protects what's inside the brain from coming out, and it protects things from outside the brain from coming in?
[00:37:19] Satish Krishnamurthy: Right. The first part is the heart of my work over the last decade and a half. So it's like your front door, if you think of the analogy, right? If somebody knocks on the door, you don't like their looks or you don't want to answer, you don't open the door. So that blood-brain barrier is functioning.
That's the blood side. Outside is the blood side.
If you get into the house and somebody's inside, the first thing you do is open the door, throw the person out and close the door. So it works much better from inside than from outside. You can open the door much better from inside.
So there are mechanisms for this, and what we found in our work as to how "garbage" that is inside the brain -- meaning the breakdown products of cells, the proteins that get into the brain -- how do they get out from the brain into the blood? That was what we were working on when we were looking at finding treatments for hydrocephalus (excess fluid in the brain). In that pursuit, what we found was, there are channels, there are pathways that permit removal of the garbage material, or the protein material, from the brain side to the blood side around the blood-brain barrier. It's the same cells that pick up the proteins and other things and throw them out into the blood, where it can be excreted through the kidneys.
We used a method by which we put in a tube called a catheter into the brain, into a space in the brain called the ventricles. These ventricles are fluid spaces that are in everybody, and the fluid is very controlled in terms of its chemical composition, in terms of it production, and it's very important to nourish the brain as well as help it grow, from when we were little babies to adulthood.
So what we found was when we put chemicals in the brain ventricles, they would go around the blood vessels. So what we said was, since tumors have a lot of blood vessels around them, we thought it may be a good idea to put the chemicals that are used in the treatment of these tumors into the ventricles so that they can go in higher concentrations.
In order to test this, we decided to conduct experiments where we put in chemicals into the ventricles and decided to examine how much of these chemicals are getting into the tumor as opposed to the brain. Because these chemicals can also hurt the brain, we need to have a difference in the amount of chemicals that is distributed in the brain tumor versus the brain tissue.
What we found was that the tumors, because they have a higher amount of blood vessels, these chemicals delivered through what we call intraventricular drug delivery, which is what I described before, is very effective in increasing the amount of drug to the tumor, but not the brain.
[00:40:24] Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Satish Krishnamurthy. He's a professor of neurosurgery at Upstate.
So let me make sure I understand this. You use a catheter to get from outside the brain into the ventricle space inside the brain, and that's how you put the medication in.
And then you leave it to biology to disseminate that medication through the blood vessels to the tumors.
[00:40:57] Satish Krishnamurthy: Think of it as you don't breathe through your chest wall, right? You breathe through the nose, and it automatically goes to the lungs and does whatever exchange happens in the blood, right, from the lungs to the blood.
It's just like that. Use the biological mechanisms to deliver the drug to the tumor. And this is a common procedure that we do in a lot of my patients. It's a very common procedure to put a tube into the brain, into the ventricle, and we can either put a reservoir, which is a small bubble or like a port, into the head, where they can inject medications at different times to deliver the drugs.
It's called an Ommaya reservoir. And these reservoirs are commonly used to collect the samples or give drugs into the brain.
[00:41:55] Host Amber Smith: Now, would this work on primary tumors that start in the brain, as well as tumors that develop when cancer spreads from somewhere else in the body?
[00:42:07] Satish Krishnamurthy: Well, the answer for this is not yet known.
I think, it is a factor of blood vessels. Right now, the results from the experiments basically suggests that if there are a lot of blood vessels in the tumor, then this method will work. However, there are other ways of delivering drugs to the tumor.
We can increase the potential of delivery to the tumor by modifying the chemicals that we use. For example, you can use specific compounds called vectors, which will deliver the chemicals to the particular cells, if you will. And there are technologies that are available out there that can use this.
We have done the initial experiments that'll show that this may be an alternative approach that can specifically treat all kinds of tumors, and not just tumors, but all kinds of other disorders. Because what we have shown is that these chemicals are distributed widely, not only in the brain, but in the cranial nerves, the nerves that are coming from the brain, the nerves that are coming from the spine, and the spinal cord.
And the spinal cord itself. So this is an extremely valuable tool in, our opinion, to distribute drugs within the central nervous system.
[00:43:27] Host Amber Smith: Now, you've written papers about this that have been published in medical journals. Are you hearing from colleagues about these techniques?
[00:43:36] Satish Krishnamurthy: Some. We have some collaborations, both here at Upstate and at Wayne State University (in Detroit). We are very excited. It's not widely known, although we publish articles, there are so many articles that are published, it's not very widely known. But of course, having, you interview me and focus on this work, is going to be tremendously valuable for the visibility of our research. And I would like to thank you for that.
[00:44:04] Host Amber Smith: Well, I want to ask you a little bit more about the blood-brain barrier. This is a physical barrier that goes around the entire brain. What does it look like? What does it feel like?
[00:44:14] Satish Krishnamurthy: It's a physical barrier, but it's not like a membrane or a skin covering or anything like that.
This is a barrier that goes along the blood vessels. There is the heart, which is big and easily seen. And then there are arteries, and these arteries branch, and they branch, and they branch. Then they get into the brain. And they are very, very tiny. They are micrometers -- they are 1,000th of a millimeter -- wide. You're looking at measurements that are very, very small when they get to the cells.
So this barrier goes along the blood vessels. It's a cellular layer that is actually supported by a small, thin basement membrane, which is micrometers thick. So it's not a physical membrane. Think of it more like a barrier like the lungs, right? There is air that goes in, but air bubbles don't go into the blood. That's dangerous. It can kill you, right? There is a partition, what's called the interface. And probably the best way to say this junction where the blood and the brain meet is a blood-brain interface, just like the lung-blood interface. We have a lot of interfaces like that. So it's not a physical barrier.
And I think a lot of things change in the transport processes and everything. As you know, it's a different function when we are in the mother's womb, and it's a different function when we come out. It changes as we age, or if we have other disorders, like diabetes or Alzheimer's.
And you see that as a change in the function of the blood-brain barrier components or brain injury. Sometimes the tumors hijack some of these systems for their own benefit.
[00:46:03] Host Amber Smith: So would that potentially change the way you treat someone, depending on the quality or the age of their interface if they're older and maybe it doesn't work as well?
[00:46:14] Satish Krishnamurthy: The answer should be yes. But we lack the methods to determine how a change in the blood-brain interface is going to affect what we are doing. That's the heart of my work, where I'm trying to figure out how chemicals go in, how chemicals come out and how to change the way, to help our patients.
Like, for example, if you have hydrocephalus, there's less clearance of the proteins through the blood-brain interface. So we need to make it go faster. But it's a disadvantage when you're treating tumors. The drug should stay in for a longer time, right, inside the brain, for it to be effective.
So we should be able to control that like you would control an engine or an aircraft or something like that, which is our goal.
Can we do that? We don't know, but it's definitely a goal that is worth pursuing.
[00:47:11] Host Amber Smith: Well, it's very interesting, and I'm glad to know that you're working on this. Thank you so much for sharing.
[00:47:16] Satish Krishnamurthy: Absolutely. It's been my pleasure. Thank you so much for bringing focus onto this part of my research.
[00:47:23] Host Amber Smith: My guest has been Dr. Satish Krishnamurthy. He's a professor of neurosurgery at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."
Here's some expert advice from registered dietitian Heather Dorsey from Upstate Medical University. How do you roast fresh vegetables?
[00:47:39] Heather Dorsey, RD: So to roast a vegetable, you would take a sheet pan. You can line it with some aluminum foil. Pick your roasted vegetables of choice, whether it be parsnips, sweet potatoes, some different types of squashes.
And then you would take a little bit a side of olive oil, and you can actually put a little bit of cinnamon in there and then baste the vegetables. And then just roast them in the oven at 350 degrees Fahrenheit till they're a little al dente. And then just enjoy them. I wouldn't have to put anything else on them because you already used a little bit of the extra virgin olive oil as your healthy fat.
[00:48:15] Host Amber Smith: You've been listening to registered dietitian Heather Dorsey from Upstate Medical University.
And now, editor Deirdre Neilen, editor of Upstate Medical Universtiy's literary and visual arts journal, The Healing Muse, with this week's selection...
[00:48:29] Deirdre Neilen, PhD: Claudia Serea's latest book is "In Those Years No One Slept." The poem she sent us is a meditation on memory and distance. How we keep someone who is far away still close to us. Here is "The Hand Grenade."
When I set the teapot on the stove
and prepare the linden flowers,
or the dry mint leaves you gave me from your garden,
I think of you.
I think of you when I go for a walk
and look at the cloud hanging over the Passaic River,
its belly full of cold rain,
and when I watch the family of sparrows
on the telephone wire.
My hand holds the phone
and I think of you
when I hang up without calling.
At night, my thoughts move inside the dreams
like chicks rustling in the eggs
set in the incubator in your kitchen.
Their wings feel for flights that aren't there yet,
not this year.
This year is grounded.
In August, slowly,
slowly,
slowly,
in your orchard 5,000 miles away,
a pear separates
from its branch
and falls through the air,
heavy,
before smashing on the ground
like a hand grenade.
[00:49:45] Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," the new biobehavioral health center at Upstate. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at HealthLinkonAir.Org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel, and graphic design by Dan Cameron. This is your host, Amber Smith, thanking you for listening.