Feb
17
2024

Ashwagandha’s Benefits

Medical news today had an article in October 2023 that reviewed ashwagandha’s benefits. I thought it would be useful to discuss this topic in an abridged version. Often things get distorted on the Internet and a reality check helps to separate facts from fiction. Ashwagandha (botanical name: Withania somnifera) is a small shrub that grows in Southeast Asia, Africa and some areas of India. An alternative name is Indian ginseng.  Ashwagandha has been part of Ayurvedic medicine for more than 3000 years.

About ashwagandha’s effectiveness

Ashwagandha is part of natural medicines that go under the name of adaptogens. The effective substances of ashwagandha were isolated. Researchers named them withanolides. They are alkaloids and consist of polyoxygenated steroidal lactones with 28-carbon ergostane skeletons.

People are taking ashwagandha supplements to counter stress and fatigue. But it also increases testosterone, which increases muscle mass. In addition, there is an increase of libido in men as well as in women.

People with insomnia benefit from the relaxing and sleep-inducing effect of ashwagandha supplements. Ashwagandha stimulates the immune system. It also significantly counters the stress response, as it lowers cortisol levels.

The active chemical components of ashwagandha

Various researchers pinpointed the diverse actions of ashwagandha extracts to withanolides, which are the pharmacologically active ingredients. There are at least 25 different chemical structures of withanolides, which are depicted in this reference: This explains the diverse effects of ashwagandha extracts on the immune system, the stress hormone axis, the libido brain centers and testosterone production. One human study showed that within 96 hours of ashwagandha extract administration the immune system was activated; T cells and natural killer cells were measured and were significantly elevated in number in comparison to controls:

Specific clinical trials showing effects of ashwagandha

Effects on the brain

In a small clinical study oral intake of ashwagandha improved performance on cognitive tasks, executive function, attention, and reaction time.

Dr. Amala Soumyanath is a professor of neurology in the School of Medicine at Oregon Health & Science University. She stated: “These laboratory studies show that ashwagandha extracts can act on neurotransmitter pathways including those involving serotonin and Gamma-aminobutyric acid (GABA), and also affect systems like the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary (SAM) axis.”

What does this mean? It means that ashwagandha contains a mix of withanolides that calm down the brain, particularly when it is stressed. At the same time, it increases serotonin and GABA, which has antidepressant and calming effects. Clinical trials have measured cortisol levels in volunteers and found that cortisol is lowered within a few weeks. This is the strongest evidence that ashwagandha in fact counteracts stress.

Libido and muscle strength

A small human study found that muscle strength was higher after exposure to oral ashwagandha in comparison to controls.

Ashwagandha showed a significant increase of maximum oxygen consumption (VO2max) in healthy adults and athletes, which is a direct measurement of exercise fitness. A clinical trial with 50 overweight males aged 40-70 years, showed that 16 weeks of oral ashwagandha increased their testosterone level by 14.7%. In addition, there were improvements in fatigue, vigor, and sexual and psychological well-being. There was also an increase of 18% of DHEA-S a precursor of testosterone. The authors felt that a larger study with a longer observation time would be beneficial to confirm this study. Overall, the objective effects of ashwagandha are in the mild to moderate category. The mild increase in testosterone affects libido only marginally. Some articles in social media are vastly exaggerating the objective findings.

Health risk of ashwagandha

There are downsides as well. Ashwagandha stimulates the immune system and in doing so may exacerbate autoimmune diseases. It also can increase thyroid hormones, which is important to know for people with hyperthyroidism or hypothyroidism. Men who have hormone sensitive prostate cancer should avoid ashwagandha, because it elevates testosterone.

Researchers pointed out that gastrointestinal upsets, such as diarrhea, nausea, and vomiting due to ashwagandha are common side effects. The higher the dosage and the longer the exposure is, the more likely it is that the patient experiences side effects. Researchers reported a few cases of reversible liver toxicity cases due to ashwagandha. At this point the effects of concomitant medications taken at the same time as ashwagandha is not known.

Ashwagandha’s Benefits

Ashwagandha’s Benefits

Conclusion

Lately social media is full of ashwagandha’s benefits. Rosy reports of increased libido, extra energy and boosts of confidence circulate on the Internet. Men are told that in order to build up muscle bulk with exercise they must take ashwagandha. This review checked the facts. There is a 14.7% rise in testosterone from taking ashwagandha and this may contribute to an increase of muscle mass with exercise, but this is not a huge effect. Also, the mild increase of libido due to the increase of testosterone is not as significant as reported in the social media. The active ingredients of ashwagandha are the withanolides, which researchers isolated. They do help to deal with stress-related problems like lack of energy and insomnia. In addition, they stimulate the immune system to give a stronger response.

Side effects of ashwagandha

But ashwagandha also has some side effects. It can make auto immune reactions worse. It can interfere with both hyperthyroidism and hypothyroidism. Men who have hormone sensitive prostate cancer must avoid ashwagandha because of the testosterone increase. Gastrointestinal upsets, such as diarrhea, nausea, and vomiting from ashwagandha supplementation are common side effects. So far scientific evidence is based on relatively small clinical trials. Scientists must conduct much bigger trials that are going on for several years to provide more in-depth information on the effects of ashwagandha.

Jan
08
2022

Sleep Training to Prevent Insomnia and Depression

A new study describes that sleep training to prevent insomnia and depression is desirable. Notably, the study published in JAMA Psychiatry took 291 people age 60 years and older and followed them for three years. In this case half the participants received treatment with sleep training, the other half treatment with cognitive behavioral therapy. The other half was the control who received sleep education therapy from a public health educator. It is important to realize that both groups received 120 minutes weekly group sessions for two months. That is to say, following training of 2 months the subjects were followed for 36 months. It must be remembered that they completed monthly questionnaires to monitor for depression and insomnia. At the end of the study almost 1/3 of the cognitive behavioral group still were free of insomnia.

The control group who received sleep education therapy initially showed no longer any

improvement. In other words, the initial progress did not last with sleep education only. The study was also published in CNN.

Results about rates of depression

Those subjects of the cognitive behavioral therapy group who had a sustained remission of their insomnia disorder had a rate of 82.6% less depression. This was in comparison to the subjects who did not sustain their treatment against insomnia. Dr. Pim Cuijpers commented that the results of the study show “a completely new and innovative way” of tackling the growing problem of depression. Dr. Cuijpers is a professor of Clinical Psychology at the Free University of Amsterdam.

A brief background about depression in older patients

Depression is common in people above the age of 60. About 30-50% of this age group develop depression. Part of this could be that older people often do not get enough sleep as middle-age or younger adults do. Melatonin production declines with older age and this may play a role in insomnia of older people. On the other hand, one of the major symptoms of depression is a lack of sleep. It seems that a lack of REM sleep, the deep sleep that makes us dream, is responsible for both troubles, sleeping (insomnia) and depression.

Cognitive behavioral therapy administered by a therapist is effective for insomnia

It is important that a therapist administers the cognitive behavioral therapy. There are recordings available online that provide cognitive therapy, but they are not individualised. Dr. Irwin said: “That’s why CBT-I is so effective in person, because the therapist is helping that individual navigate and negotiate with themselves — and it can be really hard work,” Irwin added. “I believe that’s also why CBT-I apps or online tools often don’t work — people get frustrated, disappointed or angry at themselves, and they basically stop the work.”

The rationale for cognitive behavioral therapy (CBT)

CBT for insomnia has five components: Stimulus control, sleep restriction, sleep hygiene, relaxation and cognitive behavioral therapy. Researchers gave the program the name CBT-I. Sleep hygiene and relaxation involve these sleeping habits: going to bed at the same time every day, eliminating noise and blue light from electronic devices. Also, you want to keep your bedroom cool, take warm baths and do yoga for relaxation.

Stimulus control and sleep restriction

Stimulus control involves getting out of bed, if you can’t sleep. Dr. Irvin said: “Most people stay in bed, fretting about not falling asleep, which then turns the bed into a negative space. Instead, people are taught to get up after 10 minutes of tossing and turning, do quiet, non-stimulating activities, and not to come back to bed until they are sleepy.” Sleep restriction means that a person lies in bed only to sleep plus 30 minutes. It is a way to make people with insomnia get out of bed instead of lying there awake.

Cognitive behavioral therapy

Cognitive behavioral therapy disrupts irrational thoughts and beliefs about sleep. Patients with insomnia often think “I can never sleep” or “I might die if I don’t sleep tonight.” A therapist has training to help the patient find a way back to a more realistic mindset. Eventually the patient accepts the bed as a welcoming place.

Cognitive behavioral therapy is effective in preventing depression

Dr. Irwin pointed out that chronic insomnia often leads to depression. A dangerous consequence of depression can be preoccupation with suicide. A certain percentage of patients with depression in any age group want to kill themselves. This is where cognitive behavioral therapy can intervene and make a huge difference. As mentioned earlier almost 1/3 of patients who received cognitive behavioral therapy for two months retained their normal sleep pattern. It was among this group that 82.6% had no depression compared to a control group. These are very important statistics. Dr. Irwin said: “We have shown that we can actually target insomnia with cognitive behavior therapy and prevent depression from occurring”.

Sleep Training to Prevent Insomnia and Depression


Sleep Training to Prevent Insomnia and Depression

Conclusion

A new study in JAMA Psychiatry describes that sleep training to prevent insomnia and depression is feasible. Sleep researchers used cognitive behavioral therapy sessions for two months on subjects who suffered from insomnia. The treatment group had profound effects with respect to improving insomnia and depression. Almost 1/3 of subjects treated with cognitive behavioral therapy returned to a normal sleeping pattern. And this subgroup of patients had 82.6% less depression. The lead author, Dr. Irwin thinks that cognitive behavioral therapy could become the new way of how to treat and prevent depression.

Jan
19
2019

Alzheimer’s disease is treatable with hormones

Dr. Thierry Hertoghe, an endocrinologist from Belgium, stated that Alzheimer’s disease is treatable with hormones. This talk was part the 26th Anti-Aging Conference of the American Academy of Anti-Aging Medicine in Las Vegas (from December 13 to 15, 2018).

First of all, Dr. Hertoghe treated many Alzheimer’s patients himself and noted that they often have multiple hormone deficiencies. Secondly, common deficiencies affect thyroid hormones, human growth hormone, estradiol for women and testosterone for men. But even vasopressin and oxytocin are hormones that may be lacking. Third,  after doing thorough blood tests to assess hormone levels, Dr. Hertoghe replaced what hormones were missing. Finally, many Alzheimer’s patients got their energy, muscle strength and memory back.

In the following I am summarizing what Dr. Hertoghe told the audience about the various hormones. Alzheimer’s disease is treatable with hormones. Later I provide the hormone doses that Dr. Hertoghe uses for replacement.

Progressive memory loss

Generally, patients who develop Alzheimer’s disease start losing short-term memory first, but in time they will also lose long-term memory. Often this disease process starts in the 60’s as age-associated cognitive impairment. In the 70’s it may progress further to mild cognitive impairment, only to take off in the 80’s as Alzheimer’s disease. The astute clinician may order some screening blood tests in the 60’s and 70’s. In a male low testosterone, low DHEAS and low thyroid hormones may be present. Certainly, blood tests will show this readily. Frequently, in women low estradiol, low thyroid and low DHEAS may also be present. The reason this is important is that simple hormone replacement can return a person back to normal. Yes, this is right: hormone replacement can bring a person with age-associated cognitive impairment or mild cognitive impairment back to normal! In other words, Alzheimer’s disease is treatable with hormones.

Hormones important to monitor with Alzheimer’s disease

There are 6 hormones that are important for memory restoration in Alzheimer’s patients: IGF-1 (and growth hormone), thyroid hormones, estrogen and testosterone, vasopressin (and oxytocin) and pregnenolone. However, as Alzheimer’s patients often have sleep problems, another important hormone is melatonin.

Oxytocin to calm down aggressive Alzheimer’s patients

Notably, Dr. Hertoghe found that Alzheimer’s patients often are restless and can be aggressive. This makes it difficult to care for them in a home. Oxytocin is the hormone of trust, affection, sociability and concerns about others. It calms down aggressiveness. But with oxytocin treatment the Alzheimer’s patient feels better, becomes friendly, cooperative and warm-hearted.

As an illustration Dr. Hertoghe gave an example of one of his 80-year old patients with aggressive Alzheimer’s disease. She became unmanageable for her non-married son and other contacts. 5 IU of oxytocin sublingually changed this woman into a friendly, compassionate, warm-hearted woman, and the aggressiveness disappeared completely.

Insomnia in Alzheimer’s patients

About 45% of Alzheimer’s patients develop “sundowning”. When the sun goes down they start getting hyperactive, develop unacceptable behaviors and they become restless. Research papers showed that blood melatonin levels are low in these patients. Indeed, this is why they respond very well to small amounts of melatonin at bedtime. As a conclusion, within only a few days of starting this, their sundowning disappears, and they become easier to look after.

Dr. Hertoghe provided material from several research papers that showed that Alzheimer’s patients are often deficient for melatonin. Replacement with varying doses of melatonin solved even more complicated insomnia problems.

Melatonin is a powerful anti-oxidant. Interesting animal experiments have shown that melatonin has memory-enhancing properties. Researchers believe that melatonin improves the extracellular senile plaques with amyloid-beta peptide accumulation (first of 2 Alzheimer’s lesions). In addition melatonin also decreases the intracellular neurofibrillary degeneration tangles, the second of the two specific Alzheimer’s lesions.

IGF-1 and human growth hormone

Several studies have shown that Alzheimer’s patients have a significant drop in IGF-1 levels and growth hormone levels. This affects their short-term and long-term memory. Serum IGF-1 has an inverse correlation with cognitive impairment. Dr. Hertoghe said that IGF-1 treatment in Alzheimer’s patients increases their brain volume, increases the functional network of neurons in the brain and increases memory.

Brain atrophy in Alzheimer’s patients from chronically depleted IGF-1

Dr. Hertoghe showed a slide of a normal brain with a view from the outside and a cross section view of the brain. The same slide contained the view of an Alzheimer’s patient’s brain. It showed brain atrophy resulting in a much smaller brain and the cross section displayed an increase of the hollow spaces (e.g. the third and forth ventricle). He stressed that in his view the brain shrinkage of Alzheimer’s patients is due to prolonged low levels of IGF-1. This in turn is due to a lack of production of human growth hormone.

With IGF-1 treatment the serum IGF-1 was increasing and the cognitive function in older adults recovered. Dr. Hertoghe provided many literature citations to support this, which I will not repeat here.

Case report of a male patient with Alzheimer’s disease

Dr. Hertoghe presented one of his patients with Alzheimer’s. Lab tests showed that he had deficiencies of thyroid hormones, DHEA and testosterone. But despite replacement of these hormones he remained severely affected with Alzheimer’s. He did not remember his own name, could not go to the toilet on his own, spoke only a few words and suffered from severe fatigue. He received 4 injections around his eyes with IGF-1 and mesotherapy from his doctor (described below) with human growth hormone and IGF-1. Within a few weeks he had a complete reversal of his cognitive decline. He could return to his professional driving career doing halftime work with a delivery van in the city. He could read a newspaper and understood what he was reading. Alzheimer’s disease is treatable with hormones.

Thyroid hormones

According to Dr. Hertoghe thyroid hormones help to establish short-term and long-term memory and treat the apathetic depression in Alzheimer’s patients. Many Alzheimer’s patients are hypothyroid.With this deficiency they have swollen lower eyelids, a puffy face and paleness of the face. In a 1990 study a group of Alzheimer’s patients had 26% lower T3 levels when compared to normal controls. Many patients with hypothyroidism have memory loss, before their deficiency is corrected. Dr. Hertoghe stated that 13% of all dementia cases are reversible by proper thyroid hormone treatment.

Estradiol can improve long-term memory loss

Research showed that estradiol could improve long-term memory in dementia and Alzheimer’s disease cases. Many female Alzheimer’s patients are deficient in estrogens. If they do, they have dry eyes, a pale face and thin, dull hair. In a 2005 study 33 control women were compared to 48 women with Alzheimer’s disease. The estradiol levels in the Alzheimer’s disease group showed significant depletion compared to the normal control group. There was no significant difference found with regard to progesterone, testosterone and LH&HSH levels. Another study showed that in cerebrospinal fluid of women with Alzheimer’s disease the estradiol level was significantly reduced while the beta-amyloid levels were significantly increased.

Dr. Hertoghe reviewed several studies that showed that symptoms of Alzheimer’s disease disappeared with estradiol supplementation. Both memory and mood responded to the treatments.

Men with Alzheimer’s disease are often testosterone deficient

Testosterone is important for long-term memory. Men in andropause report erectile dysfunction, general weakness and memory loss. The physician needs to be aware that the patient may be starting to develop Alzheimer’s disease. Dr. Hertoghe showed a slide based on a publication, which stressed that testosterone enhances memory. It increases brain blood flow and thickens the myelin sheets. Testosterone increases dendrite and synapses and in addition decreases amyloid beta-peptide production. Neurotoxicity is also reduced. The end result is improvement of Alzheimer’s in males with testosterone replacement.

Pregnenolone improves short-term memory

Pregnenolone gets synthesized in the brain, spinal cord and peripheral nerves. Dr. Hertoghe said that pregnenolone is a neurostimulating “neurosteroid”. Pregnenolone concentrations in brain tissue are about 25- to 35-fold higher than in the blood stream. Some cases of Alzheimer’s disease can come from a lack of pregnenolone and pregnenolone sulfate. Patients who have Alzheimer’s because of a lack of pregnenolone have blood levels that are 2.5-fold lower than pregnenolone levels in normal controls. When these patients are treated with pregnenolone, their memory improves. The mechanism of the effect of pregnenolone is by increasing acetylcholine by more than 50% in the hippocampus. It also protects the hippocampus from glutamate and amyloid beta. Pregnenolone improves short-term memory over a period of 3 to 4 months of treatment.

Vasopressin improves short-term and long-term memory loss

Postmortem studies on Alzheimer’s patients showed that there is decreased vasopressin in the brain cortex. In patients with alcoholic dementia (Korsakoff psychosis after recovery) there was decreased vasopressin in the cerebrospinal fluid. Often patients with diabetes insipidus have decreased vasopressin and are in danger of developing dementia. If not treated, they develop short-term and long-term memory loss. When treated with vasopressin or Desmopressin their memory recovers within 4 hours of starting therapy. Younger patients (50 to 73) do better with memory recovery than older patients (74 to 91).

Treatment details of hormone replacement for Alzheimer’s disease

Before hormone treatments are given to a patient it is important to do a battery of blood tests. This will help the physician to identify the missing hormones in a particular patient. Each of the missing hormones are then administered separately.

Oxytocin

This hormone can be given sublingually or intranasally. Sublingually 5-10 IU are given daily. With the sublingual approach 1 or 2 sprays are given daily. Each spray contains 8 IU of oxytocin. Improvement is visible within 2 to 5 days. A full recovery takes 2 to 3 months.

Melatonin

Most patients in the higher age group do no longer produce their own melatonin. With the oral route 1-3 mg are given every night before going to bed. An alternative is to use sublingual tables 0.5mg to 1.0mg at bedtime. The first improvement can be seen 2-5 days after the start of replacing melatonin, the full impact takes about 2-3 months from the start of the treatment.

IGF-1 and human growth hormone

Replacement of IGF-1 can be done by injecting IGF-1 or human growth hormone (HGH). HGH stimulates the liver to produce IGF-1. IGF-1 is somewhat cheaper than HGH. When IGF-1 is used, 0.3mg to 1mg is injected at bedtime. Progress is slow; the first improvement is visible at 2-4 months, it takes up to 24 to 36 months for a full recovery.

For severe memory impairment with Alzheimer’s, the doctor does a double treatment approach with both IGF-1 and HGH: first subcutaneous IGF-1 injections around the eyes 4 times per day (0.01mg each). Secondly, at the doctor’s office the doctor administers mesotherapy injections with 1mg of HGH and 1mg of IGF-1 and vasodilators 3 times per week. Two weeks later the doctor administers another course of mesotherapy. He may repeat this twice in 14-day intervals. Now the interval increases to monthly therapy for 3 months and finally every 3 to 4 months. The patient can use IGF-1 nose drops instead of subcutaneous IGF-1 injections.

Thyroid hormones

Dr. Hertoghe prefers desiccated animal thyroid hormone replacement as the T3/T4 ratio is best matched to what the ratio is in humans. Depending on the severity of thyroid hormone deficiency the patient takes 30-150mg of thyroid hormone every morning. Dr. Hertoghe starts with a low dose and slowly increases the dosage. Clinical progress is very slow. It takes until the second month before the first improvement takes place. Full improvement can take 8-12 months.

Estradiol

Replacement of estradiol in postmenopausal women with Alzheimer’s disease received ether more than 0.1mg per day or 0.625mg of conjugated equine estrogen daily. In both cases there were improvements of their memory and improvement on the Hamilton depression scale.

Dr. Hertoghe’s preferred way to treat postmenopausal women with Alzheimer’s disease is as follows. The first 25 days of each month he gives them 1-2mg of oral estradiol valerate each day and 100mg of micronized progesterone. If they prefer an estrogen cream, he gives them 1-3mg per day transdermal estradiol and 100mg micronized progesterone capsules.

The first improvement is visible after 2-4 months; there is further improvement the next 8-12 months.

Testosterone

There are two methods of how to do hormone replacement with testosterone, either by injection or as transdermal cream. The injection treatment uses 250mg of testosterone enanthate or cypionate every 2 -3 weeks. The patinet can also self-administer testosterone enanthate (50mg twice per week) for a more even blood level of testosterone. The transdermal approach involves 100-250mg transdermal, nanoliposomal testosterone daily.

The memory will improve 2-4 months into replacement therapy. The full improvement takes 8-12 months.

Pregnenolone

The replacement therapy is 100mg per day in the morning for the first 4 months. Then there is a dosage reduction to 50mg daily. Studies have shown that 30mg of pregnenolone is not enough to treat memory loss. Short-term memory improved after 3 to 4 months in about 75% of patients.

Vasopressin

The best vasopressin preparation to use is bio-identical vasopressin. It comes as 1 nasal spray with 10IU of vasopressin. Upon awakening the patient or caregiver applies 1-2 sprays into the nose. The patient receives the second dose 10 minutes before lunch by nasal spray.

Apart from hormones, lifestyle changes are also recommendable.

Alzheimer’s disease is treatable with hormones

Alzheimer’s disease is treatable with hormones

Conclusion

Who would have thought that Alzheimer’s disease could have anything to do with hormones? Dr. Hertoghe, the endocrinologist from Belgium did many hormone tests on Alzheimer’s patients and concluded that various degrees of hormone deficiencies can indeed cause Alzheimer’s disease. But what is more is that you can replace the missing hormones and see complete cures in patients with Alzheimer’s disease. Alzheimer’s disease is treatable with hormones. This is something conventional medicine can only dream of. At this point this hormonal approach is not yet mainstream medicine; but it would not be a surprise to me, if in 10 or 20 years interested physicians do this type of therapy routinely in their practice. When hormones are missing, replace them. When the memory is fading, think about testing for missing hormones! It will make a difference in the quality of life for the patient as well as for his family.

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Nov
03
2018

When you are sleepless

You are not alone when you are sleepless. Insomnia is a widespread problem in society.

Previous review of the topic of insomnia

I have reviewed the topic of insomnia before in a blog.

Briefly I pointed out that in some people there is a mutation of the gene that controls the circadian sleep rhythm. It is called the CRY1mutation. Some people have sleep disturbances from working night shifts. I mentioned the blue light of electronics that is produced by the TV screens or computer screens. The more you are exposed to it, the more it stimulates the brain to produce serotonin. This undermines the melatonin production, and as a result the person finds it extremely difficult to fall asleep. Children playing with i-phones, tablets or watching children’s programs on television can have sleep disturbances from the blue light. Blue has the frequency that over stimulates the brain and interferes with melatonin production. Drug and alcohol abuse can also interfere with the normal circadian sleep rhythm and cause insomnia.

Hormone factors of insomnia

For natural sleep to occur, we need melatonin which the pineal gland releases in the evening. It initiates and maintains sleep during the night. The natural opponent of melatonin is cortisol, the stress hormone, from the adrenal glands. Both hormones need to be in balance to allow you to sleep normally. Shortly before we wake up in the morning melatonin production goes down and cortisol production is up. Cortisol levels are low at night and high during the day. So it is cortisol that keeps us going throughout the day. But an excess of cortisol from chronic stress can also interfere with falling asleep and sleeping through the night.

Stress and insomnia

When we feel stressed, cortisol production goes way up. This has consequences regarding our sleep pattern. It can interfere with falling asleep, causes us to wake up from a deep sleep in the middle of the night and can give us problems falling asleep again. Chronic stress exposure leads to high cortisol production by the adrenal glands, which in turn will lower melatonin and cause sleep disturbances. Older people (above the age of 50) have very little melatonin production left, as there is an age-related decline of melatonin production. The melatonin production is highest in younger years and lowest in older age.

What to do when you are sleepless

There are several over-the-counter remedies, which in combination can be quite effective.

Melatonin for when you are sleepless

Melatonin (3 mg at bedtime) is a good start to see what it does for your sleeplessness. Taking a small amount of melatonin at bedtime we can re-establish the balance between cortisol and melatonin, which helps the circadian hormone rhythm and sleep pattern to come back. Some people wake up in the middle of the night and find it difficult to fall asleep again. If this happens at 3 AM, a good remedy at this time is to take another 3 mg of melatonin. Melatonin stays in the system for about 4 hours. Light during the day de-activates the effect, when light hits the retinas upon opening your eyes. You should not exceed 6 mg of total melatonin overnight. Otherwise it will interfere with the balance of cortisol and melatonin, lowering cortisol levels, which would rob you of energy during the day.

Phosphorylated serine (Seriphos)

A supplement that is freely available in the US (but not in Canada) consists of a simple amino acid. As this link shows (second item in the link) phosphorylated serine Seriphos) helps to down-regulate cortisol levels (lowering them). This means that melatonin gets the upper hand and you can sleep again.

The dosage for phosphorylated serine (Seriphos) varies from person to person, but will be in the range of 1000 mg to 3000 mg in the evening. After about 30 days the circadian rhythm may have recovered and you can stop the Seriphos. A one-day pause is required once a month for resetting the hormone receptors. Should you still have problems sleeping, you can continue with it for another month and pause again for a day. Seriphos has very few side effects.

Valerian root capsules

Another useful sleep aid is valerian root (as capsules). 500 mg to 1000 mg will help you to relax. It does not have the side effect of feeling groggy the next morning.

Other considerations when you are sleepless

Hormone problems like thyroid abnormalities (too much or too little thyroid hormones) are issues that your doctor has to investigate. Women in menopause often have sleep disturbances due to a lack of estrogen and progesterone. A knowledgeable healthcare professional is able to take care of that by prescribing bioidentical hormone creams.

When men approach andropause (the equivalent of menopause in women), they lose testosterone production. This can cause insomnia. The doctor can verify the hormone loss by a blood test. Replacement with either bioidentical testosterone cream or injections will rebalance testosterone levels. Insomnia may disappear. It is essential not to overdose testosterone, as this can also cause insomnia.

Sleep lab for when you are sleepless

When home remedies do not help, it may be time to check into one of the sleep labs to diagnose the kind of sleep disorder you are suffering from. Here is an overview what is happening there.

Essentially you get hooked up to monitors and are encouraged to just sleep as you would normally do. The physician in charge of the lab will later explain to you what the monitors showed, and tell you what type of sleep. According to the findings your doctor will recommend what measures are appropriate to remedy the situation.

Treatment for insomnia when over-the-counter remedies fail

Short acting benzodiazepams

When anxiety is not a problem, but only insomnia is (falling asleep or staying asleep) lorazepam 1 mg (Ativan) or temazepam 10 mg (Restoril) are shorter acting benzodiazepams that will help. It is not a permanent but a short “emergency break” for intermittent use, so that the GABA benzodiazepine receptors have time to recover. Otherwise, with continuous use tolerance would set in. This means higher and higher doses of the sleep medication would be necessary to achieve the same effect. Another non-benzodiazepine is Zolpidem 5 mg (Ambien). Even though this medication is not a benzodiazepine, it works on stimulating the same GABA benzodiazepine receptors.

Longer acting benzodiazepams combined with antidepressant Trazodone

For several years the combination of a small amount of the longer acting benzodiazepams, clonazepam (Rivotril) at 0.5 mg combined with a small amount of the anti-depressant trazodone (Oleptro or Desyrel) at 50 mg at bedtime has been has been in use quite successfully.

But there is a concern of drowsiness caused by Rivotril as this link shows.

Trazodone, which is an antidepressant has a sleep cycle restoring effect at low doses and has less side effects, because it is used at ¼ the dose for a full-blown depression. Males are often complaining that it reduces their sex drive, and it may cause erectile dysfunction.

Clonazepam side effects

Rivotril was originally in use to control epileptic seizures and anxiety. The combination therapy for sleep disorders uses Rivotril at ¼ of the regular dose. Although it is good as a sleep aid, it has a long half-life and stays in the system well into the next day. This may present as sleepiness and cause falls in elderly patients because of clouded attention. Replacement by one of the medium long acting benzodiazepams could be the solution. A drug pause for 1 day will help to reset the GABA benzodiazepine receptors and prevent tolerance from happening. Knowing all those effects and side effects it is wiser to reserve the use of these medication strictly when everything else has failed!

When you are sleepless

When you are sleepless

Conclusion

As I mentioned before, you are not alone when you are sleepless. Insomnia can present as having problems to fall asleep, but it may present in others as a problem in the middle of the night waking up and having problems going back to sleep again.

I described non-conventional methods to help you to sleep using melatonin, Seriphos and valerian root capsules. If this fails, a sleep lab investigation may be necessary to get to the bottom of your insomnia problem. Physicians often prescribe short acting benzodiazepams like lorazepam (Ativan) and temazepam 10 mg (Restoril).

Other possibilities to treat insomnia

There are other possibilities to treat insomnia, with a combination of a low-dose antidepressant (trazodone, brand name Oleptro in the US) and low-dose anti-seizure and anti-anxiety drug clonazepam (Klonopin or Rivotril). Anxiety can often be a big component in insomnia and this treats both. On the other hand, anxiety is a separate problem, which needs professional treatment. There can be side effects of sleepiness from clonazepam and men complain of a lack of sex drive and erectile dysfunction from trazodone. Help is available when you are sleepless. But you need professional help to work on the problem and find the solution.

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May
13
2017

Results Of Insomnia Studies

Results of insomnia studies are focusing on all angles of insomnia. We know for some time that the circadian rhythm is linked to deep REM sleep, which we only reach about 2 hours into our nightly sleep. There are several reasons why our normal sleep pattern can get disrupted.

1. Night owls have a CRY1 mutation

A recent publication on March 27, 2017 has detected a mutation of the human circadian clock called CRY1. This is a dominant gene that is responsible for delayed sleep phase disorder (DSPD). People with this genetic feature tend to go to sleep 2 hours later than the average person every day.

It occurs between 0.2% and 10% in the general population and is inherited by the autosomal dominant mode.

This gene is responsible for the phenomenon of persons being “night owls”.

2. Sleep deprivation in nursing homes

Another publication has zeroed in to what happens in the frail elderly who live in nursing homes.

Here is what sleep researchers have found out about nursing homes.

  • Older people also need 7 to 8 hours of sleep per night, not less as previously thought.
  • Let people sleep at night, and give them undisturbed sleep. The practice of waking them up every 2 hours is unnecessary and undermines a restful sleep with normal amounts of REM sleep.
  • The color of light matters: Blue/purple light coming from TVs, iPod’s, laptops or cell phones stimulates serotonin production that wakes you up. In contrast to this orange/red light stimulates melatonin production that facilitates sleep. A nursing home owner, Guildermann said: “We have made it darker at night, and what light they do have is orange/amber/red light, and we are having phenomenal results.”
  • Sleep, exercise and nutrition are the biggest components of health.

3. Night workers

One of the news stories in 2016 was about health risks of night shifts. The Bureau of Labor Statistics reported in 2000 that 15 million workers (16.8 % of the working population) were doing alternative shifts (night shift work mixed with daytime shifts). In 2016 they reported 14.8% were working alternate shifts. Among blacks, Asians and Latino Americans the percentage of working alternative shifts was higher, namely 20.8%, 15.7% and 16%, respectively.

Effect of shift work on your diurnal hormone rhythm

Shift work is more common in certain industries, such as protective services like the police force, food services, health services and transportation.

Your body rewards you, when you sleep 7 to 8 hours during the night, but it will penalize you severely, if you turn it upside down. The reason is the diurnal hormone rhythm that we all have built in. Sleep is regulated by melatonin during the night, which is released by the pineal gland (on the base of the skull). Daytime wakefulness is regulated by the stress hormone cortisol from the adrenal glands. These two hormones inhibit each other, cortisol inhibits melatonin and melatonin inhibits cortisol. All the other hormones are also regulated according to the diurnal rhythm: testosterone, for instance is highest in the morning, human growth hormone is highest between midnight and 3 AM.

Studies about the effects of shift work

There are examples of what happens when you do shift work for several years:

  1. A) A Swedish study found that white-collar shift workers had a 260% higher mortality compared to a control group of daytime white collar workers: Shift work and mortality.
  2. B) A study compared night workers in the age group of 45 to 54 with daytime workers and found a 147% higher mortality rate in the night shift workers: Shift Workers’ Mortality Scrutinized. Shift workers work at night and sleep during the day. This can be done, but it is against the physiology of your body, as I explained above. Remember that melatonin does not only regulate your sleep, it also is one of the main stimulant hormones of the immune system. If you manipulate your diurnal hormone rhythm by staying awake during the night and sleeping during the day, you pay the price by an increased risk of mortality (increased risk of death). I think this is not worth it!

4. What to do when you cannot sleep?

The first step is to take 3mg to 5mg of melatonin at bedtime. It should be taken between 10PM and 11PM. It takes 20 to 30 minutes for melatonin to take effect. If you do not fall asleep within that time frame you are likely thinking too much! Relaxation before going to sleep should be part of your evening ritual. It can happen that we experience demanding, stressful days, and despite all better effort, it is difficult to be entirely relaxed. After demanding days like that I would recommend taking 1 or 2 capsules of valerian (500 mg strength) from the health food store. This combined with the melatonin should help in more than 80%-90% of insomnia cases.

Medical tests and sleep studies

If you cannot sleep, see your physician. Sleep studies may be required or you may have problems of the thyroid (hypo- or hyperthyroidism), which may need to be checked. Other medical problems including depression have to be checked out as well. Melatonin and valerian are safe. Other sleeping pills have multiple side effects including memory problems the next day or the feeling of a mild hangover.

5. Telomeres and insomnia

Some people have no problem disciplining themselves to go to sleep between 10PM and 11 PM, which seems to be the window of opportunity to catch a good night’s sleep. Others are so used to do their late night activities (reading, watching TV, being online, going to the pub etc.) that they finally drop into bed at 1 or 2 AM. People need 7 to 8 hours of good sleep; even hard-core party goers need to get that much sleep. Nature does not make exceptions! When you go to bed only at 1AM or 2AM, it is difficult to get enough sleep.

Healthy telomeres with healthy sleep pattern

It is true that you can suffer multiple health problems, as all of your hormones depend on the resetting during your deepest sleep between 2AM and 4AM triggered by the nighttime melatonin response. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep. Shortened telomeres mean a shortened life span. The reason for this is that people with shortened telomeres develop heart attacks, strokes and cancer. This is what shortens the life span. How do we avoid this risk? Go back to healthy sleep habits. As mentioned above it is best to start going to sleep between 10 PM and 11 PM and sleep for 7 to 8 hours.

6. Electronics in the bedroom

There is new research showing that electronics in the bedroom can interfere with a normal sleep pattern. Dr. Ben Carter is the lead author and a senior lecturer in biostatistics at King’s College London. He completed a study involving 125,198 children with an average age of 14½ years. There were about equal amounts of males and females. Both sexes had the same problem. Allowing the use of electronic media interfered with their sleep time. What electronic devices are we talking about? Watching TV, using the computer, the cell phone, tablets and computer games. The study was originally published at JAMA Pediatrics.

The blue/purple light of the TV screen or a computer screen stimulates the brain to produce serotonin. This undermines the melatonin production and as a result the person finds it extremely difficult to fall asleep.

What contributes to better sleep habits

Here is a list that contributes to better sleep habits and better sleep quality:

Sleep friendly environment in the bedroom

Ensure that the bedroom is dark, soundproof, and comfortable with the room temperature being not too warm. It is important to develop a “sleep hygiene”. This means going to sleep around the same time each night, to have some down time of 1 hour or so before going to bed and getting up after the average time of sleep (for most people between 7 to 9 hours). Sleeping in is not a solution, and an alarm clock will also help to develop a sleep routine.

Avoid stimulating drinks, drugs and nicotine

You need to avoid caffeine drinks, alcohol, nicotine and recreational drugs. Smokers should butt out no later than 7PM, as nicotine is a stimulant.

Adopt a regular exercise program

Getting into a regular exercise program, either at home or at a gym is beneficial.

No heavy meal at night

Avoid a heavy meal late at night. A light snack including some warm milk would be OK.

No computer in the bedroom

It is not a sensible idea to use the bedroom as an office, reading place or media center. It stimulates by cortisol production, which keeps us awake. The bedroom is a place of rest and should be comfortable and relaxing.

What to do when waking up at night

Some sleepers wake up at night, and they are wide-awake! Leaving the bedroom and relaxing in the living room for a while can help. It goes without saying that playing video games will not help! An alternative is to take 3 mg of melatonin, which will helps to fall asleep faster, but melatonin will wear off after about 4 hours.

Self-hypnosis recording

A self-hypnosis recording is a useful adjunct to a sleep routine. Listening to it before going to sleep helps to focus on relaxation and to stop ruminating about the day and its events. Keep the volume low.

Results Of Insomnia Studies

Results Of Insomnia Studies

Conclusion

Recent results of insomnia studies have reconfirmed that we need our regular sleep to maintain our health. We have seen that some nursing homes have a practice of waking the client up every 2 hours. Nursing homes must abandoned this as it interferes with the restorative deep REM sleep. In turn this will interfere with hormone restoration overnight.

Children and adolescents must limit their time in front of the TV, iPhones and computer screens. The blue light has the frequency that over stimulates the brain and interferes with melatonin production. Some people work overnight as shift workers or party until the wee hours in the morning. This causes your telomeres in your body cells to shorten. As people restore their sleeping pattern to normal, the telomeres length will remain stable.

Important to restore normal sleep pattern

Even people who are night owls due to an inborn CRY1 gene that is responsible for delayed sleep phase disorder can normalize their sleep pattern by following a strict sleep hygiene. As people get older they lose the ability to make melatonin, but they can counter this by taking melatonin tablets at bedtime.

Remember what I said earlier: Sleep, regular exercise and good nutrition are the biggest components of health.

Nov
05
2014

How To Cope With Time Switches

This review is about how to cope with time switches. In Europe daylight saving time begins on the last Sunday in March and wintertime starts on the last Sunday of October. Here in North America we start daylight saving time on the second Sunday of March and end it on the first Sunday of November each year.

With the time switch just last weekend I thought it would be worthwhile to comment in a blog how our bodies, particularly our hormones suffer from this.

You may have heard about the circadian rhythm with respect to hormones. The changes of the sun causing the day/night cycle have profound influences on our hormones, called the diurnal hormone changes or the circadian rhythm.

How do circadian rhythms work?

In the morning when you open your eyes, light enters our eyes and the hypothalamus registers this in the suprachiasmatic nuclei (see Ref.1). There are also links from the hypothalamus to the pineal gland, where melatonin is synthetized and stored. The light signal stops the secretion of melatonin from the pineal gland, although it is still being produced during the day in the pineal gland, but stored there until the evening hours set in. You may have noticed that you start yawning when the light dims in the evening. That’s when melatonin is released into your system to let you know its time to go to sleep.

Of course, we have electrical light and can turn night into day if we choose to! This works for a limited time, but eventually tiredness sets in, and melatonin wins the upper hand. Melatonin is the master hormone of the circadian rhythm.

Cortisol and melatonin are natural opposites

It is interesting to note that cortisol does exactly the opposite. Cortisol is the adrenal gland hormone that helps us cope with stress. When we are fully awake, we need cortisol to cope with stress. Melatonin inhibits cortisol secretion and cortisol inhibits melatonin secretion, so they are natural opponents working together for your common good. This is part of the circadian rhythm. We can measure these hormones and this is how researchers have found out how this works.

How To Cope With Time Switches

How To Cope With Time Switches

Time switches affect the circadian rhythm

When we switched time back by one hour on our wristwatch and clocks, the internal time in our body did not accept that right away. The body needs to gradually adjust to this by reading the external signals: when are we opening our eyes? What is the light intensity when we get up, what is the light intensity when we go to sleep?  Some people find it easy to adjust; others find it very difficult to adjust. Some individuals breeze through the adjustment process in a day or two. For others it can as much as 1 or 2 weeks before the hormonal adjustment is completed.

Symptoms of problems adjusting the circadian rhythm

Symptoms due to time switch are a feeling of hangover on the first one to two days after the switch. This is despite you having gotten enough sleep, but the quality of sleep was not the same as before the time switch. Your head feels heavy, you are irritable, and you may feel mildly depressed. You also may find it more difficult to concentrate on one thing and you experience fatigue. Some experience insomnia. What is behind this is a disturbance of your cortisol levels. Your cortisol level is normally highest in the early morning hours, just before you wake up. As a male your testosterone level is also highest when you wake up thanks to the circadian rhythm. Both cortisol and testosterone recover their hormone storage during your deepest sleep.

Our hormones are linked to the internal diurnal clock

In women the ovarian hormones have not only a monthly rhythm, but also a 24-hour diurnal rhythm, based on the internal 24-hour clock. The hypothalamus and the pituitary gland have an intimate involvement in both sexes regarding this diurnal rhythm. They are in communication with the pineal gland that produces melatonin to regulate all of the major hormone systems. So, when we switch our watch back by one hour in the fall or forward by one hour in the spring, our body clock is out of sync with the new time that rules the world. This state of being out of sync may last for a few days. We still get tired according to the old time and we still wake up according to the old time until our internal clock has readjusted. People have genetic differences on how quickly they readjust.

Jet lag

When we travel eastward or westward through time zones a phenomenon of being “out of sync” occurs as well, very similar to what happens with time switches. It is the same re-adjusting process of the internal circadian rhythm that our bodies have to come to terms with. Some people are affected more when they travel west though time zones, and it may take them longer to adjust to it compared to traveling east. But other people complain that for them it is just the opposite, and traveling east is the problem for them. North-south travel does not cause jet lag as the internal time and the external time remain synchronized. A very similar phenomenon is happening with the spring and fall time switches. Some people find it nervier when in spring the clock is advanced by one hour and others complain that fall is their difficult time when the time is switched back by one hour. There are genetic differences of how we adjust with our internal clocks.

Shift workers

Shift workers experience problems with the circadian rhythm as well. The switch between working day shifts and night shifts leads to a condition called “shift-work sleep disorder” (Ref.3). Similar to jet lag this is due to the fact that there is a disruption of the synchronization between the body’s inner clock and external cues. The work rules do not allow enough time for recovery. It would be much more cost effective, if unions and employers allowed those who are naturally born to cope with night time shift to work those shifts and allow those who are sensitive to shift-work sleep disorder to work only day shifts. We live in an age of political correctness, but we tend to overlook how our bodies work.

What you can do to ease yourself into the time switch

1. As there is a lack of deep sleep with the time switch, it is not a bad idea to take a short nap when you feel tired during the day. Catch a nap on the weekend or on a day, when you are off work! It’s good for you! This will build up your adrenal gland hormones and give you the extra surge of energy you are craving for.

2. At the end of the day though, you need to go to bed according to the new time to train your pineal gland and your entire hormone system about the new time situation. Your body needs the cues from you, when you start and end your day, so that it can sync your internal clock with the outside time.

Melatonin restores the circadian rhythm

3. A simple remedy that fits right into your hormone rhythm is to take a melatonin tablet (about 3 mg for an adult), available at your health food store or drugstore 30 minutes before bedtime. Ref. 2 states that melatonin “restores the circadian rhythm “. This helps your circadian hormone rhythm by giving it an evening boost of melatonin. This tells your system it is time to go to sleep. At that time when you close your eyes the signals  through the optic nerve shut down. This gives the circadian rhythm yet another signal about what time it is. In just a few days (for very sensitive people in 1 to 2 weeks) your entire hormone system including the circadian 24-hour undulations will be reset. Now your internal clock has been reset and is in sync until the next time switch.

More about hormones: http://nethealthbook.com/hormones/introduction-hormones/

References

1. Melmed: “Control of Hormone Secretion” in: Williams Textbook of Endocrinology, 12th ed.Copyright 2011 Saunders, An Imprint of Elsevier

2. Rakel: Integrative Medicine, 3rd ed. Copyright 2012 Saunders, An Imprint of Elsevier

3. Daroff: Bradley’s Neurology in Clinical Practice, 6th ed. Copyright 2012 Saunders, An Imprint of Elsevier

Apr
12
2014

Lead Still Poisoning Us

We are living in an environment that puts emphasis on quality control, and companies around us take pride in their high quality products, supervised by the FDA. This is how it ideally should be. But is it really? Unfortunately not!

I read the headlines about lipsticks on April 4, 2014 and could not believe it!

When it comes to skin care or cosmetic products, things start to get scary.  Skin is not a barrier, but it is an organ of our body. From skin cream and ointment applications in medicine it is known that pharmaceutical compounds can be applied to the skin, and this way the body can readily absorb active substances.

When it comes to cosmetics, the skin areas to which cosmetics are applied have softer skin, for example the mouth. The vulnerable skin of the lips can readily absorb any chemical substance, and this is where health concerns get even more serious.

In 2010 as the above link shows the FDA determined that all of the “400 lipsticks tested had traces of lead in them, ranging from 0.9 to 3.06 ppm. Another study from California noted that there were other toxic metals in lip sticks and lip glosses containing chromium, cadmium, manganese, aluminum in addition to lead. Even to the unconcerned this sounds like a precarious cocktail of noxious substances! On June 1, 2013 I wrote a blog about toxins in the bathroom. I mentioned the dirty dozen of chemicals that repeatedly are found in cosmetics. With this new information of traces of lead still being in cosmetics, more so than previously reported, women need to be more careful about the choice of lipsticks that they are using.

1.History of lipsticks:

This overview explains that the long-lasting lipstick was only invented around the 1950’s (“Sticks on you, not on him” was the slogan).

Traces of lead were often recorded, but not really thought to be that dangerous. The thinking of the FDA at that time was that children needed to be protected from lead in house paints, but nobody mentioned that lead was part of the red pigment and therefore had to be part of a lipstick. The FDA did know this, but the concentration was supposed to be so small and absorption was thought to be negligible, so considered to be safe for an adult.

Lead Still Poisoning Us

Lead Still Poisoning Us

2. Evidence of considerable absorption of lead:

We know from several studies summarized in this link that various components of cosmetics including lipsticks and lip-glosses get absorbed through the skin. Lead is no exception to this. A 2011 study showed in children in Africa that lead-containing cosmetics for tribal ceremonies in children had higher lead concentrations in their blood than children who did not use these cosmetics.

When doing a PubMed review on the subject I came across a very interesting study: In India there is a practice that parents apply kajal (also called kohl or surma cosmetic) around their eyes, on old traditional practice. Unfortunately this is a lead-containing cosmetic, which is absorbed into the blood and can cause lead poisoning. According to this ancient belief this application of cosmetics around the eyes would keep their eyes cool and clean and is supposed to improve vision, strengthen the eyes and prevent eye diseases. None of these belief are compatible with Western medicine (although a lot of the Ayurveda medicine is valid).

In another 2010 study done in the mountainous Aseer region in the Southwest of Saudi Arabia here there is pristine air quality, 176 pregnant patients with a single baby were followed to see whether there was an effect with regard to lead poisoning in the offspring. Two groups of women were identified, those with lead levels of more than 200 mcg/L in the blood and another group with less than 200 mcg/L. The researchers noted that there was no difference with regard to prematurity, size of the baby or premature rupture of membranes (premature birth).

The conclusion of this study was that there was significant absorption of lead from 100% lead sulfide eye cosmetic “kohl” only on those who used it. To my surprise nobody mentioned anything about the lead levels in the children, which is an example of compartmentalization of science. Common sense would dictate that these children who were at higher risk from mothers with over 200 mcg/L should have received chelation treatments to remove lead (we do this in Western medicine!).

3. Different lip sticks and lip glosses analyzed in Europe and in the US:

A European study showed that 31% of lipsticks and 4% of lip glosses tested positive for lead. All of them had less than 0.88 mg/kg of lead (less than 1 mg/kg). Pink lipstick or lip gloss (0.81 and 0.38mg/kg) tested lower than purple lipstick or lip gloss (0.88 and 0.37mg/kg) and red (0.58 and 0.25mg/kg), but purple tested the highest! I did not know that until now when I researched this.  On average the tests show that the gloss has half the concentration of the lipstick.

Don’t be fooled by the difference in recommended safe levels in Canada (10 mg/kg) and Germany (20 mg/kg). Germany has a very powerful chemical industry with lobbyists that likely lead to this higher “safe” level. In Canada it is the Health Products and Food Branch of Health Canada. No country got it right so far:  A zero tolerance (meaning a blood level of 0 mg/kg in babies and adults alike) is the only solution for humans. A little bit over a long time can lead to chronic chronic lead poisoning.

One other interesting tidbit for those who need to apply something to their lips:

The more expensive lipsticks had much less lead in it than the cheaper varieties (don’t buy the dollar store brands).

Contrast this to an FDA initiated study between 2009 and 2012, published in 2012 that showed that the average lipstick concentration in 400 lipsticks tested  was 1.11 mg/kg, but the highest concentration was 7.19 mg/kg and 13 of them tested 3.06 mg/kg. Here is another review that shows more details (ppm equals mg/kg, so you can compare directly with the figures above. As stated before, in my opinion and that of toxicologists around the world who are the real experts in this a “0 mg/kg” level (no lead in the body) should be the acceptable norm!

Only organic lipsticks and lip-glosses are recommended, if you must wear any of such products. Here is a helpful blog that tells you more positive news (lead and chemical free products).

4. What are the effects of chronic low lead exposure?

Adult lead toxicity is not as common as in the past. Painters in the decades leading up to the 1970’s when laws became more stringent were the ones mostly affected (Ref.1). Keep in mind that more than 30 million tons of lead was released into the air in the US before the lead ban finally remedied this in the 1970’s.  This phasing out was completed in 1995. The mean blood lead levels of Americans declined by 35% since. The EPA is monitoring lead levels in public water systems.

Lead is a nerve poison. It leads to fatigue, insomnia, irritability, lethargy, headaches, difficulty concentrating, memory loss, and tremor. It can also affect the nerves of the extremities, more so in the arms than the legs, which was significant in the past century among painters using lead paints. (“Upper extremity paresis” found in painters). Chronic lead poisoning targets the kidneys and the bone marrow. In the kidneys leakage of the filtration units, called glomeruli, leads to loss of microglobulins that can be measured in the urine among other tests. Above a level of 30 mcg/dL (this is the same as above 300 mcg/L) electrophysiological studies reveal often the ulnar nerve conduction is disturbed, which is the cause for the arm weakness in painters. The bone marrow toxicity can be seen in stippling of red blood cells and anemia develops subsequently. High blood pressure and fertility issues are also common (low sperm count in men, higher rate of spontaneous abortions and stillbirths in women). The gums around the teeth show lead lines (blue discoloration).  I will not get into lead toxicity in children, as this is a big topic of its own. Needless to say symptoms are much worse as any pediatrician can tell you. It goes without saying that should you notice any of these symptoms, see your doctor and have appropriate tests done.

5. Treatment and prevention:

As we do not see acute lead poisoning as much as in the past, except sadly to say still in development countries and highly industrialized areas with lead emissions into the air, I like to emphasize the importance of prevention here.

a)    If you absolutely must have make-up and/or lip sticks or lip gloss, at least go for the expensive, organic products. You owe it to yourself. However, having said that keep in mind that anything you put on your skin anywhere is absorbed to a certain percentage. So, why mess with your body’s metabolism? I really question this. For your skin you can use a product called “Youth serum” from LifeExtension, where only a few drops will suffice to cover your face and neck with a thin film. Within a few seconds this is absorbed into the skin and it will stimulate your skin to grow where wrinkles are, so the wrinkles flatten out in time.

b)    Keep in mind that skin appearance is hormone dependent, males need testosterone as they age and women need bioidentical progesterone. The first link under point 2 above claims that progesterone would be cancer producing. This is not true: it is progestin, a synthetic copy of progesterone that does this. So, bioidentical progesterone in cosmetics would be cancer preventing in women (men should stay away from a woman who has applied this for at least two hours as skin transfer will block testosterone production). Worse still: if a manufacturer uses progestin (the synthetic version), the traces of it over a long period of time will act like xenoestrogens, which can cause breast cancer in the woman who uses such a product and through transfer can cause prostate cancer in a man.

c)    If you insist on using chemicals on your skin, you may want to consider seeing a naturopathic physician who does intravenous chelation. Lab tests are available to assess the levels of heavy metals and toxins in your body. If the levels are creeping up, chelation treatments from time to time may be needed in people with measured elevations of lead levels in blood tests and/or urinary lead level elevations.  Discuss this with your doctor.  Removal of any accumulated mercury, lead, and cadmium or other heavy metals will be an option. I have summarized detoxification methods elsewhere.

Conclusion:

In conclusion, I think that it has to be carefully considered, how much use of lipstick application is necessary. Next the choice of a high quality product is of utmost importance. Taking all the factors together, its constant use cannot be recommended, especially since there is not only lead present, which is a known health hazard. Beside lead there are many other chemicals that get absorbed and their effects have not been adequately tested by the agencies.

More information on vitamins and detoxification: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/vitamins-minerals-supplements/

References:

1. Shannon: Haddad and Winchester’s Clinical Management of Poisoning and Drug Overdose, 4th ed. Chapter 73, “Lead” by Michael W. Shannon, MD, MPH © 2007, Saunders

Last edited Nov. 7, 2014

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Mar
29
2014

Alternative Treatment Of Hyperactivity (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD or ADD, attention deficit disorder) has been in the spotlight on and off over the years. It affects 8% to 10% of school-aged children, and about 2% to 5% of adults who still have this condition.

Typically a parent receives a note from school that they must come to a teacher/parent meeting and it is discussed that the child is disruptive in class, not paying attention, interrupting the teacher inappropriately and forgetting to do their homework. The teacher suggests that this may be a sign of hyperactivity. The school nurse is also of this opinion and they suggest getting a prescription for Ritalin or Adderall (amphetamine type medications), drugs that have been shown in other kids to be fairly effective in treating the symptoms.

Next the child is seen by the doctor who confirms the diagnosis and Ritalin (methylphenidate) is prescribed.

In an attempt to quickly control the situation, the side effects of Ritalin are often not discussed in detail: agitation, insomnia, nervousness, anxiety, nausea, vomiting and loss of appetite, palpitations, dizziness, headaches, an increase in the heart rate, blood pressure elevation, and even psychosis (Ref.1).

It is easy to just write a prescription for Ritalin and hope that all is well. Had the parents heard of all the possible side effects, they may have asked whether there were alternative treatments available.

The causes of hyperactivity (ADHD)

The exact cause of ADHD remains unknown, but there is a clustering of this condition in some families, so there seems to be a clear genetic component (Ref.2). It appears that several genes are involved, namely those associated with serotonin and glutamate transporters, but also those affecting dopamine metabolism. Males are affected with ADHD more often than females (in children 3:1, in adults 1:1).

Alternative Treatment Of Hyperactivity (ADHD)

Alternative Treatment Of Hyperactivity (ADHD)

Some remarks regarding brain development are in order: Dr. Kharrazian describes that the grey matter of the brain develops before the age of 9 and the development of the white matter is completed by the age of 19 (Ref. 3, p.3). In ADHD patients the frontal brain is underdeveloped resulting in an inability to suppress unacceptable behavior, immediate desires and impulses. Prescription drugs may alter the behavior on the surface, but the frontal brain development is still lagging behind. The only thing that can influence this is behavioral/cognitive therapy and extra tutoring while the symptoms are controlled. The window of opportunity is closed by the time the ADHD patient has reached the age of 19. After that a juvenile ADHD turns into a permanent adult ADHD. The cases that had only childhood ADHD and outgrew it were the ones where the frontal lobe abnormalities had corrected themselves before the age of 19.

This review article has noted that there is an association between a Western style diet (sugar and fat rich) and ADHD.

Interestingly both Ref. 1 and 2, which I would categorize as having originated from mainstream conventional medicine circles, deny such an association. But the link also noted that a healthy diet with fiber, folate, and omega-3 fatty acids as well as supplementation with iron and zinc when these minerals are found to be low in the blood, do make a significant difference in ADHD patients towards normalization of their symptoms.

One of the under diagnosed causes of ADHD is gluten sensitivity as Dr. Perlmutter described in his book (Ref. 4, pages 150-158). This can spare the child or teenager the toxic side effects of anxiolytics, antidepressants or antipsychotics that may be inappropriately prescribed by their physicians, and a gluten free diet would allow the brain to recover very quickly in such cases. A food sensitivity history and some simple gluten sensitivity blood screening tests will diagnose this condition or rule it out.

To complicate matters even more, Dr. Amen has mentioned in several books that there are at least 7 different subcategories of ADHD that he has found in ADHD patients when studying thousands of single-photon emission computed tomography brain scans (SPECT brain scans). Dr. Amen mentions that the 7 subcategories of ADHD are the combined type ADD, the primarily inattentive ADD subtype, overfocused ADD, temporal lobe ADD, limbic ADD, ring of fire ADD and trauma induced ADD. Dr. Amen explains that each of these types needs to be treated differently and some of the treatment failures are explained by the fact that the wrong type of ADD was treated (Ref.5).

Treatment of ADHD

In the following I mention 5 steps that are useful for treating ADHD patients.

  1. A first step toward normalization of the metabolic changes in the brain metabolism of the affected child or adult is to adopt a diet that has been linked with low risk for ADHD: avoid food additives, cut out refined sugar, avoid known food allergies like gluten sensitivity and others. You may need to test the patient for food allergies using an elimination diet. Add a good amount of molecularly distilled omega-3 fatty acids (the pure form of omega-3 without mercury, lead or PCBs) as this has shown beneficial effects in ADHD patients.
  2. Involve a behavioral psychologist for behavioral/cognitive therapy treatments. This is particularly effective in the 9 to 19 year old category where the frontal region of the brain is still developing.
  3. Work together with the schoolteacher and get supplemental teaching in areas of academic weakness to reduce the frustrations in the classroom setting.
  4. In adolescent girls who just started their period, a relative lack of progesterone (estrogen dominance) may be a contributory factor. A small dose (20mg to 30 mg) of bioidentical progesterone from day 6 to 16 of the menstrual cycle may help significantly in alleviating the symptoms of ADHD. You may need to consult a naturopathic doctor or anti-aging physician to get a prescription for that.
  5. If all of this helps only marginally, then a smaller amount of Ritalin may be helpful; however, blood tests should be drawn from time to time to monitor for drug toxicity as the rate of absorption and elimination of the drug varies significantly from patient to patient.

It is interesting that studies have shown that a combination of Ritalin or Adderall with alternative treatment methods had a better outcome than either method alone.

Conclusion

It is important to think about the various possible causes of ADHD and not just get caught up in the knee-jerk reflex of treating ADHD with Ritalin (note that this was only step 5 above, if all the other things failed). In co-operation with the school system and using alternative ways at home first (change of diet, possible addition of low dose bioidentical progesterone cream in girls) and additional tutoring in weak school subjects the need for Ritalin may be avoided. If all else fails, the conservative approach is still available, but I suggest that drug monitoring (blood levels that should be done from time to time to avoid toxicity) is important.

More information about ADHD: http://nethealthbook.com/mental-illness-mental-disorders/developmental-disorders/attention-deficithyperactivity-disorder/

References

1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed., © 2013 Mosby.

2. Jacobson: Psychiatric Secrets, 2nd ed., © 2001 Hanley and Belfus

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

4. David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

5. Daniel G. Amen: “Use Your Brain To Change Your Age” © 2012, Harmony Books, An imprint of Crown Publishing.

Last edited Nov. 7, 2014

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Dec
07
2013

Slow Down Aging And Prevent Disabilities

You have seen it many times before: a man or a woman retires at age 65; for a while you see them around at social functions; then they are not seen any more and they return in a wheel chair only to die prematurely. You ask yourself: what can I do better to avoid this death trap?

There are several aspects to this equation: first, we would like to slow down the aging process. Part of this is to retain our physical functioning. In the following I am discussing the ingredients that are necessary to achieve the goal of aging in dignity, but avoiding disability.

It starts with a healthy mind set

You need to be optimistic and have a mindset of believing in yourself that you can do it. With a negative attitude, you will manage to find something to complain about, no matter how perfect the day has been. Negative thinking is rampant, and depression tends to be higher in the older population. If you suffer from depression or you had negative events such as accidents or abuse in the past, it is important to do some house cleaning. Do not be hesitant seeking professional help and counseling from a health professional to help you build up your self-esteem.

Regular exercise is important

A regular exercise program helps you to get your day organized. If you think that you are too busy to find the time to exercise, you are sacrificing your wellness and in fact you sabotage your health. It’s time to rethink your lifestyle! The reason you need exercise is to set the automatic pilot on staying healthy and active. If you are accustomed to sitting down in front of the computer or television set for hours, your muscles do not get the exercise they need. Fast-forward several decades and you will be one of those who rely on walkers, wheel chairs and assisted living establishments. Without training your muscles you are more prone to falls and injuries. Your balance organ is not getting the impulses it needs on an ongoing basis to prevent you from falls later in life. People in their 80’s are often stable up to the point where they trip and fall. I have seen many patients like this arrive in an ambulance where I was doing my shift as the emergency physician in a community hospital. When I summarize the fate of all of the people in their 80’s who had falls and broke their hips over the years, 50% of them made it through the surgery and went back home (often with a walker or in a wheel chair) or ended up in a nursing home; the other 50% died from complications of the surgery, often from heart attacks during the surgery or from clots in their pelvic veins or in the leg veins that dislodged and turned into pulmonary emboli. A fracture and in particular a hip fracture in your 80’s is a serious, potentially deadly accident. So, you need strong muscles and joints and you need strong bones. All of this comes free to you from years of regular exercise in your 60’s and 70’s.

Slow Down Aging And Prevent Disabilities

Slow Down Aging And Prevent Disabilities

You guessed right: good nutrition is important!

Eat right and your body will function right. This is where a lot of people are sent on the wrong path due to clever advertising from the Agro Industry, Big Pharma, the American Dietetic Association and the United States Department Of Agriculture. So they preach that wheat and wheat products are good for you, but the lab tests show that it induces hyperinsulinemia and leads to diabetes. The genetic changes of wheat (“accomplished” through forced chemical hybridization in the 1970’s) are responsible for the metabolically very active wheat belly (accumulation of visceral fat) that Ref. 1 has described in detail. But others have researched this topic as well. Ref. 2 for instance confirms that gliadin, the glue in wheat, which allows dough to stick and makes it easy to create bread, bagels and pasta, is responsible for neurological issues like numbness of fingers and feet (peripheral neuropathy), balance problems and cognitive decline all the way to Alzheimer’s disease. If you continue to eat wheat and wheat products (all contained in conveniently packaged “processed” foods), you may very well find that your balance and muscle control will deteriorate by the time you are in your eighties. This condition is not new: one of the lecturers I listened to at McMaster University in Hamilton, Ontario in 1977 referred to those unfortunate individuals who were severely disabled as the “tea and toasters”. The tea in this case was probably the lesser evil, but the wheat induced malabsorption and malnutrition was a reality already in the mid and late 1970’s.

However, if you start eating organic foods to avoid the chemicals and estrogen-like xenoestrogens from pesticides, and you cut out sugar, high-density carbs and wheat products, you will no longer have problems with weight control and you will maintain your muscle, brain and nerve function. This is not what you learn from the regular agencies mentioned at the beginning of this paragraph, but Ref. 1 and 2 will fill you in on the details. Essentially, I follow a Mediterranean diet without sugar, starchy foods and wheat or wheat products. Ref. 2 stressed the importance of enough saturated and healthy fat (omega-3 fatty acid rich oils) in a balanced diet consisting of 20% protein and low carbs. No specific numbers were given regarding the %-age of fat. I would say that a limit of about 25 to 35% for fat would be reasonable except for the Inuit who are used to a fat content in their diet of 80%. The new thinking is that healthy fats are good for your brain and heart. Healthy fats are omega-3 fatty acids (EPA and DHA) derived from fish oil as they are very protective (anti-inflammatory) oils, so is olive oil and coconut oil. These latter two are anti-inflammatory monounsaturated fatty acids. Keep in mind that you want to change the ratio of omega-3 to omega-6 fatty acids (the ratio in this link is cited as omega-6 to omega-3) more in the direction of omega-3 fatty acids, so that the ratio will be between 1:1 and 1:3. Most Americans are exposed to ratios of 1:8 to 1:16 (too many omega-6 fatty acids in fast food and processed foods), which leads to inflammation of the arteries as well. Omega-6 fatty acids, found in safflower oil, sun flower oil, grape seed oil and canola oil are bad for you when not balanced by enough omega-3’s (flax seed oil and fish oil) as they lead to inflammation through the arachidonic acid system in the body. It may be a surprise to you that saturated fats are OK: animal fat like butter, lard, cream, ghee (clarified butter), and other animal fats provided they come from clean (not antibiotic or bovine growth hormone treated) animals. Buy organic and buy organic meats as well such as grass fed beef and bison, chicken and turkey.

Here is an example of what a day would look like nutritionally in terms of a breakfast, lunch and dinner (recipes by Christina Schilling):

Breakfast:  Great Greens Omelet

(2 servings)

1 tablespoon olive oil or coconut oil

3 chopped green onions

3 cups spinach leaves or a mix of greens: kale, spinach, Swiss chard

1 red pepper cut into strips

3 eggs and 3 egg whites

2 tablespoons grated Parmigiano

In non-stick pan sauté green onion, greens and pepper strips in oil, stir eggs and egg whites and pour over the vegetables, sprinkle with Parmigiano. Cook on medium heat, till the egg mixture has started to set. Turn over and briefly let cook. Remove from pan, divide into two portions and sprinkle with a bit of salt (optional). Serve with salsa and guacamole.

Lunch: Oriental Salad

(2 portions)

1 small Sui choy cabbage (Napa cabbage)

2 cups mung bean sprouts

1 small daikon radish, shredded to yield 1 cup

1 red pepper, cut into thin slices

3 green onions, chopped

1 medium sized carrot, cut into matchstick size pieces

1 can sliced water chestnuts, rinsed.

Dressing: 2 tablespoons sesame oil,

2 tablespoons rice vinegar,(light balsamic vinegar works too)

1-tablespoon tamari soy sauce

1 tablespoon Thai sweet chilli sauce

1-teaspoon fresh grated ginger

3 tablespoons chopped fresh cilantro

Prepare all vegetables and put into salad bowl. Stir all dressing ingredients together and pour over vegetable mix. Stir gently, cover and refrigerate. This salad can be consumed immediately or kept refrigerted for a day. To complete the salad with a protein portion add your choice of 6 oz. cooked shrimp or the same quantity of cubed or sliced grilled chicken.

Dinner:  Florentine Chicken

(2 servings)

1 large boneless chicken breast

1 tablespoon of chopped fresh basil-alternatively use 1 teaspoon dried basil.

1 tablespoon grated Parmigiano

4 thin slices prosciutto

1 tablespoon olive oil

2 tomatoes- cut into halves

3 chopped green onions

2 cups baby spinach leaves

pinch of salt

Spread chicken breast flat and top it with the basil, Parmigiano and prosciutto slices. Fold into half an hold the stuffed chicken breast together at the edges with a toothpick or two. Heat olive oil in frying pan, add onion and tomato slices and put the chicken breast on top. Put lid on the pan, and cook at medium heat till the chicken is cooked through. If you test with a fork, the juices will be clear. Remove vegetables and chicken from pan, put on serving plate and keep warm. Remove toothpicks from meat, and cut chicken breast into two portions. Put spinach into pan and let the leaves wilt at medium heat (cover with lid). Put spinach on the side of the chicken and tomatoes, and sprinkle with a bit of salt.

Dessert after dinner: Berry Sorbet

(2 servings)

2 cups of deep frozen berries (strawberries, blueberries or a berry mix, no sugar added)

¾ cup of organic yogourt or goat’s milk yogurt

a few drops of liquid stevia or small amount of powdered stevia-to taste.

Put into blender and process till smooth. You will have to open the blender jar to stir the contents in between. Serve with a dollop of whipped cream,  if desired.

What about the “slow down” of menopause and andropause?

It is a fact that as we age, our hormone glands do not produce as much hormones as when we were in our 20’s and 30’s. But if you find a health care provider who is interested in anti-aging medicine (there are about 26,000 physicians, chiropractors and naturopaths who are members in the A4M), your hormones can be measured accurately from saliva and blood tests. This will tell whether you are hypothyroid, deficient in sex hormones and whether you should be supplemented with the missing hormones in adequate doses through bio-identical hormones. For instance, women are often deficient in progesterone in menopause and men deficient in testosterone. Treatment needs persistence and patience, as it often takes months for the patient to feel better and up to 2 years, to find the exact balance for you where the hormones are re-balanced and your symptoms of tiredness, insomnia, hot flushes etc. disappear. All our body cells have hormone receptors that require stimulation for the cells to function normally. Your health professional needs to pay attention to this and not just treat your symptoms symptomatically. When your hormones are in balance and you take a few supplements, your bones will be strong (no osteoporosis), your brain will be clear, your hearing perfect, and your balance great. You will be much less likely in your eighties to fall and break a bone and your mind will be clear and sharp.

Stress management

As the baby boomers age, they need to be aware of the stress in their lives. You may have been accustomed to having lots of energy when you were in your child rearing years or in your active professional career. Often we do not even notice that there may be stress in our lives. But your adrenal glands know. This is really a subpart of what I said of hormones: they need to be in balance. But cortisol, which is produced in your adrenal glands, is different from the menopause/andropause hormones. Corticotrophin-releasing hormone (CRH) from the hypothalamus and adrenocorticotrophin hormone (ACTH) from the pituitary gland are the rulers of the adrenal glands. And it is how you handle stress when you are in your 40’s, 50’s and 60’s which will determine whether you come down with adrenal fatigue, various degrees of adrenal insufficiency or not. Ref. 3 is a whole book that deals with this topic. Here I like to mention only that the best test to diagnose adrenal problems is a four-point saliva hormone test for cortisol. You connect the four points and get a curve where the cortisol level is expressed as a function of time. If this curve is below the lower normal range, which the laboratory provides for you, you need to be managed by a knowledgeable health care professional in order to build up the reserves of your adrenal glands. Yoga, meditation, deep prayer, self-hypnosis and enough regular sleep are all proven methods to overcome any stress related issues. Sometimes more effort is needed to rebuild the adrenals by specific herbs or porcine adrenal gland cortex extracts. Your health care provider can tell you more regarding this.

Useful supplements

1. On March 17, 2013 I wrote in a blog about prevention of osteoporosis the following summary:

“The best combination is 1000 mg (or 1200 mg as per National Osteoporosis Foundation recommendation) of calcium per day together with 400 to 800 IU of vitamin D3 (for cancer prevention you may want to take 4000 IU to 5000 IU of vitamin D3 per day instead monitored by a 25-hydroxyvitamin D blood level test through your physician) and 100 micrograms of vitamin K2 (also called MK-7). In the age group above 50 missing hormones such as bioidentical testosterone in men and bioidentical progesterone/estrogen combinations in women should be given as well. This works best, if you also watch your weight, cut down your alcohol consumption to a minimum (or better cut alcohol out altogether), exercise regularly (this builds up bone and muscle strength) and stick to a balanced diet resembling a Mediterranean or zone type diet (low-glycemic,  low fat, wheat free and no sugar).” I would add in view of Ref. 1 and 2 that “low fat” should now be replaced by “balanced fat diet”. With this I mean that nuts, almonds, olive oil, unsalted butter are allowed within reason. Lately there have been new insights that some cholesterol is needed for normal hormone production. What needs to be cut out are omega-6 fats and trans fats.

2. Omega-3-fatty acid supplements from molecularly distilled fish oil at a good dosage (3 to 6 capsules a day) will prevent chronic inflammation that often causes arthritis. Chicken cartilage (UC-II) from the health food store will desensitize your system in case you have rheumatoid arthritis or osteoarthritis. This will prevent crippling arthritic disease down the road.

3. Mitochondrial aging (the mitochondria are the energy packages in each body cell) is slowed down by the two supplements ubiquinol (=Co-Q-10, take 400 mg per day) and 20 mg of PQQ (=Pyrroloquinoline quinone). Co-Q-10 repairs DNA damage to your mitochondria and PQQ stimulates your healthy mitochondria to multiply. Between the two supplements you will have more energy.

4. Vitamin C 1000 to 2000 mg per day and a multivitamin supplement help to support the rest of your metabolism. Some may want to add PS (Phosphatylserine) 100 to 200 mg per day, which works together with vitamin D3 for Alzheimer’s prevention.

Conclusion

By now you noticed that nothing comes from ignoring the fact that we are aging. We need to pay attention to our body functions and think about what we can do to make us stronger. In the end we are our own caregivers. When we are in our eighties, we should still be active and our brains should function with a lot more experience than in our past. Our bones will be strong and our balance should prevent us from falling. I do not want to use assisted living and I do not like the confinement of a wheel chair. In the meantime I am going to carry on dancing.

More information on:

1. Fitness: http://nethealthbook.com/health-nutrition-and-fitness/fitness/

2. Nutrition: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/

3. Vitamins, minerals and supplements: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/vitamins-minerals-supplements/

References

1. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

2. David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

3. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA

Last edited Nov. 7, 2014

Sep
28
2013

Sleepless Nights

Sleeping problems (insomnia) are very common. About 10% of the population suffers from chronic insomnia; 30% of the population suffers from occasional sleep problems. In a large outpatient population of a clinic consisting of 3500 patients who had at least one major clinical condition, 50% complained of insomnia, 16% had severe symptoms, 34% had mild symptoms (Ref.1). Insomnia is more common among women, and older people as well as in people with medical or psychiatric illnesses. Long-term studies have shown that the same insomnia problems persist throughout many years. It is not possible to offer a simple remedy for insomnia, because insomnia is a complex problem. Here I will discuss some of the causes of insomnia and also discuss some of the treatment options.

Symptoms of insomnia

The person who suffers from insomnia will usually state that they have problems falling asleep. Worries of the day suddenly circulate through their thoughts and they toss and turn nervously looking at the clock from time to time and getting more and more anxious that they cannot sleep. Others fall asleep OK, but in the middle of the night they wake up perhaps to visit the restroom, but then they cannot go back to sleep. Others wake up 2 hours before their normal alarm clock time and they feel their stomach rumbling making it impossible to fall back to sleep. Older people with chronic diseases and general poor health suffer more from insomnia. In this setting insomnia may be more related to the underlying disease rather than old age. Psychiatric disorders also are associated with more insomnia. Treat the underlying psychiatric illness, and the insomnia disappears.

Although insomnia is a sleep disturbance during the nighttime, people who are affected with this complain of daytime fatigue, of overstimulation, yet they catch themselves making frequent mistakes, and their inability to pay attention gets them involved in accidents and falls. Longitudinal studies have shown (Ref. 1) that people with chronic insomnia are more likely to develop psychiatric disease, such as major depression,  anxiety disorder and alcohol and substance abuse. Unfortunately these disorders can by themselves again cause insomnia, which reinforces chronic insomnia. Insomnia leads to poorer social and physical functioning, affects emotions, leads to a lack of vitality and physical endurance, contributes to worsening of pain and can affect general and mental health.

Research about insomnia

Much has been learnt from sleep studies using polysomnography monitoring during a full night’s sleep. These studies have been used mainly as a research tool. In such studies eye movements, brain wave activity, muscle activity, chest movements, airflow, heart beats, oxygen saturation and snoring (with a microphone) are all simultaneously recorded. This way restless leg syndrome, sleep apnea, snoring, seizure disorders, deep depression etc. that can all lead to insomnia can be diagnosed and separated from insomnia. The stages of sleep (wakefulness, stage 1 to 3 sleep and the REM sleep stage) can also be readily measured using polysomnography (Ref.2). According to this reference the majority of insomnia cases do not need this complex procedure done.

Sleepless Nights

Sleepless Nights

Causes of insomnia

Traditionally insomnia cases are classified into primary insomnia and secondary insomnia. Secondary insomnia is caused by all of the factors discussed below. When they are dealt with, we are left with cases of primary insomnia.

The following medical conditions can cause insomnia: heart disease, pulmonary diseases like asthma and chronic obstructive pulmonary disease (COPD); gastrointestinal disease like liver cirrhosis, pancreatitis, irritable bowel syndrome, ulcers, colitis, Crohn’s disease; chronic kidney disease; musculoskeletal disease like arthritis, fractures, osteoporosis; neurodegenerative disease like MS, Parkinson’s disease, Alzheimer’s disease; endocrine disease like diabetes, hyper- or hypothyroidism, adrenal gland fatigue and insufficiency; and chronic pain conditions. Also, psychiatric conditions like major depression, schizophrenia and anxiety disorders can cause insomnia.

This list in not complete, but it gives you an idea of how complex the topic of insomnia is.
The physician who is seeing a patient with insomnia needs to rule out any of these other causes of insomnia to be certain that the only condition that is left to treat in the patient is insomnia itself. The other diagnoses have to be dealt with separately or else treatment of insomnia will fail.

Ref. 1 points to a useful model of how to think about causation of insomnia: there are three points to consider, namely predisposing, precipitating, and perpetuating factors. Let’s briefly discuss some of these.

Predisposing factors

We are all different in our personal make-up. If you are well grounded, chances are you are not susceptible to insomnia. Anxious persons or persons who have been through a lot of negative experiences in life will have personality traits that make them more prone to insomnia. Lifestyle choices such as late nights out, drinking with the buddies in a bar (extreme circadian phase tendencies) will have an impact on whether or not you develop insomnia.

Precipitating factors

A situational crisis like a job change or the death of a loved one can initiate insomnia.  However, there could be a medical illness such as a heart attack, a stroke or the new diagnosis of a psychiatric illness that has become a precipitating factor. Sleep apnea and restless leg syndrome belong into this group as well as would the stimulating effect of coffee and caffeine containing drinks. Jet lag and nighttime shift work can also be precipitating factors.

Perpetuating factors

Daytime napping to make up for lost sleep the night before can undermine sleep initiation the following night, which can lead to a vicious cycle. Similarly, the use of bedtime alcoholic drinks leads to sleep disruption later that night and can become a perpetuating factor, if this habit is maintained. Even the psychological conditioning of being anxious about whether or not you will fall asleep easily or not the next night can become a perpetuating factor.

I will return to this classification and the factor model of causation of insomnia when we address treatment options.

Drugs that can cause insomnia

One major possible cause for insomnia  can be side effects from medications that patients are on (would belong to the ‘perpetuating factors’ among causes). Physicians call this “iatrogenic insomnia”. The antidepressants, called selective serotonin reuptake inhibitors (SSRI’s) like Prozac are particularly troublesome with regard to causing insomnia as a side effect. Other antidepressants like trazodone (Desyrel) are used in small doses to help patients with insomnia to fall asleep. Some asthmatics and people with autoimmune diseases may be on prednisone, a corticosteroid drug. This can cause insomnia, particularly in higher doses; so can decongestants you may use for allergies; beta-blockers used for heart disease and hypertension treatment; theophylline, an asthma medication and diuretics. Central nervous stimulants like caffeine or illicit drugs can also cause insomnia. Hormone disbalance in general and hyperthyroidism specifically as well as Cushing’s disease, where cortisol levels are high will cause insomnia.

Treatment of insomnia

So, how should the physician approach a patient with insomnia? First it has to be established whether there is secondary insomnia present due to one of the predisposing, precipitating or perpetuating factors. In other words, is there secondary insomnia due to other underlying illnesses? If so, these are being addressed first. Lifestyle choices (staying up late every night) would have to be changed; alcohol and drug abuse and overindulging in coffee or caffeine containing drinks needs to be dealt with. Cognitive therapy may be beneficial when mild depression or anxiety is a contributing factor to insomnia.

The remaining insomnia (also medically termed “primary insomnia”) is now being treated.

The following general points are useful to get into the sleeping mode (modified from Ref. 3):

  1. Ensure your bedroom is dark, soundproof, and comfortable with the room temperature being not too warm, and you develop a “sleep hygiene”. This means you get to sleep around the same time each night, have some down time 1 hour or so before going to bed and get up after your average fill of sleep (for most people between 7 to 9 hours). Do not sleep in, but use an alarm clock to help you get into your sleep routine.
  2. Avoid caffeine drinks, alcohol, nicotine and recreational drugs. If you must smoke, don’t smoke later than 7PM.
  3. Get into a regular exercise program, either at home or at a gym.
  4. Avoid a heavy meal late at night. A light snack including some warm milk would be OK.
  5. Do not use your bedroom as an office, reading place or media center. This would condition you to be awake.  Reserve your bedroom use only for intimacy and sleeping.
  6. If you wake up at night and you are wide awake, leave the bedroom and sit in the living room doing something until you feel tired and then return to bed.
  7. A self-hypnosis recording is a useful adjunct to a sleep routine. Listen to it when you go to bed to give you something to focus on (low volume) and you will find it easier to stop thinking.

Drugs and supplements for insomnia

1. In the past benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), fluorazepam (Dalmane), temazepam (Restoril), triazolam (Halcion) and others were and still are used as sleeping pills. However, it was noted that there are significant side effects with this group of drugs. Notably, there is amnesia (memory loss), which can be quite distressing to people such as not remembering that someone phoned while under the influence of the drug, you promised certain things, but you cannot remember the following morning what it was. Another problem is the development of addiction to the drugs with worse insomnia when the drugs are discontinued. Many physicians have stopped prescribing benzodiazepines.

2. There are non-benzodiazepines drugs that are used as sleeping pills (hypnotics), such as Zaleplon (Sonata), Zolpidem (Ambien) and Eszopiclone (Lunesta).  They seem to be better tolerated.

3. Ramelteon, a melatonin agonist, is available by prescription in the US. It probably is the best-tolerated mild sleeping pill and works similar to melatonin, but is more expensive. Chances are that your physician likely would prescribe one of the non-benzodiazepines drugs or Ramelteon for you as they do not seem to be addicting.

4. However, there is an alternative: Many patients with insomnia tolerate a low dose of trazodone (Desyrel), which is an antidepressant with sleep restoring properties. A low dose of 25 to 50 mg at bedtime is usually enough for insomnia. This allows the patient to fall asleep within about 30 minutes of taking it, and sleep lasts through most of the night without a hangover in the morning. Many specialists who run sleep laboratories recommend trazodone when primary insomnia is diagnosed. However, this is still a drug with potential side effects as mentioned in the trazodone link, but 50 mg is only ¼ of the full dose, so the side effects will also be less or negligible.

5. I prefer the use of melatonin, which is the natural brain hormone designed to put us to sleep. Between 1 mg and 6 mg are sufficient for most people. We know from other literature that up to 20 mg of melatonin has been used in humans as an immune stimulant in patients with metastatic melanoma with no untoward side effects other than nightmares and some tiredness in the morning. A review from the Vanderbilt University, Holland found melatonin to be very safe as a sleeping aid. There are several melatonin receptors in the body of vertebrates (including humans), which are stimulated by melatonin.

6. Other natural methods are the use of L-Tryptophan at a dose of 500 mg at bedtime, which can be combined with melatonin. It is the amino acid contained in turkey meat, which makes you tired after a Thanksgiving meal. GABA is another supplement, which is the relaxing hormone of your brain, but with this supplement tolerance develops after about 4 to 5 days, so it is only suitable for very short term use. Herbal sleep aids are hops, valerian extract and passionflower extract. They are available in health food stores.

Conclusion

A lack of sleep (insomnia) is almost a given in our fast paced lives.

When it comes to treatment, all of the other causes of secondary insomnia need to be treated or else treatment attempts would fail. What is left is primary insomnia. This is treated as follows:

We need to review our sleeping habits, lifestyles and substance abuse. Remove what is detrimental to your sleep. Start with the least invasive treatment modalities such as self-hypnosis tapes, melatonin, L-Tryptophan or herbal extracts. Should this not quite do the trick, asks your doctor for advice. The non-benzodiazepines drugs or Ramelteon would be the next level up. It may be that an alternative such as low dose trazodone would be of help. Only, if all this fails would I recommend to go to the more potent sleeping pills (keep in mind the potential for addiction to them).

References

1. David N. Neubauer, MD (John Hopkins University, Baltimore, MD): Insomnia. Primary Care: Clinics in Office Practice – Volume 32, Issue 2 (June 2005)  © 2005, W. B. Saunders Company

2: Behrouz Jafari, MD and Vahid Mohsenin, MD (Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA): Polysomnography. Clinics in Chest Medicine – Volume 31, Issue 2 (June 2010), © 2010 W. B. Saunders Company

3. Jean Gray, editor: “Therapeutic choices”, 5th edition, Chapter 8 by Jonathan A.E. Fleming, MB, FRCPC: Insomnia, © 2008, Canadian Pharmacists Association.

Last edited Sept. 28, 2014