Wednesday, July 30, 2008

Fifty Ways to Boost Your Energy Without Caffeine

Here's a great piece by Christina Laun at the Nursing Online Education Database:

I am continually concerned about the number of people I'm seeing on sleep medications who have never been given information about natural options. This article is a great place to get you started thinking.

Monday, July 28, 2008

Lamotrigine may cause cleft palate

It is very important for women of childbearing age to know how medications they may be on might affect the health of their children. I've posted the statistics before regarding the percentage of births resulting from unintended pregnancies, so this warning goes out to ALL women, not just those intentionally trying to conceive.

In this case, the issue is Lamictal (lamotrigine). I work a lot with polycystic ovary syndrome. This is a medication often used with women needing anticonvulsants because it is one of the few in that category that does not seem to wreak havoc on the management of that syndrome. So the population I work with the most is especially sensitive to the risk I describe here.

The medical records of 684 women who had taken lamotrigine during pregnancy were reviewed for the incidence of birth defects. These results were compared to trends in children born to women who had not taken this medication during their pregnancy. The incidence of cleft palate-type birth defects was 10.4 times greater in the lamotrigine-exposed infants than it was in the non-exposed infants. The exposure noted to be most important was that which occurred in the first trimester of pregnancy.

Just be aware, if you're female and there is any chance at all that you might conceive, that you would benefit from working closely with any physician prescribing you any medication at all, for any reason, to be sure there is no unconsidered risk lurking beneath the issue being focused on with the writing of a prescription.

Holmes LB, Baldwin EJ, Smith CR, Habecker E, Glassman L, Wong SL, Wyszynski DF. Increased frequency of isolated cleft palate in infants exposed to lamotrigine during pregnancy. Neurology. 2008 May 27;70(22 Pt 2):2152-8. Epub 2008 Apr 30.

Saturday, July 26, 2008

Life-threatening constipation associated with clozaril

This one is short, and sweet, and there is no need for me to paraphrase what the authors report. The one thing I will point out is that even in combination with a laxative, clozapine was not productive in this case. Persons taking clozaril may not be the best historians or the most assertive regarding medication complications and side effects, so it is important to be thorough from evaluation all the way through treatment in order to prevent problems.

OBJECTIVE: The aim of this paper was to describe the association of clozapine with life-threatening constipation. METHOD: Case report. RESULTS: A 53-year-old man presented to the emergency department with severe abdominal pain and bilious vomiting after being on clozapine for over a year for schizoaffective disorder. Surgery revealed severe faecal impaction in the large and small bowel. Clozapine was ceased. There were significant difficulties in the subsequent psychiatric management. Clozapine was gradually reintroduced with concurrent laxative administration, which resulted in another episode of severe constipation with faecal impaction. CONCLUSIONS: Clozapine can be associated with potentially life-threatening constipation. Psychiatrists, especially consultation liaison psychiatrists, physicians, surgeons and radiologists, should be aware of the seriousness of clozapine-induced constipation and its potentially fatal complications.

Rege S, Lafferty T. Life-threatening constipation associated with clozapine. Australas Psychiatry. 2008 Jun;16(3):216-9.

Wednesday, July 23, 2008

Mixing old and new to create something better

I've got friends on both sides of the medication issue reading this blog. Some are vehemently anti-medication, while others are suspicious of natural alternatives. My desire is to make this as balanced a blog as possible, and fair to both sides. Maybe that's the Libra in me...maybe it's just that I think there are positive and negative aspects of each approach, and there are safety issues with each approach. It's not so important WHAT treatment is used, as it is WHY and HOW.

I really like this study because it integrates both schools of treatment in a promising way.

Two of the medications I write a lot about, olanzapine (Zyprexa) and clozapine (Clozaril), are notorious for their effects on blood lipids, weight gain, and diabetes risk. I'm not a big fan of either, but I do know because I work with a very skilled psychiatrist in town who completely supports my nutritional and complementary suggestions, that there are simply some people who need the medication in order to be safe to self and others. And because of that, they are simply at risk of metabolic syndrome-related side effects. I am always looking for ways that high-risk-of-side-effects medications can be used in combination with therapies that minimize the actual dose that needs to be used.

Gingko biloba is primarily recognized for its use in preserving memory. However, it was also recently tested on 42 patients with refractory schizophrenia who were maintained on stable doses of clozapine. A dose of 120 mg per day helped to reduce the negative symptoms of schizophrenia. It did not, however, reduce psychopathology symptoms.

So what's the point of taking it if it didn't reduce the medication need? I have read study after study after study over the years and it is clear, people stop taking medications when they don't like the side effects. If you can help push the balance of effects of a medication over to the positive, you might just increase compliance. And compliance to a medication regime means, potentially, better quality of life.

Who would have thought that beautiful tree with the funny shaped leaves had such a great little secret in its biochemistry?

Doruk A, Uzun O, Oz┼čahin A. A placebo-controlled study of extract of ginkgo biloba added to clozapine in patients with treatment-resistant schizophrenia. Int Clin Psychopharmacol. 2008 Jul;23(4):223-7.

Monday, July 21, 2008

Do you need medication...or do you need to de-clutter?

We are a sleepless nation. Practically every client I have counseled over the past 6 months has complained of fatigue and some type of disturbed sleep pattern. There is a lot of money, in other words, for whoever can figure out how to put the "zzzzzz's" back into the average American's life.

One group of researchers was hopeful that atomoxetine, (Strattera), a drug approved for attention deficit-hyperactivity disorder, would do the trick. What the researchers found was that this medication helped to decrease the sleepiness related to poor sleep, but it didn't improve the metabolic parameters associated with sleep disorders.

I think an important take away message here is that, like it or not, we need to sleep, and we suffer without it.

Years ago, I was the nutritionist for Apple Computers at their headquarters in Cupertino, California. Clients used to come in to see me about their weight gain, and invariably they'd tell me about the 128 hour work week they'd just completed, or the 3 hour one way commute to work, or the jaunt to Tokyo then Sydney and back to Cupertino in time to report to the boss on Monday morning. And then they wondered why they felt so horrible, why their concentration wasn't what it used to be, and why they were gaining weight.

You can't just put a bandaid on sleepiness and assume that it makes things better. You get sleepy for a reason. Melatonin levels rise when it's time to do some internal housecleaning. If you've been busy, stressed, thinking, etc., etc., etc, you've been oxidizing brain cells. You need melatonin to clear out the clutter. If you don't give your brain that melatonin one-on-one time...the things the brain can do when it's not cluttered with stress remnants, just can't get done.

Think of how long it takes to get a simple task done when you walk into your office and there are piles of papers everywhere. You have to sort through everything, clean out a work space, think about what you're going to do...and you spend a lot of extra time digging through the piles to find the papers you need to do what you need to do.

Your brain is no different. If you let the hormonal housemaid come in and organize things for you, your hormones function, you can actually be in a good mood, you can finish tasks more quickly, and you can be more creative.

So don't think of being sleepy as something annoying that you need to fix with a "fix"'re not feeling sleepy because you're caffeine deficient or running low on Red Bull. You're sleepy because your brain's trying to tell you to log off of life for a few hours and refresh.

Bart Sangal R, Sangal JM, Thorp K. Atomoxetine improves sleepiness and global severity of illness but not the respiratory disturbance index in mild to moderate obstructive sleep apnea with sleepiness. Sleep Med. 2008 Jul;9(5):506-10. Epub 2007 Sep 27.

Tuesday, July 15, 2008

Sometimes it's what you CAN'T see that you should be paying attention to

I've been in this field for many years. Back when I started, and was learning about diabetes, I was taught that the best way to measure whether or not a diabetic had good blood glucose control, was to monitor blood glucose. When records looked good, we assumed all was good. Diabetics knew better. They often manipulated their diet and knew how to eat around the readings, and could straighten out a few days before a doctor's appointment with healthy readings.

These days, the glycosylated hemoglobin test is considered a more accurate assessment. It can give the practitioner an idea of what goes on, on average, all of the time. And people who are not compliant between doctor visits can't manipulate the science behind how the test does its job.

What I've learned from this, is that sometimes, even though things look good on the surface, there are problems underneath. And we should never assume that there are no problems just because we can't see them.

Enter epilepsy.

It has been known for quite awhile that certain antiepileptic medications can deplete the body of carnitine, a nutrient that is needed for healthy weight maintenance and to protect the brain against aging. In fact, older studies recommend supplementing carnitine in persons on medications such as valproic acid (Depakote) in order to minimize problems associated with carnitine deficiency.

Researchers recently compared carnitine levels in children on three other medications (vigabatrin or Sabril*, lamotrigine or Lamictal, and topiramate or Topamax). Clinically the only group with significantly lower carnitine levels were those on valproic acid.

If the conclusion of this study was that carnitine levels were not compromised by the other three medications, that would have been logical. However, the researchers also stated that because there were no apparent symptoms related to carnitine deficiency, that doing anything about it may not be necessary.

I happen to have spent the last few months going through several hundred pages of abstracts on carnitine, and with all due respect, I must disagree. I've got dozens of papers suggesting that carnitine is important to protect the brain against oxidation; in fact, it's been proposed by numerous researchers to be a potentially important agent in the fight against Alzheimer's disease.

With all the research I'm having to wade through, I cannot believe that it is not standard practice to recommend carnitine supplementation to anyone receiving valproic acid for any reason. My list of references is very, very long and I'm only up to the year 1992. If you happen to be reading this and would like me to spend another post detailing these references when I am finished, I would be happy to do so. Simply reply to this post so I know you'd like the information.

Just because we can't see everything happening in the brain...doesn't mean we shouldn't be doing anything about the things that we do know and can do something about.

Zelnik N, Isler N, Goez H, Shiffer M, David M, Shahar E. Vigabatrin, lamotrigine, topiramate and serum carnitine levels. Pediatr Neurol. 2008 Jul;39(1):18-21.

*Sabril is sold in Canada.

Hello and an update

My posting has been somewhat erratic and for that I apologize. Sometimes life throws us curve balls that need to be honored. In this case...the curve ball was Norm.

I met Norm through my volunteer work in the cattery at the Arizona Animal Welfare League. All spring I've been seeing cats we've rescued from homes abandoned due to foreclosure. Every single one of these cases has been horribly sad...but I wasn't sure what simple me could do about it. Then I met Norm. Norm was left in a home here in Phoenix on June 1--no air conditioning, no food, only toilet water. Someone finally found him in that home on June 26, about as close to death as any living being can get and still breathe. He was so weak, he could not even stand on his own. He's needed two surgeries because his dehydration was so bad his intestines started to stick to each other and cause blockages that prevented him from keeping food down.

I was so upset when I learned of this case I couldn't sleep. I looked online and learned that in my county alone, there are currently over 30,000 foreclosed homes. All I could think about was how many other animals were out there in need of rescue? I didn't care about the overwhelming number. I just cared that someone try to do something.

Then, out of the blue, I found a small link online about a group of real estate professionals who had started a 501(c)(3) organization designed to rescue animals in just these kinds of situations. Long story short, I am now on the board and we're completely focused on lining up foster homes and donations so we can start to do the difficult work of rounding up animals who need us.

If you're interested in helping or donating, our website is soon to go live. You'll find it if you go to Lost Our Home Pet Foundation. In the meantime, you can send donations to 8105 E. Rita Drive, Scottsdale, AZ, or call Jodi Polanski at 480-688-7899 if you have a home to open as a foster.

And Norm? Well, he's been with us for about 3 weeks now, and the clinic staff say when he's completely renourished he's going to weigh about 10 pounds. Right now, after food and IV for 3 weeks, he's only just over 5 pounds. That gives you an idea of just how sick he was when he came into our lives. The main issue right now is that Norm is so playful he's not sitting still the way he ideally would in order to gain all that weight back. But the important thing is, his spirit is back, alive and well, and he's inspired a whole lot of people to step up and work together to prevent such future tragedies.

Now I can get back to the work of posting more information on this blog!

Saturday, July 12, 2008

Saying No to Psychotropic Drugs


This post was contributed by Heather Johnson, who writes on the subject of online lpn schools. She invites your feedback at heatherjohnson2323 at gmail dot com.

Saying No to Psychotropic Drugs

Depression can happen to even the hardiest of us, depending on the circumstances we’re in. While most of us bounce back to normalcy in a short period of time, others have a harder time of coping, and are often labeled by society as mentally ill and prescribed psychotropic drugs by doctors in the psychiatric field. These drugs often do more harm than good, and have come under harsh criticism as being promoted indiscriminately by psychiatrists to fill the coffers of the drug manufacturers.

The side-effects of psychotropic drugs:

In the last five years, more than 60 warnings have been issued by international drug regulatory agencies about the medical side-effects that arise when psychotropic drugs are used, especially by those under the age of 18 – suicidal tendencies, increased hostility, diabetes, heart problems, strokes, depression, anxiety, disinterest, hallucinations, mood and personality swings, sleep disorders, delusions, lack of concentration, increased heart rate, confusion, increased nocturnal urination, agitation, irritability, mania, tissue damage, imbalance of hormones, diminished sex drive, nightmares and trembling to name just a few.

Can we treat depression without psychotropic drugs?

The answer to the above question is yes, we can. By:

• Treating the cause and not the symptoms: A good physician is able to treat depression as well as if not better than a psychiatrist by identifying the underlying cause behind the feeling of intense sadness and negative emotions, and providing relevant treatment. Often the cause of depression is a sudden trauma, loss of a loved one or just loneliness.
• Checking general medical health first: A thorough medical examination often reveals that most patients suffer depression as a side effect of a greater problem, such as intense headaches and other pains caused by tumors or other chronic diseases and conditions. Treating those diseases will often solve the problem.
• Examining the drugs and antibiotics the patient is on: Some antidepressant pills cause depression while prolonged usage of antibiotics causes a weakening of the immune system leading to fatigue and anxiety disorders. Eliminating these drugs from the patient’s medication routine in a systematic and proper manner helps in the treatment of depression.
• Checking the food habits of the patient: Foods that are low in good fatty acids and rich in complex carbohydrates often cause depression. Children with attention deficit hyperactivity disorder (for which psychotropic drugs are normally prescribed) are usually found to be on a diet low in fatty acids and iron and high in sugar. Some foods cause allergies which in turn cause depression.
• Checking for conditions: Some conditions like extremely low blood sugar levels, thyroid problems and adrenal fatigue cause depression. Treating these conditions rids the patient of the somber mood.
• Following a pattern of good health: Eating healthy and nutritious food, getting enough physical exercise and sleeping well is often enough to treat depression at times. A mild sedative may be prescribed if sleep is elusive at first.

Very often, we find that mental healing is effectively accomplished with a combination of patience, tolerance and kindness. Trained medical personnel need to be committed to the patient’s well-being instead of immediately resorting to drugs or treatment by shock and incarceration.

A word of warning: It is not safe to stop psychotropic drugs abruptly without medical supervision or advice; the associated risks include side-effects and withdrawal symptoms.

Wednesday, July 9, 2008

More on cell phones--update

I am moving this post up with an update--it was a very unfunny hoax created by the Bluetooth people. I apologize for inadvertently passing it along as truth.

If you liked my recent post on cell'll love this video:

Monday, July 7, 2008

Maybe you shouldn't try this at home

Lisdexamfetamine (Vyvanse) is a relatively new drug. Literature on this medication began to appear in Pub Med about a year ago. It is classified as a "prodrug," which means that it is taken in an inactive form, which then becomes active in the body.

According to the first reviews written about lisdexamfetamine, it supposedly has less abuse potential than dextroamphetamine (Dexedrine, and in combination with other compounds, Adderall), two other medications popular for treating attention deficit-hyperactivity disorder.

However, that doesn't mean toxicity is not an issue. In the words of the researchers themselves, this is what happened when lisdexamfetamine was given to a group of rats:

In an acute study, LDX doses of 60 mg/kg and higher caused increased motor activity. At 1000 mg/kg, one rat died and another was euthanized. In a 7-day repeat-dose study, all rats dosed with LDX (14 per dose group for each sex) showed increased activity; 10 male rats and 11 female rats at 300 mg/kg/day and 3 female rats at 100 mg/kg/day were euthanized because of self-mutilation and 1 male rat at 300 mg/kg/day was found dead. In a 28-day study, only rats at 80 mg/kg showed signs of self-mutilation and thin body condition. In both the 7- and 28-day studies, LDX caused significant changes in some blood chemistry parameters (e.g. blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase) and organ weights (e.g. particularly heart, liver, brain, and spleen).

Self-mutilation is absolutely not a benign or neutral side effect.

"...the apparent lethal dose of LDX in rats is more than five times higher than the LD(50) of orally administered d-amphetamine, supporting a putative protective effect of conjugating amphetamine with lysine."

OK, whew! Apparently since rats were less self-destructive on this medication than they were on dextroamphetamine, they were good to go with the marketing!

Now, an article is showing up in Pub Med with the following title:

Poison Centers Detect an Unexpectedly Frequent Number of Adverse Drug Reactions to Lisdexamfetamine.

And the first sentence of MedLine Plus fact sheet on this medication is, "Lisdexamfetamine can be habit-forming." This about a medication that is supposedly designed to reduce abuse potential!

I cannot access the article online, but as soon as I can get the text, I'll be sure to share it.

Because of the toxicity issue, I want to post known side effects, as listed on MedLine Plus' fact sheet. If you experience any of these, consult your prescribing physician immediately:

mood swings
difficulty falling asleep or staying asleep
uncontrollable shaking of a part of the body
dry mouth
stomach pain
loss of appetite
weight loss
fast or pounding heartbeat
chest pain
shortness of breath
hallucinating (seeing things or hearing voices that do not exist)
frenzied, abnormally excited mood

I am having a hard time with a medication that was supposed to be a kindler, gentler form of a very potent--and popular--medication having some seemingly serious problems that for some reason...are just buried in the literature.

Faraone SV, Upadhyaya HP. The effect of stimulant treatment for ADHD on later substance abuse and the potential for medication misuse, abuse, and diversion. J Clin Psychiatry. 2007 Nov;68(11):e28.

Blick SK, Keating GM. Lisdexamfetamine. Paediatr Drugs. 2007;9(2):129-35; discussion 136-8.

Biederman J, Krishnan S, Zhang Y, McGough JJ, Findling RL. Efficacy and tolerability of lisdexamfetamine dimesylate (NRP-104) in children with attention-deficit/hyperactivity disorder: a phase III, multicenter, randomized, double-blind, forced-dose, parallel-group study. Clin Ther. 2007 Mar;29(3):450-63.

Krishnan S, Montcrief S. Toxicity profile of lisdexamfetamine dimesylate in three independent rat toxicology studies. Basic Clin Pharmacol Toxicol. 2007 Oct;101(4):231-40.

Spiller HA, Griffith JRK, Anderson DL, Weber JA, Aleguas A. Poison Centers Detect an Unexpectedly Frequent Number of Adverse Drug Reactions to Lisdexamfetamine. Ann Pharmacother. 2008 Jul 1.

Friday, July 4, 2008

Antidepressants and weight gain

For anyone looking for a list of antidepressants and weight gain, I have a summary chart on my website:

This listing is an excerpt from my CD, Nutritional Implications of Psychotropic Medications, a collection of fact sheets on the neuroendocrine and nutritional considerations of 59 different medications and over the counter supplements used for brain and nervous system conditions. Antidepressants are just one category.

I'll keep the link on the blog for anyone wanting it in the future.

Happy Fourth!

Wednesday, July 2, 2008

Zzzzzzzzzzap that snoring!

Snoring is one of those things we do that we tend to laugh at, but which is important not to ignore. Snoring not only impairs the sleep of the person who does it, but that of the poor loved one who tries to sleep in the same bed with a snorer.

Today's post is devoted to snorers, and their loved ones...especially my loved ones who have patiently tolerated my snoring. I promise...I'm working on it! :)

(Since I am a guilty party, I wanted a photo of a couple in which the woman was the snorer, but there appears to be a clipart gender bias when it comes to this issue. Trust me, women snore too, and when we do it ain't a dainty thang!)

One of the primary reasons people snore is because they have obstructive sleep apnea (OSA). This is a condition in which, due to certain sleep postures, the airway is obstructed during the night, cutting off oxygen supply. At multiple intervals during the night, air supply is completely cut off...snoring is the result of trying to breathe through an impaired airway. One of the more common cures for this type of snoring is a CPAP (continuous positive airway pressure) machine, fashioned after the oxygen masks used by fighter pilots. It works, but honestly, sleep docs, it's really not the most amorous solution if you're working on behalf of both people affected by this problem.

Often times the culprit in OSA is excess weight. Obesity can force new and different sleeping positions that challenge healthy breathing during sleep. People who don't sleep well can easily fall into a habit of living on caffeine and sugar for energy during the day, which can worsen the cycle of poor sleep and weight problems. Before you know're backed into a corner!

My programs all stress the importance of good sleep hygiene, in other words, making sure that most of what you do in the evenings is about signaling to your brain that sleep is coming...and then quieting your environment in order to promote that actually happening. Even little things such as changing into casual clothing, sitting in a reading chair, having a cup of chamomile tea, avoiding violent television shows and movies, minimizing alcohol intake, and avoiding intense exercise...can all help promote healthy sleep.

A very important issue to keep in mind is that with OSA, part of the problem is oxidative stress. In other words, little things you're doing that stress the brain promote degeneration of the cells in the brain that help to regulate breathing. It's not all about your weight or your habits.

Nutritionally, eating more fruits and vegetables and fewer simple carbohydrates (sweets and refined breads/pastas) can be very good anti-oxidative strategies. So can increasing your intake of omega-3 fatty acids and decreasing your intake of omega-6 fatty acids.

Recently, some researchers reported that the sleep aid melatonin may also be helpful.

What they found in rats that had been exposed to hypoxic conditions was that indices of inflammation started to show up. Brain cells started to die. And the brain, ironically, started making less of the enzymes needed to make antioxidants. When melatonin was provided, cell death was completely prevented, there were fewer inflammatory markers to measure, and antioxidant production increased.

There are two important things this study tells us. (1) When our sleep is impaired, and we're not producing enough of our own melatonin, we have potentially created an environment that gradually kills brain cells. As annoying as snoring is, the problem is about a whole lot more and it needs to be addressed. (2) Melatonin supplements can help correct the imbalance that caused the problem.

Just a footnote, I've had many clients tell me they started taking melatonin and when it didn't help them sleep...they stopped. The authors in this study did not seem to care whether or not melatonin produced sleepy rats. They focused on and reported cellular changes. These can occur whether or not you feel sleepy the first few times you try melatonin. If snoring is an issue for you, consider trying melatonin and being consistent with its use, whether or not it's immediately improving your sleep quality.

Hung MW, Tipoe GL, Poon AM, Reiter RJ, Fung ML. Protective effect of melatonin against hippocampal injury of rats with intermittent hypoxia. J Pineal Res. 2008 Mar;44(2):214-21.