Tuesday, October 19, 2010

Helping each other can really help you

A study published in the Annals of Internal Medicine (October 19, 2010 vol. 153 no. 8 507-515) found that setting up peer support brought about significant improvements in health outcomes of diabetics. While the study was of 250 men in the U.S. Veterans Affairs health system who had poor diabetic control it really applies to anyone and any condition. Patients were randomized either to usual care with nurse management or to be paired up with another age-matched patient for mutual support. The patient pairs were encouraged to communicate regularly using a phone system that prompted weekly calls. After 6 months' follow-up, there was a significant improvement in the patient-pair group, versus a significant decline the nurse-care group. One continued to get worse under normal management while the other improved.

At a personal level I know of a lot of people working on reducing diabetes symptoms using the book by Gabriel Cousens “there is a cure for diabetes” and the ones having the most success are those who have extra support. It may be a family member, partner or just a friend. We also completed a study some years ago on personal coaching to improve health outcomes and found a significant improvement in health behaviour just as a result of one quick phone call or personal communication each week from the health coach. A little bit of help can make a lot of difference.

What does this mean for you? If you are interested in changing your health behaviour for the better get some regular support. Set your goals, link up with a few friends and set regular times to talk about what you are doing. Just a phone call each week may make the world of difference.

Monday, October 18, 2010

Reduce your heart attack without cholesterol lowering drugs

A recent Swedish study of 31671 woman found that multivitamin use was associated with a reduction in the rate of heart attack (myocardial infarction). This should have been front page news around the world but it did not seem to even get a look in. This is one of the dozens of studies that show a strong link with supplementation and health benefits. The study was broken into two groups. Women with a history of CVD and woman without any history of CVD. During the average of 10 years of follow-up the woman without any history of CVD and who took multivitamin supplements had a 27% in heart attacks over the period. That is better than any stain drug to lower cholesterol. The use of multivitamins over a 5 year period, that is, those who took them the longest, saw a reduction of 41%. Wow. This is so simple and so cheap. However in the CVD group use of multivitamins was not associated with any decrease in the rate of heart attack. So if you already had a heart attack low doses of multivitamins don’t appear to help at all. The levels were what you would find in a standard multivitamin supplement such as 400ug for folic acid. Perhaps it is my bias but the levels were probably so low for someone who already had a heart attack to make any difference. Better still make sure you don’t have a heart attack. (Am J Clin Nutr (September 22, 2010). doi:10.3945/ajcn.2010.29371)

Interestingly I have been doing a lot of reading on magnesium lately and there is a lot of research on the link between heart attack, atherosclerosis, angina and most other forms of CVD and low magnesium levels. That is low levels are associated with increased risks so if you want to lower your risk increase your magnesium. This may be obvious but the highest concentration of magnesium is in heart muscle and magnesium is essential for relaxing muscles. Magnesium also stops calcification of arteries and build up of plaque (no it is not all cholesterol, it is mostly calcium blocking your arteries). Another simple hint would be to have lots of water. It sounds simple but most of us don’t drink enough of it.

What amazes me as I read the volumes of research is why our medical system doesn’t tell us this.

Thursday, October 14, 2010

Prebiotics help infants

Feeding infants with a prebiotic-enriched formula reduced the incidence of atopic dermatitis by 44 percent in a recent study released this week. This backs up a ground swell of studies highlighting the benefits of both prebiotic, probiotic and symbiotic fomulas to help with conditions such as allergy, eczema and infections particularly in bottle fed babies. Prebiotics are the foods that feed the healthy probiotics and synbiotics is when both prebiotics and probiotics are included together. Infants fed prebiotic formula had a significant reduction in the incidence of atopic dermatitis in children classified as being at low-risk, according to findings published in the Journal of Allergy and Clinical Immunology (2010, Volume 126, Pages 791-797)
The microbial ecosystem of the GI tract, particularly the large intestine has multiple beneficial functions including immune system stimulation, barrier function (provide a barrier protection against pathogens), maintenance of gut nutrition and circulation, production of nutrients and stimulation of bowel movements. It is essential that the ‘balance’ of microflora is maintained in the intestine, ensuring these important and specific functions can be carried out optimally. The main approach to increasing the number of health promoting organisms in the GI tract is the oral administration of live beneficial microbes known as probiotics or prebiotics.

In another study adding prebiotics to infant formula reduced the number of gut infections and reduce the use of antibiotics. Imagine prebiotics instead of having to treat with antibiotics. All bottle fed babies should be on prebiotic formulas. This study followed 342 infants. The infants were randomly assigned to receive either a control formula, or a formula containing an additional mixture of prebiotics over the course of 12 months, the researchers documented that the incidence of gastroenteritis was lower in the prebiotic-supplemented formula group with only 0.12 episodes per child throughout the year, compared to 0.29 episodes per child in the control group. As a result the researchers reported that prebiotic administration reduce intestinal and, possibly, respiratory infections in healthy infants during the first year of age. The likely mechanism is through an increase in bifidobacteria and their concomitant anti-pathogen effects (Clinical Nutrition. doi:10.1016/j.clnu.2009.01.008)

Wednesday, October 13, 2010

Science shows we can lose weight

In two recent studies reported in the journal of the Journal of the American Medical Association (JAMA doi:10.1001/jama.2010.1503/ doi:10.1001/jama.2010.1505) they showed that structured lifestyle programs can lead to significant weight loss in obese women. I know it sounds obvious but sometimes science needs to do that to show everyone that it really can be done.

In the first study of around 450 overweight or obese women the intervention included weekly counselling, increased activity, and reduced-energy intake with free prepackaged meals (Jenny Craig). At 2 years, weight loss was greater with the intervention than with usual care (7 kg vs. 2 kg). A good result but what was their nutritional status like?

In the second study, 130 severely obese adults (mostly women) took part in a one-year intensive lifestyle intervention consisting of diet and physical activity. One group (initial physical activity) was randomized to diet and physical activity for the entire 12 months; the other group (delayed physical activity) had the identical dietary intervention but with physical activity delayed for 6 months.

So one group started the exercise earlier. At 6 months, the early-exercisers had lost more weight, which is what you would expect but at 12 months, early- and delayed-exercisers had similar weight loss (12 kg and 10 kg, respectively). One of the findings the researchers reported was that these findings "directly counter the dogma that ... severely obese individuals do not respond to lifestyle intervention,".

So what is the key. Both programs had a strong structure and motivation built in and had pre prepared meals. The first study was sponsored by Jenny Craig (Nestle), but they had no role in the experimentation. The advantage of the pre prepared meals is that the people don’t have to think about their meals. Or is it an advantage. My preference is to get people to eat a big salad before a meal, just like the French do and what we do at home. It is also important to get people to think about nutrition beyond just calories and food beyond filling a big empty hungry feeling or some emotional need.

Depression and Chocolate Consumption

In a study of 900 adults in California who weren't taking antidepressants found those who screened positive for depression ate about eight servings of chocolate per month, while those without depression ate just five servings a month, a statistically significant difference. The research was published in the Journal Archives of Internal Medicine (2010;170(8):699-703)
Is it chocolate giving them depression or people seeking out mood foods . On a light hearted note at least this study may help identify people more likely to be depressed by observing their chocolate consumption.

Wednesday, October 6, 2010

Depression Linked to a Doubling of Risk for Dementia in Older Age

If you consider that all chronic illnesses are related through poor diet and lifestyle then it is not surprising to find a recent study in the journal Neurology (2010;75:35-41) found older adults with depression face nearly a twofold increase in risk for dementia. 950 dementia-free adults (mean age, 79) were followed for up to 17 years. Participants with depression at the beginning were roughly 75% more likely to develop dementia or AD as those without depression.
The first message is be happy and keep your memory the second message is if you treat one illness holistically you are likely to reduce your risk of many other illness. For example people with a high risk of cardiovascular disease also have a higher risk of depression, Alzheimer’s disease and so on. Treat the illness not the symptoms.
In support of this a study reported in JW Psychiatry Feb 8 2006 found depression is an inflammatory disease with the same chemical markers called cytokines (tumour necrosis factor-alpha (TNF- ) and interleukin (IL)-6 ) that you find in people with increase an risk of cardiovascular disease. The levels were significantly higher in depressed patients than in controls.

Another study reported in the Journal of the American College of Cardiology (2009; 53:1440-1447) found that people with depression were 4 times more likely to have heart failure. They also found that heart failure was about as likely to occur among those with depression whether or not they received antidepressant drugs. The authors reported that both conditions were associated with increased inflammatory levels.

Get the picture all the chronic illnesses we have are linked to inflammation. That is why I am so critical of cholesterol lowering drugs, they only lower cholesterol and not the cause of the illness, inflammation.

Monday, October 4, 2010

Nutrition and Depression

Apart from the normal dietary recommendations of more vegetables, beans, nuts, fish and fruit and less junk food, sugar laden starches and fatty foods, it’s important to reduce both nicotine and caffeine.

From a biochemical perspective, depression is thought to be an imbalance of brain chemicals, usually identified as a lack of serotonin. If you look at the biochemical pathway for the manufacture of serotonin, there are many reasons as to why it may be low. Sometimes this can be rectified simply through dietary modifications.

Serotonin is made in the hippocampus (a part of the brain) from the amino acid tryptophan. For this chemical to be converted to serotonin, it needs Vitamins B3, B6, Folic acid, C, and the minerals calcium, iron, magnesium, zinc and a particular essential amino acid called tryptophan. A deficiency in a couple of these nutrients can result in low levels of serotonin and depression.

In one experiment people who had a history of depression were given nutritionally balanced but tryptophan depleted foods. Within seven hours 10 of the 15 participants reported worsening moods and began to show signs of depression. When the tryptophan was replaced their more positive mood quickly returned.

Supplementing with tryptophan should be around one gram for low moods and up to three grams for depression. It’s best eaten on an empty stomach or in conjunction with carbohydrates. Because tryptophan is converted first to serotonin and then to melatonin, it is best taken at night before going to bed, as it will help you sleep.

Tryptophan rich foods include fish, turkey, chicken, cheese, beans, tofu, oats, eggs, nuts, seeds and milk. Ironically, following a protein rich meal, brain levels of tryptophan and serotonin levels decrease. This is because some of the other amino acids (the LNAA’s such as valine, leucine, tyrosine and phenylalanine) in the meal out compete tryptophan for carrier molecules into the neurons. In contrast, it’s a meal rich in carbohydrates and a small serve of protein which increases brain tryptophan and serotonin. Even though the food may lack tryptophan completely, it causes the release of insulin which stimulates the uptake of most of the amino acids (the LNAA’s) other than tryptophan. This phenomenon explains why some people suffering depression crave carbohydrate snacks.

The best way to get more tryptophan in your diet is to eat some of the foods rich in tryptophan with food high in carbohydrates food such as fruit (bananas) and vegetables, including potatoes and wholmeal bread. A little bit of protein should be consumed with every meal to ensure a constant supply of tryptophan for the brain. Not a huge piece of meat just a small serve of protein rich food.

During the day adrenalin levels are higher, keeping you stimulated. As adrenalin levels decline, serotonin levels rise. As the day progresses and it gets darker, melatonin levels rise and serotonin levels decline. Melatonin’s main role is to regulate the sleep-awake cycle. Without enough serotonin you can’t manufacture melatonin. This is probably why poor sleep patterns are often associated with depression.

A man’s average synthesis rate of serotonin is around 52 per cent higher than that of a woman and as a result women are more prone to low serotonin and depression.

SAMe (S-adenosyl methionine) is a naturally occurring chemical in the body that’s linked with reducing joint problems and cardiovascular disease. It’s also involved in the production of various other chemicals in the body. However, more than 100 double blind studies have shown that supplementing with SAMe is equal or superior to using antidepressants. SAMe doesn’t appear to have side effects and has many potential side benefits. SAMe has also been shown to increase the levels of serotonin and dopamine in depressed patients. Deficiencies in SAMe may be brought about by a diet low in the amino acid methionine or Vitamin B12. This can occur if you are following a stricitly vegetarian or fad diet ; in the case of stomach infections with helicobacter pylori; in situations which generate low stomach acid, or in the presence of excessive copper, lead or mercury.

The Omega 3 fats are linked with improved reception of serotonin. Studies using omega 3 fats alone and in conjunction with antidepressants have shown significant benefits. Again, no side effects and lots of side benefits. The EFAs are converted into the hormone-like prostaglandins, which stimulate the brain’s manufacture of serotonin and other neurotransmitters. Understanding this shows how very low fat diets and bad fat diets can lead to depression. Research has shown that countries, such as Japan, that have a high daily intake of fish have a much lower rate of depression than countries with a low intake of omega 3 fatty acids, such as Australia and the US.

Stress can have a depleting effect on the body and lead to particular deficiencies that may affect our mood. Stress has a negative effect on the production of DHEA, adrenalin and serotonin. This increases our need for the raw materials to build the mood enhancing neurotransmitters. Stress also increases our need for the B vitamins and tryptophan. Depression is an exhausting experience that depletes the body of mood enhancing chemicals.

Supplements for depression include: SAMe, about 200 mg twice a day building up to 200 mg four times a day after 14 days; High potency vitamin B complex with 1000 milligrams folic acid and 1000 micrograms of Vitamin B12; and, St John Wort extract (0.3 per cent hypericin) at 300 mg three times a day. St John’s Wort has been shown to be effective in dozens of clinical trials. St John’s Wort does interact with some medications, so check with your doctor or pharmacist if you are uncertain.

By adopting the nutritional approach you not only work towards the solution to depression, you may also solve other problems such as joint pain and cardiovascular risk factors

Sunday, October 3, 2010

Simple Intervention Reduces Depression

A recent study of 700 chronically depressed patients published in the Annals of Family Medicine last week found that something as simple as a frequent telephone follow-up with care managers (mostly nurses) leads to sustained improvements in depression. The intervention involved a series of telephone calls with care managers. The study went on for 18 months and almost doubled the rate of depression remission from 27% to 49%. The authors concluded that their intervention is "feasible and highly effective."

The intervention consisted of a series of telephone calls and e-mail exchanges between patient and care manager starting with a 30 minute telephone conversation for the first interview, then 10 minutes for each month after that. The care managers did not give solutions or extra treatments advice just a bit of information and motivation such as setting a self-management goal.

Imagine what would happen if they also provided advice on Cognitive Behaviour Therapy, lifestyle interventions such as exercise and socialising, and nutrition all which have shown positive results with depression. But just knowing someone was going to phone each month and speaking about it for 10 minutes a month was enough to double the remission rates.

Relaxation and breathing techniques have been shown to have a positive effect on anxiety and depression. In another study of 18 patients who undertook a program of breathing every day for 30 minutes for 6 weeks, with 17 control subjects, the group taught breathing techniques had a greater decrease in anxiety and depression than the control group. Several studies have also demonstrated the positive changes in mood from meditation. Studies have shown that meditation increases alpha brain waves, which are the relaxed brain waves, which in turn can decrease anxiety and depression. Researchers from Harvard Medical School have found that meditation activates the autonomic nervous system. This controls the parasympathetic nervous system, which may be the reason for reduced anxiety, relaxation and calmness.

A large and growing body of research is highlighting the benefits of Cognitive Behavioural Therapies (CBT). It is now realised that the brain has its own internal pharmacy which can be activated by what we believe. With CBT techniques it’s possible to alter brain chemistry, altering mood and perception.

Some research in Australia is showing success in changing depression via the internet. This program is based on CBT and relies on people going through a number of modules. Early results suggest that it’s as beneficial as CBT and face to face contact with a therapist. You can log on to the website at moodgym.anu.edu.au. What’s there to lose? At the absolute least you can learn more about depression. Other cognitive techniques that have been shown to be useful include hypnosis, Emotional Freedom Techniques, goal setting and cognitive reframing.