Mental Health Archives

Oct

2022

Overcoming Grief after a Loss

By Ray Schilling | Anxiety, depression, Mental Health, stress

This article is about overcoming grief after a loss. During the Covid epidemic many people died, which caused a lot of grief among their loved ones. Unresolved grief can cause anxiety and depression. Whenever you have lost a loved one, counseling can help you to continue the grieving process.

Claire Bidwell Smith is an author of several books and has a master’s degree of clinical psychology from Antioch University in Los Angeles. She published the book “Anxiety-the missing stage of grief” (Hachette Books, 2018). In it she explores the stages of grief and notices that anxiety is very much part of the grieving process. However, this point is often overlooked by mainstream psychologists. Claire Bidwell Smith offers strategies to deal with the loss of a loved one and overcome the anxieties that people often feel as well. Here is a write-up from CNN where Claire Bidwell Smith was interviewed.

Anxiety is a powerful emotion

Anxiety can be very powerful, but it is often mistaken for a physical problem. As a result, people present at the emergency room of a hospital for various symptoms of pain and a myriad of other complaints. After expensive tests the doctor finds no physical abnormality and the diagnosis is anxiety or panic attack. Smith said that 70% of her referrals went to the hospital first and were diagnosed as panic attacks. Patients have a hard time to understand that their anxiety is a direct result of their grieving process.

Relationship between grief and anxiety

CNN asked Smith how grief and anxiety are related. She answered that a sudden death from an infection like Covid makes you realize that we are not safe and are not in control. Everything in your life changes and emotional upheaval is much bigger than ever imagined. Grief, which consists of emotions that accompany a loss of life can force you to kneel down emotionally speaking. This process feeds anxiety. People who grieve the loss of a loved one get anxious about their own health and about the safety of other loved ones. They may not even realize that what they are experiencing is anxiety or that this is related to the grieving process.

Anxiety

Anxiety is a condition that presents with fears and worries. This can present with many different body symptoms. The patient may experience chest pains and think it is a heart attack. But tests are normal and the physician calls it anxiety. Similarly, anxiety can present as stomach aches, headaches or insomnia.

What coping strategies are available?

There are many support groups to help people with anxiety; in addition, grief therapists can help with individual counseling. It may be difficult to motivate the patient to make use of these services. Since Covid you can have access to virtual anxiety support services. It is important that people seek counseling support, as otherwise they get stuck in their anger or guilt. Unfortunately, many people give up and end up in substance abuse. They develop relationship problems and get into trouble at work or in school. So, not seeking support only backfires. Get yourself on a waiting list for a counselor! Work through your grief and you will feel better.

What is your advice to people who resist a formal mental health treatment?

Smith mentioned that there are a lot of self-guided online courses. Also, reading books and articles about grieving are useful, because you get on with your grieving process. Social media is another source for information about the grieving process. It helps you to understand what other people with the same problem experienced and how they overcame it. Having said this, people can develop a full-blown anxiety disorder or clinical depression. In this case they require an assessment by a psychiatrist.

What is the role of meditation and mindfulness in healing anxiety?

Smith pointed out that when we grieve and when we are anxious, we spend time in the past or we worry about the future. Meditation and mindfulness bring our awareness to the present moment. Meditation helps us to focus on our own thoughts. It helps us also to detach from negative thoughts or irrational fears.

Imagination as another powerful tool

Smith explained as an example that she was not there when her mother died in the hospital. When she is overcome by negative emotions regarding this memory, she envisions herself crawling into the hospital bed with her dying mother, holding her and saying good bye to her. Smith admitted that it took her about 5 years before she was ready to do these imagination experiments. By using this imagining tool your present focus is on the now away from negative emotions of the past or fears what the future may hold.

Stories help to reduce grief

How we handled a painful story from the past determines how it influences our daily thinking. Often people do not know how to handle such a story and they tend to suppress it. But psychologists found that it is much healthier to deal with these stories and reframe them. When people find a way how to explore their story, they can reframe it and remove the negative feelings that had an association with it in the past. Healing comes from therapy, from counseling, online grief forums and support groups. There are also grief writing classes where you can rewrite your story experiencing how the past memories become less powerful and the future is brighter.

Stay connected with your lost loved one

It used to be taught that the best therapy would be to “letting go and moving on”. But now psychologists think it is better to move forward with the person you have lost. Specifically, what this means is that it is OK to have an inner talk with the person you lost. Smith added: “For example, pondering: What advice would my dad give me about this job offer? What would my mom think of my new boyfriend?”

The crux of grief work is making meaning out of loss

CNN asked Claire Bidwell Smith whether she quoted Hope Edelman who authored the book “The After Grief”. Hope Edelman said in this book that the “crux of grief work is making meaning out of loss”. Smith’s reply was that this stage develops naturally. But she cautioned that guilt, regret and anger are standing in the way of our ability to make meaning. They have to be dealt with first. This is why counseling, grief work and overcoming guilt and anger are so important.

Overcoming Grief after a Loss

Conclusion

When we lose a loved one or lose our job, we experience a grief reaction. There are powerful negative feelings like anger, guilt and other feelings that make it difficult to overcome our grief. Claire Bidwell Smith is an author of several books and has a master’s degree of clinical psychology from Antioch University in Los Angeles. She was interviewed by CNN regarding her work and her latest book “Anxiety-the missing stage of grief” (Hachette Books, 2018).

Anxiety is an important aspect of grieving

In the interview she explained that anxiety is an important aspect of grieving. But many people go to the emergency room of a hospital, because they think the symptoms, they feel are physical. It is the emergency physician who tells them after several tests that they have anxiety and they need to seek a counselor. After a few months of counseling grieving persons usually feel a lot better. They are now accepting what happened in the past and hope for a better future.

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Sep

2022

When is Someone at Risk for Suicide?

By Ray Schilling | Anxiety, depression, Drugs, Mental Health, suicide

We are asking ourselves: When is someone at risk for suicide? This year’s National Suicide Week was from Sept. 4 through 10, 2022. Every day of each year it is important to be aware of signs and symptoms of impending suicide. However, the purpose of the yearly National Suicide Week is to really bring it to everyone’s attention how common deaths by suicides are. We all can contribute to improve the situation by increasing our awareness.

Some suicide statistics

In the US alone nearly 46,000 persons died by suicide in 2020. This means that there is one death by suicide every 11 minutes. In 2020 nearly 800,000 died by suicide worldwide. About 1.2 million attempted it. The hope is that the public will learn through education to recognize the signs of an impending suicide. This way the suicidal person can get counselling and hopefully not commit suicide.

Abnormal behaviors to watch out for

People who are getting suicidal may practice with guns, overdosing with pills or handle potentially lethal items. Other behavioral red flags could be giving away cherished items. The suicidal person may sleep too much or not enough. Isolation or withdrawal may be another pointer in a previously sociable person that he or she is becoming suicidal. Revenge thinking, reckless driving, agitation can all be pointers as well that the person is preparing for suicide. Justin Baker is the clinical director of The Suicide and Trauma Reduction Initiative for Veterans at The Ohio State University Wexner Medical Center. He said: ”A lot of times people need to kind of work up to that actual making an attempt because it’s a biologic thing you have to go against, your own survival”.

Watch what people say

When people become suicidal their words often indicate what they want to do. It is a warning sign, if someone is talking about wanting to die, by suicide or otherwise. Some people state that they feel like they have no reason to live. This is an alarm signal that they may be suicidal. Some people say that they feel like they are a burden for the people living around them. Other problematic statements are: “You don’t need me for this anymore” or “I feel like it’d be better if I just wasn’t here.” Someone uttering statements like these should get counseling. This allows them to vent their feelings and to reassess their situation.

Suicide risk factors

Hopelessness: People may express that they feel the future won’t be any better. Or they do not see a way out of the pain that they are in.

Obsession with death and dying: Some people ruminate about dying and they develop a plan what they may want to do to themselves.

Extreme mood swings: When somebody who usually is depressed and stressed behaves calm or cheery, this is an alarm sign that the person may be suicidal. They may have struggled with their decision to kill themselves, but when they accepted that this is what they want to do it calms their mind.

Past trauma: Abuse, trauma and neglect in the past are risk factors for suicide in the future.

Drug abuse: substance abuse predisposes a person towards being suicidal later on in life.

More suicide risk factors

Severe chronic illness with chronic pain: when a person has a chronic illness, and it is difficult to treat, people lose hope and they feel trapped. At this point suicide appears to be an option.

Mental disorders: people with schizophrenia, anxiety, depression or personality disorders are at a higher risk to turn suicidal. This is particularly so when they did not receive treatment and their mental condition deteriorates.

Family history, other factors and teen suicides

Family history of suicide: when there is a family history of suicide or a personal history of failed attempt of suicides the risk of suicide is much bigger than in the general population.

Other factors: There are many more factors that all can have a bearing on the risk for suicide. Financial loss and loss of a job are examples, but also prolonged stress from bullying or harassment. Divorce, breakup of a relationship, insufficient social support and many other negative emotions can contribute to a risk for suicide as well. A lot depends on the emotional make-up and the resilience of a person.

Teens: Teens are particularly vulnerable to commit suicide. It is important to listen to the teen in trouble and to arrange for counseling and support. More on teen suicide here.

What to do when faced with a person who contemplates suicide?

There are several crisis phones that are important to remember. In 2019 congress in the US has proposed to establish crisis lines with a simple 3-digit number: 988. But not all states have this number activated yet. The national crisis line in the US is: 1-800-273-TALK (1-800-273-8255).

In Canada the crisis hotline is: 1-833-456-4566.

There are counselors who have experience in listening to people in distress and talk to them.

When a person wants to commit suicide call 911. Sometimes a person in mental distress needs to be hospitalized and treated by a psychiatrist. Some people may benefit from electroconvulsive therapy, others from antidepressants. Cognitive therapy and behavioral therapy have a place as well in treating depressed patients. Close follow-up is important to prevent a relapse.

When is Someone at Risk for Suicide?

Conclusion

This year’s National Suicide Week was from Sept. 4 through 10, 2022. In the US alone nearly 46,000 persons died by suicide in 2020, nearly 800,000 died by suicide worldwide. It is important to recognize the signs of impending suicide. There are several high-risk factors that point to impending suicide, such as hopelessness, obsession with death and dying and extreme mood swings. There are certain constellations that are associated with a high risk for suicide: a history of a mental disorder, a break-up of a relationship, a severe illness with chronic pain and others. It is important to get the person at risk to a counselor or psychiatrist.

Treatment intervention for suicidal person

By talking it out, the pain of suffering gets eased. If there is an underlying depression it can be treated with various treatment modalities. Cognitive behavior therapy may help to change the negative thought patterns. It is important to intervene early. Close follow-up to prevent a relapse is also important.

Mar

2022

Adolescents’ Lifestyles Are Linked to Faster Aging in Adulthood

By Ray Schilling | diet, fasting mimicking diet, Mental Health, mitochondria, Mortality, Obesity, Smoking, Vitamins and supplements

A longitudinal study found that adolescents’ lifestyles are linked to faster aging in adulthood. The study started with a baseline examination in a group of adolescents around the age of 15. 30 years later doctors examined the same individuals again. The researchers found that smokers, obese people and people with untreated emotional problems were aging faster than controls who did not have these problems. CNN discussed this study as well. A fourth condition, asthma was also included in the study. Indeed, adolescents who suffered from asthma in their mid-teens were not more biologically aged at age 45 when compared to controls who never had asthma. The authors concluded that treated asthma did not prematurely age a person. However, lifestyle habits like smoking, excessive weight and untreated mental illness contributed to accelerated aging.

Does having a healthy lifestyle lower your risk of developing medical conditions and diseases?

It must be remembered that anti-aging medicine is watching out for new treatments that can prolong life. However, this is not just one “breakthrough”, but rather a number of factors that in combination lead to longevity.

Resveratrol

Resveratrol, the supplement from red grape skin can stimulate your mitochondria metabolism. Exercise more and regularly as this will also stimulate your mitochondria to multiply similar to the effects of PQQ, a supplement. I take 500 mg of resveratrol concentrate once daily.

Exercise regularly

The first thing to remember is that regular exercise will prevent about 50% of chronic diseases (diabetes, heart failure, arthritis). Consequently, this prolongs life: Lack of exercise is a major cause of chronic diseases.

Replacing missing hormones with bioidentical hormones

When you enter menopause or andropause replace missing hormones with bioidentical hormones. This will add 10–15 years of good life. This information comes from the anti-aging medicine circles and European studies of women on bioidentical hormone replacement. Here is a more conservative opinion from a US review: Counseling Postmenopausal Women about Bioidentical Hormones: Ten Discussion Points for Practicing Physicians.

Abandon sugar, starchy foods

Starchy foods (potatoes, pasta, rice, pastries and bread) and processed food accelerate aging. Avoid these foods for a healthier heart – Harvard Health. Many studies have confirmed that a Mediterranean diet is anti-inflammatory and prevents premature aging.

Are you deficient in human growth hormone?

Find out whether you are deficient in human growth hormone or not by taking an IGF-1 blood test. Dr. Hertoghe, an endocrinologist from Belgium said at various anti-aging conferences that HGH by itself prolongs life by about 15 to 20 years or more. I am deficient in HGH and I am injecting HGH myself regularly. My anti-aging physician orders my IGF-1 level three to four times per year to monitor the right dosage of HGH replacement. But it is crucial that the physician supervise the patient. This involves giving the patient only minimal amounts of HGH, which keeps IGF-1 levels in the high normal range. This is also re-emphasized in this review: Growth Hormone and Aging: Updated Review. When you overdose HGH, you lose all of the beneficial effects that HGH replacement brings.

Fasting mimicking diet (FMD)

Fasting for Longevity: 9 Questions for Dr. Valter D. Longo. When you consume only 500 to 600 calories daily for 5 days out of every month you are stimulating your telomeres (the caps on your chromosomes) to grow a little bit longer. Longer telomeres translate into longer life expectancy. In addition, your stem cells anywhere in your body also undergo stimulation. Here is more information: fasting mimicking diet for 5 days every month.

Lifestyle factors

It is best not to smoke. Keep your body mass index in the 21.0 to 22.0 range. Get enough sleep (7–8 hours every night). Use a form of relaxing exercise (yoga, self-hypnosis, meditation, Tai-Chi). This will keep the stress hormone cortisol under control; if it is constantly high from ongoing stress, it leads to premature deaths. The Science of STRESS – SLMA

Take key vitamins and minerals

When you take key vitamins and minerals every day you can add another 5 to 10 years of disease-free life to your life expectancy. Ray Schilling’s answer to Is taking vitamin supplements helpful or quackery?

All of these factors taken together help you to not age prematurely. A healthy lifestyle elongates your telomeres, which prolongs your life without diseases. It also prevents heart attacks and strokes, which again prolongs your life. And a healthy lifestyle prevents Alzheimer’s disease, so you can turn old and not have to worry about memory loss. I cannot overemphasize how important a healthy lifestyle is!

Conclusion

As summarized above, a recent study going on for about 30 years showed that premature biological aging occurs in adolescents who smoked, were obese or had untreated mental illness. On the other hand, treated asthmatics did not show this biological aging effect. I summarized what factors contribute to slowing down aging. It is a combination of proper diet, regular exercise, hormone replacement as you age and taking some supplements. One key to slower aging is to be aware of how important a healthy lifestyle is for you.

The section about having a healthy lifestyle was published previously here: Ray Schilling’s answer to What are the most exciting breakthroughs in longevity research?

Jun

2018

Writing A Medical Book

By Ray Schilling | Anti-aging medicine, Cancer, Cardiovascular disease, Hormones, lifestyle, Medical Condition, Mental Health, Mortality, Nutrition, Prevention

In my 40’s when I was practicing medicine, I was dreaming about writing a medical book. This was in the mid 1980’s and I was busy seeing 30 to 40 patients a day. I would never have found the time to write a medical book at that time. I thought, perhaps I could show how patients could stay younger for longer by adopting the right life style in order to stay well. Fast forward 3 decades, and the medical book writing began. But instead of one book the project turned into 4 books. There were too many topics to cover to fit them all in one book.

Prior to writing a medical book

First of all, in 2002 I published a large website. Its structure is like a book on the Internet: Net Health Book . It contains descriptions of the major diseases, mental and physical, and their current treatment modalities. I still maintain this work. Furthermore, I started another website in 2003, a weekly blog, called “Ask Dr. Ray” . This is a compilation of interesting research. Some medical research papers can get too scientific. For this reason I translated it into easier language. The topics tend to be anti-aging topics. This blog comes out Saturdays.

Retirement hobby

When I retired in 2010 I revamped my websites. In the process the web developer suggested I should add to Net Health Book a blog (nethealthbook.com/news) where I review current health news that I find interesting. This is a weekly blog, which I publish on Wednesdays. All of this is still going on, and it gave me lots of opportunities to write and publish on a smaller scale. In addition, I finally started publishing books.

A Survivor’s Guide To Successful Aging

My first book came out with Amazon in 2014. I had joined the A4M (American Academy of Anti-Aging Medicine) in the early 2000’s. The lectures at their conferences were very open-minded and pointed out details of what one could do to delay aging and avoid premature deaths. My own experience with changing our diet in 2001, starting bioidentical hormone replacement and changing my lifestyle became topics that were part of this book. I dedicated this book “to those who are willing to work on prevention in order to achieve a longer life without disabilities”. This is still the basis of prolonging your life.

Lifestyles can be deleterious

I start out in this book describing the obesity wave and how this changes the metabolism (metabolic syndrome). I used statistics from the Framingham Heart Study to show the detrimental effects of various lifestyles on mortality. Subsequent chapters deal with food, exercise, stress and missing hormones as life-shortening factors. There is a separate chapter on vitamins and supplements. They as a group can create 5.1% longer telomeres, which translated into 9.8 years of longer life expectancy (see also a study by Dr. Xu in the book). Subsequently it describes how a change of your lifestyle can have a positive impact. Changing your eating habits and exercise activity will make a tremendous positive difference on the long term.

Successful Aging in the Kitchen

The book ends with an appendix, written by my wife: “Successful Aging in the Kitchen”. You are presented with recipes for 7 breakfasts, 7 lunches and 7 dinners. In addition she has provided 7 healthy desserts for you. Bon Appétit!

Healing Gone Wrong, Healing Done Right

In another book, which got appeared in 2016 I gave a few examples of how famous people were failed by medicine. It started already in the past: Ludwig van Beethoven’s physicians did harm instead of healing their patient. However, this is happening now as well: physicians mismanaged the health care of Elvis Presley, Churchill, Michael Jackson and JF Kennedy. The physicians treated symptoms, but they never properly attended to the causes of the ailments of their patients. The end result was premature death in all of them. Churchill who had good genetics made it to age 90, but during his last 15 years he suffered of severe disabilities.

Treatment of symptoms will fail, treatment of causes succeed

These examples of famous people’s health problems resemble to what happens to today’s patients in various office settings. Their symptoms are mostly being treated, but their causes often not. Simply treating symptoms will not work on the long term. It did not work in the past, and it does not work now.

Other chapters in this book

Other chapters in this book deal with preventing disease, keeping a healthy brain and keeping a healthy heart. Next I discuss why food matters, followed by the health of limbs and joints. Subsequently I am discussing how to keep toxins out. The next chapter deals with how to reduce the impact of cancer. It is always important to diagnose cancer as early as possible as removal by surgery has the highest success rate at an early cancer stage. The next chapter is entitled: “Stable hormones key to health”. If any of your hormones are missing (particularly around the age of menopause and/or andropause) it is time for nature identical hormone replacement. The next chapter gives you general thoughts on anti-aging. This is followed by “supplements yes, but do not overdo it”.

Alternative treatment for ADHD

A final chapter gives you an example of an alternative treatment for ADHD, where the idea of not just treating symptomatically, but treating causes is included. References and an index are also provided for the book.

Prostate Cancer Unmasked

Furthermore, I did not intend to write this book. But in early 2016 my PSA (prostate specific antigen) level jumped from 3 to 8.6. For years it had been in the 1.5 areas, then slowly increased to 3. But 8.6 was too high for comfort! I had an MRI scan done, which showed one lesion in my left prostate, which was suspicious for prostate cancer. I was referred to a urologist at the Vancouver Prostate Centre, one of the top clinics in Canada. But I had already researched the literature and came across research by Dr. Gary Onik from Ft. Lauderdale who warned me about the pitfalls of “standard therapy”.

The conservative urologist in Vancouver

The urologist in Vancouver told me that without a positive biopsy he cannot accept that the shadow on my MRI scan would be prostate cancer. And the only way they do a prostate biopsy was by random trans-rectal biopsies. He also wanted to include me in a random clinical trial where they would compare active intervention with active surveillance. I politely declined the trans-rectal prostate biopsy and the inclusion into a trial.

Assessment by Dr. Onik

I booked a flight to see Dr. Onik in Ft. Lauderdale. His method is well researched and orchestrated.

Initial assessment

He assesses you with a rectal ultrasound and he sees the prostate on a TV screen. He said right away that I had three separate lesions, one in the left as shown on the MRI scan and two in the right lobe, which was missed by the MRI scan. False negative lesions are common on MRI scans, which can become a source of cancer recurrence.

3-dimensional prostate biopsy

The following day he booked me for a 3-dimensional prostate biopsy via the perineal approach. The perineum is easy to sterilize, so there is no risk of septicemia. A metal grid with holes for biopsy needles was used to get 96 biopsies of my enlarged prostate. For a normal size prostate, Dr. Onik said about 60 biopsy needles are normal. You don’t feel anything, because you are asleep.

Cryoablation prostate surgery

Next was the cryoablation surgery of the 3 prostate cancer lesions. This happened one month after the biopsy. I was seen at the hospital in Ft. Lauderdale. The same grid from the biopsy was used to relocate exactly where the cancer lesions were. The pathologist had confirmed them as Gleason 6 and 7 prostate cancers. This was treated with Argon sounds and frozen twice. I felt nothing, because I was under a general anesthetic. But Dr. Onik told me that everything went very well. Some cancer was too close to the neurovascular bundle, so he used the NanoKnife, an invention where nano-size holes get blasted into cancer cells, but it leaves normal tissue intact.

I needed to do self-catheterization for about one month to empty my bladder, as there was a lot of swelling from the prostate hypertrophy and the surgery. But eventually my normal water works returned.

Follow-up blood work

My follow-up PSA blood work 3 months after the surgery was down to 1.0. Prior to the surgery the Oncoblot test was positive for prostate cancer. A repeat Oncoblot test 3 months after the surgery was now negative for prostate cancer. I realize that not every physician accepts this new cancer-screening test, but I felt a lot better to know that all the cancer markers were now gone.

9 cancer treatments reviewed

In my book I described a total of 9 prostate cancer treatments and their 10-year survival statistics. None of the other treatment methods were as good as Dr. Onik’s statistics. I believe it is linked to the precision of the 3-dimensional biopsy and the surgery being done through the same grid. If you do not perform the surgery this way, you miss cancer lesions and this becomes the source of failure 10 years down the road. My book details all these alternative treatments. It also has a section on lifestyle modifying factors. I needed to write this book as a service to any man who suddenly is faced with a possible diagnosis of prostate cancer.

Unmasking prostate cancer

Like me he needs to unmask the cancer. Is it really there? How far advanced is it? Which way to safely biopsy it (definitely NOT through the rectum for fear of blood poisoning=septicemia)? What is the best method to remove it? I came to the conclusion that Dr. Onik’s method was best for me. But with the information in this book you can decide what is best for you.

Medical Questions Answered

Finally I wrote my 4th book. From more than 4400 medical questions that I have answered on the site Quora.com I selected the most popular questions for this book. The editorial board of Quora said that I own the publishing rights for my answers. The questions were rephrased without changing the meaning. I selected more than 120 questions under 44 different headings.

Here are some of the areas that are covered: Acne, the best home remedies. Aging: can it be reversed? What is the limit for a human? Alcohol: how does it affect your body? Alzheimer’s disease: which foods promote brain health? Arthritis: what can you do about osteoarthritis? Back pain: what can I do about it? Cancer: why can cancer still not be cured? There are as well 15 other answers about cancer. Depression: will my depression ever go away? Diabetes: will a 600-calorie diet help diabetes control?

Further topics discussed

Diet: I want to get rid of sugar in my diet. How can I do this long-term? Other answers about diet are included. Exercise: How useful is cardiovascular exercise? Gut disease: Is “gluten free” food healthy? Heart disease: What can I do to clean out my arteries and reduce my risk for heart disease? Hormones: Is estrogen present in the male body? Life Expectancy: What is the theoretical life expectancy of humans? Lifestyle Habits: Can good habits change your life completely? Pain: Pain relief for a headache or other pain: Aleve, Advil or Tylenol? Pregnancy: Best age for a successful pregnancy? Prostate Cancer: How dangerous is prostate cancer? Does it kill you? Schizophrenia: What complementary approach may help a patient with schizophrenia? Sleep: What happens when you go to bed late every night? And many other answers under this topic.

And the book finishes with these topics

Sugar: will I be OK living without sugar? Vaccinations: Is there a connection between vaccinations and autism? Vitamins and supplements: Are taking vitamins and supplements healthy or are they harmful? Weight loss: I am working out every day, but I am not loosing weight. What should I do? There are many more answers under this topic. Younger for longer: What are three things I can do every day to stay younger for longer?

These are only a few selections of all of the topics dealt with in this book.

Writing A Medical Book

Conclusion

I have reviewed briefly why I published the books mentioned above. My prostate cancer book developed out of the necessity that I had to deal with my newly diagnosed prostate cancer in 2016. I felt that the review process I went through would be good for those men who have to face a similar situation. The anti-aging book comes from my interest in anti-aging medicine. “Healing Gone Wrong, Healing Done Right” developed from the observation that physicians in the past and often even now tend to only treat symptoms. But if a cause can be found, this should be treated, as this often leads to a permanent cure.

Treating symptoms only will not improve the patient’s condition

Treating symptoms only will not improve the patient’s condition. “Medical Questions Answered” is a collection of medical topics where I answered various medical questions. It was a way for me to cover a vast array of medical topics. Some of the topics are dealt with in depth (acne for instance); others are very short. I have also two medical blogs that come out on Wednesdays and Saturdays. I hope that some of that medical information will be useful to you.

Sep

2016

Hidden Cause Of Depression

By Ray Schilling | alcohol, depression, Mental Health, Nutrition, Vitamins and supplements

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

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

Homocysteine as a hidden cause of depression

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

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

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

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

Hidden cause of depression and Alzheimer’s disease

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

Methylation pathway defects as a hidden cause of depression

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

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

Other illnesses due to methylation defects

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

Autism, ADHD (hyperactivity) and learning disabilities are other diseases where methylation pathway defects are present. Physicians should check patients with autism for methylation pathway defects, and appropriate supplements and diet restrictions can help in normalizing the child’s metabolic defects. Mothers should consult with a DAN physician (“defeat autism now”) who is knowledgeable regarding all aspects of autism.

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

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

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

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

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

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

Tests and treatment for hidden cause of depression

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

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

Hidden Cause Of Depression

Conclusion

Depression and several other illnesses can be related to methylation pathway defects. This can cause a lack of 5-MTHF resulting in high homocysteine blood levels. It is important that a physician checks his elderly patients for homocysteine blood levels once per year. This will prevent depression, Alzheimer’s disease, migraines and a number of other illnesses.

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

References

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

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

Jul

2016

Anxiety Is Common

By Ray Schilling | Anxiety, Mental Health, psychosomatic disease

Recently a review article was published that showed that anxiety is common. This research was conducted in England (Cambridge and London). 48 reviews about anxiety around the globe were examined. The results showed that anxiety in the world population fluctuates between 3.8–25%. Women (frequencies of 5.2–8.7%) and young adults (frequency 2.5–9.1%) are suffering from anxiety more. Among people with chronic diseases there is considerable variation in the frequency of associated anxiety (from 1.4% to 70%).

Variability of frequency of anxiety in different countries

The frequency of anxiety in various ethnic populations varies considerably around the world. For instance European and North American cultures have a relatively high anxiety rate in the population (3.8–10.4%) when compared to Indian and Asian cultures with only 2.8%. In Africa the rate is 4.4%, in Central and Eastern European countries the rate is 3.2%. In North Africa and the Middle East the anxiety rate is 4.9% while in Spanish/Latin cultures the rate is 6.2%.

Anxiety is common and there are subtypes

There are many subtypes of anxiety that have been researched.

Generalized anxiety disorder (GAD)

This disorder affects 6.8 million adults, or 3.1% of the U.S. population. It seems like women get this condition twice as often as men. The risk for developing it is greatest between childhood and midlife. People with a mild case of GAD can cope and work. Severe cases can be disabling and may be difficult to treat.

Social anxiety disorder

About 15 million US citizens suffer from this. This equally affects women and men. Typically it starts at the age of 13, but 36% of people will not ask for medical help for 10 years or more. Symptoms of anxiety surrounding social situations are so intense that it interferes severely with making friends and having romantic relationships. They end up being alone, powerless against their anxiety.

Panic disorder

6 million US citizens or 2.7% of the population suffer from this. Women commonly are twice as often affected by it than men. Panic attacks develop in early adulthood. They often suffer in silence; distance themselves from friends, family and caregivers who could offer them help. Panic disorders often occur simultaneously with depression and medical conditions like asthma, irritable bowel syndrome and substance abuse.

Specific phobias

19 million or 8.7% of the US population suffer from this. It often starts in childhood and the median onset is at age 7. People affected by specific phobias may be afraid of high bridges, of animals like spiders or mice, of thunder, of flying and a myriad of other things. It disrupts daily routines, causes limitations of work efficiency and reduces self-esteem. It also places a strain on relationships because people afflicted by this problem will do whatever they can to avoid the uncomfortable or terrifying feelings of phobic anxiety.

Obsessive-compulsive disorder

2 million or 1% of the population in the US suffer from this form of anxiety. Onset is in the teenage years, although 1/3 of adults with obsessive-compulsive disorder experienced symptoms already in childhood.

Posttraumatic stress disorder (PTSD)

7 million people or 3.5% of the US population are suffering from PTSD. Women are much more affected by PTSD than men. But a lot of soldiers who were involved in direct combat situations will suffer from PTSD. Rape can be a source of PTSD. Most people who experience traumatic events and develop PTSD will be affected by it for months or even years, but eventually recover from them; a minority will not recover. Often therapy is helpful for these individuals.

Major depressive disorder

8 million American adults or about 6.7% of the U.S population will suffer from depression between the ages of 15 and 44 years. It is more common among women. A certain percentage of depressed people commit suicide. Anxiety is often mixed in with depression.

Persistent depressive disorder

This is a form of depression that persists for at least 2 years. 1.5% of the US population or 3.3 million adults suffer from this condition. The median onset is at age 31. Like with depression, so also with persistent depressive disorder, anxiety is very common.

Anxiety is common; related illnesses

There are many medical diagnoses where anxiety is often part of the symptom complex. The medical profession often talks about psychosomatic diseases. This means that these diseases have an anxiety overlay, which is part of the condition.

For instance, bipolar disorder is a condition where extreme mood swings are common, often between elation and mania, but then switching to deep depression with suicidal thoughts. Mixed into this condition is often a certain degree of anxiety, which can be very overwhelming.
Irritable bowel syndrome is a psychosomatic disease of the gut with bowel cramps and frequent bowel movements, in others there are periods of constipation. But irritable bowel syndrome often has anxiety attached to it. They are often inseparable.

Eating and sleep disorders

Eating disorders: here the person has an intense fear of turning fat. Persons with eating disorder often restrict their calories severely, even when they are underweight. They may exercise for hours with the hope to lose weight. Perhaps the most striking condition among eating disorders is anorexia nervosa, which often affects teenage females, but adult women are affected as well. Sadly many of these women die from starvation or starvation related diseases.
Sleep disorders: more than 40 million Americans suffer from chronic, long-term sleeping disorder. Another 20 million suffer from occasional sleep disorder. In addition, often there is stress and anxiety that interferes with the normal sleep cycle.

Chronic pain and fibromyalgia

Chronic pain: Pain is a common symptom; if it is associated with a surgical procedure or with an injury it is short lived and eventually goes away. With chronic pain, the pain is present all the time. People with arthritis or nerve injuries that did not heal often have this type of pain. Fibromyalgia sufferers also have this type of pain. When a person has an underlying anxiety disorder and gets chronic pain on top of this, the pain is amplified and becomes even more chronic. On the other hand anybody with chronic pain will suffer from a certain amount of anxiety just because of the chronicity of the pain.
Fibromyalgia: this chronic musculoskeletal pain disorder is a special form of chronic pain. About 20% of fibromyalgia sufferers have either chronic depression or chronic anxiety, which certainly complicates the condition.

Substance abuse, stress and headaches

Substance abuse: about 20% of people with chronic anxiety disorders have an alcohol or substance abuse disorder; and 20% of people abusing alcohol or having a substance abuse disorder have a chronic anxiety disorder.
Stress: too much stress can turn into distress. Distress is an overdose of stress where the stressed person loses control of the situation. This can cause depression and anxiety. It can also cause physical illness.
Headaches: migraines, anxiety and depression seem to affect the same population group. Stress and anxiety can cause muscles around the neck to get into spasms and cause tension type headaches. But any headache can be brought on by anxiety.

Anxiety is common; biochemical brain abnormalities

Dr. Kharrazian has summarized in his book that Gamma-aminobutyric acid (GABA), which is a by-product of the brain cell metabolism is responsible for calming the brain (Ref.1). Most noteworthy, this mechanism is not working properly in people with anxiety. In many people with anxiety GABA is simply not produced enough to calm the brain or it gets inactivated too fast resulting in a lack of GABA with anxiety. Consequently, the end result is the same: when there is a relative lack of GABA in the brain the person develops symptoms of anxiety.

Disbalances in neurotransmitters

Disbalances in other neurotransmitters can also contribute to anxiety. As a matter of fact, serotonin is a neurotransmitter that is essential to have for a stable mood and to prevent depression. It is produced in the mid brain. Furthermore, the pineal gland stores serotonin and makes melatonin out of it, which is essential for a normal sleep pattern. When serotonin is low, a number of things can happen. Anger and increased aggressiveness are associated with a lack of serotonin. But depression, obsessive-compulsive disorder, migraines, fibromyalgia, irritable bowel syndrome, bipolar disorder and anxiety disorder are also frequently observed. Many of these illnesses have been noted above to be associated with anxiety. Ref.1 also describes that stress inhibits the conversion of serotonin into melatonin, which therefore explains sleep problems in persons who are exposed to chronic stress.

Anxiety is common; treatment options

In particular, what are the treatment options for a person with anxiety?

Treatment with anxiolytics

It is tempting to just treat the symptoms in an anxious person. But just prescribing anxiolytics like benzodiazepines (like Xanax) will not cure anxiety, just relieve the symptoms for a while. Eventually the body gets used to benzodiazepine and requires higher doses to suppress the anxiety. This can be the beginning of drug dependency, which is not what the health professional or the patient wants. As mentioned above alcohol and substance abuse is already a problem for 1 in 5 people with anxiety.

Treat sleep deprivation

An alternative is to concentrate on treating sleep deprivation in order to help the person to get a good night’s sleep. Melatonin at a dose of 3 mg at bedtime is a reasonable dose to help a person to fall asleep. If during the night the anxious person wakes up again, another dose of 3 mg of melatonin can be given. In addition, if an anxious person lies in bed and ruminates about various things that have happened during the day, a dose of valerian root (500 mg or even 1000 mg) can be useful.

Brain hormone effects

Dr. Datis Kharrazian describes in Ref.1 that valerian root increases GABA at the GABA receptor site. Research has also shown that valerian root slows down the breakdown of GABA. Although GABA is available in health food stores, GABA does not get absorbed through the blood/brain barrier easily. Only patients with autoimmune problems have a leaky blood/brain barrier and GABA can get through, but this is not a good approach to take for treating GABA deficiency. When you take GABA as a supplement, it wears off after a few days and loses its effect. It is wiser to stay away from GABA.

Cognitive therapy and behavioral therapy

This has been proven to help the person with anxiety. Often psychologists specialize in these treatment methods. Meditation and counseling therapy will also help.

Antidepressant therapy

In anxiety cases where depression is part of the psychological make-up antidepressants may have a place for a period of time. The FDA issued a warning in October 2004 about antidepressant medications, including SSRIs. These may lead to suicide and suicidal behavior in a small number of children and adolescents. But there is no way of predicting who will be affected this way. The antidepressant medications are still available and many physicians still prescribe them.

A balanced diet

A balanced diet like a Mediterranean diet provides the nutrients necessary to make GABA. People should avoid sugar in any form as it contributes to anxiety from blood sugar fluctuations.

Yoga and biofeedback

Yoga with an emphasis on breathing techniques can also be useful. Biofeedback methods are useful as well.

Anxiety Is Common

Conclusion

Anxiety is common, but also very complex, as explained above. 74.8 million Americans suffer from the various forms of anxiety mentioned. Psychosomatic disease often involves anxiety as well and it can be difficult to sort out the symptoms of patients afflicted with physical illness and anxiety. Repeat visits to the treating doctor will eventually help sort these problems out. The physician will rule out any physical problems first by doing lab tests and imaging studies.

Treating anxiety should focus on reestablishing a healthy sleeping pattern. Self-hypnosis tapes or discs are useful. Melatonin and valerian root have their place. Cognitive-behavioral therapy will help the patient to reestablish clear thoughts and minimize the anxiety symptoms. With this approach the patient will often be able to overcome anxiety. There are no instant solutions, but with time and persistence the patient will be able to take back control of his or her life.

Reference

Feb

2014

Every Patient Is Unique

By Ray Schilling | Anti-aging medicine, Heart Disease, Hormones, Mental Health, Osteoporosis, Vitamins and supplements, Women’s Diseases

Modern Western Medicine tends to see the disease of a patient as a unique entity. Conventional medicine behaves as if a disease is associated with characteristic symptoms, findings and lab test results, which are then treated in a standard fashion by treating the symptoms of the disease.

The reality though is different: The same disease can present in various patients with different symptoms.

Naturopathic physicians, integrative physicians and anti-aging physicians see patients as unique individuals with characteristic personality traits and slightly varied presentations, which may be shared in a disease entity, but differ substantially from person to person.

It is important to be aware of this uniqueness, if the caregiver wants to achieve the optimal treatment result.

Big Pharma does not like this approach as they would like you to think that the conventional medicine system is superior. A certain disease is treated a certain way, preferably with the most expensive drugs.

I thought that in this blog it would be good to shed some light on this important topic.

Menopausal women with symptoms

Let us consider an example of a 55-year old woman who has hot flashes, dry skin, a loss of hair from the outer aspect of her eyebrows, does not sleep well and has lost her sex drive. She also has put on 20 pounds in the last year despite no change in her diet.

This is how conventional medicine would handle this patient

The doctor examines the woman and does a Pap test as well. A conventional doctor would likely order standard blood tests consisting of a complete blood count, thyroid tests (T4, TSH) and FSH and LH levels. The conventional physician would find that the thyroid hormones are low with a high TSH (thyroid stimulating hormone) and would treat the woman with Synthroid (a synthetic thyroid hormone drug). The LH and FSH were found to be high indicating to the conventional physician that the woman is in menopause. He would offer the standard PREMPRO (a synthetic hormone preparation containing a mare estrogen combination with a progestin) with the warning that he will give her the lowest estrogen combination and only up to 5 years because of the negative findings of the Women’s Health Initiative.

Every Patient Is Unique

Here is an example how a naturopathic or anti-aging physician’s would investigate and treat the patient

A naturopathic physician or an anti-aging physician would likely add a female saliva hormone panel to the other blood tests mentioned above and also do a T3 hormone level as part of the thyroid blood tests. The doctor will explain to the patient that she was found to be menopausal and also hypothyroid. With respect to the hypothyroidism the physician will explain that apart from thyroxin (T4) there is a second hormone, triiodothyronine (T3) that is also necessary in order to replace all of the thyroid hormones that humans have. Drug companies assume that T4 (Synthroid) will reverse automatically into whatever amount of T3 the body needs, so they have convinced most conventional doctors to prescribe T4 drugs only (like Synthroid). The problem is that as the body ages, the enzymes necessary to convert T4 into T3 do not work as well as in a younger age.This can be verified by testing T3 and T4 levels simultaneously.

The end result is that the patient who only gets T4 replaced may still have some of the symptoms like lack of energy and depression even when T4 has been replaced. Not so with the patient treated by the naturopath or the anti-aging physician who put our patient on Armour (porcine-derived thyroid hormone replacement containing both T4 and T3).

With regard to the blood tests and the saliva hormone tests the second patient was told that the blood tests confirmed menopause (high LH and FSH) and that the saliva female hormone panel showed what was going on. In this particular patient the female saliva hormone tests showed that the progesterone level was low, the testosterone level was low and estrogen was normal. Another hormone, DHEA-S (which is DHEA sulfate, the storage form of DHEA) was also on the low side. Cortisol that had also been tested was normal. The physician explained that the woman’s adrenal glands showed a slight weakness not producing enough DHEA, which is a precursor to testosterone. The low testosterone level was responsible for her lack of sex drive. Progesterone, which needs to be high enough to counterbalance estrogen, was missing, which was likely the cause of her hot flashes and the lack of energy together with the missing thyroid hormones. The physician explained that the woman needed a small amount of DHEA tablets by mouth, a full replacement of progesterone (through the use of a bioidentical hormone cream) and also a small amount of bioidentical testosterone cream to normalize her hormones.

A reassessment of the patients 2 months later showed that the first woman still had some depression and lack of energy, while the second woman felt her normal self again. Both women had regrown their eyebrows from replacing the missing thyroid hormones and have lost several pounds since the beginning of their treatments, but obviously there were quite different clinical results. The first woman was treated in a “standard conventional medicine” fashion, which will lead to breast cancer as unnecessary estrogen was given. She also will be at risk of getting cardiovascular disease as she was replaced with Progestin, a synthetic drug thought by conventional physicians to represent “progesterone”. The Women’s Health Initiative has proven that this was the outcome with PREMPRO and yet this drug is still on the market!

The second woman received an individualized and personalized holistic treatment protocol. The low progesterone from missing her ovulations after menopause was being replaced and her body very quickly responded favorably by making her feel normal again. The missing adrenal gland hormones and testosterone were replaced and this normalized her sex drive. Both, progesterone and thyroid hormones (T3 and T4) are anabolic hormones and they gave her back her energy and restored her sleep pattern. With normal hormone levels she also lost her depression symptoms.

Two men with depression

If you thought that the difference of these two clinical approaches were just coincidental, think again. The next examples are two men in their early 50’s who see their physicians because they felt depressed and had a lack of energy. Both were normal weight.

Here is the conventional medicine approach

The physician took a history, during which a lack of sex drive was also noted. He examined the patient and came to the conclusion that physically nothing was wrong with the man, but a diagnosis of depression was made. This would account for the tearfulness, sleep problems and loss of sex drive. The doctor prescribed one of the standard antidepressants (in this case sertraline, brand name Zoloft). Three weeks later the patient returned and as he was better, a repeat prescription for the antidepressant was given. After a further two months the patient was reassessed. When the symptoms were reviewed, it became apparent that a lack of sex drive was still present, if anything the patient felt the antidepressant had made this worse. Some of the depressive symptoms have improved on the conventional antidepressant. The doctor discussed that the antidepressant could be increased by one tablet per day. The doctor also discussed the option of using Viagra for the decreased sex drive and difficulty having an orgasm.

This would be the naturopathic or anti-aging physician’s approach. Again similar to before a history was taken and a physical examination was done. The physician noted that the patient was in the age where a lack of sex drive could indicate an early andropause (the male equivalent of menopause, often difficult to spot with the first presentation). A depression questionnaire indicated that the man was moderately depressed. The patient was sent for blood tests and for saliva hormone tests (a male hormone panel). The physician stated that he would like to arrange for cognitive therapy treatment to sort out the various factors of his depression, but also help his mood by trying to start him on St. John’s wort, an herb that has been proven to be effective for mild to moderate depression. The blood work came back as normal. However, the hormone tests showed that testosterone was in the lower third of the normal range. DHEA-S, cortisol and estrogen were normal. So a few weeks later when the tests had come back the patient was called in. The doctor explained to him that the low testosterone level would explain why his sex drive had deteriorated along with his symptoms of depression. Bioidentical testosterone cream was added to the antidepressant herbal treatment. The result was that within one month this patient’s sex drive was back to normal. Together with the cognitive therapy treatments and the herbal antidepressant the depression was also resolved. After a further three months of counseling he was able to stop the St. John’s wort. Due to the counseling sessions he felt stronger than ever before and his mood remained stable even when the counseling sessions were terminated. He continued to use the bioidentical testosterone cream regularly.

These are examples of two different approaches in two identical men in their early 50’s. It appears to me that the conventional approach did a disservice to the sick person, only treated symptoms, but did nothing to solve this patient’s real problems. The second case’s depression was treated properly and the physician luckily also did not miss the underlying early andropause with low testosterone levels. Repeat testosterone levels showed a high normal testosterone level, which was now in the upper 1/3 of the normal range.

The conventional approach missed the early testosterone deficiency, which would cause heart disease, should the testosterone levels become even lower. Viagra certainly would not be the answer as this has a number of potentially serious side effects. The antidepressants at even higher doses would cause more erectile dysfunction, which was what he hoped to have treated.

Conclusion

People often have several conditions at the same time. It takes intuition, readiness to do testing, repeat close observation and repeat examination on the part of the physician. This needs to be coupled with good listening skills to sort out a patient. On behalf of the patient it is important to tell the physician all of your symptoms and observations. Be patient and never give up. A good patient/physician relationship will go a long way in sorting out complex medical problems. Every patient is unique. Not every symptom means the same thing in two different patients.

More information on:

1. Menopause: http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/menopause/

2. Depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

Last edited Nov. 7, 2014

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every patient is unique

Oct

2013

Being SAD in Fall (Seasonal Affective Disorders)

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

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

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

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

Definition of SAD

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

Brain hormone disbalance

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

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

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

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

Symptoms of SAD

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

Treatment approaches to SAD

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

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

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

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

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

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

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

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

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

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

Conclusion

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

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

References

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

Last edited Nov. 7, 2014

Oct

2013

Healthy Choices Start In Your Brain

By Ray Schilling | Alzheimer’s disease, Anti-aging medicine, Diabetes, Fitness, High Blood Pressure, Infectious Disease, Mental Health, Other neurological conditions, Prevention, Stroke, Substance abuse, Vitamins and supplements

This article deals with healthy choices start in your brain. You may have seen the CNN heading “Where is self-control in the brain?” If we want to make any healthy choices in life including sound financial choices, we need a balanced brain that makes the right decisions for us.

Two ways of making food choices

Researchers at the Caltech in Pasadena, CA have examined this question in detail using functional MRI scans and found out that there are two loci on the frontal lobe of the brain that control your impulses: the “ventral medial prefrontal cortex” (red in this link) that processes your initial image (like seeing a delicious ice cream cone”) and the “dorsolateral prefrontal cortex”(green in this link), where you decide that this is not healthy for you because it has too much sugar in it.

Two groups of volunteers

The Caltech researchers found a group of volunteers who were impulsive and made the wrong choice simply based on their taste buds without consideration for their health in general. An equally large group of volunteers was also found who had functional activity in the ventral medial prefrontal cortex and the dorsolateral prefrontal cortex, the latter of which modified the final decision into the healthy choice. The impulsive group made their decision to buy simply with the activation of only the ventral medial prefrontal cortex.

Balanced thinking required to make the right choices

The researchers think that it is this kind of lack of balanced thinking that decides whether we are going to make the right or wrong health choices for ourselves. The sad part is that ultimately, the summation of bad health decisions during life can become the cause of developing dementia, such as Alzheimer’s disease. The good news is that many of the causes of dementia can be avoided, which means that the average person could prevent dementia. I will discuss this in detail here.

Causes of dementia

It is interesting to study patients with various forms of dementia as it is often in the frontal and temporal portions of the brain where brain cells are dying off resulting in impulsive buying, impulsive behavior and lack of recent memory. It is also important to recognize that a number of conditions or factors can cause dementia:

1. Genetic causes

There are two types of frontotemporal lobe dementias, a tau-protein positive FTD and a ubiquitin-positive FTD, which has been shown to be due to a deficiency in progranulin. Both of these genetic defects are located on chromosome 17. In Alzheimer’s dementia, which occurs later in life there can be genetic defects at chromosomes 21, 14 or 19. Epigenetic factors like exercise, avoidance of alcohol, and taking omega-3 supplements can even partially prevent or postpone the onset of dementia from genetic causes.

Healthy Choices Start In Your Brain

2. Toxins like alcohol

Another example of how people can get dementia is through the effect that regular alcohol consumption has on our brains and bodies. This image of an MRI scan shows a normal brain for comparison on the right and the MRI scans of the brain of a chronic alcoholic on the left. When a chronic alcoholic has severe atrophy of the brain a psychiatric condition, called Korsakoff’s syndrome can occur. This psychotic condition as a result of the brain having been poisoned by regular alcohol intoxication. Essentially the toxic effect of high daily doses of alcohol have shrunk not only the surface of the brain, but also the deeper substance of the brain. The patient is psychotic, has loss of memory and is unable to care for him/herself.

3. Vascular damage to the brain

Strokes can cause vascular dementia that leads to Alzheimer’s disease-like memory loss. This link points out that diseases like hypertension, obesity, diabetes, atrial fibrillation, ischemic heart disease and dyslipidemia all predispose you to possibly get a stroke with subsequent dementia.

4. Traumatic head injuries

In boxers, football players and combat soldiers brain cells can get lost from repetitive head trauma leading to dementia (in this case it is called “dementia pugilistica”).

5. Infectious dementia

HIV in AIDS patients can affect the brain and cause an HIV-associated dementia. Bacterial meningitis and viral meningitis can kill brain cells and cause a form of dementia as well.

6. Immune disorders

We know that MS can go on to develop dementia as a late complication. In MS there are autoantibodies against myelin, the insulation material that surrounds nerve fibers. An important category of immune disorders is autoimmune disease that can cause dementia. The cardiologist, Dr. William Davis, has presented compelling evidence that wheat allergies can cause dementia, but if detected early and treated by a gluten free diet, this clears up the mind and stops further development of dementia (Ref.1 describes wheat allergies causing dementia; a wheat free diet is described in Ref.2).

7. Hormone deficiencies

A classical example is hypothyroidism, which in the past before thyroid medicine was available, often led to dementia. A simple blood test, TSH (thyroid stimulating hormone) can detect whether or not you are hypothyroid. The A4M recommendation for a normal level is below 2 (not below 5 as often reported by official lab value reports).

8. Lack of vitamins

Thiamine (=vitamin B-1) is often missing in alcoholics. If you are missing vitamin B-6 and vitamin B-12 in your diet, this can predispose you to develop dementia as well. Aging people lose a factor from the gastric mucosa (the intrinsic factor) that is essential to absorb vitamin B-12 in the mall bowel, which predisposes them to develop pernicious anemia and dementia. A simple vitamin B-12 injection can prevent this from happening.

9. Too much sugar consumption

Sugar consumption has skyrocketed in the 1900’s and keeps on going up in the new millennium as well. Here is a review that discusses the possibility that Alzheimer’s can be triggered by overconsumption of sugar. The higher the blood sugar levels in diabetics, the higher the risk for developing Alzheimer’s disease. A study in Seattle has confirmed this. High insulin levels are found in type 2 diabetes; they are responsible for making brain cells stimulate the production of the gooey substance amyloid that causes Alzheimer’s disease. The authors of this study showed this to be true both in humans and in animal models.

10. Lifestyle issues

These include lack of exercise, excessive weight (obesity, being overweight) and poor diet (fast foods). They play an enormous role in terms of causation of dementia in addition to the other factors mentioned. On the other hand organic foods Lack of toxins) and a Mediterranean type diet will preserve your brain cells.

Treatment of dementia

At present treatment of dementia is very limited, as we do not have a complete understanding of dementia at this point. The traditional treatment of dementia outlined here will only marginally delay further deterioration of dementia, but ultimately fail. In my opinion this is because the medical profession has been concentrating on fighting the symptoms of dementia rather than the cause.

Given the known causes mentioned above, I like to give you a list of 6 recommendations. These will help you to prevent Alzheimer’s disease and dementia in general.

Cut out sugar

I would suggest that you cut sugar out of your diet and replace it with stevia. This also includes dates, grapes, bananas; also wheat and wheat products and starchy foods like pasta, potatoes, rice and bread (see Ref. 1 and 2 for details). The manufacturers of soda drinks, pies and cakes will not be happy about this recommendation, but it will please your brain cells. You will also be surprised how easy it is now to lose weight, which will please you (this also lowers your risk for heart attacks and strokes).

Limit your alcohol consumption

Severely limit your alcohol consumption to less than 1 drink for women and 2 drinks for men per day (better still would be to stay sober) unless you want to become part of the hospital population mentioned in one of the links at the beginning of this blog.

Have your hormones checked

Have your hormones checked, particularly your thyroid hormones, but also estrogen and progesterone levels in women and testosterone in men. Our brain cells have hormone receptors for a reason. They need stimulation from our hormones, even in menopause or andropause. Replace the missing sex hormones with bioidentical hormone creams and missing thyroid hormones with thyroid tablets (Armour is the best mix of T3 and T4 thyroid hormones, not Synthroid).

Prevent repetitive brain injuries

Prevent repetitive brain injuries before it is too late. Rethink whether you really need to box, street fight, play football, rugby or hockey. An Accumulation of head concussions can cause Alzheimer’s later in life!

Use vitamins for prevention of dementia

Use vitamins for prevention of dementia: The B complex vitamins like B-2, B-6, B-12 (by injection); vitamin D3 has recently been shown to be effective in slowing down Alzheimer’s disease. Vitamin D3 is low in Alzheimer’s patients and vitamin D3 supplements will slow down this disease. Although vitamin C showed equivocal results, it does have some neuroprotective qualities and decreases β-amyloid production and acetyl cholinesterase activity. A Mediterranean-type diet (Ref.2) is also helpful in preventing dementia

Do regular exercise

Exercise daily. It will discipline you to stick to the other points mentioned above. It gives you some extra endorphins and will make you feel good about yourself.

Conclusion

Although we do not yet have a complete picture regarding Alzheimer’s disease and dementias, we do know enough to reduce our risk of getting them. When you cut out wheat and wheat products, your immune system stops production of autoimmune antibodies against your brain cells. Your opiate receptors in the brain will no longer seduce you to eat more and more sugar, starchy foods or high fructose corn syrup. You no longer have a problem cutting out high glycemic index foods (Ref.1). This will reduce insulin and reduce IGF-1 growth factors. These can lead to the production of the gooey amyloid substance that makes you lose your memory. The orbitofrontal part of your brain (particularly the dorsolateral prefrontal cortex) will be reminding you what you read here: healthy lifestyle choices start in your brain.

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

Last edited Oct. 19, 2013

Oct

2013

Music More Powerful Than Anti-Anxiety Drugs

By Ray Schilling | Autism, Cancer, heart attack, Mental Health, Pain, Stress management, Substance abuse

When was the last time you saw your physicians for anxiety and you were given a prescription that said: “for anxiety listen to your favorite music!” instead of receiving a prescription for an anti-anxiety drug (anxiolytic). This is exactly what a recent study suggests that showed prior to surgery you can control your anxiety either with anti-anxiety drugs or by listening to your favorite music. Listening to your favorite music will do you no harm, while many drugs do have harmful side effects.

How singing can change the brain chemistry

Other studies have investigated how singing can change your brain functioning in terms of brain chemistry. The researchers found that singing will release dopamine in your brain, which is responsible for feeling pleasure; it will stimulate your immune system by elevating immunoglobulin A and decreasing cortisol (the stress hormone). This in turn will preserve your immune cells (lymphocytes). Oxytocin levels of your brain are increased, which promotes social affiliation. It also calms down the autonomic nervous system resulting in a better airway opening, calming of your heart rate and soothing the wave-like muscle contractions in your gut, medically called peristalsis. You would refer to that as “butterflies in your stomach”. Music therapy reduces pain and anxiety by 50% and is important for children and adults alike.

Pain and anxiety reduced

A study in Germany showed that pain and anxiety were significantly reduced with music therapy. A Taiwanese study of women in labor found that music therapy significantly reduced pain and anxiety of women during labor. Ref. 1 explains that music therapy is useful as an adjunct to treating cancer pain, and reducing anxiety associated with colposcopy procedures. It also can help when treating patients who had heart attacks in the setting of a cardiac care unit.

Music More Powerful Than Anti-Anxiety Drugs

Hypnosis and guided imagery

Music has been successfully combined with clinical hypnosis and guided imagery where words are carefully chosen to help the patient experience pleasant feelings, which counteract the experience of pain, anxiety or fear of dying. A simple relaxation CD or tape with soothing background music will facilitate this type of therapy. This is useful for patients in a palliative care unit where they prepare themselves to accepting the inevitable death from an incurable disease. But chemotherapy patients undergoing these procedures for cancer treatments also have benefitted from a significant reduction in nausea, vomiting (side effects of chemotherapy) and pain.

Autism and music therapy

A Cochrane study showed that autistic children did better in terms of communication skills when music therapy was incorporated into the treatment protocol. One of the core deficits in autistic children is in the area of communication and social skills. This is where music therapy was most effective. Behavioral problems (stereotypic behavior) in autistic children did not respond to music therapy. A comprehensive treatment program for autistic children should therefore incorporate music therapy. Here is a blog that describes what difference music therapy can make in the lives of autistic children written by a member of the American Music Therapy Association.

Substance abuse and music therapy

An area where you may not expect music therapy to have a role is in the area of drug and substance abuse rehabilitation , which is discussed in more detail in this site. The beauty about music therapy is that it is not a drug, yet the natural endorphins that are released by the brain help the affected person getting through withdrawal easier. Music therapy helps building up self-esteem, participating in group activities, promoting self awareness and expressing feelings.

Mood disorders in adolescents

One important area where music therapy has been employed is with anxiety and depression in adolescents. Adolescents spend an average of 4 hours per day listening to music. So they are already programmed to listen to music. With the help of a music therapist they can be directed to listening to the type of music that will help them get motivated, relax more, make them feel accepted and be part of their peer groups. In this study the authors suggested to combine music therapy with dance and art therapy. In this way the whole person gets involved in the treatment and this can be integrated with conventional antidepressant treatments at reduced doses (with less side-effects) or with cognitive therapy.

General objectives of music therapy

Music therapy is best incorporated into a treatment protocol as an adjunct. It can help reduce the use of drugs for psychiatric patients, for people with anxiety and for patients with pain conditions. The Cleveland clinic has a useful summary about music therapy, which describes the uses of it for reducing anxiety, for helping with coping skills, mood improvement and distraction from pain. There are registered music therapists you can ask for help. The website of the American Music Therapy Association may have other useful links for you.

Conclusion

Music therapy is a treatment modality with no side effects, but providing effective treatment for quite an impressive range of clinical conditions as discussed. Music therapists are widely available in the US and many other countries. This treatment can be integrated with conventional or complementary treatments. It helps people to heal the body as a whole unit (mind and body).

More information on anxiety disorders: http://nethealthbook.com/mental-illness-mental-disorders/anxiety-disorders-panic-disorders-phobias-ocd-ptsd-anxiety-others/

References

Last edited Nov. 7, 2014