We made a top 50 list!

Wow, it's been awhile since I posted...I've been busy with another blog. I look forward to more regular posting here soon!

In the meantime, I just received word that we received inclusion in a "top 50" list of dietitian blogs. I consider that a wonderful compliment, given the number of blogs out there focusing on nutrition.

If you'd like to read and learn more about our colleagues, here is the link to the list:

http://radiologytechnicianschools.net/top-50-dietician-blogs/

Omega-3's in a Powder: You Saw It Here First

Hello everyone,

Just wanted to share an article you may have seen on MS-NBC.

The main ingredient in our sponsor's Omega-3 Brain Booster is the Ocean Nutrition product featured in this article. If you'd like to try it, you will receive a 10% discount on your first purchase if you click this link and use the coupon code "neuron" when you order.

I was thrilled to see this article and to know we'd brought this information to all of you long before MS-NBC had even heard of it!

What Stresses You Most--Your Weight Or The Economy?

This request comes from good friend Marsha Hudnall, up in beautiful Vermont.

If you have a moment and some inclination take the survey and share with friends/colleagues/whatever.

**********************************************************************************
We're trying to get as many responses to our survey as possible, and one way to do that is to get other blogs to mention it. Would you consider asking your readers to take the survey, or sending it to people you know?

What creates the most stress for you -- your weight or the economy? Please take our survey.

Thanks!
Marsha

Marsha Hudnall, MS, RD, CD
Director
Green Mountain at Fox Run
a women's retreat for healthy living without dieting
www.fitwoman.com
www.aweightlifted.blogs.com
http://twitter.com/MarshaHudnall

In honor of National Registered Dietitian Day

Today, my post is devoted to a special project promoting registered dietitians. I am cohosting, with dietitian Renata Mangrum, the first-ever Registered Dietitian blogfest, aimed at showcasing to the Internet-surfing public the many things dietitians do and can do to help you with your quest for help. Listed below my entry is a list of links to other blogs written by other dietitians that you can visit to see the many things my friends and colleagues do within this profession.

I started this blog when I noticed, over time, that a vast amount of research regarding the relationship between nutrition and mental health existed in the National Library of Medicine database...but it wasn't making it to the public. My guess is that is because nutritional answers to brain and nervous system problems are not nearly as profitable to spend money marketing as medications.

That doesn't mean there is not a need to get this information to where it is needed--the screens of blog readers like you!

I was surprised and excited to see how quickly blog traffic to this publication grew. One of my favorite things to do is to read research and find items to share with all of you.

I can't think of anything better I could be devoting my work and my career to. I hope you enjoy our blog...and I hope you enjoy getting to know some of the many colleagues participating in our blogfest today!

Warmest regards,

Monika M. Woolsey, MS, RD

No, fish oil isn't as multipurpose as Windex...it's still about overall lifestyle

I am devoting this blog post to my friends who think I've gone fish oil overboard! I write and talk about fish oil so much, it seems, they've gotten the impression that maybe I've forgotten about all of the other things that determine health. One of my neighbors constantly teases me about the fact that I believe in and promote fish oil like the guy who uses Windex for everything in the movie My Big Fat Greek Wedding. Colleague Karen Siegel (Houston registered dietitian and licensed acupuncturist) sent me the following article.

Note that the recommendations at the end of this quote are the same recommendations commonly made for diabetes prevention--and you HAVE seen in this blog, that I have written on the connection between diabetes and Alzheimer's disease.

It's not that I think fish oil can replace a healthy lifestyle, it's that I see so many people who pretty much have the right idea, and not balancing omega-3's is the piece that keeps them from being completely on the right train.

Though I do believe fish oil is important, this article perfectly sums up how I do feel: by no means is fish oil a "bad habit eraser"! You've got to live a healthful life, and when you do that, fish oil may help decrease your health risk.

Oh, BTW, that neighbor who teases me? She told me the other day she secretly went to Costco and got the pills...and her hair and nails have started to become longer and stronger.

Dangour AD, Allen E, Elbourne D, Fletcher A, Richards M, Uauy R. Fish Consumption and Cognitive Function among Older People in the UK: Baseline Data from the Opal Study. J Nutr Health Aging. 2009;13(3):198-202.


A UK study has cast doubt on claims that eating oily fish can protect against dementia in old age.

Data from a trial of more than 800 older people initially showed that those who eat plenty of oily fish seem to have better cognitive function.

But factors such as education and mood explained most of the link.

Researchers need to clarify what, if any, benefits fish oil has on the ageing brain, they wrote in the Journal of Nutrition, Health and Ageing.

In recent years, there has been increasing interest in diet as a way of preventing dementia.


It's not at all clear that healthy older people get any benefit from eating fish oil

Dr Alan Dangour, study leader
Much focus has been on omega 3 fatty acids found in oily fish, such as salmon and mackerel.

And there are biological reasons, backed by tests in the laboratory, why in theory, these fatty acids would be neuroprotective.

The latest study found a significant association between eating a couple of portions of fish a week and better scores on tests of cognitive function.

But when the researchers, from the London School of Hygiene and Tropical Medicine, took into account education and psychological health the association almost disappeared.

Healthy

Experts advise eating a couple of portions of fish a week, with at least one being an oily fish, because there are proven benefits on the heart.

Study leader Dr Alan Dangour said claims about the benefits of oily fish in warding of dementia in older people seemed to have been oversold.

"The evidence on this has always been sporadic.

"What this shows is there is a link between people who eat oily fish and better cognitive function, but if you adjust for education and mood this relationship goes, so it's not at all clear that healthy older people get any benefit from eating fish oil."

The evidence collected by Dr Dangour was for a study due to report later this year comparing fish oil supplements with placebo.

He added that this randomised, controlled study should provide clarification.

Neil Hunt, chief executive of the Alzheimer's Society, said: "One of the best ways to reduce your risk of dementia is by eating a Mediterranean diet rich in fruit, vegetables, grains, fish and poultry.

"However, we still do not know which components of this sort of diet help the most.

"Unfortunately this study does not add to our understanding.

"Once age, sex and education are accounted for the research does not show any significant benefit of regularly eating oily fish."

Why weight loss experts fail their clients--Part 2

I am a little behind on this post, it's been a busy week!

I wanted to continue with part 2 of a series on why weight loss experts fail their clients. In my first post, just below this one, I described a study looking at brain changes that happen in the presence of depression.

One finding was that the prefrontal cortex, important for memory retention and coordination of complex behaviors, was compromised.

And what are dietitians notorious for doing? Handing over, in a one hour session, a volume of handouts as thick as Tolstoy's War and Peace, full of do's and dont's and calorie counts and exchanges and label reading information. And then they wonder why the client didn't return for a follow up visit.

I will never forget the client who shared with me that he sometimes made two lunches, not because he was hungry for lunch #2, but because he forgot he'd even eaten lunch #1 until he went to put lunch #2's dishes in the sink and encountered remnants from lunch #1.

Yes, it's sometimes that simple. Yet, the dietitian who even takes the time to ask about memory is a rare one.

Reasons for memory issues with depression, in addition to decreased blood flow, include loss of neurons in the hippocampus, another memory center, and low levels of DHA, an omega-3 fatty acid that is an essential component of brain matter.

If those issues are not accounted for and accommodated in a treatment plan, guaranteed your clients are at great risk for dropping out of treatment. Maybe even not remembering appointments they had made, if they actually did want to return.

Another brain center with compromised function with depression is the anterior cingulate, responsible for executive, evaluative, cognitive, and emotional functions, as well as learning and problem solving, error detection, motivation, and emotional modulation.

So if you're a dietitian trying to use the intuitive eating approach and you have a client who can't evaluate how they feel, decide what to do with how they feel, set boundaries in situations that trigger feelings that trigger eating....just how far are you going to get with your approach?

And you know what we do when clients don't do what we think they should? We diagnose them with mental health issues, refer them out, and potentially set them up to be prescribed medication that only exacerbates their metabolic and weight issues.

Just think about it over the weekend. I'll be back next week with a way around this dilemma that may actually help the client to get better and leave the dietitian less frustrated.

Elizabeth Sublette M, Milak MS, Hibbeln JR, Freed PJ, Oquendo MA, Malone KM, Parsey RV, John Mann J. Plasma polyunsaturated fatty acids and regional cerebral glucose metabolism in major depression. Prostaglandins Leukot Essent Fatty Acids. 2009 Jan;80(1):57-64. Epub 2009 Jan 6.

The American Heart Association Needs to Check Its Omega-3 Math

I have heard the following recommendations made by the American Heart Association repeatedly for years now. And I hear them parroted everywhere by well-intended medical experts who, it seems, did not stop to check the math on which the recommendations are based:

Population Recommendation
Patients without documented coronary heart disease (CHD)
Eat a variety of (preferably fatty) fish at least twice a week.
Include oils and foods rich in alpha-linolenic acid (flaxseed, canola
and soybean oils; flaxseed and walnuts).

Patients with documented CHD Consume about 1 g of EPA+DHA per day,
preferably from fatty fish. EPA+DHA in capsule form could be
considered in consultation with the physician.

Patients who need to lower triglycerides 2 to 4 grams of EPA+DHA per
day provided as capsules under a physician's care.

Patients taking more than 3 grams of omega-3 fatty acids from
capsules should do so only under a physician's care. High intakes
could cause excessive bleeding in some people.

Evidence from prospective secondary prevention studies suggests that
taking EPA+DHA ranging from 0.5 to 1.8 grams per day (either as fatty
fish or supplements) significantly reduces deaths from heart disease
and all causes. For alpha-linolenic acid, a total intake of 1.5–3
grams per day seems beneficial.

I couldn't sit back anymore. Ellen Reiss Goldfarb, RD, a member of my inCYST Network for Women With PCOS collaborated with me on hopefully setting the record straight. We hope it helps, especially to get a mathematically-correct set of recommendations out to the public so they can go grocery shopping with a better sense of empowerment.

Regarding the omega-3 recommendations recently discussed, you all may want to consider that there are several contradictions within that make it very difficult (maybe even impossible) for the average American to follow them. As dietitians, it is important that we understand this math so that we help, not confuse or hurt, people who look to us for advice.

First of all, we are telling people that they are not to eat more than 3 grams of omega-3's per day unless they are under a physician's care. However, if you try to get 1.8 mg of combined EPA + DHA combined, in the form of food first, 3 ounces of Alaskan salmon, which contains 384 mg of EPA plus DHA, would have to be eaten in a DAILY QUANTITY OF 14 ounces in order to get there. Are you really saying that if you're eating enough fish to get the amount of omega-3's we recommend, that the MD has to manage it??? You are unnecessarily putting yourself out of business if you are!!!

Secondly, given those numbers for salmon, the densest seafood source of omega-3's, there is no way eating fish just a few times a week is going to get you to the level of omega-3 intake these recommendations are making. It is so frustrating watching colleagues parrot these recommendations and wondering if we're the only ones who've actually sat down and done this math..

We also went to three popular fish oil brands and calculated out how many pills you would need to get the upper level of DHA + EPA recommended. Two of those, Nordic Naturals and Carlson's, if taken at the level needed to get there, would also place your client at levels you say a physician needs to manage.

Realistically and honestly, how many of you are really doing that?

With regards to bleeding, in all of our collective years actively recommending fish oil, only one client encountered a bleeding problem. The people at greatest risk for that are people who are on medications such as coumadin...and if you work closely with a physician who "gets it"--the dose of that medication can be dropped as EPA levels rise and help normalize blood clotting function. Always start low, titrate up, look closely for symptoms in people not on contraindicated medicatoins and let the MD check blood levels in people who are...and work very hard to minimize omega-6 intake. You'll get a lot more bang out of your omega-3 buck if you focus on the omega 6 to omega 3 ratio than if you only think about one.

If you don't know how to use omega-3's to promote health, you may actually CREATE health risks for your clients, which I don't think any of you want to do.

Here are the numbers from our calculations for your reference.

EPA + DHA, total mg
3 ounces salmon 384 mg
Nordic Naturals 550 mg
Carlson's 500 mg
Barlean's 600 mg

Total omega-3 content
3 ounces salmon 3250 mg
Nordic Naturals 690 mg
Carlson's 600 mg
Barlean's 780 mg

Amount needed to meet n-3's needed to meet upper DHA + EPA recommendation/total omega-3 content of that amount
3 ounces salmon 14 oz DAILY/15.2 total gms n-3
Nordic Naturals 3.27 capsules/3.6 gm total n-3
Carlson's 3.6 capsules/6.0 gm total n-3
Barlean's 3.0 capsules/2.3 gm total n-3

Monika M. Woolsey, MS, RD
Ellen Reiss Goldfarb, RD

Why weight loss experts fail their clients--Part 1

As a dietitian with somewhat of a reputation as having expertise in disordered eating/eating disorders, I have often found myself in the middle of debates about whether or not a structured "meal plan" approach or an "intuitive eating" approach is best. I don't really agree with either, alone, though I do think that restoring someone's ability to eat intuitively should be the ultimate goal.

A recent research project helps me to define why I say that.

Mood disorders are associated with changes of fatty acid content in the brain. A group of neuroscientists finally decided to use their technology to look at how blood flow in different brain regions differed in depression, and to look at how those differences correlated with essential fatty acid levels.

In neuro-ese, here are the results:

DHA% and AA% correlated positively with rCMRglu in temporoparietal cortex. In addition, DHA% correlated negatively with rCMRglu in prefrontal cortex and anterior cingulate. No correlations were seen with EPA%. Thus, under conditions of low plasma DHA, rCMRglu was higher in temporoparietal cortex and lower in anterior cingulate/prefrontal cortex.

Translated into English, what that means:

1. In depressed subjects, the lower the level of DHA and ARA in the tempoparietal cortex, the less blood circulation there appeared to be. This is the part of the brain that integrates and coordinates sensory information.

2. Blood circulation to the prefrontal cortex and the anterior cingulate were compromised when DHA levels were low.

The prefrontal cortex is thought to be important for memory retention and coordination of complex behaviors.

The anterior cingulate is important for carrying out executive, evaluative, cognitive, and emotional functions. It is also important for learning and problem solving, error detection, motivation, and emotional modulation.

I believe, and have written profusely about it on this blog, that imbalance in fatty acids not only causes depression, but it causes changes in brain chemistry that change eating behaviors. And those eating changes only make the brain chemistry worse. It becomes a vicious cycle that can become incredibly difficult to break out of.

Both diet approaches operate on the assumption that the brain is intact and functioning completely normally. If that were the case, I argue, the client wouldn't be asking for help with an activity that should be primarily intuitive and without thinking too much about it. My clients often demonstrate signs and symptoms that the above described imbalance exist, which sets them up to fail with commonly endorsed nutrition counseling approaches.

Wednesday I'll continue with how changes in these brain regions interfere with nutrition counseling. For now, suffice it to say that a fatal error nutrition and exercise counselors make is to assume that their clients have the brain power and function that allows them to make the changes we advise them to make. And in doing so, we work against their ability to change. If we understand what's going on in the brain, we can develop therapies that harness their potential to succeed!


Elizabeth Sublette M, Milak MS, Hibbeln JR, Freed PJ, Oquendo MA, Malone KM, Parsey RV, John Mann J. Plasma polyunsaturated fatty acids and regional cerebral glucose metabolism in major depression. Prostaglandins Leukot Essent Fatty Acids. 2009 Jan;80(1):57-64. Epub 2009 Jan 6.

Nutritional compounds with promise in Alzheimer's syndrome

Anyone experiencing Alzheimer's disease firsthand probably has wondered if there is any extra "edge" they might obtain for their own risk from nutritional supplementation. A group of researchers recently reported that a combination supplement reduced the levels of already existing specific oxidative marker levels by 57% and prevented the reappearance of new molecules.

The supplement used in this study contained the following compounds: alpha-lipoic acid, acetyl-l-carnitine, glycerophosphocoline, docosahexaenoic acid (DHA), and phosphatidylserine.

I don't know about you, but this is one condition I'd rather not give a head start to my brain, and one I'm happy to be proactive when it comes to my current supplemental choices.

Suchy J, Chan A, Shea TB. Dietary supplementation with a combination of alpha-lipoic acid, acetyl-L-carnitine, glycerophosphocoline, docosahexaenoic acid, and phosphatidylserine reduces oxidative damage to murine brain and improves cognitive performance. Nutr Res. 2009 Jan;29(1):70-4.

Is your chia pet a hidden nutritional surprise?

Risperidone (Risperdal) is a common antipsychotic medication that was recently investigated for its influence on omega-3 fatty acid metabolism.

Rats were placed on two different diets, one containing alpha-linolenic acid (ALA) and one that was ALA-deficient. Then both groups were administered a dose of risperidone.

This research design was used because ALA can be converted to docosahexaenoic acid (DHA), and the purpose of the study was to evaluate the influence of risperidone on this conversion.

In rats not fed ALA, there was a significant increase in tissue DHA in the presence of risperidone, suggesting that this medication helps to increase the conversion of ALA to DHA. When there was ALA in the diet, this was not observed, suggesting that when there is enough ALA available, there is no need for any augmentation of pre-existing mechanisms.

Some questions and comments:

1. This will be an interesting line of research to follow...to determine whether schizophrenia is related to nutritional imbalances and/or deficiencies, whether there might be different types of schizophrenia, some nutritionally instigated and aggravated, others not.

2. Seems that a dietary strategy of increased ALA isn't a bad idea if you struggle with schizophrenia.

3. At this point, it is NOT rational to assume that increasing dietary ALA will eliminate the need for antipsychotic medications.

4. At the same time, it doesn't make sense to use a prescription medication to correct a nutritionally-relevant problem.

If you balance the diet and focus on adequate ALA, the amount of medication you might actually need might decrease, therefore reducing the risk of metabolic side effects.

For those who are interested, foods that are good sources of ALA include: canola oil, whole soybeans, walnuts, salva (chia), ground flaxseeds, and flaxseed oil.

McNamara RK, Able JA, Jandacek R, Rider T, Tso P. Chronic risperidone treatment preferentially increases rat erythrocyte and prefrontal cortex omega-3 fatty acid composition: Evidence for augmented biosynthesis. Schizophr Res. 2009 Feb;107(2-3):150-7. Epub 2008 Nov 7.

Diet and Parkinson's disease

I've been studying nutrition and the brain for awhile now, and it's clear I'm a big fan of omega-3 fatty acids. It's only been recently that their role in Parkinson's disease prevention is becoming clear.

Oxidative stress, or aging, is to the brain what rust is to your car. In Parkinson's disease, oxidation appears to significantly affect the brain systems regulating dopamine.

In this study, rat brain tissue was exposed to several by-products of fatty acids found in the brain, docosahexaenoic acid and arachidonic acid. It turned out that the arachidonic acid--derived compound was the most toxic to brain cells.

Arachidonic acid is derived from two main sources, certain dietary oils, and meats. It's fairly easy to identify the oils that promote arachidonic acid production. They tend to be those, which in English, begin with the letters "S" and "C"; soybean, safflower, sunflower, sesame, corn, cottonseed...the only exception would be canola. These oils have been unloaded into the food supply in recent years and as they have, many diseases, not just Parkinson's, have been on the upswing. Start reading your labels!

Arachidonic acid is also found in meat. So if you are eating large portions of meat instead of balancing your protein with other types of food, your diet may be out of balance and promoting inflammation/oxidation/aging, particularly in the nervous system. Some rules to follow which you've heard before, for other reasons, include: eat more seafood and less red meat, eat more vegetarian meals, and limit your meat portions to the size of the palm of your hand without the fingers.

Parkinson's is not a problem to be taken lightly. If you have ever known someone who has had to deal with the tremors and deterioration in quality of life...you know what I mean. Some very simple dietary choices may help you to delay or prevent having to personally deal with this challenging diagnosis.

Liu X, Yamada N, Maruyama W, Osawa T. Formation of dopamine adducts derived from brain polyunsaturated fatty acids: mechanism for Parkinson disease. J Biol Chem. 2008 Dec 12;283(50):34887-95. Epub 2008 Oct 15.

Are "vegetarians" at risk for depression?

One of my biggest jobs in this specialty is clarifying what vegetarian eating IS...and what it is NOT. Unfortunately, the vast majority of people I know who are vegetarian define that by describing what they DON'T eat, rather than what they DO eat. That is why the word "vegetarians" is in quotes in my title, because it refers to what many vegetarians consider the definition, and that is absolutely not what I define it as.

My definition of vegetarian is a person who replaces the essential nutrients found in animal based foods with non-animal sources.

People who don't eat fish have an incredibly difficult time getting omega-3 fatty acids, because they are primarily found in seafood. In addition, if they're eating more salads, thinking they are "healthy", they may be getting excessive amounts of the proinflammatory omega-6 fatty acids, which are often the base for commercial salad dressings.

"Vegetarians" with a more disordered bent to their habits, who are filling up on baked goods and processed foods, are also prone to excessive omega-6 fatty acids.

Which may explain the findings of this most recent study. Women experiencing psychological distress and symptoms of depression were divided into two groups. (It is my experience that of the two genders, women are the guiltiest when it comes to not eating meat and subsisting on salads and carbs.) The first group received 1.05 grams of EPA (a pretty hefty dose, given that most fish oil capsules have only 20-30% of that amount) plus .15 grams DHA. The second group received a placebo. They received this dose for 8 weeks.

The women on the fish oil supplement showed a degree of decrease in symptoms that the women on placebo did not.

Of the two omega-3 fatty acids found in fish oil, EPA is the one that is primarily found in fish. So if you're not eating fish, and you are having trouble with depression, chances are your food choices have something to do with that!

If you can't, off the top of your head, list five significant sources of DHA, your only other source of EPA (it can be converted when DHA stores are sufficient and there is excess in your diet), you're not getting enough. For a list of food products containing marine-algae based DHA...click here.

And, if your diet is heavy on processed foods and salads, and you are using salad dressings based on soybean or corn oil...you're likely breaking down whatever omega-3's are in your system before you can even benefit from them.

Maybe now you can see why I'm so fussy about where the line should officially be drawn between vegetarian and omnivore. It's not at all about what you don't eat...it's about what you DO eat.

Lucas M, Asselin G, Mérette C, Poulin MJ, Dodin S. Ethyl-eicosapentaenoic acid for the treatment of psychological distress and depressive symptoms in middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. Am J Clin Nutr. 2009 Feb;89(2):641-51. Epub 2008 Dec 30.

Iron and restless legs

It is becoming more well known that iron status and restless legs are connected. Many times when I share restless legs information on my Facebook page, someone will comment with a reminder of this connection.

I love that we're making a nutritional connection with such an uncomfortable problem.

However, it is important to remember, as was confirmed in a recent article reviewing numerous accepted treatments for restless legs, that iron supplementation is most likely to help the condition if there is a standing iron deficiency. If iron status is adequate, "topping off", so to speak, isn't going to fix the problem.

So....

...if you've got restless legs and you haven't checked your iron status, might be a good idea.

...if your iron levels are low, try an iron supplement.

However...

...if your iron status is fine, and/or you've tried the iron and your legs are still moving,

...consider that there are other options that may provide more relief.

Nutrition is a great place to start, and being well-nourished before trying medication is always a great strategy, but don't stop there if it doesn't turn out to be the answer.

Yes, the solution can be worse than the problem

Stress exposure, and post-traumatic stress disorder, are horrible problems. I've seen them wreak havoc on peace of mind, careers, and relationships. I think sometimes, being on the outside looking at a friend, loved one, or patient going through something we'll never completely understand because we simply did not live through it, creates anxiety because we have no productive outlet for the compassion and healing we want to provide.

As much as the object of our concern may be struggling, and as hard as we may want to be the source of relief for their pain, we need to always be careful that the help we provide is not being administered on behalf of our own pain, and not the person who is truly suffering.

For example, consider this recent study, that looked at the consequences of administering alprazolam (Xanax), a benzodiazepene anxiolytic, to a stress-exposed individual.

Animals exposed to stress were then given alprazolam on two different schedules; one group was medicated for 3 days starting 1 hour after the stress, while the other group received the medication for 3 days starting a week later. Each group was tested for symptoms of PTSD 30 days after the initial trauma.

Those animals who were immediately medicated experienced immediate relief, with now observable problems at day 30. Sounds good, except that when the rats were exposed to the same trauma a second time, they had a greater "freezing response" (something that traumatized animals and people do in stressful situations).

Early exposure also disrupted normal stress hormone function both during and outside of the second stress exposure.

So while we might feel better giving someone medicine to help them feel better, we may actually be the only ones who feel better. In the long run, the person may suffer more and longer than if we'd let them process the trauma in the way the body is programmed to naturally do, providing a safe, supportive place to heal and only introducing chemical intervention if it is deemed absolutely necessary.

Matar MA, Zohar J, Kaplan Z, Cohen H. Alprazolam treatment immediately after stress exposure interferes with the normal HPA-stress response and increases vulnerability to subsequent stress in an animal model of PTSD. Eur Neuropsychopharmacol. 2009 Jan 22. [Epub ahead of print]

More on zinc and depression

In my last post, I described a study in which zinc was shown to enhance antidepressant activity. In this study, rats whose depression and anxiety-related behaviors had been successfully treated with antidepressants were then placed on a zinc-deficient diet.

What happened?

They started to act anxious and depressed again.

We live in a culture that has created the mentality that if you're not feeling well, you go to the doctor, she prescribes you a pill, you take the pill, and you feel all better.

Unfortunately, pills can only work some of the time. And they tend to work best when you're using them in conjunction with healthy self-care behaviors. As far as I know, and I am a voracious consumer of psychiatric and neurological research, there is no pill developed that will overcome what you choose not to do.

Medication, in most cases, should be considered an ADJUNCT to treatment, not the ONLY solution to a medical problem.

The whammy here is that when you're depressed, it can be challenging to feel like doing anything for yourself at all. If you're not up to "healthy living" but you ARE motivated to take your prescription medication...at least consider taking a zinc supplement alongside the prescription. They are easy to find and inexpensive.

And they just might be what determines whether you crawl out of that whole.....

...or feel hopelessly stuck there.

Whittle N, Lubec G, Singewald N. Zinc deficiency induces enhanced depression-like behaviour and altered limbic activation reversed by antidepressant treatment in mice. Amino Acids. 2009 Jan;36(1):147-58. Epub 2008 Oct 31.

A little red meat may help your depression

If you have depression, you are not depressed because there is a deficiency of antidepressants in your body...

...however...

...you may be depressed because you have some basic nutritional deficiencies. One mineral that is involved in numerous brain and nervous system functions, and that has been extensively studied with regards to its role in the development of depression, is zinc.

Various doses of zinc were recently shown to improve immobility time in rats. Immobility in a stressful situation is a common behavior in depression. (When you are not depressed, you have better decision making and response times when it comes to managing stressful situations.)

That's exactly what fluoxetine (Prozac), paroxetine (Paxil), imipramine (Tofranil), desipramine (Norpramin), and bupropion (Wellbutrin) do!

When zinc and antidepressants were administered together, immobility time was reduced by more than either therapy produced on its own.

Practically what that says is that:
(1) if you are at risk for, or have had a history of depression, emphasizing high-zinc dietary choices and/or zinc supplementation would be a smart strategy, and
(2) if you are on an antidepressant, supplementing with zinc would be important to be sure that you get enough medication to do the job without getting so much that you set yourself up for detrimental side effects.

In fact, it seems to me that it should be an automatic recommendation of any physician, when prescribing an antidepressant, to write "zinc supplement" in the script as well...

FYI, your best sources of zinc include: red meats, liver, and oyster. And, when the originating soil is in good condtion...wheat, sweet corn, lettuce, beans, nuts, almonds, whole grains, pumpkin seeds, sunflower seeds and blackcurrant. That's a lot of different options, something for practically everyone, meat eater or not!

Cunha MP, Machado DG, Bettio LE, Capra JC, Rodrigues AL. Interaction of zinc with antidepressants in the tail suspension test. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Dec 12;32(8):1913-20. Epub 2008 Sep 11.

Your medications and your genes

DNA and genetics are not my areas of specialty but I found this study very interesting and wanted to share it. Anyone who does have expertise on this...please respond!

Alprazolam (Xanax), a popular tranquilizer, was recently reported to "intercalate" with DNA. I'm providing a link to a Wikipedia piece on what intercalation is...in short, I gather it means that somehow Xanax incorporates itself into the structure of DNA itself. Which would mean, that it potentially changes how the DNA expresses itself. This finding prompted the research to issue caution about the random use of Xanax.

Makes me wonder when I see all these medications that are associated with weight gain, if other medications have the same ability? And it also makes me wonder if other compounds, even certain foods, might also affect DNA structure and function.

It's a whole lot more complex than "eat less and exercise more"...which is why I love reporting on this specialty so much! There is always something new and different to share that provides a potential answer to someone doing a Google search.

Saha B, Mukherjee A, Santra CR, Chattopadhyay A, Ghosh AN, Choudhuri U, Karmakar P. Alprazolam intercalates into DNA. J Biomol Struct Dyn. 2009 Feb;26(4):421-30.

Do we need a kindler, gentler football?

I'm going to let the New York Times do the talking today. I hate to see stories like this, because every time I do.....I wonder how we could use some simple nutritional therapies to minimize the chances of this kind of tragedy? I don't think it's all about nutrition, but I do think a good chunk of it might be.

http://www.nytimes.com/2009/01/28/sports/football/28brain.html?th&emc=th

Here's hoping some day, someone in a place to take action on that sentiment, has the money and the connections to actually do so.

Alzheimer's, sleep, and diabetes--three very interesting amigos

I didn't realize until reading this abstract that Alzheimer's disease affects sleep patterns as well as memory. It makes sense, since adequate sleep is necessary in order to retain memory of information gained during the day.

The medication reviewed in this article is galantamine (Reminyl), and the authors suggest that it is important to time medication administration in order to gain maximum effectiveness and sleep. And, that certain medications help (and interfere with) sleep more than others.

Disrupted sleep can worsen diabetes. Since many people with Alzheimer's also have diabetes--in fact, the two diseases are starting to be recognized as being very strongly linked to each other--this connection between sleep and medication can be very important to understand.

My guess is that if you are on this blog looking for information about Alzheimer's, it is a loved one, not you, that the information is for. Here is the bottom line:
1. If your loved one had problems with sleep before being recommended or placed on medication, it might be a good idea to check with the prescribing physician to be sure this was taken into account when choosing which Alzheimer's medication to prescribe.
2. If your loved one has developed changes in sleep habits since starting an Alzheimer's medication, be sure to let the prescribing physician know.
3. If your loved one's diabetes has become worse despite diligent attention to medications and food intake, consider the influence of sleep or lack thereof.
4. Be sure to ask your physician and/or pharmacist if there is a time of day your particular medication needs to be taken for maximum effectiveness.

Nieoullon A, Bentué-Ferrer D, Bordet R, Tsolaki M, Förstl H. Importance of circadian rhythmicity in the cholinergic treatment of Alzheimer's disease: focus on galantamine*. Curr Med Res Opin. 2008 Dec;24(12):3357-67.

Which came first...the hair or the hormones?

This abstract caught my eye because I also have a blog about polycystic ovary syndrome (PCOS) and finasteride is sometimes used to treat the hirsutism (hair growth in women) that this syndrome often causes. It has now been observed to have antipsychotic properties and is being proposed as a treatment for psychosis.

Antipsychotics are increasingly being used to treat depression, and at least 85% of women with PCOS have some kind of anxiety, depression, or other mood disorder associated with this diagnosis. If you have PCOS, please do not jump to the assumption that I am saying you are psychotic. What I am trying to point out here is that there is a huge mind-body connection in the syndrome that is often ignored. Physicians can be so compartmentalized with their treatments that they focus on the acne, the hair, the infertility...and completely ignore the moods, the mood swings, the associated disrupted eating patterns...and then they and their patients wonder why treatment is not successful.

I am posting this abstract to challenge anyone who treats PCOS to figure out what is going on in the brain of the woman with PCOS since it is, after all, the brain that controls hormones. Rather than mess with hormones and create even more problems, why aren't we going to the source and looking THERE for potential solutions? Let's make this the day we shift our thinking.

Bortolato M, Frau R, Orrù M, Bourov Y, Marrosu F, Mereu G, Devoto P, Gessa GL. Antipsychotic-like properties of 5-alpha-reductase inhibitors. Neuropsychopharmacology. 2008 Dec;33(13):3146-56. Epub 2008 Mar 19.

I chose the photo I did not to be funny, demeaning, or hurtful. I did it for the benefit of those who truly do not understand what many women go through because of their PCOS. Hair growth can be devastating and lead to horrible issues with self-image. Long ago it was often called "diabetes of the bearded ladies". If you can imagine what it's like to look in the mirror and feel as though you're losing your femininity, often at a time when you're trying to conceive and desiring to be attractive to your partner...it's a situation deserving of much more attention than it often gets by physicians.

Factors potentiating the risk of mirtazapine-associated restless legs syndrome.

Restless leg syndrome (RLS) is a very annoying condition. I know, because I get it when I'm under stress. It strikes when I'm relaxing; my legs begin to move on their own as if I am a puppet and they are attached to strings.

Restless legs is officially classified as a sleep disorder. Those involuntary movements interfere with restful sleep. You can see the vicious cycle that can get started, as poor sleep can make a day more stressful, which can exacerbate restless legs, etc., etc.

So this article about risk factors for restless legs syndrome caught my eye on a recent cruise through the National Library of Medicine database.

In 181 records reviewed over a 3 1/2 year period, in individuals taking the antidepressant mirtazapine (Remeron), eight percent reported having RLS, tending to start within a few days of beginning mirtazapine therapy. This trend seemed to be more frequent if, in addition to mirtazapine, the individual was using tramadol and/or dopamine-blocking agents.

Be sure to let your physician know if you've noticed this syndrome developing. There are alternatives, pharmacological and non pharmacological, that won't steal your sleep in the name of making you feel better.

Kim SW, Shin IS, Kim JM, Park KH, Youn T, Yoon JS. Factors potentiating the risk of mirtazapine-associated restless legs syndrome. Hum Psychopharmacol. 2008 Oct;23(7):615-20.

Let's not play around with our adolescents!

Methylphenidate (Ritalin) is a very common, in fact the most common, choice for treating attention deficit-hyperactivity disorder (ADHD). One of its major effects is to interfere with social interaction so that people with ADHD are not overly intrusive or disrespectful of normal social boundaries with others. A recent study of methylphenidate in adolescent rats showed that not only did this medication accomplish that goal, it interfered with social and play behaviors considered to be normal for these rats at this developmental stage. In other words, methylphenidate somewhat overshot the mark when it came to inhibiting pre-medicated behaviors.

Of course, to a parent who is frustrated and tired from managing a child whose behaviors have not demonstrated appropriate boundaries, this can be a welcome change. However, social interactions and recreational activities are important for teaching skills important to a productive adult life. Chemically denying a child these learning opportunities may create more problems later in life, when that child does not have the social skills that promote successful relationships, careers, and stress management.

I of course believe there are many options to consider before medication, and they are discussed elsewhere in this blog. If you do believe methylphenidate is the only rational solution to your child's situation, I would at least recommend closely observing your child's social behavior. If s/he has become a wallflower and swung completely in the opposite direction, at least discuss this change with the prescribing caregiver. There ARE other medications and options that can help set your child up for a successful adulthood...which is one of the primary responsibilities of responsible parenthood.

Vanderschuren LJ, Trezza V, Griffioen-Roose S, Schiepers OJ, Van Leeuwen N, De Vries TJ, Schoffelmeer AN. Methylphenidate disrupts social play behavior in adolescent rats. Neuropsychopharmacology. 2008 Nov;33(12):2946-56. Epub 2008 Feb 27.

Sweet dreams for fewer migraines

If you've ever had a migraine, you know they're debilitating. I get them. When they come, my vision gets squirrely, my thinking gets fuzzy, and all I want to do is sleep. I'm completely useless for as long as one chooses to stick around.

I've tried the pharmaceutical options, and while they worked, I always wished that there was a natural solution. For me, that solution came with changing my work situation, moderating caffeine intake, stress management, and incorporating yoga into my activity routine. When I found this article, I realized that I've also been better to myself when it comes to sleep, and not cutting myself short in that department. Maybe that's part of the reason I rarely have migraines anymore.

The scientists in this study gave a 3 mg dose of melatonin to 22 children who complained of regular migraine or tension-type headaches. By the time the study was over, 3 months later, 2/3 of the subjects reported a decrease in headache frequency of 50%, and 4 subjects reported having no headaches at all.

Of course, you can go out and buy some melatonin. But what I'd recommend, first of all, is taking a good hard look at your sleep habits. Are you giving yourself at least 7 hours of sleep a night? Or are you hooked on late night TV? Are you sitting in bed with your laptop surfing the net when you should be dreaming?

It's an easy solution for a serious and unpleasant problem. Take care of your head--and your head won't have to hit you where it hurts to get your attention.

Miano S, Parisi P, Pelliccia A, Luchetti A, Paolino MC, Villa MP. Melatonin to prevent migraine or tension-type headache in children. Neurol Sci. 2008 Sep;29(4):285-7. Epub 2008 Sep 20.

Thanks to all of you and Happy 2009!

Hello readers,

I had no idea whatsoever that my random posts about mental health would gain so much readership. In one short year this blog has grown from a reader here and there to 1300 readers from 112 countries, and 1600 page views per month.

Thank you so much for your interest!

I can tell by the comments you take the time to post, that you are all sincerely desiring to take control of your health. I understand the responsibility that goes with that kind of trust, given the diagnoses and medications I address when I write. I hope as 2009 progresses that I continue to write about meaningful topics that give you inspiration and tangible ideas for actions you can take in your respective lives.

Please do let me know how I can improve on this blog, and please comment where you see fit. This blog is a community effort, steered by the interests of you, the readers.

Happy New Year everyone!