Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

By | Abdominal Pain, Hormones, Insomnia, Mental Health, Pain, Prevention, Stress management, Vitamins and supplements

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies 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 takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. 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.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. 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.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

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

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. 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

Last edited Nov. 7, 2014

Sep
07
2013

Preserve Your Muscles And Joints

By | Anti-aging medicine, Arthritis, Diabetes, Fitness, Health, Heart Disease, Men's Health, Nutrition, Obesity, Prevention, Vitamins and supplements, Women’s Diseases

Our ancestors were hunters and gatherers, constantly on the go. They did not have to think too much about their muscle and joint health, they simply moved them. In our society this has changed a lot. At work we spend hours sitting at a desk, and then we use computers and watch television at home. Instead of walking to the neighborhood store, we use our car.

Here I will review what we can do to keep our joints and muscles in top shape until a ripe old age.

Brief intro regarding the anatomy of joints and muscles

Our joints are designed to give us full mobility. But the joints cannot do it alone. The muscles are designed to allow the joints to move in a full range. Without exercise the muscles will shrivel up (medical term “atrophy”) within only 2 to 3 weeks. So without regular exercise your joints won’t do you any good. Besides the joint capsules need regular stretching in full range exercises to produce the lubricating fluid (synovial fluid) that nourishes the joint surfaces and the menisci of the knees. Think of muscles and joints as being a functional unit designed to move you about.

Our joints have aerodynamic designs to do the most optimal job for our body. For instance the knees have more of a hinge design that includes menisci for shock absorption while the shoulders and hips have more of a ball and socket type construction.

Wear and tear with aging

It is usually thought that injuries and aging wear down the joints. But there are other factors such as the wide spread use of statins that can contribute to muscles weakness. Ironically statins are taken to protect the heart, but side effects can interfere with the ability to exercise your heart because of aching muscles and joints.

With optimal nutrition and avoidance of wheat and wheat products to prevent autoimmune arthritis (lupus, rheumatoid arthritis, dermatomyositis) your joints can stay young for much longer (explained further below). But your joints and muscles need to move through a full range of motion regularly to keep the blood circulation and nutrition of their tissues in top shape.

What causes joint deterioration?

Aging, weight gain, diabetes, smoking and lack of exercise all are known to cause a worsening of arthritis, particularly osteoarthritis, but also rheumatoid arthritis. The wrong diet with lots of sugar and starch and trans fats (hamburgers, pasta, sugar soda drinks) causes hyperinsulinemia (insulin overproduction, like in type 2 diabetes) and is almost guaranteed to make you sick with arthritis, obesity and diabetes.

There is also evidence that wheat causes inflammation and arthritis by stimulating your pancreas to produce too much insulin. This has been proven for dogs and for humans. A good diet book to follow is Dr. William Davis “Wheat Belly Cookbook” (Ref. 1) with 150 recipes. If you are overweight, these recipes will also help you to lose some weight effortlessly.

A caution to marathon runners: the constant pounding of prolonged jogging can cause osteoarthritis of hips and knees decades down the road. You may want to switch to different exercises before this happens.

Preserve Your Muscles And Joints

Preserve Your Muscles And Joints

What helps joints?

Molecularly distilled omega-3 fatty acid helps to prevent inflammation of your joints. Vitamin D3 will help your bones to be strong to support the tendons and ligaments. Chicken cartilage can build up joint cartilage within a few weeks! So, if you feel pain in your joints use 3 capsules of omega-3 (the strong, molecularly distilled ones) twice per day. This will help your joint inflammation within 3 to 4 weeks. If this alone is not enough add chicken cartilage from the health food store, which will help to build up the hyaline cartilage within your joints. For those who are questioning the effect of chicken cartilage, here is a 1993 chicken cartilage Harvard study proving it.

Below are more general steps that will help your joints, ligaments and muscles.

Maintaining health of joints and muscles

a)    It starts with good nutrition.

Hamburgers and deep fried French fries will not do the trick. Muscles require protein from meat, fish, poultry and dairy products. If you are a vegetarian you need to become knowledgeable on what essential amino acids are and what combination of vegetables will give you the amino acid composition to build up a full protein.

Joints need ingredients from cartilage, which you find in chicken cartilage (available in health food stores as fikzol (type II cartilage). I you prefer, chicken soup would also give you the ingredients to build up cartilage, but it would require a lot of regular chicken soup consumption to achieve this.

Sugar and starchy foods, which are broken down within half an hour after a meal into sugar in your blood, cause an insulin response from your pancreas. This in turn can cause inflammation in your joints and tendons. It is interesting to note that type 2 diabetes and arthritis are associated. A ketogenic, low sugar/starch diet will prevent arthritis and diabetes as it reduces the insulin level in the blood, which in turn turns off inflammation in the joints.

b)   Supplements:

Omega-3 fatty acids will help control any inflammation including the inflammation from arthritis (you need 3 capsules of the concentrated, molecularly distilled fish oil twice per day to achieve this).  DMSO gel, available in health food stores in the US, can also be used to rub onto inflamed joints. It will penetrate tissues rapidly, is nontoxic and helps control inflammation along with the omega-3 fatty acids. Regular anti-inflammatory pain relievers (NSAIDs) are harsh on your kidneys and can irritate the gastric lining causing bleeding gastric erosions, so definitely not recommendable.

Glucosamine, chondroitin sulfate, or a combination of both is available in the health food store and has been shown to help with osteoarthritis. I contributes to building up hyaline cartilage.

c)   Watch your weight:

It has been shown that the rate of degenerative arthritis (=osteoarthritis) in obese people is much higher when compared to slim people.

d)   Exercise:

You need to move your joints, ligaments and muscles every day to maintain their strength and range of motion. A daily workout at home or in a gym is best. I recommend 30 minutes of a treadmill or equivalent (jogging, Stairmaster etc.) as aerobic exercises. Then you need 30 minutes of isometric exercises like a circuit on exercise machines in the gym or dumbbells and expanders (resistance bands) at home. I consider this as the basic fitness routine every day.

Ballroom dancing and Latin dancing or Zumba is also a good combination exercise, which I would recommend on top of the basic exercise. Dancing helps to maintain your balance as well, which is something the older population tends to lose. In addition dancing stimulates your brain cells and makes you less vulnerable to develop dementia in old age.

Other aerobic exercises that can be recommended are walking (brisk walk) and/or intermittent jogging. Swimming has the advantage particularly for arthritis sufferers that you are floating. It allows you to exercise your leg and arm muscles, even if you have some arthritis pains.

e)  Pain relief: What could you do for pain relief? I do not like NSAIDs as this will damage your kidneys on the long-term and cause gastric erosions that can bleed massively. Electro acupuncture is very useful for muscle and joint pains and has no side effects. Physiotherapy treatments are useful to recondition your muscles and build up the range of motion of your joints. Chiropractic treatments for back and neck pain will also help. Instead of narcotics, why not try low dose Naltrexone (LDN). It has been shown to help with the pain of fibromyalgia.

Conclusion

In this brief review I have attempted to show you that your body is not on a one-way street in the direction of disability and death. There is a lot we can actively do to prevent this from happening prematurely. Just eat right, supplement (if you have symptoms), exercise and be active. Soon you will no longer be aware of your previously achy joints or muscles, as the pain tends to melt away when you are reconditioned.

More information on fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

References:

1. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014

Jun
15
2013

Electro-Acupuncture Is Twice As Effective As Conventional Acupuncture

By | Abdominal Pain, Arthritis, Gastrointestinal Disease, Other neurological conditions, Pain, Substance abuse

I am discussing here that electro-acupuncture is twice as effective as conventional acupuncture. Imagine that you had lower back pain and your doctor said that physically everything was OK. Would you consider traditional Chinese acupuncture? According to Ref. 1 chances are that 70% of patients with back pain will get better with a few visits to an acupuncturist. In 1972 Dr. Ulett’s laboratory at the University of Missouri succeeded in getting the first NIH research grant for the study of acupuncture in the US. During these studies they found remarkable facts, the most important perhaps that electrical stimulation of acupuncture needles resulted in a doubling of the effectiveness of traditional Chinese acupuncture. After extensive research Dr. Ulett stated: ”The ancient practice of traditional Chinese acupuncture is now obsolete” (Ref.1). The much simpler, but more effective electro-acupuncture using electrical skin pads instead of needles replaced traditional Chinese acupuncture.

The science of electro-acupuncture

In 1958 news came from China that they were doing major surgeries with patients staying awake and pain free only with the use of electro-acupuncture. In other words no chemical anesthesia was necessary to make patients comfortable. Professor Ji-Sheng Han from the Beijing Medical University observed that only electrical stimulation was powerful enough to produce the pain relief that was necessary to allow general surgery. Dr. Han conducted systematic experiments to study the phenomenon of electro-acupuncture and published this in Ref. 2. One of the experiments consisted of two rabbits. Electro-acupuncture anesthetized the donor rabbit. The vet removed spinal fluid from the first rabbit and transferred it into the second rabbit (the recipient rabbit) that did not receive further treatments.

The second rabbit was pain free and the vet performed surgery 

The injection of spinal fluid made the second rabbit pain free to the point where the vet could performed surgery on it without pain. Other researchers such as Dr. Pomeranz found that the brain released endorphins in response to electro-acupuncture, powerful morphine-like substances. It was the endorphins that were responsible for making the recipient rabbit of Dr. Han’s experiment pain free. Other experiments of Dr. Pomeranz showed that naloxone, a morphine and endorphin blocker also blocked the analgesic effect previously found by transferring spinal fluid. These lines of experiments also explain why some patients did not respond to electro-acupuncture, as they have a deficiency in the pain control system of their brain lacking endorphin release. Dr. Han did 30 years of experimentation and also observed patients very closely.

Placebo effect investigated by Dr. Han

Dr. Han also investigated the placebo effect and found that this can explain about 30% of healing. However, the remainder of the 70 to 75% response to electro-acupuncture in his opinion was due to the procedure. He was able to explain that traditional Chinese acupuncture points were merely spots on the body where electric currents penetrate the skin easier. When internal nerves pick up the electrical signals the also transmit to the spinal cord and to the brain. The electrical impulses then switch over in the brain and spinal cord to nerves that go to other areas of the body. This explains how electrical impulses can travel from conducting polymer pads applied over acupuncture points, release neuropeptides in the brain and help the body to heal. Functional MRI studies confirmed that certain frequencies stimulate the brain through electro-acupuncture or traditional Chinese acupuncture to give pain relief.

Electro-Acupuncture Twice As Effective As Conventional Acupuncture

Electro-Acupuncture Twice As Effective As Conventional Acupuncture

Electro-acupuncture produces stronger signals in the brain

These types of studies have also shown that electro-acupuncture produces stronger signals in the brain than traditional Chinese acupuncture.

Beside pain relief many other applications exist for electro-acupuncture. Addiction medicine makes use of electro-acupuncture in weaning people from morphine or heroine etc. The health professional can use this method to treat psychiatric illness, particularly depression. It is useful in relieving nausea and vomiting due to chemotherapy with cancer treatments or associated with pregnancy without affecting the pregnancy. However, this may also be useful as an adjunct to treating high blood pressure and cardiovascular disease.

One area where clinical hypnosis and electro-acupuncture have a closely relationship is called “conditioned healing” (Ref.1). For instance, with posttraumatic stress disorder (PTSD) in soldiers who returned from battle or in rape victims researchers showed that hypnotherapy treatment while using electro-acupuncture for 30 minutes at the same time can be useful in alleviating the symptoms these patients experience.

A few case studies using electro-acupuncture

Here are a few case studies that illustrate the use of electro-acupuncture with regard to patients (modified Ref.1). A treatment consists of a 30-minute session where the patient is either sitting or resting comfortably on an examining table. Treatments initially are often given twice per week until the pain is only about 50% of the original pain (severity of pain is scored on a 0 to 10 scale in the beginning). From that point on the visits are reduced to weekly sessions. Most clinical problems require three to 12 sessions. If the pain goes away, but returns after a few weeks, repeat sessions can be scheduled, which often lead to pain relief in a shorter time interval than was the case with the original problem. Chronic problems can be treated on an ongoing basis once per month, if there was a clinical response, but the pain reoccurs.

A 53-year-old painter with left shoulder pain

A 53-year-old painter with left shoulder pain, which radiated into the left chest, had problems with painting above his head. His physician did heart studies, but everything was OK. He was told that this was due to a muscle spasm in the shoulder muscles. One electrode was placed over the hoku point (also called LI-4  acupuncture point), which is located over the first interosseous muscle between the thumb and index finger, the other electrode over the area of pain in the left shoulder. Only seven treatments, twice per week for 2 weeks were given, then treatments with weekly intervals were administered. This approach cured his shoulder problems, and he could return to paining.

A 39-year-old woman with lower back pain

A 39-year-old woman came to the office complaining of lower back pain, which radiated into her right leg to the knee area. After tests she was told that she had spinal stenosis with sciatica (irritation of the sciatic nerve). No surgery could be done for this. She was given twelve electro-acupuncture treatments with one electrode placed below her right knee (ST-36 acupuncture point) and another electrode placed over her right lower back over one of the BL acupuncture points. She was almost pain free for about two weeks, but the pain came back after the last treatment. Since then she has been getting ongoing monthly electro-acupuncture visits with about 80% pain relief. Keep in mind that spinal stenosis is a condition for which regular medicine has nothing to offer other than symptomatic pain medication, which she did not want.

A 30-year-old schoolteacher with anxiety attacks 

A 30-year-old schoolteacher suffered from anxiety attacks and agoraphobia (fear of open spaces) for several years. The therapist used conditioning with electro acupuncture to treat this woman. She received a series of treatments with electro-acupuncture over both interosseous muscles (hoku acupuncture point or LI-4) for 30 minutes during which time she was also listening to a relaxation tape with music in the background and suggestions for self-hypnosis. The physician taught her how to do self-imagery at home. Subsequently she did this for 10 minutes two or three times per day. Several weeks later she was able to control her anxiety attacks and overcome her fear of open spaces. In the beginning she rated her symptoms as 8 to 10 in severity on a scale from 0 to 10. At the end of the sessions, she only had occasional symptoms with a 1 to 2 rating on this scale.

A 50-year-old man with cluster headaches 

A 50-year-old man with cluster headaches who had been investigated extensively by a neurologist without any other underlying cause was treated with electro-acupuncture. The electrodes were placed on acupuncture points of the head. Within only 4 sessions most of the headaches were gone. After 8 sessions he had no more headaches. However, a few weeks later his cluster headaches returned, but with ongoing monthly treatments he is able to prevent them from recurring. He did not like the side effects of all the pain medications, so he rather goes for his monthly booster electro-acupuncture treatments.

Take-home message regarding electro-acupuncture

Many people never considered traditional Chinese acupuncture for fear of needles. However, extensive research by Dr. Han and Dr. Ulett showed that electro-acupuncture with electrically conducting polymer pads or with EKG pads will replace the acupuncture needles. Not only is this method needle free, but also the weak electrical impulses that are used with electro-acupuncture treatment double the effectiveness of the older acupuncture method.

Many acupuncturists use both methods of acupuncture, but Dr. Ulett who used traditional acupuncture in the past has completely abandoned it and uses electro-acupuncture with the HANS machine instead. It is a complementary medical treatment, which has been authorized by the FDA.

More on pain conditions: http://nethealthbook.com/neurology-neurological-disease/pain/

References

1: 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

2. J.S. Han: “The Neurochemical Basis of Pain Relief by Acupuncture”. Vol. 2. Hu Bei Science and Technology Press, Beijing, 1998 (784 pages).