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.

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. www.discoverandrecover.wordpress.com 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 www.stopeatingdisorders.com.

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!

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 her...so 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

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: http://en.wikipedia.org/wiki/Sprague_Dawley_rat

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.

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 then...to 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 turning...you'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.

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.