Hidden in plain sight

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Yesterday I gave a presentation at the Nordic Ophtalmology meeting on the topic of weight loss in idiopathic intracranial hypertension (IIH). People with IIH have a large risk of going blind and they have frequent migraines, so treatment is obviously a priority. Patients are usually young women with obesity, and weight loss tends to result in drastic improvements of migraine frequency and strength for these patients, and they reduce their chances of sustaining permanent eye damage.

While the mechanisms for this debilitating disease are poorly understood, there is a clear link with obesity. But when the other speakers on the panel were speculating about why this disease develops no one hardly mentioned anything to do with environmental factors. Instead there was a very clear focus on biological risk factors, such as the increased mechanical pressure exerted by excess adipose tissue, anatomical factors, hormones and the like. While these factors can obviously be important they are likely to be a long way down the causal chain. 

When you consider than the vast majority of patients are young women with obesity, the things that come to my mind as potentially causal are a lot further up the potential causal chain, and include things like social pressures to be thin, body dissatisfaction, stigma, shame, childhood traumas, and stress. These, in turn, lead to drastic changes in inflammation, as well as substantial hormonal and metabolic changes, which could eventually trigger the intracranial hypertension. 

Personally, when it comes to obesity, I am very much leaning towards the environmental factors, specifically psychological and emotional factors/responses that we develop during the early years of our childhood as root causes of the disease. I would not be surprised if this applies to patients with idiopathic intracranial hypertension as well. That is why I think these patients can really benefit from a holistic treatment approach that includes things like weight loss, stress reduction, exercise, body acceptance, cognitive therapy, yoga, and mindfulness. 

2 thoughts on “Hidden in plain sight

  1. Bingo! Your last two paragraphs say so much that I, too, believe is a big tree we need to be barking up. Add to your holistic treatment/intervention list specifically: breathwork+ yoga and mindfulness. These practices can, as you already know, greatly enhance relaxation and the ability of the person to react in a different way to stressors. As well, they can enable traumatized people who could sometimes (often!) be described aptly as disconnected heads sitting on bodies they are essentially unaware of, to be re-connected and able to experience themselves as whole beings – bodies with sensation, etc.

    Delighted to have discovered your blog and work via Dr. Sharma’s blog.

    Liked by 1 person

  2. Holistic interventions clearly have huge potential for helping us with many of our so called lifestyle diseases, although there probably needs to be more scientific evaluations before such methods can break through in medicine on a wide scale.

    I totally agree that there needs to be a re-connenction with the body in many cases, such as idiopathic intracranial hypertension, for example through the methods you describe above. Once again, my thanks for your insightful comments.
    Erik

    Like

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