My new alternative to medication

I know a lot of you are coming to this blog looking for information about your medication. I wanted to share with you my experience last night that got me thinking about therapy and medication.

I have a friend who has been inviting me to join her in tango class. My interest in this dance started a few years ago when I took a Spanish class at the local community college and I had to do an oral report on Argentina. It's become my goal to get down there someday, and in the meantime to learn to tango so I can have more fun when I get there.

So I finally went to the class last night. It was so...much...fun!!! A big part of the dance is not so much the choreography as it is letting loose and just experiencing the music. In fact, a big portion of the class we were assigned by the instructor to just close our eyes and "feel" the music.

I have learned from learning other styles of partner dance, that it is impossible to participate if you bring any kind of control issues to the floor. Dance is all about partnership. Listening to your partner's unspoken communication, and working with that energy to create beautiful movements. Tango is no different. You have to listen to the music, sense your partner's energy, and within all of that input, together, spontaneously express yourselves in a compatible way as you move across the floor.

If you have any self-consciousness whatsoever, you ruin the flow. One partner I tried to dance with was so caught up with what I was doing wrong and what I needed to correct so that his experience would improve that I found myself not even trying to work with him. With others, things just flowed.

The lesson flew by, and way too soon, it was time to go. My friend and I lingered in the parking lot and I told her it seemed that couples who took the time to learn to dance together would probably have better relationships. Because everything that you have to do on the dance floor to succeed, is everything you need to do in life to succeed. It's a lot of give and take, losing a sense of who's right and who's wrong...and about just being yourself. Tango, as are other dances, is completely about knowing how much to let another person into your space and where boundaries need to be defined. That's pretty much what life is about, too.

Isn't that what therapy is about? Not that counseling doesn't have its place, but sometimes you just have to stop talking about how you want to live your life...and just do it.

Hopefully one of these days I will be posting a photo of myself from Buenos Aires, rose in my teeth, tangoing the Argentinian night away!

Mental health and the presidency

Several years ago a teenage client of mine had her first manic episode in the middle of her school day. Her behavior was bizarre enough that most people thought she was high on meth. I ended up intervening, getting her to the hospital, insisting on a urine test which I knew would be negative, and eventually getting her the proper diagnosis and help.

Most people I know who would be diagnosed with bipolar disorder would be angry, they'd be paralyzed, they wouldn't accept the diagnosis. And they would go around for the rest of their lives, not managing the diagnosis, and likely as a result, not realizing their full potential.

Not this teen. She showed up at her next appointment with a list of names. She decided to do an Internet search to see if any famous people had been diagnosed with bipolar disorder. On her list were some remarkable names, including Abraham Lincoln and Winston Churchhill. She said to me, "I decided that if Abraham Lincoln can be bipolar and do incredible things....so can I."

And that is what this remarkable woman has done ever since her diagnosis.

Her exercise intrigued me, and I've since become interested in reading biographies of American Presidents, not so much to learn the facts of the eras in which they led, but to learn more about their personalities. I began to see that many of them, in the documents and legacies they left, left some great clues for us regarding their personalities and mental functioning.

I recently surfed the Internet to see if anyone else had written about this, and learned that a few years ago, some researchers at Duke University actually did. They propose that about half of our presidents have actually had diagnosable mental disorders, if you use the criteria in the Diagnostic and Statistical Manual of Mental Disorders. The incidence cited is about what is found in the general population, so mental illness is not anything more common or rarer in our country's leaders.

Some of the examples they provide:

Ulysses S. Grant struggled with social phobia and alcohol abuse. This combination makes sense, since if you have trouble being around people and your job has a lot of people wanting to be around you...you're going to need some self-soothing at the end of a long day.
Howard Taft had sleep apnea and often fell asleep in meetings. Sleep apnea is correlated with depression.
Abraham Lincoln is thought to have been bipolar. One account I read said his depressive bouts were so severe he would not even allow himself to carry a pocket knife.
Franklin Pierce witnessed the violent death of his son in a railway accident just before he assumed office, and he suffered from symptoms indicating depression or post-traumatic stress during his term. The study noted that his associates described Pierce of being a different person than the one who had energetically campaigned for office.
Richard Nixon abused alcohol.
Calvin Coolidge reportedly had social phobia, and experienced depression after his son died
Thomas Jefferson's behavior was consistent with social phobia.
Theodore Roosevelt and Lyndon Johnson both are believed to have had bipolar disorder. (I read both their bios last summer and was struck with (1) the amount that Roosevelt accomplished during his term and (2) the extreme behavior that Johnson was allowed to act out in such a prominent position. It was like no one knew what to do with him, and he intimidated his way all the way up to the top. Just this week Johnson's bio was on PBS. If you're interested in this topic, get a hold of a copy. It's fascinating to watch his contemporaries describe his energy, his complexity, and his mood swings in the detail they did without ever using the words "manic" or "bipolar")
John Quincy Adams had clinical depression. (I recently read this bio and throughout, his writings reflected a despair that he was not accomplishing much with his life.)
Rutherford B. Hayes, James Garfield , and Dwight D. Eisenhower all appear to have had depression.
Franklin Pierce did, too, along with alcohol issues.
Woodrow Wilson lived with generalized anxiety disorder.
Ronald Reagan had Alzheimer's disease, which may have started to manifest during his service.

Contemporaries of several of these men even expressed, likely in observing behaviors related to these conditions, early on, that they may never achieve anything noteworthy in their lives.

MY COMMENTS

1. Wow! My client is part of a distinguished list of people who proved themselves to be very important to our country and our heritage. I love to use this list with clients who have not had the courage to admit their diagnosis, for fear of being stigmatized. Having a mental health diagnosis is clearly not about lacking intelligence or capability to achieve great and wonderful things. And it's important to note, mental health diagnoses do not discriminate. They reach across those party lines and affect individuals regardless of their political bent.

2. I wasn't surprised to find this article. When I worked in a treatment center there seemed to be a disproportionate percentage of our population coming from what I used to call the "Big P" professions: Performers, Politicians, Psychologists (and related therapists and social workers), and Preachers (people in ministry-related work). I can't tell you why it played out that way, except for maybe the first two categories are people who use public attention as a way to convince themselves they're really ok and a way to distract from inner turmoil...and the latter as people who seek out professions looking for answers they haven't yet found. I won't get a Nobel Prize for that theory, and honestly, I'm just surmising.

And for anyone reading this who works in one of the "Big P" professions, please take my observation as a compliment. The most intelligent, creative, inspiring people I know are my clients. I think these variations on cognitive function are what drive our inventions, our art, our newest and greatest ideas. It's when we stigmatize people who have them and make them feel something is wrong with them that we prevent them from achieving their true potential.

3. I must qualify before saying anything here, I'm seriously considering not voting for President for the first time ever since I've voted. I'm simply not enthusiastic about either option this time around...so this is not at all a hint at my political leaning. But what I must say is that it distresses me very much that the party that supposedly is mental health-friendly seems to think it is ok as part of campaign strategy to needle the other party's candidate because he is "hot-headed".

I see the same personality, but coming from someone who was a POW, my first inclination is to think it's likely part of some understandable post-traumatic stress disorder. I don't think that someone who has PTSD and isn't managing it appropriately should be given responsibilities that his level of cognitive functioning are not able to manage. However, neither do I think it is responsible, especially if you call yourself mental health-friendly, to bully someone and then use the resulting response as a weakness to capitalize on for personal gain. Especially not when respecting and taking better care of veterans, a whole host of which are returning from Iraq with PTSD, is a prominent campaign issue.

I'm not sure I want to know what our country would be like had Thomas Jefferson and Theodore Roosevelt not served us, and therefore, I choose to refrain from jumping to the gun about anyone's mental state and fitness for a job I certainly wouldn't want to have myself.

As it is clearly illustrated in this Duke article, having a mental health diagnosis does not preclude one from greatness. Having a mental health diagnosis and not appropriately managing it, or treating someone as if they are a lesser person for having one...are the problems we'd be best to work at solving.


Davidson JR, Connor KM, Swartz M. Mental illness in U.S. Presidents between 1776 and 1974: a review of biographical sources. J Nerv Ment Dis. 2006 Jan;194(1):47-51.

Oh, the tangled web we weave, when science we manipulate in order for profits to achieve...

Oh, this story just won't go away.

Years ago, when olanzapine (Zyprexa) was fairly new to the market, my colleagues started commenting that they noticed huge weight gains (like 40-50 pounds) in short time intervals (like a month). No matter where we attempted to get information, Lilly, this drug's manufacturer, insisted that this drug did not increase weight gain.

I had the opportunity to meet one of Lilly's lead marketing guys at a national conference. We exchanged cards and when I got home I emailed him with a proposal that the team of nutritionists I was training in the area of psychotropic medications and hormone imbalances, work with Lilly to create a diabetes management educational program targeted specifically at psychiatrists, who were not specialized in this area but who appeared to need support in order to use these new medications in safe and appropriate ways.

I received an email in return, carbon copied to quite a few people at Lilly, stating that "weight gain on our medication is an unscientific rumor". (I now call this correspondence my "60 Minutes E-mail").

It wasn't 6 months before Lilly was required to put a black box warning on this very medication regarding its potential to cause diabetes. Apparently the timing of my original email struck a raw nerve.

What really bothered me about this whole situation was at the very time Lilly was insisting that that this drug did not cause weight gain, they were marketing it to eating disorder specialists as a treatment option for anorexia nervosa.

Yes, you heard me correctly. Lilly apparently wanted us to believe that the drug doesn't cause weight gain if you use it in people who don't want to gain weight, but it is very effective in causing weight gain in people who desperately need to gain weight.

Fast forward to last Friday. I'm scanning new research abstracts in Pub Med and right next to each other I see these two titles:

Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial.

Olanzapine (LY170053, 2-methyl-4-(4-methyl-1-piperazinyl)-10H-thieno[2,3-b][1,5] benzodiazepine), but not the novel atypical antipsychotic ST2472 (9-piperazin-1-ylpyrrolo[2,1-b][1,3]benzothiazepine), chronic administration induces weight gain, hyperphagia, and metabolic dysregulation in mice.

There is also, in Pub Med, research to suggest that this medication may trigger binge eating disorder.

So apparently, the newest, quickest way to cure anorexia is to replace it with another eating disorder. Never mind that it creates hormone imbalances that are strongly documented and have mandated a warning be placed on this drug.

I thought when we helped people with anorexia, they were supposed to be healthy in all respects. Not just normal weight with a risk of developing diabetes. Which, by the way, is starting to be associated with Alzheimer's disease.

Insert huge, frustrated, sigh...

Bissada H, Tasca GA, Barber AM, Bradwejn J. Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2008 Oct;165(10):1281-8. Epub 2008 Jun 16.

Coccurello R, Caprioli A, Conti R, Ghirardi O, Borsini F, Carminati P, Moles A. Olanzapine (LY170053, 2-methyl-4-(4-methyl-1-piperazinyl)-10H-thieno[2,3-b][1,5] benzodiazepine), but not the novel atypical antipsychotic ST2472 (9-piperazin-1-ylpyrrolo[2,1-b][1,3]benzothiazepine), chronic administration induces weight gain, hyperphagia, and metabolic dysregulation in mice. J Pharmacol Exp Ther. 2008 Sep;326(3):905-11. Epub 2008 Jun 20.

Theisen FM, Linden A, König IR, Martin M, Remschmidt H, Hebebrand J. Spectrum of binge eating symptomatology in patients treated with clozapine and olanzapine. J Neural Transm. 2003 Jan;110(1):111-21.

Gebhardt S, Haberhausen M, Krieg JC, Remschmidt H, Heinzel-Gutenbrunner M, Hebebrand J, Theisen FM. Clozapine/olanzapine-induced recurrence or deterioration of binge eating-related eating disorders. J Neural Transm. 2007;114(8):1091-5. Epub 2007 Mar 20.

Kluge M, Schuld A, Himmerich H, Dalal M, Schacht A, Wehmeier PM, Hinze-Selch D, Kraus T, Dittmann RW, Pollmächer T. Clozapine and olanzapine are associated with food craving and binge eating: results from a randomized double-blind study. J Clin Psychopharmacol. 2007 Dec;27(6):662-6.

Do we really need to do this kind of stuff in the name of science?

I read scientific research an average of 2 hours a day. I see some pretty strange things. Today I encountered the horrible.

Mexican scientists interested in whether or not melatonin could lessen the damaging effects of a caustic burn, induced such a burn in the esophagi (plural for esophagus) of rats. Their rationale was that caustic ingestion (you know, things like drinking Liquid Plumr) is a serious life-threatening event in children.

I don't understand why, since melatonin is a naturally occurring substance, they couldn't just do the research using children who had already, accidentally, ingested something caustic? Since the purpose of the research is supposedly to help these children, wouldn't the research be best conducted on the population it is intended to help?

This is just cruel. I almost didn't post this because I didn't want to reward this kind of sadistic thinking by giving it attention. But at some point you just have to stand up and say, "That's just wrong."

Oh, by the way, the melatonin worked. So while these guys were busy in their lab burning rat throats in order to get a publication, Mexican children who could have benefited from being subjects in the study...sat in the hospital with burnt throats and no melatonin to help them. Go figure.

Larios-Arceo F, Ortiz GG, Huerta M, Leal-Cortés C, Saldaña JA, Bitzer-Quintero OK, Rodríguez-Reynoso S. Protective effects of melatonin against caustic esophageal burn injury in rats. J Pineal Res. 2008 Sep;45(2):219-23. Epub 2008 Mar 26.

Monkeys with no memories and the marijuana munchies

Endocannabinoids are chemicals we make that are important in many functions, including cognitive thought, and memory. When our internal endocannabinoid levels are low, we also start to crave sugar. (THC, the active ingredient in marijuana, is also a cannabinoid, and using it messes with our cannabinoid system, giving us the munchies).

In this study, endocannabinoid levels were evaluated in the prefrontal cortex area of 23 pairs of brain cadavers of people with schizophrenia and normal age and gender matched comparisons. Messenger RNA levels for endocannabinoid production were lower in the schizophrenic brains.

Eighteen brains of macaque monkeys who had been exposed long-term to one of two antipsychotics, haloperidol (Haldol) or olanzapine (Zyprexa), were compared to brains that had never been exposed to these medications. There was no significant difference in their endocannabinoid levels. So even though the medication was helping some aspect of the schizophrenia, it was not correcting the endocannabinoid imbalance.

That might provide one reason why it might be hard for schizophrenics to stay compliant with their medication--they're not being given a medication that helps their brains remember to take it.

As a nutritionist, I also see an important "next study". Knowing that omega-3 fatty acids DO improve cognition and memory, I wonder what would happen if that supplementation was added to the protocol?

It also explains why these clients have such an appetite for sweets, and the kind of foods that further degrade the brain. It's coming from a pretty entrenched biological mechanism.

Eggan SM, Hashimoto T, Lewis DA. Reduced cortical cannabinoid 1 receptor messenger RNA and protein expression in schizophrenia. Arch Gen Psychiatry. 2008 Jul;65(7):772-84.

OK, I managed to keep a straight face until now, which I wanted to do since schizophrenia is an entirely serious topic and people with the disease deserve my respect. Completely. But do you know how hard it was to word this study without using the distracting phrase "monkey brain"? I figured this guy must have been a subject, given his predilection for popsicles.

Fish and dementia

I've talked a lot about how fish develops brain power. It also helps you hang onto the brain power you have! In a French study, 1214 seniors without dementia were followed for 4 years. During that time, 65 of them developed dementia. It was found that the higher the person's eicosapentaenoic acid (EPA) level, the lower the risk of dementia. Factors that could have explained this trend that were factored out included: age, education, diabetes, and vitamin E levels. EPA appeared to be a more significant determinant in this population than did the "other" fish oil, docosahexaenoic acid, or DHA.

When individuals also had depression, it appears as total fatty acid ratios also became important. High ratios of the omega-6 fatty acids to omega-3 fatty acids were also important in risk determination.

One thing to take away from this study: Omega-3's are important for preserving brain integrity. Secondly, balancing the right kind of fats and limiting the potentially destructive ones (omega-6's, if you've been reading this blog that means the "S" and "C" oils), is important for managing mood and preventing depression.

Samieri C, Féart C, Letenneur L, Dartigues JF, Pérès K, Auriacombe S, Peuchant E, Delcourt C, Barberger-Gateau P. Low plasma eicosapentaenoic acid and depressive symptomatology are independent predictors of dementia risk. Am J Clin Nutr. 2008 Sep;88(3):714-21.

Trans fat information

Yes, I've been a little quiet lately. I've been traveling, and also ramping up to re-launch my newsletter, After the Diet. This next issue is about food policy, which I really want to get out before the election.

Don't fret, I did my best to be nonpartisan! The goal was mainly to illustrate how the things we believe about food and the foods that show up in our food supply are related to deals cut on Capitol Hill. I do my best to stay right down the middle. My obligation is to help anyone who can benefit from my expertise, since diabetes, infertility, depression, you name it, affect Democrats, Republicans, Libertarians, and Independents.

It matters not to me HOW you vote, it matters THAT you vote, and that when you do, your vote is informed.

So I researched some issues related to foods and put them together in a newsletter.

The graphic you see is a handout, included in that newsletter, that I developed on trans-fats, since they've recently been making a lot of news and I see clients misusing this information since they don't understand it.

If you're interested in any of the following:
--why wild salmon isn't really wild
--why the United States sued Mexico to import high-fructose corn syrup
--how flooding in Iowa may be raising the price of shrimp
--why catfish is not so easy to find in your grocery store
--what food-related legislation was actually co-sponsored by (!) John McCain and
John Kerry
--what FDA warning is potentially reducing the IQ of babies
--what one simple change Americans could make to collectively save $18,630,000,000
then you might be interested in subscribing to my newsletter.

I'm already working on the next edition, which will cover the following topics:

Melatonin: The Ultimate Antioxidant?

Dietary Aspects of Melatonin Balance

Sleep, Weight, Insulin Resistance, and Aging

Why Do Pilots Have Shortened Lifespans?

Is It Attention Deficit Disorder? Or Is It Sleep Deprivation?

It's a really fun publication and I'd love to have you subscribe!

I promise, once I get this issue out, there's lots and lots to blog about.

Stay tuned!