Weight change in Parkinson and Alzheimer patients taking atypical antipsychotic drugs.

As much trouble as I have with indiscriminate use of antipsychotic medications, I do think they have important uses in certain situations, and that we have to be very careful about overgeneralizing their negative aspects.

For example, these medications are increasingly being used to help control side effects in some serious illnesses such as Parkinson's disease and Alzheimer's disease. In some cases, especially when not managing these side effects can make things hard to manage for these individuals' caregivers (who are often family in a home situation), it is important to balance considerations about overall quality of care, caregiver sanity and health, and weight. Each situation is different, and there are no easy answers.

Sixty-one Parkinson's patients on either quetiapine (Seroquel) or clozapine (Clozaril) for at least six months were compared to 28 Alzheimer's patients in similar situations. The weight changes, though small, were statistically significant. Parkinson's patients trended toward weight loss compared to controls, and Alzheimer's patients trended toward weight gain.

It may not be that these medications cause weight changes in one direction or the other...but rather, they foster metabolism moving in a direction that genetic tendency long ago pre-programmed. It is important to not be afraid of a medication that can help ease the life of the caregiver. Of course, judicious use and close monitoring are always the caveats that go with any medication decision. Alzheimer's patients seem to be prone to developing diabetes and that should not be ignored.

I was glad to see this study attempt to parse out exactly what these medications do and why. That's a great use of scientific minds.

Sitburana O, Rountree S, Ondo WG. Weight change in Parkinson and Alzheimer patients taking atypical antipsychotic drugs. J Neurol Sci. 2008 Sep 15;272(1-2):77-82. Epub 2008 Jun 16.

Smoking reduces serum levels of lamotrigine.

If you smoke, and you are using seizure medications, take notice--smoking was shown in a recent study to reduce blood levels of lamotrigine (Lamictal). That means that, in order for the medication to be effective in a smoker, you need more of it.

The obvious solution here...is to quit smoking. You'll save money on cigarettes as well as medication. Hopefully at some level any smokers reading this will file this information into their "reasons to quit" pile and eventually think about doing so!

Reinsberger C, Dorn T, Krämer G. Smoking reduces serum levels of lamotrigine. Seizure. 2008 Oct;17(7):651-3.

Television, epilepsy, and children

When I first read the title to this abstract I knew I had to use it in the blog. Here scientists have determined that television exposure can cause epilepsy in some children...and instead of working to minimize exposure to the trigger, they're looking for a pill that allows the child to continue the behavior causing the problem.

I could tell you what medication was found to be most effective, but that would make me part of the problem. If you're a parent who knows your kid's brain doesn't tolerate television...get rid of the television and teach him how to otherwise spend his free time! Here's a concept, interact with him like parents used to do in the old days.

That's kind of how we do things anymore, isn't it?

We know too much food can cause weight gain, but rather than stop eating...we spend billions of dollars looking for ways to allow us to, quite literally, have our cake and eat it too.

We know we need a minimum amount of sleep in order to properly function. But in this day and age of 24 hour schedules, a whole new pharmaceutical specialty has sprung up, medications that drive wakefulness in people who simply need to make more time for sleep.

Instead of suggesting to the parents of these children that they might best be encouraged to learn to play the piano, play a sport, or, God forbid...READ...we want to figure out how to medicate the kids so they stay on our revenue-generating map.

I give up. But what I would like to request, if we're going to encourage studies like this one and call it science, is that we at least make the study designs interesting for the reader.

I mean, if kids who probably shouldn't be watching television are allowed to watch television anyway because they're another important profit niche for certain drug manufacturers, wouldn't it be more important to know whether Sesame Street or Spongebob Squarepants is more effective at creating seizures? Seems to me that kind of information could be really important when it comes to marketing plans. Not just for the drug companies but all those companies who love to use those programs to sell junk to kids, who need to hold on to their audience.

The best part is going to be when Bert and Ernie are called to testify in court. Now THAT will be television worth watching.

Etemadifar M, Raoufi M, Maghzi AH, Ebrahimi A, Kaji-Esfahani M, Mousavi SA. Television-provoked epilepsy in children: a follow-up survey from isfahan, iran. Arch Iran Med. 2008 Nov;11(6):649-53.

Your brain loves lipoic acid!

I'm primarily a food first, supplements second kind of person. However, lipoic acid is a supplement I love to recommend. It's not something that you can readily find in food, but it does a whole lot of good, especially in the brain.

It can delay and prevent Alzheimer's disease, and dementia, in a variety of ways. It helps to increase acetylcholine levels. Acetylcholine is the neurotransmitter in charge of memory function. It helps to bind free radicals, preventing them from doing damage. It prevents the formation of proteins associated with inflammation.

Not a bad friend, is it?

The amount given in the two studies evaluating lipoic acid's effect on the brain was 600 mg per day.

Lipoic acid is also unique in that it has the ability to make other antioxidants more powerful. The authors of the article reviewed here suggested that in combination with curcumin, EGCG (active ingredient in green tea), and DHA (in fish oil and marine algae), lipoic acid could be a very powerful warrior in the fight against degenerative brain disease.

Hmmmm...anyone for some fish curry, with a green tea chaser?

Maczurek A, Hager K, Kenklies M, Sharman M, Martins R, Engel J, Carlson DA, Münch G. Lipoic acid as an anti-inflammatory and neuroprotective treatment for Alzheimer's disease. Adv Drug Deliv Rev. 2008 Oct-Nov;60(13-14):1463-70. Epub 2008 Jul 4.

Folic acid and brain health--don't forget it!

As my last post discussed, depression is not just about mood. It's about the integrity of neurons and the systems that support them. One very strong connection that research is increasingly supporting, is the link between depression and inflammation. Inflammatory markers commonly used to identify heart disease, such as homocysteine, are being correlated as well with depression.

Here, 27 subjects were divided into two groups. One group was given fluoxetine (Prozac) and folic acid, while the other was given fluoxetine and placebo. (Folic acid was given because it has been shown to help prevent elevated homocysteine.) Another 15 subjects were given nothing at all, for a basis of comparison.

As happens in cardiovascular studies using folate as an intervention, plasma homocysteine levels dropped with folate supplementation. The interesting finding, however, was that when subjects took the Hamilton Depression Rating Score, those who had received the folate showed greater improvement than those who only received the fluoxetine. There was no significant difference in serotonin levels, so the researchers concluded that folate was not affecting the mechanism by which fluoxetine works.

So the bottom line seems to be...you can't just fix depression with a pill. How you take care of yourself (i.e., how you choose to eat) can be a crucial factor in whether or not your brain works at its absolute best.

If you want to add more folate to your diet, here are your best food choices: fortified breakfast cereal, whole wheat products, meat, beans, liver, eggs, sunflower seeds, asparagus, leafy green vegetables, oranges, strawberries, melons.

Resler G, Lavie R, Campos J, Mata S, Urbina M, García A, Apitz R, Lima L. Effect of folic acid combined with fluoxetine in patients with major depression on plasma homocysteine and vitamin B12, and serotonin levels in lymphocytes. Neuroimmunomodulation. 2008;15(3):145-52. Epub 2008 Aug 21.

Aging brains and medicine

How medications work at different points in life can be a very important consideration. I see many, many studies looking at the viability of antidepressant therapy in the elderly. Recently there seems to be a flurry of research looking at how to medicate (note I did not use the word "treat") depression when it occurs as a comorbidity with diagnoses such as stroke or Alzheimer's disease.

In this study, the naturalistic finding was that as rats (and probably humans, too) age, the rate at which they are able to generate new neurons declines. The survival rate of those new cells starts to deteriorate as well.

The good news is that the response to fluoxetine (Prozac) was the same across the board.

The bad news is, that in none of the groups, even the young rats who had a better ability to make new neurons, did fluoxetine enhance that ability.

Hmmm...is it just me, or does it make sense that if a medication is going to work, it needs some brain cells to work on?

Cowen DS, Takase LF, Fornal CA, Jacobs BL. Age-dependent decline in hippocampal neurogenesis is not altered by chronic treatment with fluoxetine. Brain Res. 2008 Sep 4;1228:14-9. Epub 2008 Jun 24.

Sneak peek at new drug booklet

Here is a sample page from the newly released booklet, This Is Your Brain On Psych Drugs. You can order this booklet by clicking here.

This study gives new meaning to the term, "mama's boy"...

Several years ago I was diagnosed with uterine fibroids. For all of my medical knowledge and connections, I was very distressed to learn that the treatments for this very common gynecological condition seemed to be very crude and invasive. There really wasn't much research into gentle, natural, or nutritional solutions. Every physician I spoke to just wanted to give me a hysterectomy, despite my young age. Some couldn't figure out why I wouldn't consent, given the fact I was not going to have children and my uterus was, therefore, essentially useless and unnecessary.

When I shared my situation with another female friend, she immediately said, "Well, if it was men who got fibroids on THEIR reproductive organs, you can guarantee there would be a gazillion dollars devoted to researching any possible way to treat them without removing the affected body part!"

Ever since, when I see some kind of gender inequity in medicine, I think of that conversation and remind myself that, unfortunately, sometimes men have to hurt in a unique and most unexpected place in order for them to think more creatively about how they treat women, personally and clinically.

This study is about depression and not fibroids, but it makes my point. Something I find very frustrating with my work in polycystic ovary syndrome is the reluctance on the part of some endocrinologists who treat the disorder to acknowledge the extreme anxiety, depression, and mood swings this disorder promotes. Even though 85% of the over 1,000 women who answered a survey on my website reported at least one of these problems, there are physicians who will flat out say depression is not part of the disorder. Or, rather than trying to understand what may be driving the depression, they simply write a script for an antidepressant.

Well...here's what might happen if you treat depression so superficially. Female rats were treated, throughout pregnancy and lactation, with fluoxetine (Prozac). Later on, the sexual behavior of their male offspring was observed. They appeared to have less incentive to participate in sexual activity. This lack of libido wasn't coming from any measurable, explainable change in hormones, these guys just didn't seem to want any.

With all due respect, knowing that fish oil/omega-3 fatty acids are a great option for depression as well as promoting libido, this kind of problem simply shouldn't be something we have to encounter or research. Except to identify and define precisely why we shouldn't be encountering or researching it.

Oh! And if you're male and you're feeling a little uncomfortable while reading this, you've just experienced what every woman in history has felt when she was told she had to have a hysterectomy that may have been unnecessary. Welcome to the world of medicine without compassion.

Gouvêa TS, Morimoto HK, de Faria MJ, Moreira EG, Gerardin DC. Maternal exposure to the antidepressant fluoxetine impairs sexual motivation in adult male mice. Pharmacol Biochem Behav. 2008 Sep;90(3):416-9. Epub 2008 Apr 4.

Be sure to vote! No one knows what's best for you but YOU.

"Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania."

Bipolar disorder, to me, is a fascinating disorder. It seems to affect some very intelligent and creative people, and that, I believe, is precisely why it is so hard to treat. The manic episodes it can produce can be part of the thrill of having the disorder. I've had more than one client who accepted medical treatment for bipolar disorder complain that the medication took away the "edge". People started to ask if anything was wrong. We kind of like manic people for their charisma, for the creative performances, work output, etc., that they give us. And, because mania is a natural kind of high, giving it up can be somewhat of a chemical straight jacket.

However, bipolar disorder is also neurodegenerative. Meaning if it progresses unchecked, all that extra brain energy that's requiring oxidation of glucose to fuel all those charismatic neurons is also creating a process that's not unlike a "rusting out" of the brain. So, if we want to preserve the creativity and contributions of people born with this kind of hardwiring, we have to work harder to understand the hardwiring, and develop medications that don't leave people feeling zombied. Plus, we have to encourage lifestyle choices that promote longevity.

One of the worst risk factors, it appears, (in other words, a group of people we now know we have to work extra hard to learn how to help), is people with bipolar disorder who smoke. In this study, what was found was that the subjects who smoked did not respond as well to the medications they were given.

What is really interesting about this study, is that the medications tested happened to be antipsychotics that have been found to be helpful in some cases of bipolar disorder. No traditional mood stabilizers, such as lithium, were used. I wish that had been included in this study, because this study may not be saying that bipolar smokers have worse treatment outcomes, as much as it says when a patient is diagnosed with bipolar disorder who smokes, they may do better with a different category of medication.

Our patients depend on us to be diligent with scientific process and not let our bias interfere with their well-being.

Berk M, Ng F, Wang WV, Tohen M, Lubman DI, Vieta E, Dodd S. Going up in smoke: tobacco smoking is associated with worse treatment outcomes in mania. J Affect Disord. 2008 Sep;110(1-2):126-34. Epub 2008 Feb 15.

New booklet: This Is Your Brain On Psych Drugs

As this blog grows, it is harder to read in a logical, stepwise fashion. So, I've taken the information from the most commonly read posts and compiled a 26 page booklet that summarizes this information.

If you'd like ordering information, it is available at this link.

I was prompted to do this by seeing the information be so widely read, and so to those of you who have done this, thank you so much for the inspiration!

Which came first? Who's on first? Medications and weight gain

As I mentioned in a recent post, olanzapine (Zyprexa) is strongly correlated with weight gain. It's no ordinary kind of weight gain, it's the kind that is associated with hyperlipidemia, diabetes, and even diabetic ketoacidosis. Because of this, it is a popular drug for researchers to study, with regards to its nutritional and metabolic implications. My own fact sheet lists almost 300 references with regard to these interactions.

Now, researchers are starting to look at whether or not certain genetic profiles are more likely to induce weight gain when using this drug. And it turns out, how the leptin gene is expressed may be significantly affecting how a person responds to this medication. Leptin is a hormone that helps to regulate body weight, metabolism, and even reproductive function.

What is interesting is that as I read the research, there are also studies coming out suggesting that the people who best respond to some of these medications may also be the ones who experience the most weight gain when using them. And the whammy there is that the people who experience the most weight gain when using the drugs, are the ones most likely to have low compliance with regard to using them. A medical "Who's on first?" dilemma.

It's fascinating that the brain, weight, and metabolism are all so intricately linked. It certainly means there will be plenty of information for me to blog about, way into the future.

I very much look forward to that!

Srivastava V, Deshpande SN, Nimgaonkar VL, Lerer B, Thelma B. Genetic correlates of olanzapine-induced weight gain in schizophrenia subjects from north India: role of metabolic pathway genes. Pharmacogenomics. 2008 Aug;9(8):1055-68.

Kuzman MR, Medved V, Bozina N, Hotujac L, Sain I, Bilusic H. The influence of 5-HT(2C) and MDR1 genetic polymorphisms on antipsychotic-induced weight gain in female schizophrenic patients. Psychiatry Res. 2008 Sep 30;160(3):308-15. Epub 2008 Aug 20.

A Chinese herb with antidepressant activity

I love Chinese medicine and think there is a lot of potential with its options to treat conditions Western medicine simply doesn't manage very well. It's challenging to share this specialty in an evidence-based blog like this one, because much of the research that is reported, uses terminology that is not meaningful to a Western-trained practitioner like myself. So I was grateful that this group of Chinese researchers took the time to study an aspect of their practice, as well as report on it, in a way that is meaningful and potentially useful to their Western colleagues and friends.

These researchers investigated the activity of xiaobuxin-tang (XBXT), which is a traditional Chinese herb that has been used as an antidepressant in China for centuries. Previously, these researchers discovered that XBXT improves the serotonin balance as well as the behavior of chronically stressed rats with depression. In this particular study, the researchers demonstrated that XBXT stimulates neuron development in the hippocampus, the brain's memory center. (Hippocampal neurons tend to degenerate and die in the throes of depression.) Levels of compounds associated with neuron formation, such as brain-derived neurotropic factor (BDNF), were also increased in the presence of XBXT.

The overall activity of XBXT was compared to that of the antidepressant imipramine.

This little guy here felt so good on XBXT he's still celebrating eight months into the year of the rat!

An L, Zhang YZ, Yu NJ, Liu XM, Zhao N, Yuan L, Chen HX, Li YF. The total flavonoids extracted from Xiaobuxin-Tang up-regulate the decreased hippocampal neurogenesis and neurotrophic molecules expression in chronically stressed rats. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Aug 1;32(6):1484-90.

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!