Mannion AF, et al. Paper #2. Presented at: EuroSpine Annual Meeting; Sept. 2-4, 2015; Copenhagen, Denmark
I have been recommending books by John Sarno, MD for the last 20 years. The improvement in patient pain is truly astounding considering the only treatment is reading a book!
Now, a study from Denmark looked at the relationship between chronic pain and pessimistic people. 2,500 patients filled out a questionnaire about “back beliefs” and those who were pessimistic and inactive were more likely to suffer from back and neck pain when compared to those who were more optimistic and exercised regularly.
These findings correlate very nicely with Dr. Sarno’s beliefs dating back from the 1970’s!
28th European College of Neuropsychopharmacology (ECNP) Congress. Abstract S.02.03
Pharmacogenomics testing that measures DNA variation in drug metabolism has been shown to improve outcomes in depressed and anxious patients. For years, it was basically either trial and error or prescribing a drug depending on what side effects we might or might not expect to see. Now, we have a better idea why some medications work for some patients and not for others.
Most drugs are metabolized by 6 pathways in the liver (cytochrome P450) and is easily tested in our office. In one study 23% of patients improved by trial and error versus 40% who underwent genetic testing.
We not only use DNA testing for psychotropic medications but for many other types of drugs, too.
Most Medicare and Medicare Advantage programs cover the costs. Unfortunately, only a few commercial insurance companies will pay for it.
Yesterday, I wrote about healthy food choices from the perspective of Dr. Neal Barnard. Today we will look at it from the viewpoint of Dean Ornish, MD who is a clinical professor of medicine at the University of California. He is the founder of the Preventive Medicine Research Institute and was a keynote speaker at a medical conference that I recently attended.
His approach has been so successful over the past 35 years, that it has been recognized by Medicare for its success in preventing heart disease and diabetes.
Basically he looks at 4 parameters:
3. REDUCE STRESS
He also touts the benefits of a plant based diet but realizes that most people will still want animal fat as their source of protein. The flexibility of this may be more appealing for the average person. His data over the past 35 years has documented the reversal of aging and atherosclerosis and even curing diabetes. As I mentioned earlier, his programs are covered by Medicare and probably led the way for Medicare to cover nutritional consultations by registered dietitians for not only diabetes and kidney disease but also heart disease, high blood pressure and obesity. Very few commercial insurance companies will pay for this.
To get more information about this, I would suggest you look at www.ornishspectrum.com
More and more studies are linking nutrition to mental health disorders. There is also evidence that nutritional habits and micronutrient deficiencies can affect brain metabolism. By micronutrients, we are talking about vitamins, minerals, amino acids and omega-3 fats. All of these have been shown to be connected with anxiety, depression, ADHD, schizophrenia and possibly even dementia. Even a great diet may not prevent a nutritional deficiency if you are genetically predisposed to abnormal cellular uptake of nutrients. As much as 70% of the population is unable to metabolize Folic Acid properly!
THIAMINE (Vitamin B-1) is essential for the nervous system. A deficiency can cause anemia, heart disease, fatigue and memory impairment
FOLIC ACID supplements have been given to pregnant women for years to help prevent congenital neurological defects in the newborn. It is also known that low folic acid is related to depression due to its adverse effects on neurotransmitters like serotonin. Activated Folic Acid may be necessary for those who cannot metabolize regular folic acid appropriately
VITAMIN B-12 deficiencies are very common and are associated with depression, memory loss and neuropathies (numbness and tingling) as well as anemia. It is very common, especially in patients taking METFORMIN and NEXIUM type drugs.
VITAMIN B-12 and FOLIC ACID deficiencies have been associated with both memory loss and dementia.
(Vitamin B-6, Folic Acid and Vitamin B-12 deficiencies may lead to an increase in a protein called HOMOCYSTEINE which may be associated with an increased risk of heart disease.)
VITAMIN D deficiencies are very common and have been associated with a decrease in the neurotransmitter dopamine. It has been seen in people with fatigue and depression and has been associated with brain development, schizophrenia and autism
OMEGA-3 fats are thought to modulate serotonin, dopamine and norepinephrine which may have a beneficial effect on depression. Many people take Omega-3’s to prevent heart disease, but proof to date is suspect.
IRON is important in energy production, DNA synthesis and neurotransmitters. Most people associate iron deficiency with anemia but it is also a cause of Restless Legs Syndrome, which is very common. It is NEVER normal to be deficient in IRON unless you are a female with heavy periods. All patients with iron deficiency need to be evaluated for other underlying diseases, especially colon cancer!
ZINC is important for immunity, energy metabolism and insulin storage as well as neurotransmitters. Zinc deficiencies have been associated with fatigue and mood disorders.
COPPER is also necessary in regulating neurotransmitters and may also be associated with mood disorders, fatigue and possibly ADHD.
When we check for nutritional disorders in the office, we look for INTRCELLULAR deficiencies and not just BLOOD deficiencies, because even though nutrient levels may be normal in the blood stream, it doesn’t guarantee that the body can actually utilize them. This is called FUNCTIONAL MEDICINE and can be very helpful in treating many disorders in conjunction with proper medications.
Both the MAYO CLINIC and The CLEVELAND CLINIC now have departments of functional medicine.
Researchers have found a connection between common anticholinergic drugs and dementia. Examples of anticholinergic medications include common anti-histamines like Benadryl which are used to aid in sleep (Tylenol PM) as well as chlorpheniramine, a common sedating OTC medication for allergies. Medications used for overactive bladders like oxybutynin and tricyclic antidepressants like Elavil, which are often used for migraines and chronic pain have been linked to memory problems even at low doses.
There are many annoying side effects of these type of drugs, like dry mouth, constipation and urinary retention but when these medications are used long term-it doesn’t matter how low the dose is-the risk of dementia rose.
It should be noted that the newer non-sedating allergy medications (Allegra) do not affect memory. All tricyclic medications should be used with caution in older patients, especially with heart disease and one bladder medicine, Myrbetriq probably does not affect memory. It should also be noted that it is considered a DUI if you have an accident while under the influence of Benadryl-even if you took it the night before!
Monahan et al, Clin Interv Aging. 2012;7:143-157
It can sometimes be difficult distinguishing between a cognitive impairment as opposed to Alzheimer’s Disease. It is not unusual to forget someone’s name or to misplace car keys or a cell phone. This would be examples of a cognitive problem. A more serious problem would be forgetting to turn the oven off or becoming disoriented while driving.
Here are some other examples that might suggest a serious problem such as dementia (please note that physical or psychiatric problems can make symptoms worse):
1. Repeating the same things over and over, such as questions or stories
2. Forgetting the correct month or year
3. Difficulty handling complicated financial affairs, such as balancing a checkbook, income taxes, and paying bills
4. Inability in planning, preparing, or serving meals
5. Not being able to take medications in the right dose at the right time
6. Difficulty with walking or physical ambulation
7. Taking less interest or pleasure in doing things, hobbies, or activities
8. Feeling anxious, nervous, tense, fearful, or panic
9. Hearing voices, seeing things, or talking to people who are not there
10. Wandering, pacing, or doing things repeatedly
If you have any concerns about yourself or a loved one, please contact our office.
Probiotics contain helpful bacteria and assists in the balancing of microorganisms in the human body. In the past, I have written about the benefits of probiotics in helping gas, bloating and diarrhea, as well as potentially preventing heart disease and lowering cholesterol. It is known that chronic GI disorders are associated with anxiety and depression. There was a study a few years back in mice which showed that chemically induced inflammation in the bowel increased anxiety and when given probiotics, the anxiety decreased. There was a human study in Canada that showed improvements in anxiety, anger and depression as well as lowering the stress hormone cortisol in people who took probiotics for 30 days after breakfast. It is interesting that prebiotics (complex sugars to promote the growth of probiotic bacteria) may lower cortisol levels but have no effect on stress.
There are many different probiotic brands available without a prescription. The ones I recommend the most are VSL3, Align and Florastor although there are many others that will work as well.
Researchers think that the lack of inhibition in the part of the brain called the AMYGDALA may lead to anxiety and fear. Studies using a nasal spray called oxytocin showed an altered response in the amygdala resulting in almost an immediate decrease in anxiety and fear. The results were not only observational but also were seen on MRIs of the brain done within 30 minutes of using the drug. These finding were only studied in men and it is not known whether women will have the same response.
Oxytocin is a drug used by Obstetricians for the induction of labor in pregnant women. Side effects such as hypertension, brain hemorrhage and nausea and vomiting have been seen. The reason this study was done because of known anti-anxiety effects seen by researchers in the past to see if this could be used for anxiety alone. This study is investigational and oxytocin is NOT currently recommended for use at this time for anxiety disorders
Depression consists of many different symptoms (sadness, anxiety, lack of concentration or motivation, fatigue amongst others) and is related to an imbalance of neurotransmitters. The main neurotransmitters are serotonin, norepinephrine and dopamine. Many patients who are depressed and taking antidepressants do not achieve the benefits that they are hoping to achieve. One theory is that many patients lack sufficient amounts of L-METHYLFOLATE in the brain. Without enough of this, it may be impossible to regulate these neurotransmitters. It is also known that up to seventy percent of depressed patients may have a specific genetic factor that limits their ability to convert folic acid or folate from food to L-methylfolate.
We are now doing a simple blood test in the office to determine whether or not you have a deficiency or not.
L-methylfolate is available as a prescription medical food called DELPIN, but is very expensive. There are also some vitamins that contain L-methylfolate (as opposed to plain folic acid) that are available at a much cheaper price.
Call our office if you would like more information or to be tested. Insurance coverage varies but may cover a portion of the costs.
Neurology 2014 Sep 2
Will the controversy over Vitamin D ever be resolved? Because Vitamin D plays an essential role in brain health, it has been postulated that a deficiency of it may be associated with cognitive disorders and Alzheimer Disease. (Vitamin D and its metabolites mediate the synthesis of various neurotransmitters including acetylcholine, catecholamines, serotonin, and dopamine. Vitamin D also helps maintain neurite outgrowth and promote synaptic plasticity, influences neurotransmitter synthesis, protects against oxidative stress and mitochondrial dysfunction, reduces the proinflammatory response, and regulates ageing). This comes at a time when some healthcare professionals have recommended not to screen for Vitamin D deficiency and some insurance companies have decided not to pay for testing.
Normal Vitamin D levels in the blood is 30. Any results lower should be treated. There is no evidence, however that once levels are above 30-40 that there are any further benefits.