Topamax and kidneys...these two will probably never be BFF's

I've noticed in looking at my blog statistics that a previous entry on kidney stones resulting from topiramate (Topamax) use continues to be one of my most visited pages on this blog. So when I found more information about this medication and its effect on kidneys I wanted to be sure to share it.

Within 5 days of starting topiramate, the six subjects in this study experienced an average drop of calcium in their urine of about 31% and of citrate by about 40%. When calcium and citrate are not showing up in the urine, it's likely because it's accumulating elsewhere. Like in kidney stones.

Interestingly, increasing the topiramate dose seemed to improve calcium readings and to worsen citrate readings. Meaning you might get less of one kind of kidney stone and more of another.

The authors of this study said that the degree of reduction of urinary citrate was profound enough to be compared to the clinical presentation of renal tubular acidosis. This is a condition in which the body's pH is shifted to an unhealthy level, promoting important changes such as bone demineralization. And THIS will cause rickets in children and osteomalacia in adults. These are not things you will see or feel in those first few days. You need to measure them clinically.

I would strongly recommend, if you and your physician have concluded that the absolute only way to manage your bipolar disorder, your migraine, or your epilepsy, is with topiramate, that you closely monitor your urinary metabolites to be sure you're not doing more harm than good.

And if you're one of those souls who's been convinced that it might be nice to try topiramate to see if it helps you lose weight, consider that you might not just be
losing fat, you might also be losing bone. What's the point of being thin if you have to be sick when you get there?

The only way to know is to monitor. Please don't stick your head in the sand and hope it's not happening to you.

Warner BW, LaGrange CA, Tucker T, Bensalem-Owen M, Pais VM Jr. Induction of progressive profound hypocitraturia with increasing doses of topiramate. Urology. 2008 Jul;72(1):29-32; discussion 32-3.



I found a photo of a kidney stone on the 'net. Imagine trying how it feels to pass something this big through an opening about as big as a piece of cooked pasta. Now you know why I'm trying to get your attention!

This topic hit home for me and because of that I want to pass along a very important warning

Hello everyone,

Last night I attended a memorial service for a neighbor. A month ago she committed suicide, in a very violent fashion. Most of us were dumbfounded, as this neighbor, to all of us, was a healer, kind, loving, always smiling. What most of us did not know, until last night, as her daughter spoke, was that our friend struggled with bipolar disorder. She had been on many different medications, and apparently had a rotation going of different medications. The issue seemed to be that she would develop a tolerance to one regime, so she would rotate through different cocktails as one set lost its effect.

Apparently, on her own, she decided to wean herself off the medications. No supervision from her doctor.

I wonder if this is how she got herself into trouble.

I do my best in this blog to stay neutral, and let you, the readers, decide if medication is for you, or if you'd rather choose an alternative option. I still feel that way.

However, what I do want to insist on, after this personal experience, is that if you are on medications, that you do not manage the use of these medications, or even alternative options, on your own. Whether it's in a bottle or from a plant or a food, when you use chemicals to alter your brain chemistry, you alter your brain chemistry. Once the compound is in your body, regardless of its origin, you really don't have any control over where, when, and how this compound is going to work.

Please do not operate on the assumption that because you are "getting off meds", that what you are doing is safe. It can be, but only if done correctly. Please do not assume that because what you are taking is organic and/or was not sold to you by a pharmaceutical company, that you're in good hands. You may...or you may not be.

It can be very hard to reach out for help when the problem you have is a mental health issue. I lived just yards from this neighbor, she knew what I did for a living, and never once did she ask me for any information. But the important thing to remember about a mental health issue is that it affects how you think, reason, feel, and act. Even if you feel that you're in control, it's always important to have at least one human sounding board to depend on when making decisions affecting how your brain functions.

I don't want any of you to ever think I said anything to encourage you to endanger yourself. If I present new information that you think might be helpful, please download it and share it with your provider. Don't act on it alone. I want all of you to be around as long as I can come up with new and helpful information to post on this blog.

Fifty Ways to Boost Your Energy Without Caffeine

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

http://noedb.org/library/features/50_ways_to_boost_your_energy_without_caffeine

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.

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.

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.

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, Ozşahin 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.

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"...you'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.

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!

Saying No to Psychotropic Drugs

By-line:

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.

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 phones...you'll love this video:

http://www.koreus.com/video/telephone-portable-mais-popcorn.html

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:

restlessness
mood swings
irritability
difficulty falling asleep or staying asleep
uncontrollable shaking of a part of the body
dizziness
headache
dry mouth
stomach pain
nausea
vomiting
loss of appetite
weight loss
fever
fast or pounding heartbeat
chest pain
shortness of breath
fainting
seizures
hallucinating (seeing things or hearing voices that do not exist)
aggression
frenzied, abnormally excited mood
seizures
tics
blisters
rash

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.

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a607047.html

Antidepressants and weight gain

For anyone looking for a list of antidepressants and weight gain, I have a summary chart on my website: http://afterthediet.com/antidepressant_medications.htm

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!

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 it...you'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.

Some help for skin problems

About a week ago I was visiting an addictions treatment center and something that really struck me was the severity of skin issues I saw in many of the residents. Part of that may be due to poor nutrition, part to stress, and part as a result of drug use itself.

In any case, there's a great website I found with information on healthy skin care that I thought would be of interest to some of you reading this blog. I'll post the information as a permanent link, but if you are interested now, the name is http://www.highonhealth.org.

Cigarettes and coffee for breakfast...why it's so easy to get stuck in that rut

My teaching assistant today comes from Star Wars. He is here with me, because I have lost track of the number of times, when trying to do a serious presentation about neurotransmitters, I have said, "R2D2" when I meant to say "DRD2". I will have to check the Universal Diagnostic and Statistical Manual to see if I meet the criteria for Intergalactical Dyslexia...

What R2D2 and I would like to tell you about his almost-namesake today, the DRD2 receptor, is that this subset of dopamine receptors is sensitive to how we eat. DRD2 is responsible for impulse control. People who have a disturbed DRD2 system are more prone to problems such as shoplifting, gambling, alcohol addiction, nicotine addiction, and binge eating. They also seem to have more intensive carbohydrate cravings.

Scientists recently reported that this receptor is especially sensitive to food restriction. That is, people who restrict their food intake seem to be more sensitive to the reinforcing effects (the effects that make you feel good and want to use) of several addictive substances, including opiates, nicotine, and psychostimulants.

(That is why R2D2 is a little wired today; he was running late and drank his coffee but skipped breakfast to be sure we got this posted.)

This particular study suggests that the same effect can be provoked when restricting food and using dopamine-promoting medications such as pramipexole (Mirapex). For anyone taking medications for Parkinson's disease or restless legs syndrome, this could be important information to discuss with a nutritionist.

One of the enhanced responses with food restriction is locomotion. And that makes me think of people who abuse some of these chemicals. They stimulate themselves, which suppresses their appetite, which enhances their stimulation and increases their physical activity. On an ongoing basis, (and people who abuse drugs tend to not only use them just once) that can create a calorie deficit which reinforces the positive effects of the drug use. And that can reinforce staying addicted.

Even if you're not using illicit drugs, maybe not eating and living on cigarettes and coffee is kind an offbeat, roundabout way to jumpstart the dopamine system into motion. I have had many, many clients who tell me they feel addicted to sugar, and when they simply don't eat it they feel better. Maybe this is one of the reasons for that relationship.

Just a little fun fact on this Friday that will hopefully give you something to think about.

R2D2 and I are now going to eat breakfast.

Collins GT, Calinski DM, Newman AH, Grundt P, Woods JH. Food restriction alters N'-propyl-4,5,6,7-tetrahydrobenzothiazole-2,6-diamine dihydrochloride (pramipexole)-induced yawning, hypothermia, and locomotor activity in rats: evidence for sensitization of dopamine D2 receptor-mediated effects. J Pharmacol Exp Ther. 2008 May;325(2):691-7.

Great video on why we need omega-3 fats

http://www.youtube.com/watch?v=eIgNpsbvcVM

I'll let Susan take credit for today's lesson. :)

When you play with antipsychotics, you play with fire.

Antipsychotic medications have worked wonders to enhance the lives of many people. However, in recent years, antipsychotics have also been used for an increasing number of off-label uses and in progressively younger populations than they ever were before. Before handing these medications out like they are candy, it's important to evaluate the risks associated with using these medications. A recent study suggested that we should be much more careful about choosing our treatment populations than we have been to date.

Before I get to the meat of the study, I'd like to preface this post with an explanation of the study design. The authors of this study are concerned about safety risks in young children and pregnant women when they are given antipsychotic medications. However, they had to develop a research model that did not place young children and pregnant women at risk in the process of looking into this issue. So...rather than give antipsychotics to these two populations, they chose to administer a battery of antipsychotics to a group of roundworms. Roundworms were chosen because they are an accepted research model for investigating matters related to brain and nervous system development. That is definitely a limitation of the study, as most people I know would not say they have much in common with this guy...but that's one of the tough things about studying medications and their risks...how to investigate those risks without causing more damage.

Anyway...when the roundworms were given three of these medications, clozapine (Clozaril), fluphenazine (Prolixin), and haloperidol (Haldol), there was less development of neurons in general and axons (a specific anatomical feature of a neuron) in neurons devoted to mechanosensory function (that's touching and registering what you're touching). Neurons that were produced also tended to not migrate to the location where they would be expected to migrate, meaning there might have been neurons there, but they were, so to speak, all dressed up with no place to go.

In some neurons, axons grew past their functional anatomical size. And some had abnormal anatomical features.

Other antipsychotics produced similar results, although not to as significant a degree. The drugs mentioned included: risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), trifluoperazine (Stelazine) and olanzapine (Zyprexa).

I'm not going to pontificate about the ethical dilemma encountered when treating a pregnant woman with schizophrenia. The choices made in those situations involve complex risk/benefit considerations that are the responsibility of the patient and her physician.

However, I will say that responsible use of these medications in women of childbearing age is imperative. Forty-nine percent of all pregnancies ending in childbirth in 1994 were unintended, and 48% of all women aged 15-44 in 1994 had had at least one unintended pregnancy at some point in their life. It happens, and it happens a lot.

So if you're a physician and you're handing out prescriptions for antipsychotics for off-label uses to women of childbearing age...no matter how much judgment, education, evaluation, etc. you think you're providing, you really are playing with fire.




Donohoe DR, Weeks K, Aamodt EJ, Dwyer DS. Antipsychotic drugs alter neuronal development including ALM neuroblast migration and PLM axonal outgrowth in Caenorhabditis elegans. Int J Dev Neurosci. 2008 May-Jun;26(3-4):371-80.

http://www.guttmacher.org/pubs/journals/3002498.html

Who is the real addict?

Friday I participated in a meeting at a chemical dependency treatment center. This is a place where people have been medicating their problems with stimulants and who are learning to use communication, conflict resolution, and coping skills to ride through life's challenges so that life does not defeat them. One of the biggest problems in this population is stimulant use, in the form of methamphetamine.

The message this and other treatment centers are working hard to encourage...is that when you listen to your body, it will tell you if you need to sleep, eat, address a conflict, or participate in a relaxing activity to help ride through situations that cannot be immediately addressed. When you push through feelings and ignore what they're telling you, you can push yourself to a point so low that it becomes tempting to use chemicals to pull out of the situation.

Today, I was reviewing research and ran across an abstract that completely contradicts this point of view. This article discusses the "potential" for treating CFS with neurostimulants, such as bupropion (Wellbutrin), dextroamphetamine (Dexedrine), and methylphenidate (Ritalin, Concerta).

No wonder treatment centers abound. The drug industry is advocating throwing stimulants at problems that very well may best respond to intensive self-care. I'm not trying to say that chronic fatigue is not a genuine problem. I just wonder where the logic is in trying to blast a person out of a fatigued state that may be telling us something very important about the person's overall health, their lifestyle choices, and the way they deal with stress.

It's no wonder our many public service attempts at reducing illicit drug use fall on deaf ears. The message seems to be that if you can figure out a way to present your problem to the doctor in a way that fits with an "official" medical problem, you can legally buy a way out of your problem. If you're less savvy, or don't have access to a doctor who is open to such creative thinking, you can still get the job done. It just might land you in jail at some point down the road.

An addict is an addict, whether legally managed or scoring treatment off the street.

Valdizán Usón JR, Idiazábal Alecha MA. Diagnostic and treatment challenges of chronic fatigue syndrome: role of immediate-release methylphenidate. Expert Rev Neurother. 2008 Jun;8(6):917-27.

For women with epilepsy--get the facts straight before you worry

Here's an interesting abstract. I post it partly for the important medical information it provides but also to comment on the interesting editorial twist that may affect how readers interpret the information.

The subjects: women with epilepsy and the children they bore.
The question: whether epilepsy affects the development of those children. (As quoted by the authors of the study, "We aimed to ascertain the prevalence of cardiac malformation (CM) and its association with antenatal exposure to an antiepileptic drug (AED) in infants of mothers with epilepsy.")

At 3 months of age, 462 babies born to mothers with epilepsy were examined by a cardiologist to see if they had at least one of several heart defects: atrial septal defect, tetrology of Fallot, patent ductus arteriosus, pulmonic stenosis, ventricular septal defect, tricuspid regurgitation, and transposition of great arteries. Possible correlations between the existence of these defects and any of the following were evaluated: mother's epilepsy history, use of antiepileptic medications in the first trimester of pregnancy, mother's age, seizure frequency during pregnancy, and folate supplementation.

There were a few significant relationships. Prematurely born children were more likely to have heart defects. Use of more than one medication was also a significant contributing factor. And there was a trend, though not significant, for children whose mothers who had used valproic acid (Depakote) to have heart defects. No relationships to mother's age, epilepsy history, seizure frequency, or folate usage were noted.

So even though there were only three identified contributing factors, two of which involved antiepileptic medications, the authors were allowed to title their publication in a way that somewhat masked this relationship. It also, for someone skimming research abstracts, could lead to an impression that epilepsy itself, and not the way in which epilepsy is treated, is the problem.

I am a diligent scientist and try to get the facts straight before I put anything on this blog, or in anything I write. But anyone reading this blog knows that all you have to do is turn on the evening news and see how vague headlines become top news stories and "facts" are generated without any meat behind them.

It's simply not fair to generalize to all mothers with epilepsy. There were an awful lot of babies in this study who did not have heart defects, 426 to be exact. That's a lot of unnecessary fear to be putting out there for women with epilepsy. Of course, the take home message is that women of childbearing age may not be the most appropriate candidates for valproic acid, but somehow that got lost in the analysis.

Thomas SV, Ajaykumar B, Sindhu K, Francis E, Namboodiri N, Sivasankaran S, Tharakan JA, Sarma PS. Cardiac malformations are increased in infants of mothers with epilepsy. Pediatr Cardiol. 2008 May;29(3):604-8.