Brain Warrior Dr. Daniel Amen has been called the most popular psychiatrist in America. His main claim to fame is the SPECT (Single Photon Emission Computed Tomography) scans he does on all his patients, for everything from poor school performance to alcoholism, and even marriage counselling. They cost thousands of dollars and expose patients to radiation. He tells patients their disease or lifestyle has created visible holes on the scans where the brain should appear smooth, and he believes showing patients the pretty pictures is instrumental in getting them to understand their problems and cooperate with treatment. He runs a commercial empire of clinics, publishing, media appearances, and other endeavors that have made him a multimillionaire. His latest book, co-authored with his wife Tana Amen, is The Brain Warrior’s Way: Ignite Your Energy and Focus, Attack Illness and Aging, Transform Pain into Purpose. The publisher sent me a review copy of the book. I thought it was worthless and I was not planning to write a review; but when I realized PBS was airing the Amens’ infomercials promoting the book, I felt compelled to offer my own assessment.

It is basically a self-help book. It contains some practical advice about weight, diet, exercise, sleep, stress, etc. – all the things we all know impact our health. It uses the concept of “Brain Warrior” to indicate that commitment to a healthy lifestyle is a mindset requiring us to fight and never give up. It recommends expensive SPECT scans to monitor progress. It recommends dietary supplements; avoidance of gluten, GMOs, artificial sweeteners, and whole categories of foods; and much more, none of it supported by credible scientific evidence. It is larded with lumpy brain pictures from SPECT scans purporting to show “Before, more vulnerable” beside “After, healthier, less vulnerable.” Who knows what the pictures really mean? It is also larded with testimonials that don’t really seem to support its thesis. For instance, John decided he needed to lose weight and after losing 50 pounds and exercising he now feels great. Does that make him a Brain Warrior? Did he get a SPECT scan? If he did, did that change anything?

There is a reason there are so many self-help books. They don’t work. They take a few common-sense ideas, over-simplify them, and prescribe a complicated course of action that is time-consuming and difficult to follow. People read them and are initially enthusiastic, but they rarely follow through, soon lose interest, and are in the market for the next self-help book.

Dr. Amen is not science-based

I am not a fan of Dr. Daniel Amen. I first wrote about him on Quackwatch in 2005, “A Skeptical View of SPECT scans and Dr. Daniel Amen.” In 2007, his lawyers complained that my article was unfair and put him in a negative light. I asked a series of pointed questions and they tried to answer them; I showed that their answers were inadequate. I never heard from the lawyers again. I wrote “SPECT Scans at the Amen Clinic: A New Phrenology” on SBM in 2008 and “Dr. Amen’s Love Affair with SPECT Scans” on SBM in 2013. Others have written articles critical of Dr. Amen for reading too much into SPECT scans; Daniel Carlat called the scans “spectacularly meaningless.” Neely Tucker wrote a critical article in The Washington Post. Neurologist Robert Burton criticized Amen in an article on Salon titled “Brain scam.” Burton and I both formally complained to the PBS ombudsman because airing Amen’s infomercials implied that PBS endorsed his claims as good science; the ombudsman responded that the local stations determine programming and airing a program doesn’t imply endorsement by PBS.

Amen’s Wikipedia page says “Amen’s use of SPECT scans to aid in psychiatric and neurological clinical diagnosis is based on unproven claims and has been criticized by psychiatrists and neuroscientists on ethical and safety grounds”

The power of positive thinking

The Brain Warrior’s Way is for people with problems like addiction, depression, memory problems, obesity, cancer, and many others. It is also for anyone who wants to look and feel their best and who wants to excel at work, school, or relationships.

Much of the book sounds like it is channeling Norman Vincent Peale on the power of positive thinking. Reject negative thoughts. Focus on abundance rather than on deprivation. Repeat affirmations like “I will have better focus” or “I can support my immune system so my cancer won’t come back.” [Ha! Lots of luck with that!]

A typical Brain Warrior testimonial: Kyle is a seventh degree black belt in martial arts. He said he just couldn’t give up Pepsi and bread because it was too hard. Tana pointed out that getting a black belt was much harder than deciding not to open a can of Pepsi. By thinking of it that way, he lost 40 pounds and felt happier and stronger.

Another Brain Warrior story: Dr. Amen ate dinner with a friend who was overweight and diabetic, seemed oblivious to what he ordered, and had to inject insulin at the dinner table. Amen told his friend he was worried about him because he was in the obese range of BMI. The “obese” label got his friend’s attention; he proceeded to lose 53 pounds and was able to cut his insulin dose in half. He reported better focus, energy, memory, and sexual ability. No mention of a SPECT scan, and no reason to think he wouldn’t have done just as well if he had listened to his doctor’s advice.

Questionable statements

  • “Food pollution is killing us.”
  • “Mild traumatic brain injuries are a major cause of psychiatric illness.” [No reference given.]
  • “The greatest danger from antibiotics does not come from those prescribed by your doctor, but rather from the foods you eat.” [No reference given.]
  • “Disorders ranging from ADD, autism, depression, and schizophrenia have been connected to intestinal bacteria imbalances that increased gut permeability.” [No references given. This idea is related to the fad diagnosis of “leaky gut,” a hypothetical condition not recognized by mainstream medicine.]
  • “The constant messaging from the alcohol industry has people feeling they must drink two glasses of wine a day to feel healthy.” [Whaaat? I’ve never seen any such messaging.]
  • “One of our closest friends…told us that our service men and women were offered unlimited Baskin Robbins ice cream during lunch and dinner.” [I seriously doubt that.]

“Brain type” nonsense

“Know your brain type.” (balanced, spontaneous, persistent, sensitive, cautious, and combinations of those, like spontaneous-persistent-sensitive, for a total of 16 types). You can visit the website for a questionnaire as well as specific suggestions to help each type. Amen is big on classifications. He has written about 7 types of ADD, 7 types of anxiety and depression, 6 types of addictions, and 5 types of overeaters. He claims each type requires a different treatment plan. He just made all those types up; they are not recognized by other psychiatrists or scientists.

He also offers a computerized neuropsychological test called Brain Fit WebNeuro that assesses how your brain works in 14 specific areas, scoring each on a scale of 1-10. I took the test, but didn’t get my results because that requires signing up for an account and accepting a barrage of e-mails. It claims to measure things like motor coordination, processing speed, and ability to read faces, but it relies on subjective answers to questions that have nothing to do with those skills. The test has not been validated and is not used elsewhere. In my opinion, the results of such a test are meaningless.

Supplements

The Amens say everyone should take these three essential supplements: multivitamins, omega-3 fatty acids, and vitamin D. That goes way beyond the evidence. They even claim that people who take a multiple vitamin have “younger looking DNA.” [No reference given.] They say researchers at Harvard found that a low level of omega-3 fatty acids is one of the leading preventable causes of death. [Again, no reference given. I think they are talking about this study, which was far from definitive and does not address whether there is any benefit from supplements.]

For most patients, they also recommend gingko, vinpocetine, probiotics, apha lipoic acid, vitamins B, C, and D, huperzine A, choline, phosphatidylserine, and N-acetyl-cysteine. They admit these individual supplements have not worked in large studies, but they think they know how to use smart combinations of supplements effectively to address multiple mechanisms including inflammation, blood flow, blood sugar stabilization, antioxidant support, and nutrient loading. I don’t think they know what they think they know.

Nutrition advice

Diet: 70% plant-based, 30 % high quality protein, with healthy fat mixed in. OK.

Nutrition principles:

  1. Focus on high-quality calories. [OK]
  2. Drink plenty of water, half your body weight in ounces (80 ounces of water daily if you weigh 160 pounds). Tana starts the day with 16 oz. warm water with lemon and ginger, which is “cleansing and alkalinizing.” [There’s no evidence to support drinking that much water, or to show a benefit of “cleansing and alkalinizing”]
  3. Eat high-quality protein in small doses throughout the day. [High quality protein is good, but the evidence doesn’t support the recommendation for small doses throughout the day]
  4. Eat smart carbohydrates (low glycemic, high fiber). [Makes sense, fills you up so you’re less hungry]
  5. Focus on healthy fats. [OK]
  6. Eat from the rainbow. [Colorful foods tend to be healthy, but the Amens’ claims go beyond the evidence, especially when they claim that certain nutrients in colorful foods “aid in detoxification”; Detoxification is an alternative medicine buzzword]
  7. Cook with brain-healthy herbs and spices. [They go way beyond the evidence here, claiming miraculous benefits from things like turmeric, which was pretty well debunked by a recent systematic review]
  8. Make sure your food is as clean as possible. Organic, antibiotic-free, hormone-free, pesticide-free, chemical-free, foods that don’t promote inflammation. [More alt-med buzzwords]
  9. Eliminate any potential allergens or internal attackers like gluten. They say there are scientific reports of people having psychotic episodes when they ingest gluten. [Not supported by any of the three references they give; the referenced studies only show an association of celiac disease with certain mental disorders but do not establish causation]
  10. Eat healthy during the day, but fast 12 hours at night. [The value of 12-hour fasting has not been established]

They provide a list of 100 best brain-healthy super foods. [There’s no such thing as a super food.] They say certain foods are “clearly weapons of mass destruction” and say we should limit or avoid these altogether: sugar, artificial sweeteners, gluten, soy, corn, and dairy. They say grains turn to sugar in the body and cause obesity, heart disease, diabetes, and cancer.

Demonizing sugar and artificial sweeteners

They recommend avoiding all forms of sugar. They repeat the claims of Robert Lustig that sugar is addictive and “is the PRIMARY cause of obesity, hypertension, heart disease, cholesterol problems, and diabetes – all of which cause brain damage.” They cite a study showing that sugar had the same negative impact on your cells as cigarettes, and was associated with accelerated aging. That’s not what the study showed. It showed a correlation between sugar-sweetened sodas and shorter telomeres, but it also showed a correlation between fruit juices and longer telomeres. Yet the Amens proscribe all fruit juices. They repeat the popular calumnies about the alleged dangers of artificial sweeteners, which have been clearly debunked by the published evidence.

Demonizing gluten

They say gluten-free diets have led to reduction, even full remission, of symptoms in a subset of schizophrenic patients. Again, that’s not what their reference says. It reports an increased incidence of celiac disease in schizophrenics, and improvement (but not full remission) of symptoms when wheat was eliminated from the diet. And the reference points out that other studies had failed to replicate these results. It suggests that individualized dietary modification “might” be a useful adjunct to anti-psychotic medications in a minority of patients.

Other advice

“Avoid anything that hurts your brain.” And there are a lot of those, from smoking to alcohol, from poor decisions to fruit juice(?!), from gadget addiction to unhealthy peer groups.

They make the standard recommendations for sleep hygiene, but add lavender.

“Get key laboratory tests.” CBC, general metabolic panel with fasting blood sugar and lipid panel, Hgb A1C, vitamin D, thyroid panel, C-reactive protein, homocysteine, ferritin, free and total serum testosterone, estrogen and progesterone. Most of these are not indicated as screening tests, and doing unnecessary lab tests is likely to do more harm than good.

They recommend The Great Cholesterol Myth by Steve Sinatra and Jonny Bowden, cholesterol denialists.

They say “Used properly, music is medicine.” They say a brain enhancement playlist will enhance creativity, mood, memory, gratitude, energy, focus, motivation and inspiration. They even suggest specific pieces of music.

They ask readers to keep a detailed journal, helpfully providing pages of elaborate templates with places to record “Things I am grateful for today,” “Read my One Page Miracle,” “Start the day with 16-20 oz. of water,” a list of brain-enhancing foods eaten, ratings of mood, energy, memory, inner peace, etc. on a scale of 1-10, and much more. They list a sample day’s menu, but don’t include recipes. You have to buy a separate book for that, The Brain Warrior’s Way Cookbook.

Conclusion: nothing to see here, move on

There’s nothing new here. Most people already know what they should do to stay healthy: avoid tobacco, control weight, eat a nutritious diet, exercise, avoid stress, get adequate sleep, etc. If thinking of yourself as a warrior helps motivate you to lead a healthy lifestyle, I guess that’s a good thing. If looking at a SPECT scan of your brain frightens you or reassures you, I guess that might help Dr. Amen enlist your cooperation with his treatment plan, but I don’t think it’s worth thousands of dollars and exposing yourself to radiation just to find out something you could have learned without a scan.

Much of the advice in this book is mainstream medical advice, and there are helpful practical hints like putting your food on a smaller plate and not shopping for food when you are hungry. The problem is that the good advice is inextricably mixed with false information and misleading statements, and with detailed recommendations that are not supported by science. I cannot recommend this book.

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.