January 2013

The Long Goodbye

Two weeks ago my mother-in-law passed away. Unfortunately, she had started leaving us long before her body finally gave out. She had Alzheimer’s disease. It started 7 years ago. At first we noticed that she was repeating herself. Then, she would get uncomfortable and disoriented when she left her house. She came to visit our family out in Oregon and every morning she would pack her bag and announce that it was time to go back home.

She loved to eat chocolate ice cream for dessert. After having her nightly treat she would ask for it again, forgetting that she had already eaten it. Then the opposite started happening. She forgot how to eat and drink. That is what finally brought about her death.

The entire process of the disease was slow and painful for her loved ones. Watching such a dynamic, brilliant woman slip away was so difficult. We have no idea what it was like for her since communication was virtually impossible. However, every once in awhile she would say something that gave a glimmer of the person she had been. It would last only a moment.

Alzheimer’s disease is something that we all dread. It is estimated that over 5 million people suffer from this devastating disease. As we baby boomer’s age, the incidence is increasing. If nothing changes, twenty percent of the population will have Alzheimer’s disease by 2050.

Fortunately, there is ongoing research that may change that statistic. There are several studies that look promising. Read on.

A drug that is currently used for psoriasis called Stelara has been found to improve cognitive impairment and amyloid plaques in mice that are bred to develop Alzheimer’s. Inflammation leading to deposits of beta amyloid is thought to be at the root of this disease. Stelara is a super strong medication that treats autoimmune disease and reduces inflammation Human trials are soon to follow.

One of the other possible causes of this disease is that the brain becomes resistant to insulin. In theory, a diabetes medication called Metformin should halt and possibly reverse cognitive impairment. In fact, a study done on 2008 found that patients with diabetes and Alzheimer have showed cognitive improvement after being on Metformin.

A small study done in Canada has found that Alzheimer’s patients treated with intravenous immunoglobulin showed no further cognitive decline after three treatments. Researchers believe that the antibodies in the immunoglobulin halted the inflammation that causes beta amyloid to be formed in the brain. Further clinical trials on this promising treatment are ongoing.

One of the things that we know can help right now to prevent Alzheimer’s is for all of us to eat a heart healthy diet, exercise, and challenge our brains. Learn a new language, find a new way to work, or learn ballroom dancing. All of these things will help. Hopefully in the future we can cure this devastating disease and then none of us will have to endure the long goodbye which is beautifully explained in this quote:

“She is leaving him, not all at once, which would be painful enough, but in a wrenching succession of separations. One moment she is here, and then she is gone again, and each journey takes her a little farther from his reach. He cannot follow her, and he wonders where she goes when she leaves.”
― Debra Dean, The Madonnas of Leningrad

Do You Need A Happy Pill?

I see a lot of depression in my practice. My experience treating it has been similar to what is discussed in medical literature. In about 70% of patients there has been some improvement with antidepressants, but a full remission has occurred in only 40 to 50%. In the interest of boosting this disappointing remission rate, I have been searching for something that will either augment antidepressants or that could be used alone.

I have found a supplement considered to be medicinal food. It is safe, and it really does work. It is a vitamin that is a form of folic acid known as L-methylfolate.

Folic acid is an essential B vitamin. It is found in green leafy vegetables, eggs, cereals and fortified foods (to name a few). When you take in folate or folic acid in your diet it is absorbed by the small intestine where it is converted by an enzyme into L-methylfolate. This metabolite is used to make serotonin, norepinephrine and dopamine, which are all important for mood regulation.

Scientists have identified 40 mutations on the gene responsible for making the enzyme that converts folic acid into L-methylfolate. The most common genotype is known as C677T. If there is one mutation on this gene your ability to convert folic acid is reduced by 34%. If you have two mutations, it is reduced by 71%. Now you probably are seeing where I am going with this.

If you have a defective enzyme then you cannot convert folic acid to L-methylfolate properly and you will have lower serotonin, norepinephrine and dopamine levels. These gene mutations are extremely common. The treatment is simple. It is a prescription of L-methylfolate, a vitamin. If given in the proper amounts (7.5 to 15 mgs) it can improve mild depression relatively quickly. In a study of elderly depressed patients, the response rate at 6 weeks was 81%. Results are often seen in just two weeks.

A recent study of those with major depression found that adding L-methylfolate improved depression from 7% for those on an antidepressant alone to 18.5% with the addition of L-methylfolate over a period of 60 days.

It is well tolerated with no more side effects than placebo. It does not interact with other medications. In my experience, if an antidepressant has produced a positive response but the patient is still somewhat depressed L-methylfolate can help.

The results I have seen are impressive. When I treat those with MTHFR mutations (with or without mild depression) with L-methylfolate their mood improves and often they sleep better. Related problems such as irritable bowel will often get better as well.

If you are depressed and/or on medication for depression, I recommend you ask your doctor to see if you have the genetic abnormality that I mentioned. The blood test is called MTHFR. It just makes sense. If serotonin levels are genetically low then why not find a healthy way to boost them?

Count Your Blessings

I recently traveled to Argentina where there is a species of butterfly that lives for only 24 hours. Watching these pretty little beings and trying to come to grips with the recent shootings around the country makes me wonder: What if we all had only one day to live? Would we do things differently?

There are waterfalls where the butterflies live that are 250 million years old. In the scheme of things, comparing our longevity to the age of the falls, isn’t our life just a blink in time, or the comparative equivalent of 24 hours or less? None of us knows how long we have on this earth. That is painfully apparent. Maybe it is time to change our perspective.

These times we live in are difficult because many of us feel that our jobs, family and children should be happy, healthy and perfect. It would be wonderful if our lives turned out like a Hallmark movie. Unfortunately, that is not the way it usually works. Sometimes frustrating, irritating, painful and hurtful things happen. How we deal with these things can determine how we go on and ultimately, how healthy we are. There is a simple way to cope, survive, thrive and heal.

Simply put, it can be done with gratitude.

Finding things to be grateful for can help us feel better emotionally and physically. There is a fair amount of research available through Dr. Robert Emmons at the University of California at Davis. In one study, he divided his study subjects into three groups. As a daily activity, one group was asked to write five things that they were grateful for, another described five things that stressed them and the third group was asked to list any five events that affected them. After 10 weeks, those in the gratitude group felt better about their lives, exercised more and had fewer doctor visits compared to the other two groups.

In another study, people with neuromuscular disease such as post-polio syndrome were asked to write in a daily gratitude journal. After doing so, they were more optimistic about their lives and slept better when compared to the control group.

A study done in Connecticut found that people who had a heart attack and looked at it as a blessing (because it helped them to appreciate life more) had a lower risk of having a second heart attack compared to those who did not see it that way.

All that research supports the life-saving advice I follow myself: When things gets stressful and frustrating, take a moment and count your blessings. Think about those little butterflies that have only one day to live. It makes no sense to waste time with anger, grudges or regret. Identifying things that we are grateful for or expressing gratitude to people in our life who we appreciate makes a lot more sense. It costs nothing and the payoff is huge.

The Power Of Positive Thinking

I have an idea for the coming year. Before fulfilling the rest of your resolutions, you might want to try this: Think positively!

There is always a lot of talk about the power of positive thinking. Is there any basis to it? Research suggests that there is.

A recent study done in England followed 166 senior citizens for six years to see how attitude affected their health. The researchers administered a questionnaire to see how people approached health problems. They also took saliva and blood tests that measured cortisol levels and C-reactive protein, markers for stress and inflammation.

Over the years, people who looked at their health problems in a more positive light had lower cortisol and C-reactive protein levels. The positive thinkers handled stress better and had less inflammation than their more pessimistic counterparts.

Another study done at Yale followed 598 people who were at least 70 years of age (and initially without disability) for 11 years. As some became ill or disabled, those with a positive attitude were 44 more more likely to fully recover than those with a negative attitude.

In addition, a review of 84 studies found a strong relationship between optimism and physical outcomes. Regardless of the severity of disease, the effect held. This included cancer outcomes, heart disease, pregnancy outcomes and immune strength.

Cultivate Positive Thinking
There are some people who look at the glass as half empty others who see it as half full. And then there is another group that sees it as always totally full (with liquid and air). How can you become the latter? Here are five ways to start.

1. Hang out with positive people. Negativity can be contagious and conversely, so can positivity.

2. In a stressful situation, try to find the silver lining. As an example, if you get lost driving with your husband because he refuses to ask for directions, start paying attention to where you are and enjoy the different scenery.

3. Give positive feedback to those around you. There is always something positive you can say even when it might be tough. In the above scenario you can thank your husband for driving safely.

4. Give positive feedback to yourself. We are often harder on ourselves than anyone else. Cut yourself some slack. As an example, you can be proud of yourself for not losing your temper with your husband who is getting you hopelessly lost!

5. Keep a gratitude journal. If you can find several things a day to be grateful for, your attitude will change and you will find that you feel better physically.

It is important to your emotional and physical well-being that you find a way to be optimistic. It is all in how you look at things. In the words of Abraham Lincoln, “Most folks are about as happy as they make up their minds to be.”


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