Can a pill really cure stress?

It used to be that when I met people, and they asked what I did for a living, that I told them I was a nutritionist. Until a few years ago, on a flight back from an eating disorder conference in Washington, DC. I had the window seat and my boss had the aisle seat. The woman in the middle appeared to be excited about her trip to Phoenix, and wanted to chat things up with the two of us. She started with me.

"Are you from Phoenix or DC?"

"I'm on my way home from a conference."

"What was the conference about?"

"Eating disorders. I work in a treatment center."

Without any closure, she physically picked herself up, turned toward my boss, and started the same conversation a second time...only to discover that it went in the exact same direction. She turned her body away from my boss and sat rigidly, staring at the back of the seat in front of her.

Airlines still served meals back then, and when the three of us received ours, I realized that the seating pattern that evening was an anorexic's worst nightmare. It was clear from the way she was manipulating her food, moving it around to look like she'd eaten more than she had, and picking as much fat off of her sandwich as she could, that this young woman had a pretty serious eating disorder.

I felt for her. I knew in the right setting, at the appropriate time, having the two of us to share perspective and compassion with could have been a gift. But not on that day.

I don't talk about eating disorders anymore unless I'm prompted to. I tell people I specialize in stress-related disease. That is, if I'm in the mood to talk. I can't get people to stop talking when they learn that this is my area of interest!

It's the exact same specialty, just a different spin. I help people who manage their stress in ways that can get them into trouble. No one wants to admit they have an eating disorder. But e-v-e-r-y-o-n-e wants a place to unload their stress!

I get to help a lot more people by focusing on the stress instead of its resulting dysfunction. Apparently the drug companies have figured this out, too. (But did you have to read this far into this blog post to figure that out---have you ever seen an ad on the evening news for a drug that successfully helps with bulimia? Erectile dysfunction--yeah, we got a pill for that. Urinary incontinence--yeah, we can help you with that. Starving yourself to death? Sorry, we're just not comfortable going there...too personal!)

It's been proposed for awhile that depression often results when the stress hormone system doesn't properly regulate itself and stress hormones are oversecreted. Scientists recently injected stress hormones into mice and then evaluated what kind of changes they observed. They discovered that stress hormones reduce the ability of the hippocampus (brain's memory center) to generate new cells, which, understandably, over time, reduced hippocampal volume. Acute exposure to stress hormones created more of a "depressed" response in these mice, while prolonged exposure seemed to elicit an "anxious" presentation.

Antidepressant medications administered at the same time the stress hormones were administered prevented these changes.

OK, but instead of waiting until stress is at a point where it's doing damage...what about reducing stress from the source? What about taking on fewer responsibilities? Setting boundaries? Prioritizing sleep? Developing a support system, especially one outside of your work connections? Picking up a hobby? Not buying into the mentality that the harder you work and the less you sleep and the more e-mails you have...the better person you are?

I'm not arguing that the meds aren't a valuable tool. But I do know that people who push themselves to the point where they need medication to undo what stress has done have been out there for a long time pushing themselves before they finally admit maybe they need to do something about it. What about all the oxidative stress and aging and other physical damage that happened on the road to Prozac? We're able to measure some of the things we can reverse with medication...but I sure hope that doesn't leave us falsely reassured that everything we did to ourselves because we didn't want to relax a little bit more can be fixed when we get to that item on our "to do" list.

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.

There's something fishy about depression treatment...

Here's the study I've been looking for. There are plenty of studies showing the effectiveness of antidepressant medications. And there are plenty of studies showing the effectiveness of fish oil in treating depression. But no one had compared the two. Until now.

In Iran, researchers compared the separate relative effectiveness of eicosapentaenoic acid (EPA), one of the chemicals commonly referred to as fish oil, and fluoxetine (Prozac). What they found was that EPA was equally as effective as fluoxetine, in an 8 week trial, in reducing symptoms of depression. The most superior outcome was found in subjects who received both EPA and fluoxetine.

If you're wanting to try this at home, as always, discuss this with your physician. The risk of using fish oil in conjunction with antidepressants is almost always outweighed by the potential benefits--however, it is not advised that you discontinue any prescription medications you are on without consulting with the prescribing party.

A word about EPA. There is a lot of confusion about what it means to use fish oil. Most products available in the grocery store that are labeled as containing "omega-3 fatty acids" actually contain ALA, a great omega-3 but not the one that has been associated with improved mental health. If you're using omega-3 eggs, or vegan (marine algae-based) omega-3's, you're getting DHA, not EPA. That primarily comes from fish. Even though you will read that there are conversions to EPA from both ALA and DHA, the efficiency of these conversions is great and likely not enough to achieve results such as were seen in this study.

If your diet is high in pro-inflammatory oils (those "S" and "C" oils you see me routinely discuss in this blog), it will be harder to get effects described in this study. You're going to need to tweak your diet in order to get the most bang for your buck. And, realistically, that means you're going to have to get rid of most processed foods and salad dressings.

But, for those individuals motivated to make these changes, the results can be profound. I see it routinely in my private counseling. It is certainly my first recommended item of action when someone is trying to reduce the number of medications they are on.

Finally, for physicians who prescribe antidepressants, this study suggests that if you do so without strong nutritional guidance as well, you're not as helpful to your patients as you have the potential to be. It's not just about pills. Your patients did not become depressed because they were antidepressant-deficient!

Jazayeri S, Tehrani-Doost M, Keshavarz SA, Hosseini M, Djazayery A, Amini H, Jalali M, Peet M. Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder. Aust N Z J Psychiatry. 2008 Mar;42(3):192-8.

Another gift from the rain forest

Here's an article I found interesting. When I review medication research a huge percentage of the off-label uses of medications are in the area of chronic pain. Catuama is a medication that appears to help with inflammatory-based pain. Unfortunately, it didn't seem to help with neuropathic pain. (That's the kind of pain diabetics get after having the disease for awhile.)

A Pub Med search found only 7 articles, and the ones I felt strong enough to share were one suggesting that Catuama also has a mild antidepressant effect and one suggesting that it may help with ventricular fibrillation.

A very huge disclaimer here...I did not see anything about interactions with other medications and I did not see anything about toxicity. That doesn't mean these are not potential risks, it mostly means research is so new this may not yet be published. So please don't mix this med with your heart medications and please don't just stop taking medications because you read this post. If you'd like to try Catuama it's a good idea to coordinate this with the person who is managing any prescription medications you may be taking.

I couldn't find a decent photo to show you what it looks like. The most I can gather is that it comes from Brazil. But if the information helps some of you...then I wanted to share it.

Have a great weekend!

Quintão NL, Ferreira J, Beirith A, Campos MM, Calixto JB. Evaluation of the effects of the herbal product Catuama in inflammatory and neuropathic models of nociception in rats. Phytomedicine. 2008 Apr;15(4):245-52.

Campos MM, Fernandes ES, Ferreira J, Bortolanza LB, Santos AR, Calixto JB.Pharmacological and neurochemical evidence for antidepressant-like effects of the herbal product Catuama. Pharmacol Biochem Behav. 2004 Aug;78(4):757-64.

Pontieri V, Neto AS, de França Camargo AF, Koike MK, Velasco IT.The herbal drug Catuama reverts and prevents ventricular fibrillation in the isolated rabbit heart. J Electrocardiol. 2007 Nov-Dec;40(6):534.e1-8. Epub 2007 Sep 24.

Watch out Lilly...here comes Lipton!

Who thought such a simple item you may already have in your cupboard could be so beneficial? I'm talking about tea!

I think if you're interested enough in health and the brain to even be reading this blog, you know that green tea has many health benefits. It's a great antioxidant, and it improves the brain's blood flow, making it easier for waste products to be flushed away from where they can do damage.

Scientists took green tea one step further in the following experiment. Mice were divided into three groups, each group receiving one of the following treatments: green tea, an antidepressant (in this case, desipramine/Norpramin), or an anti-anxiety medication (in this study, diazepam/Valium). Both low and high doses of green tea reduced depression-like behaviors within 30 minutes of administration.

Depression can slow thought processes and therefore problem solving, so these mice were put in a maze and timed for their performance. Higher doses of green tea reduced the time it took to complete the task.

One potential downside to the higher doses of green tea was that the higher doses also had somewhat of a sedative effect and reduced muscle strength and activity. The mice also were less responsive to exposures to a painful stimulus, in this case, heat.

The moral of the story appears to be that moderate doses of green tea might not be a bad thing. I'd recommend the decaffeinated version--and there are lots of great ones out there.

A green tea tip for all of you: Did you know you can cook with green tea? One of my company's sponsors, Organic Bistro, has a frozen dinner with green tea vegetables (www.theorganicbistro.com). So if you don't like to drink tea, you can sneak in some of its benefits by combining it with foods you DO enjoy.

Since it's Earth Day week, I'll slip in a little plug for thinking "outside the brain" and looking for organic brands of green tea. Here's a nice website with some options...http://greenshopper.com/product.aspx?parentId=235&childId=407

Sattayasai J, Tiamkao S, Puapairoj P. Biphasic effects of Morus alba leaves green tea extract on mice in chronic forced swimming model. Phytother Res. 2008 Apr;22(4):487-92.

HMO's and Insurance Companies...Who's In YOUR Wallet?

First of all...it's great to be back! I was traveling, and while it's kind of fun to say I saw both the Atlantic and Pacific oceans in the period of a week, I do like my base camp and I really missed reading research. I'm looking forward to getting back into my daily groove.

Last week, I read an article in the New York Times about insurance companies, and how they are starting to ask consumers to absorb the cost of medications by asking that these medications be paid for not by flat copayment, but proportionate to the cost of the medication.

Nice. First we're convinced that we absolutely need all these drugs, and that we can get them for cheap, then once we're dependent on them...we're thrown under the financial bus.

Right now, the medications that are being sold under this new proportionate plan are not any of the medications that I focus on with this blog. However...since several of the medications you readers are on, are some of the most popular medications out there, I suspect it won't be long before these insurance companies start to see dollar signs in terms of the quantity of people they can expect to help finance this venture. Categories of medications like antidepressants...and insulin sensitizers and statins, which are commonly prescribed when the antidepressants start to mess with hormone balance.

That's the bad news.

The GOOD news is, I finally felt vindicated for having sat through this scenario for the last 25 years, wishing people would see what I have always seen...that when you take responsibility for your own health, and don't depend on people who make money off of you to help you, you have a good chance of getting better results. Think about it. Why would a drug company spend millions and millions of dollars to develop a product that you eventually wouldn't need once you started using it?

My goal, ever since I started what I do, is to put myself out of business. I started learning to play golf last year and it has been very frustrating to have to put it aside to attend to the demands of my growing business. I have a children's story I'd like to publish. And there are a couple of screenplays roaming around in my head that I'd love to get into theaters.

But the drug and insurance industries don't have that goal. Their goal, as is the goal of most corporations, is to increase market share and return on investment. Which means you can (1) increase the dosages of medications you sell to already existing customers, (2) find new customers for your medications by either creating new diagnoses or finding off-label uses for your already developed products, and/or (3) increase the price you charge for the product. Hmmmmm...nowhere in there do I see "helping the patient feel better".

Of course, I'm not naive. I know some medications are entirely necessary and even life-saving. But I also see so many conditions that could drastically improve with a few judicious lifestyle choices.

Last week I listened to the husband of a friend tell me what it was like to go through an in-vitro fertilization (IVF) procedure with his wife. He was near tears as he spoke about the trauma, the callousness of the providers, the emotional stress...the expense, and the feeling of failure as a human being when the entire investment of time, emotions and money did not produce the desired result.

He drove me to the bus stop, and I headed to the airport. As I was standing in line to board my plane, a colleague phoned me. She'd gone through my professional training and had been using my protocol on women with infertility. And she told me, that with just a few nutritional tweaks, these women were getting pregnant! Not only that, their depression was responding with equal profundity. Even the women who'd failed with the same IVF procedure as my other friend and who had given up on ever having children, were seeing results.

There's something very wrong with a system that promotes a $20,000 emotional and financial (mis)adventure over a $12 bottle of Costco fish oil...but we as consumers need to shift our expectations for help from those who stand to make money off of our misfortunes and invest in choices, behaviors, and financial purchases that are empowering and affirming. You'll never get a company making money off of you to change how they do things if it means less money. But we can certainly get their attention if, collectively, we start to say "no" to some of their answers to our problems and "yes" to options that make more sense.

You bet the power of where you pull out your wallet is tremendous. And when groups of thousands of wallets get together...well, that's the vision I have that will finally get these screenplays out of my head!

Eating well. Physical activity. Adequate sleep. Less stress. It's that simple. It's incredible what prioritizing these four areas can do to your overall health. Not to mention your budget.

http://www.nytimes.com/2008/04/15/opinion/15tues1.html?hp

Some kinder, gentler options for epilepsy

Epilepsy is one of those disorders that I think we just assume is medical, and that medication and complex neurological procedures are the only options for treatment. This is where I have to disagree! A lot of epilepsy is metabolic and nutritional, and it's exciting to see colleagues researching some of these kindler, gentler options.

This particular study focused on children with mental retardation, a demographic where epilepsy is very common.

The bad news is, only 20% of these children were even given metabolic testing.

The good news is, twenty-eight percent of those children chosen in the study, who had been given metabolic testing, were shown to have some kind of metabolic abnormality. That percentage jumped to 75% when the seizures were originating from multiple locations! In 22% of the children studied, a carnitine deficiency was identified, and that was linked to their medication--valproic acid or Depakote. Carnitine is an easy to find, very practical supplement to use in situations such as this.

The researchers concluded that a systematic evaluation of mentally retardation would help to identify those who have a metabolic (and potentially treatable) component to their seizure disorder.

The good news is...if they can get the word out to other practitioners, the other 80% of those kids can also have the world of nutritional therapies opened up to them as treatment options.

Parikh S, Cohen BH, Gupta A, Lachhwani DK, Wyllie E, Kotagal P. Metabolic testing in the pediatric epilepsy unit. Pediatr Neurol. 2008 Mar;38(3):191-5.

Nuts about nuts

Hello everyone,

I'm doing a bit of cross-posting between my two blogs today, since this topic is important for both areas of interest. I'm waist deep in drug research so you'll be getting more of that information as the month progresses (and as my tax paperwork is officially en route).

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Happy Monday to all of you!

Sorry for the silence, I was in Boston for a sports nutrition conference, promoting the Nordic Naturals line of fish oils. I've been sidelined from my half marathon training with a cranky knee, and it was so nice to get off of the elliptical trainer, get outside, and walk along the Charles River to and from my hotel and the conference!

Something I was very happy to see, throughout the conference, was the emphasis on nuts in general as a healthy food. I've been frustrated for a long, long time that the walnut people seemed to be the only nut commodity board with media contacts. Not that I don't like walnuts, but there's nothing wrong with other nuts as well.

I did an analysis for an article a few years ago, in which I compared the ratios of beneficial fats (omega-3's and monounsaturated) to potentially detrimental fats (omega-6's and polyunsaturated). And when they were all lined up in terms of most beneficial to least beneficial...walnuts actually turned up at the bottom of the list. Macadamias came out on top!

I use that analysis in my trainings, and dietitians will always immediately say, "But macadamias are so high in fat." Precisely. But it's the kind of fat that keeps us healthy. Lucky for me...my very favorite way to have nuts is macadamia nuts roasted in coffee, the way they fix them in Hawaii.

Anyway...(I tend to get distracted in this blog, don't I?)...

...one of the presentations showed data for macadamias, pecans, and pistachios, suggesting that they, too, are good foods to include in an anti-inflammatory (aka pro-mental health) diet. Nuts, in addition to good fats, have a variety of antioxidants that can delay and prevent aging and help fight stress. I even learned that the green part of pistachios contains lutein, which makes them good for eye health. Who knew a food so fun to eat would also be so helpful to my health?

Of course, there's a limit to how many nuts can be healthy, and fat has calories, no matter where it comes from. But if you're reaching for a handful of pistachios instead of a bag of Fritos, it's nice to know you're also reaching for better health.

So this week...go nuts!