Jul
22
2017

Relaxation Reduces Inflammation

Relaxation can calm your mind, but new research has shown that relaxation reduces inflammation as well.

This article is based on a research paper in Frontiers in Immunology in June of 2017.

It concentrated on the calming effect of meditation on the nuclear factor kappa B (NF-κB), which causes inflammation. We know that overstimulation of the sympathetic nervous system activates the inflammatory pathway by expressing the genes responsible for NF-κB. These authors showed that the reverse is true also, namely that inflammation can be suppressed through meditation.

This metaanalysis of 18 research papers included 846 participants.

Here are brief summary findings of these 18 studies. Note that diverse relaxation methods had very similar results on the genes expressing inflammatory markers.

1. Qigong practitioners

A group of Qigong practitioners had 132 downregulated genes and 118 upregulated genes when compared to non-meditating controls. Meditation strengthens the immune system and delays cell death.

2. Sudarshan Kriya yoga

One form of yoga breathing is called Sudarshan Kriya yoga. When this form of breathing yoga was practiced for 1 hour per day the stress-related response on white blood cells was shielded compared to controls that did not meditate this way. Those practicing yoga had a strengthened immune system. Genes inhibiting cell death were also strengthened.

3. Chronic lymphocytic leukemia

Eight patients with chronic lymphocytic leukemia were practicing the “seven yoga breathing patterns”; the popular Indian yoga teacher, Swami Ramdev, developed these. Those patients who practiced the breathing yoga technique had 4,428 genes that were activated compared to controls. They showed an up to twofold upregulation, which strengthened their immune system.

4. Loneliness in older people

Loneliness in older people causes inflammation, morbidity and mortality. 55-85 year old volunteers were taking a course of mindfulness-based stress reduction. The researchers wanted to find out whether it was due to increased inflammation that older people were more susceptible to disease. Blood mononuclear cells were tested for genome-wide transcriptional profiling. Those older persons who had reported loneliness had more transcription factors for nuclear factor kappa B (NF-κB) than controls without feelings of loneliness. After an 8-week course those who no longer felt loneliness had a reversal of proinflammatory gene expression. The genes that had changed expression were located on monocytes and B-lymphocytes; these are cells of the immune system.

5. Care workers for patients with mental health problems

Care workers who looked after patients with mental health problems or chronic physical problems have been known to have stress-induced chronic inflammation markers in their blood. A study involving 23 caregivers used a practice of Kirtan Kriya Meditation (KKM) assisted by an audio recording every day for 8 weeks. There were questionnaires filled in for depression and mental health before and after the 8-week trial. Blood samples for transcriptional profiling were also taken before and after the KKM trial. The KKM meditation group had significantly less depressive symptoms and showed improvements in mental health. 49 genes were downregulated and 19 were upregulated compared to the controls. The pro-inflammatory NF-κB expression was decreased; the anti-viral gene expression was increased. This was measured using the IRF-1 gene. This gene controls the expression of the interferon-regulatory factor 1 (IRF-1 gene), which controls the immune response to viral infections. The interesting observation here was that a time of only 8 weeks of meditation was able to reduce inflammatory substances in the blood and could activate the immune system to fight viruses better. Further tests showed that it was the B cells and the dendritic cells that had been stimulated by the meditation.

6. Younger breast cancer patients

Younger breast cancer patients taking a mindfulness meditation course: Another study involved younger stable breast cancer patients after treatment that also had insomnia. Both breast cancer and insomnia were known to be associated with a lot of inflammatory markers in the blood. A total of 80 patients were enrolled in the study, 40 were treated with Tai-Chi exercises, the other group of 40 with cognitive-behavioral therapy. Tai-Chi exercises reduced IL-6 marginally and TNF (tumor necrosis factor) significantly. There was a 9% reduction with regard to the expression of 19 genes that were pro-inflammatory; there was also a 3.4% increase with regard to 34 genes involved in regulating the antiviral and anti-tumor activity in the Tai-Chi group when compared to the cognitive-behavioral therapy group. While cognitive therapy has its benefits, the winner was the Tai-Chi group where 68 genes were downregulated and 19 genes were upregulated. As in the prior study the pro-inflammatory NF-κB expression was decreased, which reduced the inflammatory response.

7.  Study with fatigued breast cancer patients

Another breast cancer study, this time with fatigued breast cancer patients, was observed. The patients practiced 3 months of Iyengar yoga. After 3 months of yoga there were 282 genes that were upregulated and 153 genes that were downregulated. The expression of NF-κB was significantly lowered. This suggests a lowering of inflammation. At the same time questionnaires showed that the fatigue factors had been significantly reduced 3 months after initiating yoga exercises.

8. Mindful meditation used in younger breast cancer patients

A group of 39 breast cancer patients diagnosed before the age of 50 received six weekly 2-hour sessions of mindful awareness practices (MAP). This program is tailored to cancer survivors. In addition to the group sessions the patients also did daily exercises of between 5 minutes and 20 minutes by themselves. The control group consisted of patients on a wait list. The investigators used several psychological measure (depression and stress) and physical measures (fatigue, hot flashes and pain) to assess their progress. Gene expression in the genome and inflammatory proteins were measured at baseline and after the intervention. Mindful practices showed clear benefits: they reduced stress, and sleep disturbances, hot flashes and fatigue showed improvement. Depression was also marginally reduced. There were 19 proinflammatory genes that had been turned off, but not in the control group that did not do mindful practices. Tests for changed genes revealed that transcription factor NF-κB was significantly downregulated. Conversely the anti-inflammatory glucocorticoid receptor and the interferon regulatory factors were increased. Downregulated genes were shown to come from monocytes and dendritic cells while the upregulated genes came from B lymphocytes.

9.  Telomerase gene expression

Lifestyle modification changes telomerase gene expression: 48 patients with high blood pressure were enrolled either in an extensive lifestyle program teaching them about losing weight, eating less sodium, exercising, adopting a healthy diet and drinking less alcohol; the other choice was to use transcendental meditation (TM) combined with health education with weekly sessions for 4 months. It turned out that both programs led to an increased expression of telomerase genes. Both groups did not show telomerase changes, but the authors stated that the observation time was too short for that to occur. The extensive health education program turned out to be better for patients with high blood pressure as it decreased the diastolic blood pressure more and resulted in healthier lifestyles.

10. Older patients with insomnia

Mind-body interventions for older patients with insomnia: A sample of 120 older adults with insomnia was divided into two groups. One group was treated with cognitive-behavioral therapy (CBT), the other group with Tai Chi. The control group consisted of a group of people participating in a sleep seminar. 4 months after the intervention the CBT group had a significantly reduced C-reactive protein (CRP). The proinflammatory markers were reduced in both groups after 2 months and in the Tai Chi group this remained low until 16 months. Gene expression profiling showed that CBT downregulated 347 genes and upregulated 191 genes; the Tai Chi group had downregulated 202 genes and upregulated 52 genes. The downregulated genes were mostly inflammatory genes while the upregulated genes controlled mostly interferon and antibody responses.

11. Patients with bowel disease

19 patients with irritable bowel syndrome (IBS) and 29 patients with inflammatory bowel disease (IBD) were treated with a relaxation response-based mind-body intervention. This consisted of 9 weekly meetings, each lasting 1.5 hours and practices a home for 15-20 minutes. The participants were taught breathing exercises and cognitive skills designed to help manage stress. At the end of the mind-body intervention and at a follow-up visit 3 weeks later participants of both the IBS and IBD groups scored higher in quality of life and lower in the level of anxiety they had before. They had reduced symptoms of their conditions. The IBS group showed an improvement in 1059 genes. These were mostly improvements in inflammatory responses, in cell growth, regarding proliferation, and also improvements in oxidative stress-related pathways. The IBD group showed improvements in 119 genes that were related to cell cycle regulation and DNA damages. Other genetic tests showed that NF-κB was a key molecule for both IBS and IBD. The main finding was that relaxation response-based mind-body intervention was able to down regulate inflammation in both IBD and IBS.

12. Caregivers for Alzheimer’s patients receiving a course of MBSR

A course of mindfulness based stress reduction (MBSR) was given to a group of 25 caregivers. Using 194 differently expressed genes the investigators could predict who would be a poor, moderate or good responder to the MBSR intervention. These genes related to inflammation, depression and stress response. 91 genes could identify with an accuracy of 94.7% at baseline whether the person would receive psychological benefits from the MBSR program.

13. Higher state of consciousness in two experienced Buddha meditators

Genetic test showed, similar to the other cases described here that genes involved in the immune system, cell death and the stress response were stimulated. EEG studies in both individuals during deep meditation were almost identical with an increase of theta and alpha frequency ranges.

14. Rapid gene expression in immune cells (lymphocytes) in the blood

One study used gentle yoga postures, meditation and breathing exercises. 10 participants who were recruited at a yoga camp had yoga experience between 1.5 months and 5 years. Their response resulted in 3-fold more gene changes than that of controls. Otherwise the findings were very similar to the other studies.

15. Genomic changes with the relaxation response

The relaxation response (RR) is the opposite of the stress response.  One study examined how various modes of entering into the relaxation response like yoga, Qi Gong, Tai Chi, breathing exercises, progressive muscle relaxation, meditation, and repetitive prayer would lead to beneficial gene effects. As in other studies inflammation was reduced and the immune system was stimulated from the relaxation response. This was verified with detailed gene studies. The authors noted that different genes were activated in people who had done long-term RR practice versus people who practiced RR only for a shorter time. There were distinctly different gene expressions.

16.  Energy metabolism and inflammation control

Relaxation responses beneficial for energy metabolism and inflammation control: Experts with experience in RR were compared with a group of novice RR practitioners. Experts and short-term practitioners expressed their genes differently at baseline. But after relaxation both experts and novices had gene changes in the area of energy metabolism, electron transport within the mitochondria, insulin secretion and cell aging. The upregulated genes are responsible for ATP synthase and insulin production. ATP synthase is responsible for energy production in the mitochondria and down regulates NF-κB pathway genes. Inflammation was reduced by these changes. All these beneficial gene changes were more prominent in expert RR practitioners. Other beneficial changes noted were telomere maintenance and nitric oxide production in both expert and novice RR practitioners.

17. Relaxation changes stress recovery and silences two inflammatory genes

Mindfulness meditation changes stress recovery and silences two inflammatory genes: Experienced meditators were tested after an intensive 8-h mindfulness meditation retreat workshop. Two inflammatory genes were silenced by mindfulness meditation compared to controls. Other genes that are involved in gene regulation were found to be downregulated as well. These experienced meditators had a faster cortisol recovery to social stress compared to controls.

18. Vacation and meditation effect on healing from disease

This last study investigated the effect of a 6-day holiday retreat. One group was offered a 4-day meditation course, one group was the control group just holidaying and the third group was an experienced meditation group who also took the retreat meditation course. Depression, stress, vitality, and mindfulness were measured with questionnaires. All groups were positively changed after the holiday and remained this way at 1 month after the retreat. 10 months after the retreat novice meditators were less depressed than the vacation control group. At the center of the experiment was the gene expression study. 390 genes had changed in all of the groups. The authors assumed that this was due to the relaxation experience of the retreat. The genes involved related to the stress response, wound healing, and injury. Other genes measured inflammation (control of tumor necrosis factor alpha). Another set of genes measured the control of protein synthesis of amyloid beta (Aβ) metabolism, which causes Alzheimer’s disease and dementia. All groups had markers that indicated less risk of dementia, depression and mortality, which was likely due to the relaxation from the retreat.

Relaxation Reduces Inflammation

Relaxation Reduces Inflammation

Conclusion

This study is a meta-analysis of 18 research papers. The authors found that very different approaches to relax the mind have fairly consistent universal effects on reducing inflammation. Most of this work was done with genetic markers. No matter what type of relaxation method you use, you will have beneficial effects from it. But the beneficial effect is not only strengthening the immune system, it also improves sleep, depression, anxiety and blood pressure. In addition it is improving your stress response, wound healing, risk of dementia and it reduces mortality. We don’t quite understand all of the details yet.

What is definitely documented is the effect of the mind-body interaction. It also points clearly to the relaxation response from meditation and similar relaxation methods. This has been proven beyond any doubt through genetic tests.

May
20
2017

Prevention Of Telomere Shortening

Dr. Mark Rosenberg gave a talk on prevention of telomere shortening. This was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The detailed title was: “The Clinical Value of Telomere Testing”.

What are telomeres?

Telomeres are the caps at the end of chromosomes. They are very important in the aging process. Prematurely shortened telomeres are linked closely to all major diseases like cardiovascular disease, cancer, diabetes and more. Telomeres are also a measure of the aging process. Aging occurs due to a decrease of the number of cells in organs and/or because of a lack of functioning of these organs. Telomeres get shortened every time a cell divides. But when the telomeres are used up, there comes a time when cells can no longer divide. These cells become senescent cells or they enter apoptosis (programmed cell death).

The senescent cells can become a problem when they get transformed into cancer cells and their telomeres lengthen again. These cancer cells divide rapidly and this can become the reason why cancer patients to die.

What is the significance of telomeres?

Telomere dysfunction is the first sign that the telomeres are getting shorter in a person compared to the average telomere length in a comparable age group. This is not only important for aging, but also has clinical implications. The shorter telomeres are, the higher the risk for cardiovascular disease. Telomere length also provides prognostic information about the mortality risk (risk of dying) with type 2 diabetes and for many cancers. Many physicians incorporate a telomere blood test into periodic health checks, if the patient can afford it.

Interventions that help telomere length

Here are a number of things we can do to lengthen our telomeres.

  1. Rosenberg mentioned that the strongest effect on telomere lengthening comes from caloric restriction and weight loss. 80 years ago they showed at the Cornell University that rats put on calorie restriction had a 30% increase in their mean and maximum lifespan. Many research papers have confirmed that the same is true in man and that the common denominator is telomere lengthening.
  2. Next are regular physical activity, meditation, reduction of alcohol consumption and stopping to smoke.
  3. Taking antioxidants and omega-3 fatty acids regularly will also lengthen telomeres.
  4. Improving one’s dietary pattern by adopting a Mediterranean type diet that contains cold-pressed, virgin olive oil.
  5. Telomerase activators. Here is some background on the TA-65 telomerase activator, which is based on Chinese medicine. A one year trial was completed with 250 units and 1000 units of TA-65 per day. The lower dose (250 units) showed effective telomere lengthening, while the placebo dose did not. The 1000 unit dose did not show statistical significance.

Should you wish to take TA-65, only take 250 units per day, not more.

Cancer and telomeres

There is a strong correlation between cancer and telomere shortening. When cells are at the brink of dying toward the end of their life cycle the telomeres get shorter and shorter. This is the point where the cells can turn malignant. Certain genetic abnormalities help the malignant transformation, like 11q or 17q deletions or a p53-dependent apoptosis response. Once cancer cells have established themselves they activate telomerase in 85% of cases. In the remaining 15% of cancer cases telomeres are activated through telomerase-independent mechanisms. Here are a few examples.

CLL

CLL stands for chronic lymphocytic leukemia. It is a disease of the aging population. At age 90 people’s bone marrow cells have a telomere length of only 50% of the length at birth. This is the reason that in older age CLL is more common. Researchers observed a population segment and found that the shorter telomeres were, the poorer the overall prognosis and overall survival for CLL was.

Lung cancer

In patients with non-small cell lung cancer the telomerase activity was examined. When telomerase activity was present, the 5-year survival was only 55%. When telomerase activity was absent, the prognosis was 90% survival after 5 years.

Prostate cancer

  1. Telomere shortening in stromal cells was found to be associated with prostate cancer risk. Men with shorter telomere length in stromal cells had a 266% higher risk of death compared to men with normal telomere length.
  2. Another study took blood samples and determined the telomere length in lymphocytes (the immune cells). Those men who came down with prostate cancer within a year after the blood sample was taken had short telomeres. The risk for prostate cancer in these patients was 355% higher than in the prostate cancer negative controls.

Yet another study looked at surgical tissue samples from 596 men that

Underwent surgery for clinically localized prostate cancer. Patients whose samples showed variable telomere lengths in prostate cancer cells and shorter telomeres compared to prostate samples with less variable telomere length and longer telomeres had a much poorer prognosis. They had 8-times the risk to progress to lethal prostate cancer. And they had 14-times the risk of dying from their prostate cancer.

Breast cancer

Breast cancer is diverse and consists of cases that are genetically inherited (BRCA1 and BRCA2), but there are also cases where the cancer is local or more advanced (staging). In families with mutated BRCA1 and BRCA2 telomeres are significantly shorter than in spontaneous breast cancer. Increased telomerase activity in breast cancer cases is directly related to how invasive and aggressive the breast cancer is.

  1. One study was shown where blood leukocytes were analyzed for telomere length in 52 patients with breast cancer versus 47 control patients. Average telomere length was significantly shorter in patients with a more advanced stage of breast cancer than in early breast cancer. Mutated HER patients had the shortest telomeres. It follows from this that checking for the HER status and blood telomere testing adds to the knowledge of potential cancer development and prognosis.
  2. Short telomere length was associated with larger breast tumors, more lymph node metastases and more vascular invasion. More aggressive breast cancer cells have higher telomerase activity. More than 90% of triple negative breast cancers have short telomeres.

CNS disorders and telomeres

Dr. Rosenberg presented evidence that shorter telomeres are associated with dementia. But dementias with Lewy bodies and Alzheimer’s disease are also linked to short leukocyte telomeres. The length of blood telomeres predicts how well stroke patients will do and how people with depression will respond to antidepressants.

Cardiovascular disease and telomeres

Our blood pressure is kept constant through the renin-angiotensin-aldosterone system. When this system is not stable, our blood pressure shoots up and causes cardiovascular disease. This is tough for the heart, as it has to pump harder against a higher-pressure gradient. A study of 1203 individuals was examining the connection between leukocyte telomere length and renin, aldosterone and angiotensin II activity. It concluded that oxidative stress and inflammatory responses affect the telomere length of leukocytes and that the more stress there is in the renin-angiotensin-aldosterone system, the more cardiovascular disease develops. The conclusion of the study was that the overall cardiovascular stress leads to shortening of leukocyte telomeres.

Prevention Of Telomere Shortening

Prevention Of Telomere Shortening

Conclusion

Telomere length testing from a simple blood test will become a more important test in the future as hopefully the cost comes down (currently about 300$). It can predict the general aging status by comparing a single case to the general telomere length of the public. But it can also predict the cancer risk, risk for mental disease and cognitive deficits (Alzheimer’s disease). In addition your cardiovascular status is also globally assessed with this test. What can be done, if the test comes back with short telomeres?

It allows you to change your lifestyle and adopt a healthy diet. You can exercise regularly, take antioxidants and meditate. There are even telomerase activators that are gradually becoming more known. They lengthen the telomeres. The cost of telomerase activators will likely still be a problem for some time. All in all telomere length tests are here to stay, but effective intervention at this point is largely limited to healthy lifestyle choices. This is good news: healthy lifestyle choices like non-smoking, exercise and avoiding non-processed foods are either free or have a reasonable price tag. Telomerase activators are big business and at this point not really affordable!

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Apr
01
2017

When Food Causes Inflammation

Dr. Hal Blatman gave a talk about when food causes inflammation. His talk was presented on Dec. 9 at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The original title was “Food, Pain and Dietary Effects of Inflammation”.

Dr. Blatman is the medical director of Blatman Health and Wellness Center, Cincinnati and Batman Medical Services, Manhattan.

General remarks about nutrition

Dr. Blatman pointed out that mistakes of nutrition are often behind chronic diseases and illnesses. The physician’s task is to explain to patients how their food intake can be changed to improve inflammation in the body and how the body can heal itself.

Hippocrates said 400 BC “Let food be thy medicine and medicine be thy food”.

In this context Dr. Blatman stated that nutrition could exacerbate symptoms or relieve symptoms and there must be rules for good nutrition. If we do not take care of our nutrition, the gut flora composition changes and causes leaky gut syndrome. But if we consume healthy foods all of this improves.

Mathematical formula for when food causes inflammation

To make it easier to understand the impact of food on our health the speaker offered this formula: G-B+R=P

G stands for good, beneficial things you can put into your body.

B = bad, toxic things that affect your body negatively.

R = reserves that your body has since birth (minus the amounts you have used up)

P = pain and problems you are going to experience

It is P (pain and other medical problems) what brings the patient to see the doctor. G and B is what the patient can change. When done right, the P value in the formula reduces and the pain or medical problems go away.

Nutritional rules

Dr. Blatman said there are three rules about nutrition.

Rule #1 is to not eat fake or toxic foods

He listed NutraSweet, Splenda, Saccharin, margarine and olestra.

  1. Aspartame experiments on rats showed that it can cause cancer: Dr. Blatman said that in man it has been shown to cause multiple myeloma and Hodgkin’s lymphoma. Aspartame worsens depression, 10% is metabolized in the liver into methanol, a nerve poison.
  2. Splenda (sucralose) is made from chlorinated sugar. It reduces beneficial microflora in the gut. It also interacts with liver enzymes that are known to interfere with the bioavailability of oral drugs.
  1. Saccharin alters gut bacteria and increases glucose tolerance.
  2. Hydrogenated fat and margarine. Insects don’t eat margarine, mold will not grow on it, and it will not support life. Merchants like it because food does not turn stale on shelves. Hydrogenated fats like margarine are considered to be poisons. They raise the bad LDL cholesterol levels and reduce beneficial HDL cholesterol levels. The prostaglandin balance changes so that inflammation occurs. There is increased evidence of diabetes and the cell membrane composition changes. Proinflammatory cytokines can cause pain in the dorsal root ganglions. It follows from all of this that it is best to cut out all hydrogenated fat and margarines.
  1. Partially hydrogenated vegetable oil. The cell membrane consists of two lipid layers at a specific ratio of omega-6 essential fatty acids and omega-3 essential fatty acids. It also contains triglycerides, phospholipids and protein. It is expected that the cell membrane absorb nutrients to move into the cell and eliminate waste out of it. The cell membrane needs to remain flexible and within neurons needs to transmit electrical information. The membrane composition is critical for the cell membranes to perform optimally. It is here that the physician has to explain this to the patient. All the fats we eat are the raw material, which will make up our cell membranes. So what fat we eat that day is built into the cell wall that is made that day or is repaired. If we eat hydrogenated fat that day, this is built into the cell wall.  A membrane with hydrogenated fat will:
  • Not transmit nutrients inside the cell
  • Will not transmit waste out
  • Causes the membrane to lose flexibility
  • In a nerve cell there will be abnormal neuron transmission

If we eat hydrogenated fat, we become like a “genuine GM truck fixed with inferior parts”, so Dr. Blatman. The interesting observation is that it takes 4 months after eliminating hydrogenated oil from the diet to get it out from red blood cells. Be aware that French fries increase pain for 4 months, so why eat them?

  1. Olestra, an artificial fat: Olestra has been developed as an artificial fat and is used in chips. It can cause diarrhea, abdominal cramps and weight gain with long-term use. Olestra belongs into the group of fake/toxic foods. Don’t eat Pringles or chips that are made with this.
  1. Healthy oils

There are two types of essential fatty acids, omega-6 fatty acids and omega-3 fatty acids. Many processed foods contain only omega-6 fatty acids, because this is the cheapest way to produce them (they are based on vegetable oils). Instead you want to eat healthy fats like omega-3 fatty acids contained in nuts and fish. You can also add molecularly distilled, high potency omega-3 fatty acids (purified fish oil) as a supplement to help restore the balance between omega-6 and omega-3 in your food intake. Avoid omega-6 fatty acids from corn oil, safflower oil, grape seed oil, soybean oil, cottonseed oil, canola oil and peanut oil.

Compare the metabolism of omega-6 fatty acids with that of omega-3 fatty acids.

The linoleic acid of omega-6 fatty acids gets metabolized into arachidonic acid, which causes pro-inflammatory mediators, PGE2 and LTB4. On the other hand with omega-3 fatty acids alpha-linolenic acid (ALA) is metabolized into EPA, DHA and the anti-inflammatory mediators PGE3 and LTB5.

It is easily understandable why a surplus of omega-6 fatty acids from processed foods will disbalance the omega-6 to omega-3 ratio. This ratio should be 1:1 to 3:1, but many Americans’ omega-6 to omega-3 ratio is 6:1 to 18:1. Omega-6-fatty acids cause arthritis, heart disease and strokes. Be particularly careful in avoiding soybean oil, which is the most popular oil in the last few decades to foul up the omega-6 to omega-3 ratio through processed foods.

When it comes to balancing omega-3 and omega-6 fatty acids in your diet, be aware that nutritional balancing can help you restore the ideal omega-6 to omega-3 ratio of 1:1 to 3:1. An easy way is to cut out processed foods as much as possible. Supplement with molecularly distilled fish oil capsules to add more omega-3 fatty acids into your food intake. Dr. Blatman gave the example of rheumatoid arthritis patients that were put on omega-3 supplements. After 24 weeks their joint swelling and tenderness went down.

Rebalancing the omega-6 to omega-3 ratio was able to treat depression as this research showed. This makes you wonder how much depression may be caused by overconsumption of processed food.

Dr. Blatman suggested the following doses of omega-3 supplementation for various purposes:

  • 1 gram/day as supplementation for healthy adults with a good diet
  • 1-3 grams/day for people with cardiovascular disease
  • 5-10 grams/day for patients with an autoimmune disease, with chronic pain or with neuropsychiatric conditions

He mentioned that these doses are empirical, but in his opinion definitely help. Due to quality differences he suggested that you buy fish oil capsules in a health food store where the quality is best. Stay away from discount stores (the quality is the worst) and drug stores.

Other healthy oils are olive oil and coconut oil. They are also useful for cooking.

Rule #2 is not to eat inflammatory foods

Our body functions like a luxury car; it needs pure food to function. Anything less leads to inflammation, particularly when you eat sugar and processed foods.

Inflammatory foods are sugar, white flour, fruit juice and white/red potatoes. A medium potato=1/2 cup of sugar! Other problematic foods are wheat grain contained in breads, pasta, cereal and thickeners in soups and sauces.

What is the problem with these foods? They break down the zonulin proteins that are a bridge between the lining cells of the gut.

This leads to an increase of intestinal permeability, and leaky gut syndrome can develop. Inflammatory cytokines from visceral fat add to the gut inflammation, and cardiovascular disease and high blood pressure can develop.

Fried potatoes, in particular the consumption of French fries, have been identified as the cause of inflammatory bowel disorder (IBD). Countries with the highest consumption of French fries have the highest incidence of IBD.

A Mediterranean diet and the DASH diet are anti-inflammatory diets.

Rule #3 is to not disturb the bowel flora

A healthy bowel flora is symbiotic with the body. You achieve this by eating green leafy vegetables. A toxic flora from dysbiotic microbes comes from eating white flour, white sugar and red meat. Red meat leaves residues on which dysbiotic bacteria thrive.

Symbiotic gut bacteria produce vitamin K, cobalamin, pyridoxine, biotin, riboflavin, pantothenic acid and short fatty acids. They also degrade metabolic toxins, prevent pathogens from colonization and they stimulate the immune system to mature.

Dysbiosis occurs when the wrong diet consisting of sodas, white flour, sugar and red meat is over consumed. There are toxins that are produced by the dysbiotic microbes. These injure the bowel wall and make the immune system work harder. Immune system dysfunction, fatigue and fibromyalgia can follow.

Dr. Blatman stated that gut dysbiosis that causes leaky gut syndrome could also cause ulcer disease, diabetes, heart disease, fibromyalgia, chronic fatigue syndrome, chronic pain and even cancer.

When Food Causes Inflammation

When Food Causes Inflammation

Conclusion

This was a whirlwind tour through a talk given by Dr. Blatman during the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas. What food we eat determines what gut bacteria we harbor, symbiotic ones or toxic ones. This in turn determines which way our health develops. But the content of what we eat is also important. If we consume processed foods we end up consuming way too many omega-6 fatty acids, which cause inflammation, arthritis and heart disease. This is happening in front of our eyes, if we start seeing things the way they are. I was aware of this since the mid 1990’s. In a lecture I attended at a continuing education conference a cardiologist pointed out that inflammation was the determining factor of whether or not our patients would get a heart attack. The lecturer mentioned then that the older cholesterol concept would be replaced by the newer inflammation concept. He was right, but it goes even further! There is the important omega-6 to omega-3 ratio, and fish oil supplementation helps. At the same time it is necessary cutting out processed foods. But there is the newer insight that our bowel flora and red meat consumption can culture toxic bacteria in our own gut. It is in our power to start eating more vegetables and cut out sugar and starchy food. It is time to see chips and French fries not as a “convenience” but a hazard to your health. Food does not have to cause inflammation; right food choices will help us to stay well and live longer.

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Mar
04
2017

Weight Loss Surgery Is Unnecessary

Dr. Flavio A. Cadegiani gave a talk saying that weight loss surgery is unnecessary. Dr. Cadegiani is the director of a weight loss clinic called Corpometria Institute in Brasilia, Brazil. He is board certified in endocrinology and metabolism and in internal medicine. His talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended.

Here are the main topics that he presented.

Weight measurements are wrong when based on the BMI

Dr. Cadegiani stated that we do not understand obesity, because we look at it from the wrong angle. Current dietary approaches have failed. But obesity research is still proceeding in the wrong way. If all else fails, weight loss surgery is finally suggested as a last resort. But this is wrong.

The problem with body mass index (BMI) is that an athletic body type may be called “obese”, because the BMI exceeds 30.0. However in a very muscular person the reason for the elevated BMI is an increased muscles mass, not fat. Body composition scales reveal that, but a simple weight measurement does not.

Dr. Cadegiani recommended measuring waist circumference with <94 cm (37 inches) for men and <88 cm (34.65 inches) for women being normal.

10 reasons why we are misled by the BMI

  1. The inventor of the BMI was a mathematician. It was explicitly stated that the BMI would not predict the level of fatness of an individual. The other factors are bone mass and muscle mass.
  2. Because the BMI ignores the waist size, it is scientifically invalid.
  3. There are physiological reasons why it is wrong: there is no allowance made for the relative proportion of the bone, muscle and fat content.
  4. The BMI gets the logic wrong: the CDC site claims that the BMI “is a reliable indicator of body fatness for people”. This is simply not true!
  5. The BMI is based on bad mathematics: the formula assumes low muscle mass and high fat content.
  6. The BMI is lying by scientific authority: Dr. Cadegiani said it has an “air of scientific authority, but it is mathematical snake oil.”
  7. The BMI suggests that there are distinct categories of underweight, ideal, overweight and obese. It assumes sharp boundaries that hinge on a decimal place. All of this is nonsense.
  8. Cynical people could suspect that medical insurance companies lobby for the continued use of the BMI as it keeps their profits high. Sometimes insurance companies charge higher fees for people with an elevated BMI.
  9. Doctors can contribute to the continued use of the BMI, if they don’t feel the need to use another way of assessing their obese patients.
  10. It is embarrassing that we still base the assessment of obesity on a 200-year-old mathematical formula when more reliable measures are known.

Bariatric surgery done too easily

Dr. Cadegiani noted that publications on bariatric surgery (=weight loss surgery)

underreport surgical complications and deaths. The bariatric industry is rich, and 90% of the booths during obesity conferences belong to bariatric-related companies. Long-term follow-up studies are lacking. Those who do follow-ups report an increase of pancreatic tumors after 10 years following bariatric surgery.

Long-term follow-ups also describe a 70% increase of psychiatric disorders including depression and alcoholism. Those who had bariatric surgery experience a 200% increase in suicides.

Overcoming weight centered approach

Here is how to avoid the weight-centered approach that would lead the clinician to wrong conclusions.

There are four factors being taken into account:

  1. Metabolic blood markers are included in the assessment
  2. Body composition scales are used and incorporated in the assessment
  3. The patient participates by measuring waist circumference and body weight
  4. Clinical signs and symptoms are incorporated

Classic metabolic markers are liver enzymes and hormone levels like testosterone, Thyroid (T3) LH and IGF-1. The lipid metabolism is monitored through apoB and triglyceride levels. Inflammation is monitored through uric acid levels, ferritin and C-reactive protein (CRP). An oral glucose tolerance test and fasting insulin level can predict diabetes 5 to 10 years before it will occur clinically. Other metabolic markers are homocysteine and metalloproteinases. Insulin resistance can be measured with newer tests.

Oxidized LDLc is the only marker that is linked to diabetic retinopathy. Another marker, resistin is an independent marker for obesity-related cancer, cardiovascular disease and overall mortality. A triglyceride-waist circumference index has been found to be the best predictor for future development of diabetes.

Body composition analysis

The patient measures his/her own waist circumference and body weight on body composition scales. This gives additional information about fat and muscle composition. Dr. Cadegiani’s team likes to understand what is really going on in terms of what triggers fat excess.

Questions are: what is the level of emotional overeating? How much anxiety is there in the patient’s life that leads to overeating? What is the social and cultural environment? What were previous weight loss attempts? And what is the family history in term of excessive weight?

Other important factors are to check for binge eating disorders or night eating syndrome. In addition any patient planning to go for weight loss therapy should be checked for depression, mood disorders and suicide potential.

Otherwise body composition scales by electrical bioimpedance were found to be very useful in assessing fat and muscle percentage as well as visceral fat percentage.

Aggressive clinical approach improves metabolism

Dr. Cadegiani and his group have published their own research paper in February 2017 showing that an aggressive clinical approach can prevent the need for bariatric surgery.  This publication describes that in a group of 43 subjects who were thought to be bariatric surgery candidates only 3 patients (7%) went on to have the procedure done. 93% of the subjects were able to shed pounds with the method offered and avoided bariatric surgery.

They documented that clinical parameters and blood tests all improved on their program. The researchers focused on triggers that caused obesity in their patients. The measured markers were oxidized LDL cholesterol, triglycerides, the liver enzymes ALT and μGT, fasting glucose, Hemoglobin A1C, uric acid and CRP. All of these parameters improved with the modification in food intake. 81.2% of the weight loss was from the reduction of fat mass. 46.5% of patients had a normal waist circumference measurement at the end of the trial. They also achieved normal body fat and visceral fat percentages. As already stated 93% of all the patients in this trial avoided weight loss surgery, called bariatric surgery.

Dr. Cadegiani suggested that obesity should be approached with a scientifically based and responsible method. This will change the way we manage obesity.

Weight Loss Surgery Is Unnecessary

Weight Loss Surgery Is Unnecessary

Conclusion

Attention to detail of the patient with weight problems will allow the patient to reduce fat percentage. Waist measurements should be regularly performed as well as body composition scales measurements. This way the physician can follow the fat and muscle percentages. Key to success is to reduce the refined carb contents of food intake (sugar and starchy foods) and have a calorie deficit diet. Exercise is also an important component. An aggressive clinical approach to obesity can improve the clinical outcome and can prevent bariatric surgery.

Sep
03
2016

Hidden Cause Of Depression

About 15.7 million Americans suffer from depression every year, but there remains a hidden cause of depression.

Not everybody responds well to antidepressant medicine. Only 30 to 50% of depressed people respond to antidepressants. There are two blood tests many physicians do not know and therefore fail to order: homocysteine blood levels and 5-methylfolate levels (5-MTHF).

Homocysteine as a hidden cause of depression

In 2004 a research group studied 924 middle-aged men. They noted that those men who fell into the highest third of homocysteine levels had a two-fold higher risk of being depressed than those who fell into the lower third of homocysteine levels. Other studies showed that SAMe, a nutrient that is required to build up mood enhancing neurotransmitters was sadly lacking in depressed people. In addition, folate levels were also found to be low in depressed people.

Having found this association between lack of nutrients and depression offered new opportunities to treat depression. Two studies examined the effect of taking 5-methylfolate on the effect of antidepressants. The result was astounding: in one study 7% of patients taking an antidepressant experienced improvement of their depression when assessed with a standard depression score. However, the same group improved their depression by 19% when 5-methylfolate was given in addition to the antidepressant.

Patients with the most severe depression on antidepressants had a 16% improvement of their depression. Adding 5-methylfolate to the antidepressant caused a 40% overall improvement in these severely depressed people, 24% more than without this simple vitamin supplement.

There is other evidence that patients with depression recover faster in the presence of 5-methylfolate. Moderately depressed patients recovered within 231 days on antidepressants alone, but in only 177 days when 5-methylfolate was present as well. The most severely depressed patients recovered within 150 days with antidepressants alone, but recovered within only 85 days on 5-methylfolate and the antidepressant.

Hidden cause of depression and Alzheimer’s disease

The story is getting more involved. Depression is related to proper balance of neurotransmitters that can be influenced by antidepressants and 5-methylfolate. But new research showed that Alzheimer’s disease (dementia) patients with cognitive decline have elevated homocysteine blood levels. A study in the New England Journal of medicine in 2002 found that after 8 years of observation more than 75% of them were diagnosed with Alzheimer’s disease. When blood homocysteine levels exceeded 14 micromole per liter the risk of Alzheimer’s had doubled compared to those with normal homocysteine levels. The researchers concluded that homocysteine is an important risk factor for the development of Alzheimer’s diseases and dementia, although it is not the only one.

Methylation pathway defects as a hidden cause of depression

40% of the population is defective in one or more genes that control the so-called methylation pathway in each of our cells (Ref. 1). This can slow down the metabolism of brain cells including the synthesis of certain neurotransmitters. At the same time it can cause the rising of homocysteine, which is then a useful marker for methylation defects. Another marker is the 5-methyl folate level, which, when low, indicates a deficiency in methyl donors including 5-methylfolate (5-MTHF).

Mental illness is an area where epigenetic factors play an important role. Depression that responds only partially or not at all to SSRI’s (antidepressants) often responds to L-methylfolate, a simple supplement from the health food store as a supplement. Similar epigenetic approaches can be used to treat psychosis, schizophrenia, bipolar disorder and Alzheimer’s disease.

Other illnesses due to methylation defects

Dr. Rozakis mentioned that 92% of migraine sufferers have a defective methylation pathway involving histamine overproduction and they can be helped with a histamine-restricted diet (Ref.2).

Autism, ADHD (hyperactivity) and learning disabilities are other diseases where methylation pathway defects are present. Every patient with autism should be checked for methylation pathway defects, and appropriate supplements and diet restrictions can help in normalizing the child’s metabolic defects. DAN physicians (“defeat autism now”) are well versed in this and should be consulted.

S-adenosylmethionine (SAMe) defects are another type of methylation defect, which is associated with certain liver, colon and gastric cancers.

Dr. Rozakis went on to say that methylation defects lead to disbalances between T and B cells of the immune system and are important in autoimmune diseases like lupus or rheumatoid arthritis.

Methylation defects can also cause autoimmune thyroiditis and type 1 diabetes. They can also cause cardiac disease by raising homocysteine levels, which causes dysfunction of the lining of arteries and premature heart attacks.

Epigenetic factors through global methylation defects from vitamin B2, B6 and B12 deficiency can cause many different cancers. Hypomethylation is the most common DNA defect of cancer cells.

With skin diseases it has come to light that atopic dermatitis, eczema, psoriasis, scleroderma and vitiligo are related to methylation.

When we age, certain hormones are gradually missing, which leads to menopause and andropause. This leads to impaired cell function, elevated cholesterol, arthritis, constipation, depression, low sex drive, elevated blood pressure, insomnia, irritable bowel syndrome and fatigue. Replace the missing hormones with bioidentical ones, and symptoms will normalize.

Tests and treatment for hidden cause of depression

It is important for a physician to test patients for homocysteine levels once per year. As we age, we tend to lose some of the methylation pathway enzymes, which can result in an increase of homocysteine in the blood. A normal homocysteine level is less than 7 to 8 micromoles per liter. This is lower than the commonly recommended 15 micromoles per liter.

If the homocysteine level is too high, the treatment consists of methionine containing foods like dairy products and meat. Methionine, an essential amino acid, functions as a donor of methyl groups, which will normalize the methylation pathway defect and allow the homocysteine level in the blood to decrease. Research studies have been using 1000 to 5000 micrograms of 5-methyl folate daily to reduce homocysteine. Other B vitamins are necessary to reduce homocysteine, like vitamin B2, B6 and B12 in addition to 5-MTHF.

Hidden Cause Of Depression

Hidden Cause Of Depression

Conclusion

Depression and several other illnesses that are related to methylation pathway defects can be caused by a lack of 5-MTHF resulting in high homocysteine blood levels. It is important for elderly patients to be checked for homocysteine blood levels once per year to prevent depression, Alzheimer’s disease, migraines and a number of other illnesses mentioned above.

Once a methylation pathway defect has been identified, it is relatively easy to treat the patient with a proper methionine rich diet and 5-MTHF supplements as well as other B vitamins as discussed. It can prevent a lot of disability and human suffering.

References

Ref.1: William J. Walsh, PhD: “Nutrient Power. Heal your biochemistry and heal your brain”. Skyhorse Publishing, 2014.

Ref. 2: http://www.askdrray.com/life-expectancy-is-influenced-by-lifestyle/

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Jun
04
2016

Genetic Screening For Better Health

Dr. Matt Pratt-Hyatt gave an overview about genetic screening for better health at the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas. The talk was entitled ”Genetic Screening: A Tool for Better Health with Age”. He showed that with more sensitive genetic screening techniques minor genetic changes can be detected. These are a lot more common than previously thought of. Matt Pratt-Hyatt, PhD is Associate Laboratory Director for the Great Plains Laboratory in Lenexa, KS.

Specifically, Dr. Pratt-Hyatt explained that single nucleotide polymorphisms, frequently called SNPs (pronounced “snips”) were the most common type of genetic variations among people. These genetic changes in the DNA often cause disease. Different types of genetic testing can identify the gene defects of SNPs. One of the questions is how aging can be better managed when genetic defects are known.

When it comes to our genetic material there are over 3 billion base pairs, all contained in 23 chromosomes. These are home to 20,000-25,000 genes, most of which are normal.

A gene has three regions all of which can have mutations. In the middle there is the coding region; one end is the regulatory region for transcription initiating; at the other end the transcription termination signals are located. Minor mutations in any of these regions can have major implications for the health of the individual or they can stay silent SNPs. SNPs are classified into missense mutation or nonsense mutation. This description just shows how intricate and complex the process of mutations can be!

Three types of sequencing are commonly used:

Three types of genetic screening for better health

  1. Sanger sequencing
 utilizes certain dyes that correspond to specific nucleotides of the DNA. The benefits of Sanger sequencing is that it can cover one gene completely. It can find previously unknown mutations. But the disadvantage of Sanger sequencing is that you cannot process a large number of genes.
  2. The Florophore-base detection looks at multiple SNPs in a single run. This method is cheaper than whole genome sequencing. But one of the disadvantages of Florophore-base detection
is that only a limited number of SNPs can be processed per run. It also can miss new mutations.
  3. Benefits of next generation sequencing 
are that it can look at 1000s of SNPs per run. It is much more accurate than previous technologies. A drawback
though is that the equipment is much more expensive.

Not all of these tests have to be done, but the physician can make the choice of the appropriate one for the patient. The following are some applications with regard to how genetic screening can be useful for better health.

Detoxification as part of genetic screening for better health

Since the 1970’s and 1980’s it has become clear that there are many steps in the detoxification process in the liver. It involves major enzyme systems that are controlled by the P450 genes. Several genetic defects are known that run in different families. These effects are very important for drug detoxification and metabolism. Any mutation in one of the P450 controlling genes will lead to accumulation of the drug that is normally detoxified by this enzyme system. As any drug has toxicity at higher levels, the consequence is possible toxicity, if the drug is not discontinued or lowered. When people age, they often have spontaneous mutations of the P450 detoxification system and this should be taken into account by doctors who prescribe medications. Common drugs that cause problems with the P450 controlled detoxification are antidepressants, the blood thinner Coumadin, the antibiotic erythromycin, the asthma medication Theophylline and many others.

Here is an example of how important this knowledge is in an elderly patient who was sent to the hospital with an irregular heartbeat. The electrocardiogram allowed a diagnosis of atrial fibrillation. The doctor treated the patient with a cautious loading dose of 0.5 mg of Coumadin in an attempt to thin the blood of the patient. This would prevent a blood clot or a stroke due to the arrhythmia. Normally a small dose like this would not do much in terms of blood thinning, as it would take several days of a low dose like this to achieve blood thinning. Unbeknown to the physician, this patient was different as he had a defect in the Cyp2c9 gene, a subtype of the P450 system. Very quickly the patient developed bleeding gums and bruising of the skin in various locations. When blood tests were taken, the INR, a measure of the clotting system, was 3.7, a value that should not have exceeded a level of 2 to 3. Genetic testing confirmed a homogenous mutation of the Cyp2c9 gene that explained the toxicity of Coumadin in this case, one of the many drugs that is detoxified by the P450 system.

Mental health as part of genetic screening for better health

Many mental illnesses can be caused by defects in various parts of the brain metabolism. This is particularly so when it involves the synthesis of brain hormones. If there are genetic defects, this can lead to the particular brain metabolism that is associated with depression or schizophrenia. Even dementia, Alzheimer’s disease and Parkinson’s disease can be caused by genetic defects. Methylation pathway defects are another source of possible genetic defects, which can affect multiple metabolic pathways. This is the cause of many diverse conditions like autism, diabetes and some hereditary cancers. The reason it is important to be aware of such genetic aberrations is that often vitamin B2, B6, niacin, vitamin B12 and the minerals magnesium and zinc can stabilize a person with methylation defects.

Cholesterol as part of genetic screening for better health

People with obesity have problems with their lipid metabolism, diabetes, high blood pressure and often heart disease and strokes. Changes in cholesterol metabolism are at the center of these problems. Cholesterol is one of the building blocks of cell membranes, and cholesterol is one of the normal components in the blood as long as the subfractions are properly balanced (LDL and the HDL cholesterol). Unfortunately many people have minor or major defects of the biosynthetic pathway of cholesterol. There are 5 genes involved in the acetyl CoA biosynthesis. 21 genes are involved in the main cholesterol biosynthesis pathways. Over 10 genes control cholesterol metabolites. Historically these genes were detected because of various familiar gene defects that caused problems with the biochemical processes surrounding cholesterol. Familial high cholesterol levels (familial hypercholesterolemia) is one of these common conditions.

Patients who have this condition will often have high cholesterol and also often have a family history of gall bladder surgery for gallstones and a history of premature heart attacks or strokes. Early diagnosis and careful clinical intervention can improve the outlook for many patients.

Genetic Screening For Better Health

Genetic Screening For Better Health

Conclusion

Not all genetic conditions can be helped by modern medicine. But many minor genetic abnormalities can be worked around or drug interactions can be avoided provided the genetic defect is known. It is encouraging that newer test methods have now shown success, as they are more affordable than in the past. As time progresses the price of these genetic tests will come down even further. Mental health, detoxification pathways and the metabolic syndrome of obesity are practical applications where genetic tests have significance.

May
07
2016

Sun Exposure Helps Many Symptoms

For the past few years it has become evident that sun exposure helps many symptoms. Patients with psoriasis have skin plaques on their skin. With sun exposure some of them disappear and the skin appearance improves. Patients with seasonal affective disorder have worsening of their depression over winter. Depression lifts with more sun exposure in the spring. Even a complicated disease like MS, which is more common in the northern latitudes, improves with sun exposure or a move to the southern states.

Osteoporosis: sun exposure has a positive effect

Osteoporosis was the subject of an April 2016 study from Argentina.

The researchers counted the amount of actinic keratosis lesions on the skin of subjects. This correlated well with lifetime sun exposure. Next the occurrence of hip fractures from osteoporosis was measured. The two were correlated. This case control study had 51 patients with hip fractures. Controls were 59 patients from the same hospital without hip fractures. The mean age was 80 years of age. 23.5% of patients with a history of hip fractures were observed to have actinic keratoses. In contrast 40.7 % of actinic keratoses were found in controls. The authors conclude that higher sun exposure is protective of hip fractures, but led to more actinic keratoses. They also stated that higher actinic keratoses rates, which are precancerous skin lesions are a risk for developing skin cancer. It is important to balance risk of osteoporosis from a lack of sun exposure with the risk of skin cancer from overexposure to the sun.

We know that higher doses of vitamin D3 in combination with vitamin K2 and calcium supplementation prevent osteoporosis. Reasonable daily doses are 5,000 to 10,000 IU of vitamin D3 per day, 200 micrograms of vitamin K2 per day and 500mg of calcium daily.

Psoriasis: sun exposure helps many symptoms

Psoriasis is an inflammatory condition of the skin with plaques and a characteristic skin rash. This February 2016 study from Turkey showed significant differences between women with psoriasis versus controls. Bone density studies showed lower levels in psoriatic females than in female controls. Female psoriasis patients had lower vitamin D levels than female controls. Male psoriatic patients showed no difference from controls. Low levels of vitamin D3 may be triggers for osteoporosis to develop in female psoriasis patients. Inflammation may also be a contributory factor. The C-reactive protein (CRP) was elevated in female psoriasis patients.

Clinical observations have shown for years that the rash of psoriasis patients tends to improve during the summer.

Seasonal affective disorder: sun exposure lifts the mood

Seasonal affective disorder (SAD) has been known to respond to light therapy. Typically it peaks in the winter months and presents in mostly females who live far away from the equator. They improve when they travel to a sunny spot such as the subtropics or the southern states of North America during the winter months. But light therapy, vitamin D3, antidepressant therapy and counseling the mood swings of seasonal affective disorder will lessen.

In this 2014 study it was shown that depression in older people was not related to the darker months (between October and March). The summer depression rates in older people were identical to the winter depression rates.

In a group of 38 patients with SAD 14 patients were treated with white light visors, 15 with infrared visors and 9 served as a control (visors, no light). Both white light and infrared treated groups showed prevention of SAD while the control group developed SAD.

A 6-week trial was published March 2015. It involved 78 patients (51 Afro-Americans and 27 Caucasians). They all had SAD and were treated with 10,000-lux bright light for 60 min daily in the morning. Caucasians had a response rate of 75%. African-Americans had a response rate of only 46.3%. The investigators found that the symptomatic improvement and the rate of treatment response were the same in both groups. More education resources are needed to treat the Afro-American subgroup of patients. This can overcome the inconsistent application with the bright light.

In a study involving 185 female undergraduates of the Pacific Northwest, vitamin D blood levels were measured and a correlation of low vitamin D with depressive symptoms was found in SAD patients.

In a small study the hypothesis was tested that vitamin D3 in higher doses would be beneficial for SAD patients. Eight subjects were treated with 100,000 I.U. of vitamin D3, while seven subjects received phototherapy. All subjects had their vitamin D blood levels checked. Interestingly the vitamin D3 group improved on all depression scales. The phototherapy did not show improvement on the depression scale. The vitamin D level increased 74% in the vitamin D3 group and 36% in the phototherapy group.

All of these studies seem to indicate that SAD is more common in a younger population while in older people depression seems to be year-round. SAD does respond very well to 1-hour exposure of 10,000 lux of light in the morning.On a sunny day a walk in the sun for 1 hour would be equivalent to being exposed at home with a SAD light. High dose vitamin D3 supplementation makes sense as SAD depression was found to be associated with low vitamin D levels.

Multiple sclerosis: sun exposure makes a difference

Multiple sclerosis (MS) has been shown to be more common in northern latitudes of the northern hemisphere. It is thought that sun exposure leads to higher vitamin D3 production in the skin, which prevents MS. On the other hand, once MS is established it can be ameliorated by sun exposure or high doses of vitamin D3.

This 2015 Australian study showed the same findings with a large group of MS patients.

This 2015 study from Sweden indicates that there is a compelling connection of prevention of MS through sun exposure or the taking of supplements of vitamin D3. In view of this evidence the authors suggest that you should take vitamin D3 supplements for prevention of MS before trials confirm this further.

Sun protection needed to prevent skin cancer

We have been hearing the slogan “slip, slop and slap” for skin cancer prevention. Slip, slop and slap stands for: slip on a shirt; slop on the sunscreen and slap on a hat. This publication dated March 2016 questions whether the precautions have been too zealous.

On the other hand the statistics regarding higher precancerous actinic keratoses in patients without osteoporosis are alarming too. It seems better to use high doses of vitamin D3, which will prevent osteoporosis, depression (SAD), MS and also improve psoriasis. Sun protection has decreased skin cancer, but did not curtail melanoma rates because sunscreen lotion can be penetrated by infrared radiation. This means that you are best advised to stay out of the intense sun between 11AM and 3PM. Use vitamin D3 supplements in higher doses as this protects your skin. Research from England indicates that melanoma patients are usually the ones that are susceptible to melanoma genetically. They also have low vitamin D levels in the blood to a certain degree from skin cancer formation. The researchers recommend strongly that those at risk for melanoma need to be on higher vitamin D3 supplementations. When a patient is diagnosed with melanoma high doses of vitamin D3 should also be used.

Sun Exposure Helps Many Symptoms

Sun Exposure Helps Many Symptoms

Conclusion

It is not a myth: sun exposure helps many symptoms as explained above. Diverse body systems like osteoporotic bones, psoriatic skin and seasonal affective disorder respond to sun exposure. Sun exposure also prevents MS, a degenerative central nervous system disorder. The effects of vitamin D3 can explain some of this effect. It likely stems from sun exposure to the skin. But sunlight has hormonal effects. This occurs through the optic pathways and connections to the hypothalamus. We know that the sun helps combat many symptoms, but more research will be necessary, till we know exactly how it works.

Oct
24
2015

Best Anti-Aging Products

Every day there is some news about a vitamin or supplement that is supposed to be good for you. But the ordinary person does not really know what will have an effect on anti-aging and what will not.

In the following I will review the key vitamins and supplements that have published anti-aging effects. With this I mean that there has been a consensus of anti-aging experts that several studies have shown a positive clinical effect of vitamins and supplements. Not all claims in the media are proven.

Vitamins and supplements needed for heart attack and stroke prevention

  • Vitamin K2 has emerged in several studies as an important vitamin that removes calcium from the vascular compartment and transports it into the bones where it is stored. Osteoporosis prevention is closely linked to heart attack and stroke prevention, which in my opinion is not widely known. Another study from 2013 was using a much larger patient base of 36,282 postmenopausal women of the Women’s Health initiative in the US who were followed up for 7 years. Initially there was some confusion as to how compliant the patients were in taking the required 1000 mg of calcium carbonate and 400 IU of vitamin D3. The supplement compliant group when compared 7 years into the trial had 35% to 38% less fractures of the hip than the placebo group. This supplementation did not cause kidney stones in the study group, as is often cited by some physicians as the reason why they do not want to recommend supplementing with vitamin D3 and calcium. In other words all of these kidney stone concerns you have so often read in the media are not true.
  • The second vitamin needed is vitamin D3 in doses of 4000 IU to 5000 IU per day. This helps to absorb calcium in the gut, but also helps to transport it into the bones away from the arteries. Apart from these vitamins and supplements regular exercise is needed to condition heart and lungs. The overall effect is that osteoporosis, heart attacks and strokes are prevented. Keep in mind that sugar needs to be avoided as well to prevent oxidation of LDL cholesterol.
  • PQQ and Co-Q-10 are also needed for heart attack and stroke prevention (see below). These two supplements strengthen the mitochondria, the tiny power packages within the heart muscle cells and the brain cells. The better the support, the more resilient the heart and the brain are to the changes with aging. The heart and the brain are particularly rich in mitochondria.
  • Vitamin D3, alpha-lipoic acid and resveratrol are also needed for prevention of heart attacks and strokes, because of the anti-inflammatory action (see below).
  • Magnesium and green leaf tea extract have been proven to be beneficial in terms of preventing heart attacks
  • Hawthorn is an herb that has been found useful for prevention of heart disease and treatment of mild heart failure (in Germany known as “Crataegutt”).

Mitochondrial function needs to be improved

If we want to have energy when we age, we need to take care of our mitochondria. This is where the biochemical processes take place that produce energy for us.

As I have summarized in this blog, there are several steps and supplements that will help us preserve mitochondria:

  • Mitochondrial aging is slowed down by ubiquinol (=Co-Q-10). Co-Q-10 repairs DNA damage to your mitochondria.
  • Another supplement, PQQ (=Pyrroloquinoline quinone) stimulates your healthy mitochondria to multiply. Between the two supplements you will have more energy as optimal mitochondrial function is ensured.
  • There are simple lifestyle changes you can make: eat less calories as this will stimulate the genes, which in turn stimulates your cell metabolism including the mitochondria.
  • Resveratrol, the supplement from red grape skin can also stimulate your mitochondria metabolism. Exercise more and regularly as this will also stimulate your mitochondria to multiply similar to the effects of PQQ.
  • Alpha-lipoic acid is an anti-oxidant that counters the slow-down of mitochondrial metabolism.

Anti-inflammatory vitamins and supplements

Since the mid 1990’s it is known by the medical profession that inflammation plays an important role in the development of heart attacks, strokes, inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, Alzheimer’s disease, diabetes mellitus, arthritis (both rheumatoid arthritis and osteoarthritis), multiple sclerosis, just to name a few. Here is a list of vitamins and supplements that counter inflammation:

  • Vitamin D3: Vitamin D3 is an anti-inflammatory helping to prevent heart disease and cancer.
  • Alpha-lipoic acid: This anti-inflammatory is both water and oil soluble. It is an antioxidant protecting from cardiovascular disease, diabetes, and may reduce the size of a stroke.
  • Bioflavonoids: Bioflavonoids are found in fruit and vegetables. One of the most potent ones is resveratrol. Resveratrol prevents oxidation of LDL cholesterol, which prevents heart attacks. It also prevents Alzheimer’s disease and helps prevent insulin resistance.
  • Garlic: This herb has anti-inflammatory effects, stimulates the immune system and lowers blood pressure moderately. It is used as an adjunct in treating high blood pressure, prevents heart disease and various cancers. It helps to reduce inflammation with osteoarthritis.
  • Ginger root extract: Ginger root is an anti-inflammatory, but also has anti-nausea effects and is useful for seasickness, morning sickness and side-effects from chemotherapy. Arthritis is also helped by it.
  • Ginseng: Ginseng is a popular herbal medicine; it has anti-inflammatory effects and improves immune function. Often people take it during the cold and flu season.
  • Green tea extract: Green tea extract is anti-inflammatory and has anti-oxidant effects. It is used for cancer prevention, stomach upsets, and diarrhea. It also helps in patients with Crohn’s disease and helps prevent heart disease.
  • Melatonin: Melatonin is a natural hormone produced in the pineal gland. It is a powerful anti-oxidant and anti-inflammatory. It also helps you to sleep. In higher doses it is used as anti-cancer medicine as it stimulates the immune system.
  • Rutin: Rutin is a bioflavonoid that is used to strengthen blood vessels, helps in stroke prevention and helps with osteoarthritis.
  • Selenium: Selenium is a trace element and an important anti-oxidant and anti-inflammatory. It stimulates the immune system, helps in prevention of cancer, and converts T4 thyroid hormone into the more active T3 thyroid hormone.
  • Cod liver oil (omega-3) and krill oil are both omega-3 fatty acids. Krill oil contains more DHA, while fish oil derived omega-3 fatty acids contains more omega-3. Both krill oil and fish oil are needed as supplements to prevent arthritis, strokes, heart attacks, osteoporosis, diabetes, dementia, Alzheimer’s and inflammation.
  • Coenzyme Q10 has antioxidant properties, but also anti-inflammatory properties and helps to prevent cancer and heart disease.
  • Flax seed: Ground flax seed has anti-inflammatory omega-3 in it, cancer-protective lignans, blood pressure lowering properties and mild blood thinning activity. Flax seed has a rather tough shell. With a cheap coffee grinder you can easily grind your flax seed. In a few seconds it is ground. It is important to wipe out the grinder after use with a damp cloth to prevent future rancidity of leftover ground flax seed.

Methylation defects and vitamin supplementation

Some people are born with enzymatic defects in the methylation pathways. They are more prone to diverse diseases like autism, depression, anxiety, schizophrenia, adrenal dysfunction, addiction, cancer, allergies, immune weakness, diabetes etc.

Here is a list of the methylation pathway vitamins and trace elements important for those who are born into families where mental illness or diabetes is frequent, as they are the ones who often have methylation defects, many of which can be corrected (Ref.1).

  • Vitamin B2/riboflavin: Riboflavin is used for neonatal jaundice as part of phototherapy. Some adult patients experience relief from migraines.
  • Vitamin B6/pyridoxine: Pyridoxal phosphate is a co-factor of many enzymatic reactions in amino acid, glucose and lipid metabolism.
  • Vitamin B12/methylcobalamin: Vitamin B12 is essential for your nerve function, bone marrow function (or severe anemia follows). It gives you energy and keeps you normal, but it is not a cure all. Sometimes in older patients absorption is a problem, but B12 injections every couple of months can easily overcome this.
  • Folate (from food or folic acid): Research about neural tube defects (spina bifida) in the baby of a folate deficient mother led to the discovery of folic acid. Heavy smokers and drinkers can get folate deficient. Folate is needed in DNA synthesis.
  • Magnesium: Magnesium is involved in more than 300 biochemical reactions within the body. It helps with asthma, bone health, muscle pain and prevents heart attacks. It also cures psychiatric disease like anxiety and agitation. Magnesium is a co-factor for many enzymes reactions.
  • Zinc: Because zinc is an essential trace element, it is involved in many organ systems and zinc is used for many health problems. People may have heard that zinc is an important supplement in male infertility and erectile dysfunction. But it is also needed as a supplement in diabetes, high blood pressure, psoriasis, macular degeneration and night blindness. Zinc is a natural opponent of copper meaning that when zinc is low, copper levels in the blood are often high. This constellation can cause insomnia.

What makes a vitamin or supplement an anti-aging product?

If a vitamin or supplement fits into one of these following classes, it helps slow down aging and thus would be considered an anti-aging product:

  1. Antioxidants (fight oxidant stress): a typical representative would be vitamin C, which prevents oxidative damage of our DNA. Others are B vitamins (B1, B3, B6, B12 and folate), acetyl-L-carnitine, alpha-lipoic acid, bioflavonoid, garlic, ginger root extract, Gingko biloba, ginseng, green tea extract, L-glutathione, magnesium, manganese, melatonin, N-acetyl cysteine, potassium, rutin, selenium, vitamin E, and coenzyme Q10. We have discussed them above.
  2. Anti-inflammatory action (fighting inflammation): vitamin D3 comes to mind, which suppresses inflammation in nerves (MS) or in blood vessels preventing heart disease. Others are alpha-lipoic acid, bioflavonoid, garlic, ginger root extract, ginseng, green tea extract, melatonin, rutin, selenium, cod liver oil (omega-3), coenzyme Q10, and ground flax seed.
  3. Preserving mitochondrial function: B-vitamins and coenzyme Q10 are examples that do this. Mitochondria are important to provide energy in the body. Others are acetyl-L-carnitine, alpha-lipoic acid, ginger root extract, ginseng and selenium.
  4. There are vitamins and supplements that will prevent insulin resistance. This is pretty important as diabetes, where insulin resistance is present will shorten life expectancy. Ginseng, green tea extract, magnesium are examples of supplements that prolong life through countering insulin resistance. Others that do this are B vitamins (B1, B3, B6, B12 and folate), vitamin D, alpha-lipoic acid, beta-carotene, chromium picolinate, garlic, ginger root extract, manganese, potassium, and selenium.
  5. Other supplements are prolonging life by providing membrane integrity: beta-carotene, garlic and selenium belong into this group. Others are ginger root extract, ginseng, cod liver oil (omega-3), and ground flax seed.
  6. Partial methylation defects can be cured with B vitamins explained earlier and this has been shown to help improve some mental disorders significantly, improve life quality, prevent suicides and prolong life.

Many vitamins and supplements have not only an action in one of those categories, but in two or more (Ref. 2).  B1, B3, B6, B12 and folate belong into category 1, 3, 4 and 6, so there is a huge overlap and this is what anti-aging physicians consider an advantage. Often conventional physicians shake their heads and say that the overlapping actions would prove that they are worthless. However, as time went on conventional physicians have started to adopt more and more the anti-aging concept, because science is proving in large trials from the Karolinska Institute in Sweden, from various Chinese universities, from American universities like Loyola University and Harvard Medical School, Salk Institute and others that the overlapping concept is valid.

Because of the overlapping effect of vitamins and supplements you may not need to take all of these listed here as long as you have a good overlap. I have listed dosages of vitamins and supplements in this link (scroll half-way down to the table entitled: Vitamins and supplements, your basic “life insurance”).

Best Anti-Aging Products

Best Anti-Aging Products

Conclusion

Although the topic seems to be complex, the basic idea is simple. We need to get away from processed food and return to eating whole foods, preferably organic foods. A good diet is the Mediterranean diet with an emphasis on vegetables, fruit and lean meat. Cook with coconut oil, but also use olive oil in salads. With this basic approach most of the vitamins and supplements I mentioned above are included. If you want to get more sophisticated, you may want to add some of the key vitamins and supplements I mentioned. It is also useful to use lab tests to establish, whether there are vitamin deficiencies, and it is equally important that vitamin levels-such as vitamin D3- are not too high and not too low. Supplementation without verifying the need for it or exceeding the dosage needed is not contributing to health (Ref.3). Many of the issues discussed in this blog are covered in more depth in my anti-aging book (Ref.4).

 

References

Ref.1: William J. Walsh, PhD: “Nutrient Power. Heal your biochemistry and heal your brain”. Skyhorse Publishing, 2014.

Ref.2: Life Extension: Disease Prevention and Treatment, Fifth edition. 130 Evidence-Based Protocols to Combat the Diseases of Aging. © 2013

Ref. 3: Ronald Klatz, MD, DO and Robert Goldman, MD, PhD, DO, FAASP, Executive Editors: “Encyclopedia of Clinical Anti-Aging Medicine & Regenerative Biomedical Technologies”. American Academy of Anti-Aging Medicine, Chicago, IL, USA, 2012.

Ref. 4: Dr. Schilling’s book, March 2014, Amazon.com:“A Survivor’s Guide To Successful Aging: With recipes for 1 week provided by Christina Schilling

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Oct
17
2015

Depression Needs Treatment

Depression is common: 10% of all men and 20% of all women have a period of depression in their lives. In people with medical illnesses depression is more common: 20% to 40% (Ref.1).

The peak age for depression is usually the age of 25 to 44. There are special groups where depression is also common. In adolescents 5% are affected with depression and 13% of women tend to get depressed after delivery, a condition called postpartum depression.

In any age group with depression there is a risk of suicide, but with adolescents this is particularly true.

About 10% to 15% of people with general medical illness are developing depression, such as patients with Parkinson’s disease, stroke, Alzheimer’s disease, cardiac disease, HIV infection, end-stage renal failure and cancer.

Causes of depression

Officially it is not known what causes depression. That is what medical textbooks say. However, other books like Datis Kharrazian’s book “Why isn’t my brain working?” offers several scenarios that can cause depression and he has examples of cases that were cured of depression (Ref.2). He points out that deficiencies in two major brain transmitters can cause depression: serotonin and dopamine.

  1. Serotonin is produced in the midbrain from the amino acid tryptophan in two biochemical steps. These biochemical conversions require iron, vitamin B6, vitamin B12, niacin, folic acid and magnesium as co-factors. But you also need the “large neutral amino acid transporter” (LNAA) to transport tryptophan through the blood/brain barrier into the brain.
  2. Dopamine is a neurotransmitter that is produced in the frontal lobes of the brain. It is also necessary for learning. Dopamine is synthetized by the brain from tyrosine, which has to be manufactured in the liver from the amino acid phenylalanine. You need to have a healthy liver to produce tyrosine, which needs to be transported through the blood/brain barrier into the brain; similar to tryptophan this requires the “large neutral amino acid transporter” (LNAA). People with hepatitis, fatty liver, insulin resistance or diabetes may have problems with the LNAA transporter, which can cause dopamine deficiency (Ref.2). But as mentioned earlier they may also have low serotonin because tryptophan was not transported into the brain. This will happen with sugar overconsumption, as insulin resistance develops and affects the LNAA transporter resulting in both low serotonin and dopamine (Ref.2).
  3. Since the 1990’s it is known that inflammation is also a possible factor in the causation of neurological disease including depression. Ref. 2 points out that gut issues can become brain issues as inflammatory substances can leak trough a leaky gut into the blood stream and trough a leaky blood/brain barrier into the brain. Hypothyroidism can activate brain inflammation and lead to an imbalance of the neurotransmitters. Gluten sensitivity is also an important cause of depression through the inflammatory connection, but few physicians recognize the full impact of this.

Tests for depression

There are no laboratory tests that would define depression. However, every patient should be checked for hypothyroidism, a common cause of depression. If hypothyroidism is found, this can easily be treated by thyroid hormone replacement.

Otherwise the diagnosis of depression is made based on mental status examination, history and review of symptoms. A good start is to ask: “In the past 2 weeks how little interest or pleasure in doing things have you had?” and “Have you been feeling down, depressed, or hopeless in the past 2 weeks?” (Ref.3).

There are detailed psychometric questionnaires available such as the Beck Depression Inventory that can assist the physician to establish the diagnosis.

Myths of depression

One of the myths regarding depression is that it would be contagious. A study on 2000 high school students showed that depression was not infective. The contrary was true: human interaction with friends who had a “healthy mood” improved depression. By the same token, when you constantly compare yourself with your Facebook friends, and you are not in the best mood, your mood may worsen and you could become depressed.

Treatment of depression

Despite advances in the treatment of depression the response rate with antidepressant therapy is limited to 60% to 70%. According to Ref.4 inadequate dosing and misdiagnoses account for the fact that 30% to 40% of treated people with depression have treatment failures. Typically the first antidepressant involves a selective serotonin reuptake inhibitor (SSRI), but newer trials have shown that the older monoamine oxidase inhibitors (MAOIs) have a higher success rate when treating depression initially (Ref.4).

A good antidepressant for mild to moderate depression is St. John’s wort, which is recommended by Ref. 5 as having less side-effects as other antidepressants.

In treatment resistant depression the psychiatrist often employs other combinations of antidepressants. In addition cognitive/behavioral therapy is added, which makes the overall treatment more successful. It goes without saying that complicated cases of depression belong into the hands of an experienced psychiatrist.

Suicides

Unfortunately there is still a stigma attached to have a mental disease like depression and people are in deep denial. Friends who do not understand depression may inadvertently say things that make the symptoms of the depressed person more severe and distance themselves at a time when they would need support from friends. The end result is loneliness, feelings of being misunderstood and having suicidal thoughts. Often it is men who will resist seeking treatment for depression, women are better in getting treatment started.

This is where a psychiatrist needs to intervene. If this does not happen, people start attempting suicide and finally commit suicide. In the US committed suicides have a gender ratio of male to female of 3:1 to 10:1. These situations become very difficult. The family needs to step in and talk to the patient. It is best to accompany the patient to the hospital for an assessment. Going to the hospital may be done privately or by ambulance. Don’t be shy to call 911 for an ambulance. Better to be cautious than have a major crisis that ends in completed suicide.

Alternative depression treatments

There are alternative treatments for depression.

1. Magnetic therapy for depression: This therapy is also called transcranial magnetic stimulation (TMS) and was approved for Canada and in 2008 by the FDA.

But it is not as powerful according to Ref. 3 as unitemporal electroconvulsive therapy.

2. Bifrontal electroconvulsive therapy (ECT): Electroconvulsive therapy with two pedals applied to the front of the skull appears to have the best results in terms of treating depression.

3. Omega-3 fatty acids (EPA and DHA) are powerful anti-inflammatory agents, which will take care of the inflammatory component of depression. Both fish oil and krill oil in combination give the optimal response as outlined here.

4. Vitamin D3 is also anti-inflammatory and will contribute to an improvement with existing depression, but it also helps prevent the development of depression when taken in regularly as a supplement.

5. Light box therapy: The observation of seasonal affective disorder (SADS) can develop as a result of lack of light. This has led to the discovery that light boxes are helpful for treating depression and also for prevention of depression due to seasonal affective disorder.

A light box should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often it takes up to 4 weeks to reach its full benefit.

6. It is known for a long time that alcohol is a depressant; it can actually cause depression and in persons with bipolar disease it can trigger a flare-up of that disorder as well.

7. Finally it matters what you eat: sugar and too much starchy foods (high glycemic index carbs) lead to insulin overproduction and insulin resistance. This causes inflammation, and this will cause depression. As mentioned earlier it also lowers the two key brain transmitters, dopamine and serotonin.

The solution is an anti-inflammatory diet, the Mediterranean diet without sugar and high glycemic index carbs; only low glycemic index carbs are allowed. This will normalize insulin production and eliminates inflammation.

8. Vitamin supplements: Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.5). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

9. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.6).

10. Exercise on a regular basis helps to equalize the mood and seems to exert a slight anti-depressant effect on the person who engages in regular physical activity.

Depression Needs Treatment

Depression Needs Treatment

Conclusion

I have attempted to show the complexity of depression and what is known about its causes and treatment. Very likely there are several causes for depression and further research will hopefully bring more clarity to this. Treatment modalities, both conventional and unconventional have been developed over the years by trial and error. The physician and patient need to use common sense: if a treatment is working, stick to it and use it. If it does not work, move on and try something else. More difficult cases should be referred to a psychiatrist who has the most experience with difficult to treat cases. Do not neglect life-style factors and alternative depression treatments as they can often help to stabilize depression significantly. We all must be vigilant about suicide risks in depressed patients and act by calling 911, if necessary to intervene.

More info on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

1. Depression, Major: Fred F. Ferri M.D., F.A.C.P., Ferri’s Clinical Advisor 2016, by Elsevier, Inc.

2. Dr. Datis Kharrazian: “Why Isn’t My Brain Working?” © 2013, Elephant Press, Carlsbad, CA 92011

3. Goldman-Cecil Medicine “Major depressive disorder” 2016, by Saunders, an imprint of Elsevier Inc.

4. Massachusetts General Hospital Comprehensive Clinical Psychiatry, Second Edition: Theodore A. Stern MD, Maurizio Fava MD, Timothy E. Wilens MD and Jerrold F. Rosenbaum MD © 2016, Elsevier Inc.

5. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.

6. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

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