Saturday, May 31, 2008

Is your cell phone making you fat?

Hmmm...betcha rolled your eyes when you saw THAT headline. So did I until I read this abstract.

Here was the study setup:

Male Djungarian hamsters were exposed, 24 hours a day for 60 days, to radio frequency electromagnetic fields (EMF's) at three different levels of intensity, measured in units of megahertz (MHz). The MHz levels used were the standardized electromagnetic frequency ranges utilized by European telecommunications networks. Exposure equalled the upper exposure limit allowed in Germany.

The hamsters were divided into two groups, one group was actually exposed to the EMF's, while the other was exposed to every aspect of the setup except for the electromagnetic energy. This was to insure that there was not some outside artifact in the setup that might cause any observable change.

At the lowest level of exposure (383 MHz), a temporary increase in body weight up to 4% was observed. At the middle level of exposure (900 MHz), a more significant (up to 6%) and permanent increase was observed. Interestingly, at the highest level of exposure, there were no observable effects on body weight.

What does this mean? Well, the obvious conclusion is that if you are a hamster with weight issues you should stick to using land lines.

Seriously, what I'm drawing attention to here is that sometimes answers to important scientific questions are not always in the most obvious places. A person gains weight, they assume it's about how much they eat and how little they exercise. And, the confounding counterargument is that a person who is spending time on his/her cell phone is not as physically active as someone engaged in other activities. So who's to say what the real cause of the weight gain is?

The other aspect of this argument is the amount of electromagnetic exposure these hamsters were subjected to. It was high, granted, but when I read this study I immediately thought of all the that Blackberry addicts out there, who cannot ever separate themselves from their little electronic gadgets. The people I see at parties, on street corners, etc., who cannot cut the techno-umbilical cord, no matter what interesting and engaging live social opportunity happens to be sitting right in front of them. THAT is the group of people I'd want to study, compared to casual cell phone users...and to...maybe members of that remote South American tribe that just this week had its first-ever introduction to a helicopter.

The connection in this area of research that scientists seem to be pursuing is the effect of electromagnetic activity on the metabolic action of the hormone melatonin. Healthy melatonin function is important for good mental health, and that is what those of you reading this blog are interested in pursuing. And that is why I'm posting this information on this blog. Melatonin is commonly thought of as the sleep hormone, but it has a lot of other very important activities, and its action is sensitive to electromagnetic activity.

There clearly need to be many, many studies that parse this kind of finding into its multiple aspects in order to figure out what exactly is going on. But in the meantime, it's probably not unwise to be sure that you strike a healthy balance when it comes to the amount of time you spend in contact with certain technological toys.

Lerchl A, Krüger H, Niehaus M, Streckert JR, Bitz AK, Hansen V. Effects of mobile phone electromagnetic fields at nonthermal SAR values on melatonin and body weight of Djungarian hamsters (Phodopus sungorus). J Pineal Res. 2008 Apr;44(3):267-72.

Photo courtesy of't Google the greatest?

Wednesday, May 28, 2008

What to do about essential tremor

I recently gave a presentation at UCLA, after which a very nice woman asked me if I knew anything about diet and essential tremor. I did not, and I promised to get back to her. What I learned took a little while to get through! For her benefit and the rest of you reading this, here is a short synopsis.

Essential tremor is very strongly genetic. Interestingly, at the same time I was reading research on the topic, I was reading a biography of our second President, John Adams. I learned that he, his son, and his famous cousin Samuel all experienced the affliction, as evidenced in handwriting samples available for analysis. Samuel's tremor was so bad that toward the end of his life he had to dictate all of his correspondence. There was some alcoholism in the family, to which some of this may be attributed, but even so, a genetic link seems to be apparent.

As far as dietary considerations, some of the more common considerations have been whether or not caffeine and ethanol (alcohol) consumption are correlated with tremor severity. While caffeine intake is lower in people who have tremors, tremor severity is not clearly correlated with total caffeine intake. So the reason for this association is not completely understood. Ethanol appears to have a more consistent influence on tremors.

Reduced body mass is a common problem with essential tremor, likely because of the energy spent in nonproductive muscle activity. One research group recommended that physicians pay attention to this and encourage adequate nutritional intake in persons with essential tremor. There may be an interesting conflict in this observation, in that individuals who are trying to gain weight tend to eat more protein...and red meat intake was recently associated with a greater degree of tremor severity in men (not women). This finding underlies the importance of not giving out dietary advice unless it is specifically evidence-based with regard to the problem at hand, not just general advice that might work on the average person.

My friend asked me specifically about the potential for using omega-3 fatty acids to help with tremors. To date, no research is in Pub Med regarding this possibility. However, it was only in April 2008 that the potential connection between omega-3 intake and Parkinson's disease showed up in the literature, so I would venture to guess it won't be long before this research is available.

Supporting my assumption is the fact that a correlation has been shown between a Mediterranean diet pattern and a lower incidence of essential tremor. Even though there is research suggesting that the blood components associated with essential tremor and red meat consumption don't consistently explain the origin of tremors, you have to admit, it certainly never hurts, for many reasons, to eat more fish and less red meat, more fruits and vegetables and healthy fats!

In going through my medication fact sheets, I find that three of the psychotropic medications I regularly research have been reported as being used in an off-label fashion for essential tremor. These medications are olanzapine (Zyprexa), pregabalin (Lyrica), and topiramate (Topamax). Olanzapine and pregabalin are associated with weight gain, and topiramate with weight loss. Given the fact that weight change even in the absence of medications is a problem, it would seem that minimizing the dosages of medications that might interfere with overall health would be an important consideration. Medications can also change one's appetite for certain kinds of food. My experience is that, especially with olanzapine, appetites for carbohydrates and the wrong kind of fats can intensify, which can make adherence to a Mediterranean diet challenging.

The dietary emphases I describe above, to start with the Mediterranean diet in hopes of decreasing the necessary dose of medication for tremor management, would be the most ideal combination of approaches.

I also found some interesting effective non-pharmaceutical therapies that might be worthwhile to try. Who knows, maybe they can help put all that good nutrition into muscle and nerve tissue where it's needed, and prevent unnecessary loss of important tissues. Weight training, for example, improved their steadiness and decreased the magnitude of their tremors. Behavioral relaxation training was also found to reduce tremor severity.

Quite an interesting--albeit unexpected research project! Thank you for stimulating my interest in compiling information with potential to help others.

Lundervold DA, Belwood MF, Craney JL, Poppen R. Reduction of tremor severity and disability following behavioral relaxation training. J Behav Ther Exp Psychiatry. 1999 Jun;30(2):119-35.

Paulson G. Illnesses of the brain in John Quincy Adams. J Hist Neurosci. 2004 Dec;13(4):336-44.

Louis ED, Kavanagh P, Gertrude H. John Adams' essential tremor. Mov Disord. 2005 Dec;20(12):1537-42.

Louis ED, Jurewicz EC, Applegate L, Luchsinger JA, Factor-Litvak P, Parides M.Semiquantitative study of current coffee, caffeine, and ethanol intake in essential tremor cases and controls. Mov Disord. 2004 May;19(5):499-504.

Dogu O, Sevim S, Louis ED, Kaleagasi H, Aral M. Reduced body mass index in patients with essential tremor: a population-based study in the province of Mersin, Turkey. Arch Neurol. 2004 Mar;61(3):386-9.

Louis ED, Keating GA, Bogen KT, Rios E, Pellegrino KM, Factor-Litvak P. Dietary epidemiology of essential tremor: meat consumption and meat cooking practices. Neuroepidemiology. 2008;30(3):161-6.

Scarmeas N, Louis ED. Mediterranean diet and essential tremor. A case-control study. Neuroepidemiology. 2007;29(3-4):170-7.

Louis ED, Zheng W, Applegate L, Shi L, Factor-Litvak P. Blood harmane concentrations and dietary protein consumption in essential tremor. Neurology. 2005 Aug 9;65(3):391-6.

Yetimalar Y, Irtman G, Gurgor N, Basoglu M. Olanzapine efficacy in the treatment of essential tremor. Eur J Neurol 2003 Jan;10(1): 79-82.

Zesiewicz TA, Ward CL, Hauser RA, Pease Campbell JA, Sullivan KL. Pregabalin (Lyrica) in the treatment of essential tremor. Mov Disord 2007 Jan;22(1):139-41.

Zesiewicz TA, Ward CL, Hauser RA, Salemi JL, Siraj S, Wilson MC, Sullivan KL. A pilot, double-blind, placebo-controlled trial of pregabalin (Lyrica) in the treatment of essential tremor. Mov Disord 2007 Jun 19.

Lyons K, Pahwa R, Comella CL, Eisa MS, Elble RJ, Fahn S, Jankovic J, Juncos JL, Koller WC, Ondo WG, Sethi KD, Stern MB, Tanner CM, Tintner R, Watts RL. Benefits and risks of pharmacological treatments for essential tremor. Drug Saf 2003; 26(7): 461-81.

Ondo WG, Jankovic J, Connor GS, Pahwa R, Elble R, Stacy MA, Koller WC, Schwarzman L, Wu SC, Hulihan JF; Topiramate Essential Tremor Study Investigators. Topiramate in essential tremor: a double-blind, placebo-controlled trial. Neurology 2006 Mar 14;66(5):672-7.

Connor GS, Edwards K, Tarsy D. Topiramate in essential tremor: findings from double-blind, placebo-controlled, crossover trials. Clin Neuropharmacol. 2008 Mar-Apr;31(2):97-103.

Bilodeau M, Keen DA, Sweeney PJ, Shields RW, Enoka RM. Strength training can improve steadiness in persons with essential tremor. Muscle Nerve. 2000 May;23(5):771-8.

Monday, May 26, 2008

Are your legs restless for relief?

Restless legs syndrome (RLS) has become a popular target for drug therapy. Two popular medications used to treat RLS are levodopa and ropinirol (Requip). Not a whole lot is really known about RLS; therefore treatment algorithms and standards have yet to be consistently used.

Separately from drug treatment, several studies have identified that iron metabolism is abnormal in individuals with RLS. There is some thought that normalizing these imbalances is an important part of treating the syndrome.

However, one group of researchers identified that physicians, rather than doing a comprehensive metabolic/nutritional evaluation and treatment of RLS, tend to jump right into prescribing medication. The treatment protocols for 27, 22 of which were on levodopa and 5 were on ropinirol, were studied after a year of medication treatment.

Severity of symptoms was only documented in 2 of these patients! If you don't create a measurement of baseline, there is no way progress can be measured...and in turn appropriateness of continued medication cannot be determined. This is akin to a person complaining of lightheadedness. Then, without even measuring blood pressure, prescribing an antihypertensive agent and not having any idea of how you're going to decide if the drug of choice was appropriate, effective, or devoid of side effects.

Despite the fact that iron status has been documented to be a significant contributor to restless legs in a fair number of people, serum ferritin levels were not obtained in 18 and transferrin-iron saturation (Tsat) percentages were not obtained in 20 of the study subjects.

An interesting aspect of this study is that 96% of the prescribing physicians were family practitioners. They were not neurologists or psychiatrists, who would be the specialists most likely to have strong experience in treating restless legs, as well as in working with medications used to treat them. This finding is similar when it comes to antidepressants--more than 90% of all scripts for medications in this category are written by family practitioners, not psychiatrists.

Makes you wonder if the burden of what needs to be known in a more generalist type of work such as family practice, places these physicians in a position to know too little about too many things. On the other hand, in my work, when I am asked to provide treatment (or even an opinion, for that matter), about an area of nutrition or medicine about which I am not an expert, I recognize my limits and I refer to someone better equipped to do the right job.

For more information on RLS and iron, please visit this link from the National Institute of Health:

Molokwu OC. Appropriate use of dopamine agonists and levodopa in restless legs syndrome in an ambulatory care setting. Ann Pharmacother. 2008 May;42(5):627-32.

Sunday, May 25, 2008

I'd like to introduce you to some of my other writing!

I've been a little quiet here, haven't I? Here in Phoenix we had a wacky weather week, starting out in the triple digits and then plummeting to the point where I had to turn my heat on a couple of mornings. Knowing just what kind of scorching rebound is just around the corner, and knowing I'll be hiding out inside, working to avoid the heat, I decided to drop the work for a few days, get some great long runs in on those wonderfully cool mornings, and hole up with a few reads that had absolutely nothing to do with neurons, medications, or medical diagnoses. If you're looking for a novel that will start you out laughing, then catch you completely by surprise with the premise that suddenly shows up mid-book, check out Life of Pi. I sat down with my morning coffee today and I only looked up because one of my cats jumped on the sofa to remind me I'd forgotten her lunchtime treat. Great way to spend a lazy Sunday!


...I have also been non-blogging because I've been updating some of my consumer booklets. I thought I'd share a couple of sample pages from the three most popular here in case any of you are interested.

Polycystic Ovary Syndrome
I do most of my work with polycystic ovary syndrome (PCOS), the #1 cause of infertility in the US, which is related to several mental health issues and often exacerbated with the administration of psychiatric medications. Here is a sample from the 30 page booklet:

I decided to write this booklet because most information I found about depression was, well....depressing! Most of it focused on external reasons for being depressed, and very little educated about hormones, neurons, and the disease process that depression truly is. I wanted to empower people with depression to view their diagnosis as something as neutral to discuss as high blood pressure, not something to be embarrassed about. I also wanted to share a lot of ideas for preventing or recovering from depression that did not involve prescription medications.

These .jpg files are coming out a little small, but if you copy them and enlarge them you can hopefully see them.

Post-traumatic Stress Disorder

This booklet came about after 9/11. I felt very helpless sitting all the way out here in Phoenix when one college classmate had to make her way down 75 flights of stairs to safety, while another was conducting a meeting in the Pentagon when the building was hit. This was initially part of my own grief process, but it's turned out to be useful to people with PTSD from a number of different causes.

An interesting note about the booklet: I originally wanted to use clip arts depicting different cultures from all around the world as a way to communicate togetherness during a crisis. However, I could not find a single clip art of a Muslim in traditional dress participating in a modern day activity. I figured that using the art that I found would only make things I came up with "Plan B", which was to engage my nephews in the illustration work. I think it was meant to be illustrated by them all along, because the most frequent comment I get about the book is that the children's art really softens the message and makes it a lot easier to read about something that is very hard to experience, let alone discuss.

What we would do without the children in our world!

Here is a sample page:

This last one is my absolute favorite, but it's a little difficult to market. I never feel it's appropriate to try to sell something to a person who's in I have this one on my website in the hopes that friends and loved ones will find it.
If you know people who you think might benefit, perhaps you can let them know about it.

All of these items can be ordered in my bookstore, at

I hope you all are enjoying your holiday and doing as much socializing and non-work as I am...I need to finish up my novel tomorrow, and then it's back to reading and writing about research.

See you later in the week!

Wednesday, May 21, 2008

It's the marijuana, stupid

Much of my work is with polycystic ovary syndrome, PCOS, an inflammatory syndrome that is the leading cause of infertility in the United States. Women who have this syndrome are plagued with intense carbohydrate cravings that can make it nearly impossible to follow any kind of healthy diet.

A dietitian with the syndrome, who had a master's degree in nutrition, once told me, "If it's carbohydrate, and it's not nailed down...I eat it."

It happens more often than not, when I work with clients who have PCOS, that they cannot conceive of being in a physiological state where the majority of their thoughts revolve around sugar and where to find more. They might politely listen to what I have to say about how to eat to quell these cravings, but the inevitable question at the end of my pitch for my nutrition plan is, "OK, but what am I going to do when I crave sugar?" They have absolutely no knowledge of a time when cravings did not rule their food choices, and their experience causes them to assume that my program is going to fail their expectations just as every other diet has done.

That's why I work so hard for those clients who are willing to trust me and try my program. It's incredibly rewarding to talk to them a couple of weeks later and hear the surprised delight over not spending hours of time and energy trying to suppress the urge to binge on a chocolate cake.

It seems that one of the reasons women with PCOS have so much trouble with their carbohydrate cravings, is that their endocannabinoid systems are out of balance.

You may know of cannabinoids as the substance in marijuana that causes the munchies. These compounds have been found to be important appetite regulators.

Of course, in Western medicine, when receptor trouble is identified, that means dozens of scientists in drug companies around the world race to find the right chemical to fix the troubled receptor.

Currently, a drug has been developed designed to "improve" the function of cannabinoid receptors. For a lot of obesity scientists, this drug, rimonabant, (Acomplia), was supposed to be the obesity miracle drug. However, Acomplia was tripped up during the FDA approval process, because there were concerns about an increased risk of severe depression being a major side effect. That is what has been tested and observed with Acomplia use.

What is also apparently a concern is that since this drug is somewhat like "anti-marijuana," it has potential for antagonizing many of the neuroprotective properties that marijuana may actually have. In other words, users of Acomplia may find themselves at increased risk of neurodegenerative diseases such as Multiple sclerosis, Alzheimer's disease, Amyotrophic lateral sclerosis (ALS), Parkinson's disease, and Huntington's disease.

So what are women with PCOS--and men whose obesity is also fueled by carbohydrate cravings supposed to do?

If you're a regular reader of this blog, you should know by now that the first answer to any question should always be fish oil. :) Yup, fish oil can help to silence the marijuana munchies.

I included a reference for your perusal, but I have to say, it was a client who taught me about this. We'd spent a couple of hours in our initial assessment, and I gave her my standard omega-3 and diet protocol. She had been embarrassed to tell me in that initial meeting, that every Sunday evening she baked a chocolate cake, which she used to satisfy her voracious carbohydrate appetite. Two weeks into using fish oil, she had thrown out two chocolate cakes, because her appetite for sweets had so radically diminished, she didn't even think about bingeing.

The relationship between carbohydrates and omega-3 balance is so strong, that I know I've titrated the right dose of fish oil with the right amount of other fats when the cravings are gone.

If you've taken fish oil and you have not experienced a drop in carb cravings, chances are you either aren't taking enough of the stuff...or you haven't eliminated enough of the other fats that get in the way of fish oil doing its amazing job.

So don't despair because the FDA kept rimonabant out of the drug supply and out of YOU. Give thanks, and look to the ocean for an even better way of getting the same results.

Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG. 2006 Oct;113(10):1148-59. Epub 2006 Jul 7.

Kim AH, Kerchner GA, and Choi DW. Blocking Excitotoxicity. Chapter 1 in CNS Neuroprotection. Marcoux FW and Choi DW, editors. Springer, New York. 2002. Pages 3-36.

Engeli S, Heusser K, Janke J, Gorzelniak K, Bátkai S, Pacher P, Harvey-White J, Luft FC, Jordan J. Peripheral endocannabinoid system activity in patients treated with sibutramine. Obesity (Silver Spring). 2008 May;16(5):1135-7.

Watanabe S, Doshi M, Hamazaki T. n-3 Polyunsaturated fatty acid (PUFA) deficiency elevates and n-3 PUFA enrichment reduces brain 2-arachidonoylglycerol level in mice. Prostaglandins Leukot Essent Fatty Acids. 2003 Jul;69(1):51-9.

Monday, May 19, 2008

Speak up! There may be options that don't cause weight gain

Schizophrenia is a challenging problem to manage. I'm not a huge fan of medication, but I AM a huge fan of keeping people safe as well as healthy. And in the case of schizophrenia, that often means medication MUST be part of the treatment plan.

I wish, though, that in the process of keeping our schizophrenic loved ones safe with regards to reducing self-harming and otherwise destructive behaviors, we could keep them metabolically safe. In other words, I wish we could also create an antipsychotic that didn't significantly increase weight gain, as well as risk of diabetes and heart disease. The most we seem to be able to do, right now, it seems, is be aware of the relative health risks that medications in this category pose.

One medication that seems to be working well, is ziprasidone (Geodon). One hundred eighty five individuals with schizophrenia or schizoaffective disorder who were initially on either risperidone (Risperdal), olanzapine (Zyprexa), or conventional antipsychotic agents, were switched to ziprasidone, and maintained on this medication for one year. Cholesterol, triglyceride, weight, and behavioral measures were recorded at regular follow-up intervals during this time.

In the individuals who had been switched from risperidone or olanzapine, there were overall significant improvements in weight, total cholesterol, and triglyceride levels. These changes did not seem to show up, however, in those who were switched over from other antipsychotics.

The take home message here is that there seems to be a spectrum along which these medications lie, from most weight-neutral to least weight-neutral. It's important to be aware that if you or someone you know is on medications and you notice changes in metabolic health, that you ask about alternatives.

I know that there are many other reasons why psychiatrists make medication choices in their treatment planning. I have several clients in my case load who simply are not well managed unless they are using the weight-promoting antipsychotics. Their treatment goals are different than what I am referring to here.

If there is a weight/cholesterol/diabetes issue whose onset seems to correlate with the use of an antipsychotic medication, and there are medication options that have not been considered, it is surely worth inquiring about the possibility of using them. Often times, the burden of this communication falls on the loved one, as the person with the problem is not in a cognitive place to be able to do this for himself/herself.

Just know, often times there are options, and it is your right to ask for a discussion about what those options are.

Weiden PJ, Newcomer JW, Loebel AD, Yang R, Lebovitz HE. Long-Term Changes in Weight and Plasma Lipids during Maintenance Treatment with Ziprasidone. Neuropsychopharmacology. 2008 Apr;33(5):985-94

Friday, May 16, 2008

Eye see some potential problems with Ritalin

Ritalin has its purpose. But Ritalin is also given to an awful lot of children. In fact, one source I found estimates that as many as 10 to 15% of all children have been placed on Ritalin at some point. Some researchers believe that children who are sleep deprived can act as if they have ADHD. And sometimes they get the diagnosis simply because they aren't behaving. Often, Ritalin is given before any behavioral, nutritional, or otherwise alternative options are considered. What that all means, potentially, is that there are many, many children out there who are at risk for what the researchers in this study discovered.

Twenty-seven female rats were divided into 3 groups; each was given a different oral dose of methylphenidate (Ritalin). Changes in eye tissue observed (at all doses, the degree of change correlated with the dose) included:
(1) degenerative changes of the corneal epithelium, the protective layer of cells on the outside of the cornea. (these changes included the appearance of apoptotic bodies, which are vesicles produced by dying cells.)
(2) increased collagen (fibrous material) production
(3) edema (fluid accumulation) around corneal cells
(4) vacuolization in cell cytoplasm (appearance of vacuoles, which help to
remove unwanted material from cells)

Interestingly, a group of Australian researchers is reporting that children diagnosed with ADHD actually respond better to fish oil than they do to Ritalin. oil can help to preserve eyesight.

I italicized the word "diagnosed" in that last paragraph, because while fish oil can help to improve the biochemical imbalance that is the foundation of ADHD, a child who is misbehaving because of poor parental boundaries including appropriate not going to change with a single pill or supplement available on the planet. It's called taking the time to be a good parent.

Kids can be snotty, they can be weird, and they can challenge your patience to the max. But when they misbehave, they're not asking for medicine. They're asking you to show them you know they are there, that they are important, and that you have the ability to set the boundaries that help them to feel safe and to be healthy. Not an easy job in this day and age, but the children in our lives owe it to us adults to have a vision for their healthy futures, and to protect their vision in the process.

Gozil R, Take G, Bahcelioglu M, Tunc E, Oktem H, Caglar G, Calguner E, Erdogan D.Dose-dependent ultrastructural changes in rat cornea after oral methylphenidate administration. Saudi Med J. 2008 Apr;29(4):498-502.

Thursday, May 15, 2008

An egg-selent idea for slowing down Alzheimer's

On my infertility (PCOS) blog, I post a weekly item about a food and its health benefits. This week I chose eggs, which have a couple of brain-related nutrients I thought you all, as readers of this blog would enjoy. So I am cross-posting for your benefit.

Aaahhh eggs, the misunderstood member of the nutrition family. Poor guys...when I graduated from college, in the height of the low cholesterol-low fat craze, we were indoctrinated to teach that "egg" was just another word for poison.

My how things have changed!

A couple of months ago I heard Dr. Susan Kleiner ( speak at a conference. She shared that not once has there been a research study demonstrating that when you take eggs out of the diet, that this dietary change reduces cholesterol. As well, there has been research demonstrating that adding eggs (plus yolks) to the diet does NOT raise cholesterol. All those yolks I threw down the drain all those years...for nothing.

I figured I'd better find some hard research to back THAT one up, so here's a quick list of interesting titles I found in PubMed:
Dietary cholesterol from eggs increases plasma HDL cholesterol in
overweight men consuming a carbohydrate-restricted diet
Egg yolk improves lipid profile, lipid peroxidation and retinal abnormalities
in a murine model of genetic hypercholesterolemia.

There are many more, but here I just wanted to make my point. Egg yolks are not the ugly stepchild of the protein family anymore.

In fact, there are some great nutrients to be found in eggs.

1. Lutein and xeanthin are two carotenoid compounds that can help maintain visual health. One group of researchers reported that 6 eggs per week can help increase lutein and xeanthin levels in the macula, the part of the eye that degenerates in this country's leading cause of blindness, macular degeneration.

2. Eggs contain choline. This compound is very important for brain function. Choline is the building block for acetylcholine, the neurotransmitter involved in memory, and the one that many Alzheimer's medications seek to increase.

This compound is exceedingly hard to get in the diet. In fact, about the only two places you can find it, are egg yolks, and soy. (Well, also in cooked chicken, beef, veal, and turkey livers, but I didn't think that would have any of you running for your grocery lists so it goes in parentheses.)

If you've got PCOS, you've probably been told to avoid soy. So that leaves egg yolks for getting this very important memory booster.

3. If you hate fish but you need to increase your fish-based omega-3 intake, omega-3 eggs are a very cost-effective option. If you struggle to get enough vegetables in your diet, omelets and frittatas are great ways to get them in. Just be sure you use olive oil when you cook them.

I thought it might be timely to include eggs on this blog, because as food prices rise, they can certainly be much more cost-effective than salmon, as well as other proteins that are now taxing your grocery bill.

Mutungi G, Ratliff J, Puglisi M, Torres-Gonzalez M, Vaishnav U, Leite JO, Quann E, Volek JS, Fernandez ML. Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet. J Nutr. 2008 Feb;138(2):272-6.

Fernández-Robredo P, Rodríguez JA, Sádaba LM, Recalde S, García-Layana A.
Egg yolk improves lipid profile, lipid peroxidation and retinal abnormalities in a murine model of genetic hypercholesterolemia. J Nutr Biochem. 2008 Jan;19(1):40-8.

Wenzel AJ, Gerweck C, Barbato D, Nicolosi RJ, Handelman GJ, Curran-Celentano J. A 12-wk egg intervention increases serum zeaxanthin and macular pigment optical density in women. J Nutr. 2006 Oct;136(10):2568-73.

Goodrow EF, Wilson TA, Houde SC, Vishwanathan R, Scollin PA, Handelman G, Nicolosi RJ. Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations. J Nutr. 2006 Oct;136(10):2519-24.

Wednesday, May 14, 2008

Windex, epilepsy, and bones

In an earlier post I discussed an emerging relationship between antidepressant use and decreased bone density. The problem is not limited to antidepressants. In fact, there is a large body of research devoted to the same issue in people with epilepsy.

The data is a little bit challenging to read through, as one study reports a finding that only one medication causes changes in bone health, while another finds problems in several. In digging through the available discussions on the topic, I discovered one article suggesting that the research discrepancies may be more related to our lack of knowledge about bone health, and therefore our ability to design a study that really tells us what is going on, than it does poor research methodology.

In this study, researchers looked at the effects of three antiepileptic medications on bone health. What they found that even though levetiracetam (Keppra) did not decrease bone mass, it did reduce bone strength and bone formation. What that means is that studies that define bone health only in terms of bone density/mass will not find changes in bone health even though they exist.

The more accurate thing to say is that antiepileptic medications change bone integrity, a more all-encompassing way to define the event, than to narrow the definition down to one method of measuring bone health and strength.

My statistics professor in graduate school used to always tell us, "If you torture the statistics long enough, they'll always confess," so if you really want a study to say what you want it to say, you can refine it and define it to do just that.

This blog is intended to help those people who use the medications, and the most important message seems to be here, is that if you take any kind of psychiatric medication, be sure you are diligent about following recommendations to maximize bone health: minimize your caffeine intake, and be sure you get calcium in your diet.

And here I go with my fish oil again. Fish oil can be a wonderful ally for two reasons: (1) if used properly, in many cases, it can minimize the necessary dose of a medication, therefore limiting the chances of encountering negative side effects, and (2) it in itself helps to strengthen bone.

My neighbor says I'm like the guy in My Big Fat Greek Wedding, only I'm waving fish oil at everything instead of Windex! I'm beginning to think she's right.

Ha! Made you read all the way through the post to see what in the heck Windex had to do with epilepsy and bones. That was my intent! :)

Pack AM, Morrell MJ, Randall A, McMahon DJ, Shane E. Bone health in young women with epilepsy after one year of antiepileptic drug monotherapy. Neurology. 2008 Apr 29;70(18):1586-93.

Chou IJ, Lin KL, Wang HS, Wang CJ. Evaluation of bone mineral density in children receiving carbamazepine or valproate monotherapy. Acta Paediatr Taiwan. 2007 Nov-Dec;48(6):317-22.

Nissen-Meyer LS, Svalheim S, Taubøll E, Gjerstad L, Reinholt FP, Jemtland R. How can antiepileptic drugs affect bone mass, structure and metabolism? Lessons from animal studies. Seizure. 2008 Mar;17(2):187-91. Epub 2008 Jan 3.

Monday, May 12, 2008

Check out these blogs

Hello everyone,

I wanted to share some other blogs with you that I thought might be helpful. I'm fairly new to the whole blog thing and it amazes me how easy it would be to spend days on end bouncing from one blog through a blog roll to another and another...and then, to suddenly jolt out of your e-coma wondering where you spent the last week!

On behalf of the marriages of my blog readers, being someone who aspires to spend as little time in front of the computer as possible, and who has trouble actually making that happen, I haven't created a blog roll. I figured it would be better to mention a few of my favorites from time to time. Here are two.

1. This blog's owner, Duane Sherry, is quite humble about who he is. He's more well-read in the area of psych meds and alternatives than most psychiatrists! Duane and I have discussed our slightly different viewpoints--he has a much stronger opinion about meds vs. natural alternatives than I do. That probably stems from the fact that I am working with people on medications and trying to educate physicians about alternatives, but in the process of gaining their trust, I do need to respect the therapies they're trained in and currently using. Those wacky lawyers out there can make it very difficult for physicians to be open-minded about things! Because of my position in the system, I have to make them as happy as I do the docs and the patients...and that means being a little bit more moderate (or, as I told Duane, the quintessential Libra who obsesses about information and takes forever to come to a conclusion about anything.)

If you like anything I write about potential alternatives to psychiatric medication, you will certainly enjoy Duane's body of work.

2. Joanna Poppink is a psychotherapist in Los Angeles who is a tireless advocate for people with eating disorders. I've known her for years, presented with her at a conference, and have so much respect for the energy she puts into this population. Someone who works as hard as Joanna should be able to put herself out of business because she's eradicated the problem she worked so hard to solve. Unfortunately, with eating disorders, that just isn't happening. So if you need good information from a professional and compassionate soul, check out

And then, once you check out these two blogs, turn off your computer and hug your spouse!

Your meds, your beverages, and your weight

As beautiful as the weather is here in Phoenix right now, it's clear, summer is just around the corner. It always catches me off guard in the spring, when it's so beautiful outside and I want to spend as much time as possible out there...but it's not warm enough for me to be aware of the fact that I'm losing water to the atmosphere. It's only when my eyes start to burn that I realize I've allowed myself to become dehydrated.

This past week I worked with a client who learned the same lesson the hard way. In the month since I'd seen her, despite following a very healthy diet, she gained weight instead of losing the weight she'd wanted to. As we chatted, it became clear that the problem was not in what she was eating, it was in what she was drinking. With our record low humidity readings, it would have been a challenge for anyone to stay hydrated. But in her case, she is also on medications that were increasing her thirst. And she was coping with it by heading to the refrigerator and drinking as much as she could of anything she could find that would quench her insatiable thirst.

Her experience is not unusual. Many psychiatric medications increase thirst. If you compound that with a change in weather, you've got to really be smart about your choices.

Here are some of the rules we discussed, which I hope are helpful to you all as well.

1. Read your labels! Many beverages are sweetened with high fructose corn syrup, which adds calories and can promote the development of diabetes. You've already got more of that risk if you're on many psychiatric meds, so don't double the trouble.

2. Watch out for fruit juices. Even though they've got vitamins, antioxidants, etc., they also have calories. Read the serving size on the label and stick to one serving at a time. I like to freeze fruit juice into ice cubes and then use those cubes in mineral water. I also throw a shot of fruit juice into a smoothie to help intensify the flavor. You can also add juices to marinades and salad dressings if you like to cook and feel creative. It's just not the best idea to drink large quantities right out of the bottle.

3. Look for mineral waters and waters flavored with essences. One of my current favorites is Metro Mint, which tastes like a liquid mint candy. Essences are calorie free, and it's a great way to get flavor in what you're drinking without calories, sugar, or artificial sweeteners.

4. Have fun with herbal teas! There are dozens of flavors, and you can mix and match to create your own concoctions. Here in Arizona a favorite is sun tea. If you have a big glass jar, fill it to the top, add some tea bags, and let the sun brew it over the course of a day.

5. Green tea is one of my favorites. It's full of antioxidants, and it also helps to increase blood flow to the brain. Be sure to look for the decaffeinated version to be sure hydration and sleep don't interfere with each other.

6. Get creative! Just before I sat down to write this blog, I took some decaf green tea I'd brewed in my coffee maker earlier today and then refrigerated, and poured a shot of Metro Mint water in it to wake it up a bit. Mmmmmmm.....!

7. Beware of caffeinated drinks. Caffeine not only makes it hard to sleep, it can promote insulin resistance. And both insulin resistance AND caffeine can promote weight gain. That's a double whammy you absolutely don't want on your plate.

8. Decaf ice coffees, as long as they're not Frappabinos with extra whipped cream, are ok...but remember, even decaffeinated coffee has a little bit of caffeine in it. If you are an all-or-nothing kind of person and tend to go over the top with things you perceive to be "good", then you still might overdo it in the caffeine department.

9. Be sure to eat lots of fruits and vegetables. They are high in water content and can help to keep you hydrated.

10. Drink lots of smoothies and eat lots of soups. Again, it doesn't matter if you "eat" or drink your liquids, it matters that liquids get into you!

Friday, May 9, 2008

A painful reminder: drugs aren't always the answer

I have two reasons for writing this post this morning.

First of all, I spend a couple of hours a day reading new research on psychiatric medications, and it seems that there is a real trend toward throwing all kinds of medications at people with neuropathic pain. If you're the head of marketing at a major pharmaceutical organization, and you're looking at the health statistics in this country, and you see how many people are overweight and headed toward a diagnosis of diabetes...well...anyone looking at you sitting at your desk looking at those numbers is going to see a gazillion dollar signs in that cartoon bubble floating over your head.

To put it another way, anyone who can come up with a sure-fire way to treat neuropathic pain is sitting on a pile of money.

My second reason for posting this is a lot more personal. I have a private client, not overweight at all, whose bulimia has progressed to the point where she has developed diabetes. She got herself into big trouble with her medications because the one she wanted to use, insulin, was the only one she felt controlled her neuropathic pain. Her physician didn't see eye to eye with she decided to use both his meds and hers. We almost lost her over the conflict.

I know why the physician is holding his ground, and I support his choice. But I also have compassion for the physical pain this person must be enduring, which must be a constant reminder, thanks to the ruthless negative voices in her head, that she's really screwed up this time.

So...I've been researching some other options that would allow her to manage her pain, allow her to focus on recovering from the eating disorder, and make the doctor happy.

Enter alpha-lipoic acid. This is an anti-oxidant that isn't all that easy to find in foods, but is right there in the health food store. Not only does it help to regulate diabetes, it's turning out to be very effective in addressing neuropathic pain.

A European study looked at a group of 443 patients who had successfully managed their neuropathic pain with alpha-lipoic acid for at least 5 years. About 300 of them were switched to gabapentin (Neurontin), and 150 of them with no acute symptoms went without any treatment at all during this period of time.

Seventy-three percent of the untreated group started experiencing pain as early as two weeks after discontinuing alpha-lipoic acid. In the gabapentin group, 45% had to stop taking the drug because they could not tolerate its side effects. Fifty-five percent of those using the drug, even though they had done well with alpha-lipoic acid, did not respond to gabapentin. They ended up requiring another medication...which in this study ended up being pregabalin, carbamazepine, amitriptyline, tramadol, and/or morphine .

The researchers commented on the cost of using alpha-lipoic acid as compared to a prescription medication. Not only was there the direct medication cost, but those on medication had almost twice as many office visits during the three months of the study as those who were on the supplement. Not mentioned but important to consider, was the likely additional costs of treating the medication side effects.

The moral of the study? Drug companies, the better mousetrap has already been built. Let's do the right thing and, rather than looking at those dollar signs, get it into the nerves of people like my client who deserve to not have to live like this anymore.

Ruessmann HJ; on behalf of the German Society of out patient diabetes centres AND (Arbeitsgemeinschaft niedergelassener diabetologisch tätiger Ärzte e.V.). Switching from pathogenetic treatment with alpha-lipoic acid to gabapentin and other analgesics in painful diabetic neuropathy: a real-world study in outpatients. J Diabetes Complications. 2008 Apr 8

Wednesday, May 7, 2008

Soda pop, blood pressure, sleep deprivation, and funky rats

You can tell if you read this blog much that I'm a member of the melatonin fan club. Here's another reason why.

(Oops, for the benefit of the legal eagles, here's my disclaimer.) This post is going to be one of those studies that either empowers you to make better choices...or provides justification for some of the things you're doing that you know deep inside you might want to change but aren't ready to change. I'm going to give you the information because it's interesting and enlightening, and from that point forward, how you handle the information is your responsibility.

If a big finger just jumped out of the screen and starting shaking at you, and your monitor just let out a huge sigh...that was e-Mom. I hate being e-Mom, so let's get back to research.

Sprague Dawley rats* were divided into two groups for this study. One group was fed a high fructose diet, while the other received regular rat food. Another group of rats was divided and fed in the same two ways, only they were also supplemented with melatonin in their drinking water.

The high fructose diet rose blood pressure, while the rat chow diet did not. In fructose-fed rats who also received melatonin, blood pressure also rose, but to a lesser degree.

What this study might be suggesting:

1. It would behoove you to read labels and learn just how many foods (especially beverages) contain high-fructose corn syrup. If you take me up on this challenge, and you put all those products back on the shelf instead of in your grocery cart, you just might be surprised at how much you shave off of your grocery bill.

2. Paying attention to how much sleep you get, and getting more of it if you've been depriving yourself, may help you keep your blood pressure under control. And if you do THAT, you also might be surprised at how much more you shave off of your medical bills by not needing so much blood pressure medication.

3. If you actually do put all that soda and sweetened juice back on the shelf and decrease your caffeine intake, you might actually be able to get to sleep at a normal hour.

What this study is not advocating:

1. Eat all the junk food and drink all the soda pop you want, just be sure to stop in the supplement section for the bargain size bottle of melatonin on the way to check out.

2. Eat more rat chow.

Have a great day, all.

**I always see "Sprague Dawley rats" in these studies. Interested in why this one breed seems to be the rock star of research animals, I looked them up in Wikipedia. Fascinating little critters. If you're a science nerd like me, here's the link for more information:

Leibowitz A, Peleg E, Sharabi Y, Shabtai Z, Shamiss A, Grossman E. The role of melatonin in the pathogenesis of hypertension in rats with metabolic syndrome. Am J Hypertens. 2008 Mar;21(3):348-51.

Monday, May 5, 2008

Let me sleep on it

Sleep problems, insulin function, weight gain, and mental health diagnoses...these four issues seem to be BFF's in the world of neuroscience. Is it that people with mental health issues just don't sleep well...or does insomnia promote the development of these issues? Does weight gain cause insulin dysfunction...or vice versa? It's hard to sort through all of the possibilities and definitively conclude, but it's important to remember that taking care of yourself in a number of areas, not just watching what you eat, can be important in managing all of these issues.

Sleep is the one most people have a hard time with. They don't get enough of it, they deprive themselves of it when life throws them curve balls, they even brag about how little they get. But the evidence is overwhelming, every single organ in the body struggles to work the way that it should when we view sleep as a lifestyle inconvenience rather than a necessity.

It's about the hormone, melatonin. It's not just the thing that makes you sleepy, and it's not just the supplement you can take when you can't sleep, it's one of the body's most powerful anti-oxidants and anti-aging chemicals. When we don't sleep, we set ourselves up to self-destruct and physically age, much, much faster than we need to.

Take the pancreas. It's the organ that releases insulin whenever we eat and need to transport all that energy into cells.

In the presence of melatonin, researchers observed that it helps the body to better manage the way it uses insulin. There seemed to be a better response to the cascade of hormones and signals that manage blood glucose levels...and the hormones that transport that glucose to where it needs to be used.

If you think about how you feel after a night of tossing and're a little groggy and maybe slow to react to events and just "not completely with it"...consider that it's not just your head that's feeling that way. Your entire body has to work harder to be on target when it doesn't get the right amount of sleep.

And keep in mind, when your insulin is not working the way it should, your body also doesn't manage weight the way it should. Practically every client I work with has sleep issues. And they all know, because I drill it into them every time we meet, if they don't get their sleep under control, there's not a whole lot that diet and exercise are going to be able to do about weight. First things first.

Ramracheya RD, Muller DS, Squires PE, Brereton H, Sugden D, Huang GC, Amiel SA, Jones PM, Persaud SJ. Function and expression of melatonin receptors on human pancreatic islets. J Pineal Res. 2008 Apr;44(3):273-9.

Friday, May 2, 2008

Now if I could just remember where I found this article...

If I were to be able to tally the time I've spent over a lifetime looking for lost things...especially my keys...there would probably be enough time there to pursue my Ph. D in neuroscience. And I'd likely find myself in a program conducting studies like this one, which looked at how stress affects the memory center (and why mine doesn't seem to ever register "last key location" in any functional part of my neurons).

Most researchers in the area of depression agree that a characteristic biological marker of depression is an elevated level of cortisol, a stress hormone. The researchers in this study decided to see just what cortisol does to the hippocampus, the brain's memory center, both short- and long-term.

Chronic exposure to cortisol decreased the ability of the hippocampus to regenerate neurons, and the volume of existing neurons decreased. These changes could be prevented with the administration of two different antidepressants, imipramine (Tofranil), and fluoxetine (Prozac).

Short-term exposure to stress brought out "depressed" behaviors in the rats. Long-term exposure seemed to create more of an anxious presentation.

The researchers concluded that the physically damaging effects of stress could be prevented with antidepressants.

I conclude that the next time I lose my keys, if I can remember to do so, I'm going to use that as an indicator that I may be trying to do too many things in too short a time. And that I need to do something to reduce my stress level. I really don't think I need to be taking an antidepressant to prevent memory loss!

Murray F, Smith DW, Hutson PH. Chronic low dose corticosterone exposure decreased hippocampal cell proliferation, volume and induced anxiety and depression like behaviours in mice. Eur J Pharmacol. 2008 Mar 31;583(1):115-27.