I coulda had a V8--er--fish oil pill

There's a part of me that knows that as long as science continues to do things the way it does things, I have journalistic job security.

But the heart inside me really wishes they'd get it so I could trash this blog and head for an isolated Costa Rican beach until I find another pressing issue to blog about.

What I mean by "getting it" is that the reason we're so sick as a culture is not because we're not taking enough medicine, or that we haven't created the perfect medicine. It's because the perfect medicine is sitting right under our noses and we refuse to acknowledge it because it won't give the people who make money off of people being sick...a patent or a respectable profit margin.

Someone who sees things the same way finally got his words into a peer-reviewed journal.

He reports that you can reduce the incidence of heart attack if you get people to take, in combination,
a statin medication,
three different blood pressure medications,
a folic acid supplement, and
an aspirin.

This brave new concoction has been called the "polypill". Yikes! It doesn't take long even for someone who hates math to figure out how many people THAT marketing...um..."treatment" approach employs.

In the words of the author delivering this breaking news,

Unlike the proposed "polypill", EFAs are endogenous molecules present in almost all tissues, have no significant or few side effects, can be taken orally for long periods of time even by pregnant women, lactating mothers, and infants, children, and adults; and have been known to reduce the incidence cardiovascular diseases including stroke.

I propose that a rational combination of omega-3 and omega-6 fatty acids and the co-factors that are necessary for their appropriate action/metabolism is as beneficial as that of the combined use of a statin, thiazide, a beta blocker, and an angiotensin converting enzyme (ACE) inhibitor, folic acid, and aspirin. Furthermore, appropriate combination of omega-3 and omega-6 fatty acids may even show additional benefits in the form of protection from depression, schizophrenia, Alzheimer's disease, and enhances cognitive function; and serve as endogenous anti-inflammatory molecules; and could be administered from childhood for life long.

Sigh...wonder how many pharmaceutical company trash cans that brilliant idea ended up in?

Fortunately, you can decide if you want to support your own health with this idea. It is available over the counter. It's totally up to you.

Das UN. Essential fatty acids and their metabolites could function as endogenous HMG-CoA reductase and ACE enzyme inhibitors, anti-arrhythmic, anti-hypertensive, anti-atherosclerotic, anti-inflammatory, cytoprotective, and cardioprotective molecules. Lipids Health Dis. 2008 Oct 15;7:37.

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.