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Wednesday, March 4, 2020

Helping stressed out kids!

The ever brilliant Dr. Kastner offers up a nice concise summary of how to help kids with stress!  Enjoy here.

Sunday, February 2, 2020

3 (or 2?!) ingredient banana and oats cookies!

Wow, Clean and Delicious strikes again, offering a health-packed banana and oats cookie recipe using only mushed ripe banana mixed with oats and chocolate chips (I leave these out). Spoon cookie sized blobs onto a cookie sheet and pop into a 350 degree oven for 15 min.  Or first add a spoonful of omega three rich flaxseeds or chia seeds or anti-inflammatory cinnamon to kick up the health benefit even further.

Bottom line, Clean and Delicious recipes have found a new fan here.  Enjoy!

Saturday, February 1, 2020

No bake peanut butter oat bars!

Love these healthy recipes that even a non-cook -- i.e. me -- can manage. So, here you go, no bake peanut butter oat bars. Mix rolled oats, peanut butter, a dollop of maple syrup (or I sub in date syrup) and chopped cranberries, pat the mixture into a parchment lined pan and refrigerate a good hour before cutting and serving. Or, enjoy the full recipe with actual amounts here, for those of you who do that measuring thing. All thanks to my new favorite recipe source, Clean and Delicious. By the way, I hate to state the obvious, but use no sugar and no oil added and unprocessed ingredients here, and everywhere, to maximize healthiness. Enjoy.


Sunday, January 19, 2020

Exercise for depression!

For you neurobiology-loving folks, here's a lovely summary slide on the brain benefits from exercise, thanks to Medscape.  I nice remember to get moving today, and most days. Here you go. Enjoy:



Lean into anxiety, and other key CBT concepts made simple!

Although I absolutely don't agree with everything this Norwegian therapist chats about on You Tube, he has published a load of videos that make key cognitive behavioral concepts simple and accessible to all, especially for those struggling with anxiety.  Worth a listen! Enjoy!


Sunday, January 12, 2020

Write down three good things that happened today!


This evening, and every evening, write down three good things that happened today and their causes. Nice job. You've taken a research supported step towards being happier.  Enjoy!



Monday, January 6, 2020

Do NOT take supplements willy-nilly!

Wow, a great reminder not to take supplements carelessly. Ack. Today's Forbes article powerfully communicates a recent study finding that a variety of supplements taken during chemotherapy for breast cancer can INCREASE risk of recurrence and even death. SIGH.  Be careful out there. Read the article.  And, as always, more than ever, try to get your healthy vitamins and minerals and omega threes from a meticulous diet!  And discuss every supplement you take with all of your doctors, especially those of you on chemotherapy it seems!


Saturday, January 4, 2020

Learn first aid/CPR in school?

Why isn't (very) basic first aid and maybe even CPR (for older kids) offered routinely to every upper school student everywhere? Isn't it as important as algebra or Latin? (No insult intended to Latin-speaking mathematicians out there.)

Isn't it not only useful but empowering for our kids (and most of us) to have a clue of what to do when bad stuff happens, from scrapes to horror?  (Not to mention, more folks knowing this stuff might save more lives or limbs!)

Possible to do? Yeah, sure, although my kids weren't lucky enough to run into such teachings at school, so the post. For starters, the Red Cross offers an array of classes from the online digital lessons to group lessons of CPR for schools.  Or, there are always books that can be folded into school clubs, bio class and so on. While learning the bones, why not learn how to bind a twisted ankle for a trip to the ER? Or, while learning the importance of blood components, why not also learn how best to press on wounds or to bandage them, to stop the bleeding? Wouldn't the relevance of the subject make any class all the cooler and more memorable for kids, and so be a plus for all sorts of related learning at the same time ? (Or is this just a doc's bias, that learning to take care of folks, makes learning more fun?)

Take care out there.

Friday, January 3, 2020

3-ish ingredient healthy cheese-ish sauce!

Steam potatoes (maybe 4 golden Yukon) and carrots (a couple clean/peeled) and briefly high speed blend with a couple of cups of unsweetened nondairy milk (I like oat) and a cup-ish of nutritional yeast plus seasonings (generous onion powder, salt, pepper, garlic powder, whatever you like).  Wala. Cheese-ish sauce.  (And blend in some steamed/boiled cauliflower if you want to make it lighter.)

Pour the magical brew on anything! Steamed broccoli! Nachos! Mac and cheese-ish! Enjoy! Your health surely will! And happy new year!

P.S.  Just found a wonderful hack with this stuff, too.  Add it to your leftover vegan vegetable soup for a lovely, healthy vegan cheese-ish soup!  Really!

Thursday, December 19, 2019

Tricky little vitamin D

Over one billion-ish people have low vitamin D levels Not great news, considering vitamin D plays important roles throughout much of the body, as well as the brain, and so this post!

But... er... what is vitamin D anyway? Truth is vitamin D isn't really a vitamin. A total misnomer. See, vitamins are organic chemicals that -- by definition -- we can NOT make and so MUST eat, albeit in itty bitty quantities. However, while we can eat our vitamin D (via fish, egg yolks, fortified foods and so on).  We alternatively also can make it, or we can with a little help from the sun shining on our skin.  So the stuff would be more accurately named hormone D, but we'll stick with the usual name for convenience. Vitamin D it is. 

Since vitamin D can be made via our exposure to the ultraviolet B rays of sunshine, it's tough to evaluate.  I.e. when is vitamin D a chicken and when is it an egg? I.e. do vitamin D levels serve as markers of good health, mental health and/or fitness? Do we simply get outside and exposed to sunshine more when we feel better, and so have more robust vitamin D levels when we feel better?  Or do the better vitamin D levels make us feel better? Or both?

So, is it relevant that lower vitamin D has been found in those with anxiety and depressive symptoms? Or do the lower levels simply reflect that emotionally uncomfortable patients tend to stay inside? In other words, do lower vitamin D levels cause poorer emotional health or reflect it


How your body makes vitamin D

There is hope that supplementing with vitamin D might support physical health. And, indeed, a meta-analysis (a big, careful look at a bunch of studies) of vitamin D supplementation for cancer looked promising. Other studies, however, have not found such supplementation helpful, like a Lancet systematic review of meta-analyses, a New England Journal of Medicine (a reliable resource) review, or a humungous study in JAMA (another awesome resource)

And no wonder, Vitamin D is famous for its role helping to manage calcium (the building block of bones)If vitamin D levels go low, adult bones (that constantly are in a state of turnover) can be damaged -- going soft (osteomalacia), becoming painful or fragile (osteoporosis) and/or breaking (fractures). And for those still growing (kids), low vitamin D can be disastrous, causing rickets -- poor mineralization of growing bones, that then become bowed and deformed. Fortunately rickets has become rare since vitamin D's discovery and fortification of foods with it. Vitamin D also is important in helping stop cell proliferation and increase cell differentiation (i.e. it's anti-cancer), enhances the immune system and decreases autoimmunity (I.e. anti-infection and anti-autoimmune disorder), helps with insulin and glucose management (anti-diabetes) and interacts with the renin-angiotensin system (anti-hypertensive).
  
What about mental health? Should I be encouraging patients to up their vitamin D for mood or anxiety or any brain anything? Sadly, as so often in medicine, the bottom line answer: who knows?
There's some promising info though. One bitty study found that vitamin D worked better than light therapy for seasonal depression.  And, a 2019 meta-analysis found vitamin D supplementation helpful for major depression (although calling this finding "tentative"). And, a recent review found Vitamin D promising for depression And, a very preliminary bitty study found some benefit from Vitamin D supplementation for serotonin levels, inflammation, and anxiety.

Even if we're sold, though, and we want to up our vitamin D levels and are okay with supplements, how much to take? Again, sorry, but who knows? Many say vitamin D levels are best kept 30 ng/ml or above, with levels between 20-30 ng/ml being viewed as borderline.  Although, a world expert, Dr. Finkelstein at MGH, is challenging this, saying levels like 15 or even 10 are okay for most. (Except perhaps for those with higher fracture risk or who are pregnant.) 

By the way, even these levels can be tricky to ascertain. (Ack!) The assay for vitamin D levels can be erratic; double checking often makes sense. 

So how and how much to take if our levels of Vitamin D are pathetic (like mine)?  Frying our skin in UV rays is one effective way to up our levels, but it is lousy for our skin (speeding skin aging and upping skin cancer risk). And, it's tough to consume enough vitamin D through diet alone, even for fish and egg yolk lovers (which I am not).  So despite my wariness of supplements, for those with low  levels, vitamin D supplementation might be worth discussing with our doctors My favorite guru suggests 1000 IU a day, aiming for a level of 30ng/ml, but that's just one opinion.

Bottom line, vitamin D is one tricky little non-vitamin, but an important one, one we probably should keep an eye on, and chat with our docs about.  




Tuesday, December 17, 2019

Skip the vaping!

Bad news. Over 5 million teens and kids use e-cigarettes -- aka vape, and it's not great for them. Yup.  Over 1/4 of high school seniors and even almost 1/10 of those sometimes bitty-seeming 8th graders say they have vaped in the last month, per 2019 stats. And use has been increasing! And now we know -- even if it is a little safer than smoking cigarettes -- which accounts for 1 in 3 deaths of those between age 35 and 70 -- vaping still is not safe!

Do you even know what I'm talking about? What in the world is vaping? Some of us old folks haven't a clue.  Vaping only has been around the last decade or so, after all. Vaping is simply inhaling a vaporized liquid. Devices that make such vapors readily available have become quite the rage and have a variety of names -- vape pens, pod mods, tanks, ENDS (electronic nicotine delivery devices), e-hookahs, and e-cigarettes. The liquid these devices vaporize also have a load of names -- e-juice, e-liquid, cartridges, pods, or oil. Most contain glycerin as a base and THC or nicotine or flavorings plus a battery device to heat the brew up into vapor forms, so suspending their itty little particles in the air.  Some vaping flavors contain as much nicotine in a single go as in a whole pack of cigarettes, with all the unfortunate addiction potential and health consequences that means.

The FDA lists almost a hundred harmful chemicals in regular cigarettes, so e-cigs sometimes have been presented as a safer option, as they do have vastly fewer of these nasty chemicals.  However, they still often carry a load of these chemicals, including the ever-toxic and carcinogenic elements lead and cadmium, and organic chemical compound formaldehyde.

And, most still have the super addictive chemical nicotine in them, that can either come from the tobacco plant or be made synthetically.  So, not surprisingly, e-cigs can increase the chance of young people also taking up regular cigarette smoking to get those nicotine hits, with all the disastrous health consequences that means! Worse, some brands use tasty flavors and marketing tacts especially appealing to the young, like a famously popular minty flavor.

Unfortunately, nicotine in all forms is lousy for the still quickly developing adolescent brain, with the stuff interfering with memory and attention processing, amongst other things.  Also, nicotine is well known to be a stimulant parasympathomimetic alkaloid chemical that's not only super addictive, but also lousy for cardiovascular health, raising blood pressure, amongst other things.

And, worse, e-cigs unfortunately have their very own dangers. There has been an outbreak of severe lung injuries caused by them! So much so, the CDC now recommends all vaping/e-cigarrete use be avoided!  There have been over a couple thousand lung injury cases and dozens of deaths caused by a syndrome called EVALI (for e-cigarette or vaping product use associated lung injury). Symptoms can include cough, shortness of breath, chest pain, fatigue, weight loss, fever, and GI symptoms. Vitamin E acetate which has been added to a load of THC containing vaping products, apparently as a thickening agent, looks like one primary lung damage culprit.  A recent huge study looking at over 30,000 souls, also found that there is a 30% increased risk in chronic lung disease (like bronchitis, emphysema and asthma) for those who vape versus non-vapors-non-smokers!

So, although vaping devices came onto the market claiming to help curb smoking, they have been found to have their very own risks. And, for those wanting to cut back on cigarettes (yay you!), looks like considering other options long and hard and with a good doc would be very wise. Short term (!) use of the good old fashioned nicotine gum or patches or of the newish fancy drug Verenicline (that turns on nicotinic receptors a little but not enough to cause addiction) are a few options worth chewing over with a good doc, depending on specifics about your health and medication list and allergies and so on. And, you might want to skip the vaping!  And good luck out there!

Tuesday, November 5, 2019

How to help kids with anxiety disorders?

  • NOTE: Please do not use this blog post (or any post) as a substitute for diagnosis or treatment; because it isn't! Instead see a mental health professional and doctor for evaluation and treatment!
  • HOW to tell if our kids are anxiety ridden?
    • It's sometimes hard to tell!
      • Especially as it can start at an age where kids have trouble describing it, with the median age of onset being 11 years.
      • And anxiety can look so different in different kids and at different ages or developmental levels. Some anxious kids throw fits, while some cry, some cling, some withdraw, some whine, some complain of bodily symptoms (like stomach aches!), some express worries through their play or art, while some actually can talk about it.  
    • And it can be hard to tell the extent of the anxieties.
      •  However, when anxieties start filling their days and/or getting in the way of their lives (such as social events, activities, sleep, school and so on!), it is a problem, one that might benefit from professional help. 
  • WHY do our kids have to suffer from anxiety anyway?! 
    • Because anxiety is good for them -- that is until it isn't! 
    • Anxiety often is a healthy, normal and helpful emotion. Really. 
      • Think about how anxiety helps zebras (or any of us) who see lions crank up bodily systems to flee. The striped zebra hearts race, breathing speeds, and adrenaline and sugar and stress hormones flood their zebra bloodstreams, all increasing chance of survival.
      • Anxiety similarly helps keep our kids safe, motivating them (or any of us) to jump out of the way of today's lion equivalents -- speeding cars and so on. 
  • WHEN is anxiety a problem? 
    • When kids' bodies act like there are lions lurking day in and out, despite an absence of lions (or metaphoric lions), this can be an anxiety disorder, and it's lousy for happiness and health, and merits a visit to pediatricians and to mental health specialists!  
      • And make these appointments soon! 
        • The classic stitch in time saves nine applies; early care matters.
  • WHAT are the anxiety disorders? 
    • Problematic symptoms merit attention whether they meet criteria for an anxiety disorder or not. Anxiety disorders can include: 
      • Social Anxiety Disorder (SAD) 
        • Although most kids have anxiety about social or performance situations, those with SAD have such intense fear that it gets in the way of their functioning (whether at school, socially, or at home). 
      • Generalized Anxiety Disorder (GAD) 
        • Kids with GAD can't help worrying, and worry so much it interferes with their functioning (whether at school, socially, or at home).
        • Symptoms can include restlessness, excess fatigue, difficulty concentrating, irritability, tense muscles, difficulty sleeping, upset stomach, and a feeling like they're going nuts, dying, or losing control. 
      • Separation Anxiety Disorder (SAD) 
        • Kids with SAD have more distress at separating from loved ones than typical for their age, so much so that it gets in the way of their lives.
      • Panic Disorder (PD) 
        • Kids with PD have recurrent, unexpected anxiety attacks, plus at least a month of worrying about further attacks, this interfering with their lives. They often also have agoraphobia, a worrying about being places where escape is hard. 
        • Panic attacks generally peak within 10 minutes and can include racing heart, shortness of breath, sweating, lightheadedness, too. They might look clammy, pale and shaking.
      • Post Traumatic Stress Disorder (PTSD) 
        • After a trauma where their own lives are endangered or after seeing or learning about the death or injury of loved ones, some kids develop PTSD symptoms like: 
          • Reexperiencing Symptoms (Recurrent thoughts about what happened, nightmares, flashbacks, getting upset at reminders) 
          • Hyperarousal Symptoms (Difficulty falling/staying asleep, feeling irritable, having trouble concentrating, startling, feeling on guard) 
          • Avoidance and Numbing Symptoms (Avoiding thinking about the trauma, avoiding relevant people/places/situations, forgetting parts of the trauma, as well as losing interest in activities, feeling detached, having difficulty experiencing strong emotions, and losing interest/hope in the future) 
  • HOW can we help kiddos with anxiety disorders? 
    • Fortunately, many ways! 
      • And often kids do better when we use multiple approaches! 
      • This is a highly treatable condition! 
    • Medical Evaluation! 
      • This treatment step is listed first for a reason! Please take kids to their pediatricians and soon! 
      • And talk to the pediatrician about the anxiety.
      • Brains are part of bodies! Anxiety can be a symptom of medical disease, or worsened by medical disease and so merits medical work up and attention! 
      • And if specialists are involved in children's care, see them, too! 
        • Pulmonologists, cardiologists, allergists, endocrinologists and so on can offer essential input! 
      • And explicitly ask or remind all involved docs to look for and treat all potential contributing medical causes for emotional symptoms! 
      • Sometimes bringing along a written summary helps.
        •  As it's hard to remember or to think or to communicate everything effectively when kids are squirming or looking uncomfortable! 
      • Useful testing can include: 
        • Labs (bloodwork) such as: Chemistries. Complete blood count. Vitamin D. Folate. B12.  Lipid profile. Magnesium. Calcium. Phosphorous. Thyroid function testing. And so on! 
        • Sometimes: EKGs, pulmonary function tests, Head imaging, genetic testing, and so on! 
      • Referrals to specialists, like neurologists, pulmonologists, allergists, cardiologists (as symptoms dictate) are sometimes helpful! 
        • For example, if asthma is poorly controlled, asthma induced shallow or rapid breathing can feed anxiety! 
    • Treatment! 
      • Combination Treatment tends to be most quickly helpful!
        • Treatment with cognitive behavioral therapy (CBT) AND serotonin re-uptake inhibitor medications (SSRIs) seems to have the best data to help anxiety symptoms in the young most quickly! 
        • The huge CAMS study of over 500 kids and adolescents found that after 12 weeks: 
          • About 80% treated with SSRI (sertraline) + CBT improved much/very much 
          • About 55% of those treated with SSRI alone 
          • About 60% for those treated with CBT alone 
          • About 24% for those given placebo (sugar pill) 
      • Cognitive Behavioral Therapy 
        • Is a goal-oriented therapy that looks at thought and behavior patterns and helps change unhelpful patterns into more helpful ones. 
        • Emotions are often less the problem than the avoidance behaviors and unhelpful thoughts that feed the anxiety symptoms! 
        • This admittedly can be challenging to get started
          • As we are asking kids to walk into the lion's den of talking about their anxiety. 
          • And it can be challenging to find a cognitive behavioral child therapist with an outside of school  hour free! 
          • And it's hard for most to find the time and resources to make this happen. 
        • But still make it happen! Therapy helps anxiety, and with some advantages over medication treatments.
          • It helps with next to no risks or side effects, except that of better self-awareness.
          • And its results tend to be lasting, unlike medications which stop helping when they are discontinued.
        • Therapy literally helps the child build a healthier pattern of nerve cells in the brain. 
          • "Neurons that fire together wire together." Every time you have a thought, you are more likely to have that thought again. When children build more helpful patterns of thought in therapy, they are literally building more helpful patterns of nerve cell connections.
        • Other therapies also can be of help!
          • Therapies can build understanding and can help kids repair the damage mental health issues including anxiety disorders can leave in their wake, like isolation or relationship issues and so on. 
      • Medications 
        • As in the study above, SSRI medications alone also can be of help, although less dramatically than combination treatment!  
        • SSRIs are generally considered the gold standard anti-anxiety medication for the young, and are often hugely helpful and tolerated okay. But not always, and not for everyone. So follow up with a good and attentive child psychiatrist.
        • And read all FDA paperwork before starting these medications (or any medications)! 
        • SSRIs include those I prefer to use in kids -- fluoxetine (Prozac), escitalopram (Lexapro) and sertraline (Zoloft).
        • They all boost serotonergic neurotransmission, but there are differences between them, so if one doesn't work or isn't tolerated, sometimes another does and is! 
        • Worth a mention, genetic testing is inching its way into regular clinical practice, and offers sometimes helpful information around medications.
        • SSRI side effects can include: 
          • Stomach upset, fatigue, weight gain, tremor, anxiety (when starting up especially) 
          • Increased risk of bleeding, especially if combined with NSAIDS (Motrin, Advil, ibuprofen, aspirin), so talk to your doctor before using any such meds! 
          • There is also a risk of mania.
          • And even a risk of suicidal ideation, so the black box warning, the FDA's mega-warning! 
        • Again, read the full FDA medication guides and all label warnings and discuss with the prescribing doctor before taking these meds, and all meds! 
        • Sertraline 
          • While it is FDA approved for kids with Obsessive Compulsive Disorder, it is often used for other anxiety disorders too. 
          • It additionally uniquely boosts dopaminergic neurotransmission and binds at the sigma 1 receptors that may have a role in anxiety. 
        • Fluoxetine 
          • FDA approved for kids with obsessive compulsive disorder (and for major depression) but often is used for other anxiety disorders. 
          • The Lancet meta-analysis endorsed this as the most effective antidepressant for kids, which might be very relevant to those with depression commingled with their anxiety. 
          • It additionally uniquely boosts norepinephrine transmission, which can feed anxiety symptoms early on. 
      • Parents often can help!
        • Self care matters! 
          • In airplanes they direct parents to put on their own oxygen masks first for a reason; and it's a lovely metaphor for how parent self-care is essential for child care. 
          • Fold in anything that better could support parent health and well-being -- like therapy, couple's therapy, exercise, yoga, medical check-ups and so on! 
          • And remember kids are sponges! They tend to sense when parents are anxious, which can feed their own anxiety. 
            • With 1/3 to 1/2 of the risk of anxiety disorders being genetic, many parents of anxious kids are anxious, and merit treatment!
        • Talk with your kids about what's going on!
          • But not during acute anxiety symptoms!  
            • When the anxiety center of the brain is firing like crazy, it tends not to be the time to try to work with the reasoning part of their brains.  
            • Wait it out. Talk later on.
          • Then, feel free to encourage kids to voice their worries! 
            • Open questions often do good.   
            • And listen to their answers, and let them know you have. 
              • "I hear you are feeling uncomfortable." 
              • "I hear worries are bothering you." 
            • Collaborative discussions can help.
            • When they're ready. 
            • Ask kids how they would like to take anxiety on?
              • This invites them to problem solve!
              • No worries, again, if they don't talk, or don't share specific ideas.  
          • One round of reassurance can be helpful but usually not a lot more than that!
            • Too much reassurance inadvertently can reward unhelpful behavior patterns. Instead, often it's better to offer the TLC and so reward steps made to face anxieties and overcome avoidance behaviors. 
          • Use language that externalizes symptoms.
            • Language that refers to anxiety not as part of children but as something they are facing.
        • Rewards
          • Fold in rewards when children face worries!
            • After a child faces a fear is a great time for a game or a book store trip or hot chocolate or tea.
        • Anxiety 
          • Model confidence; be thoughtful about how your own experience of anxiety is shared.
            • Sometimes talking to a therapist can help figure out how best to do this.
        • Avoid avoidance!
          • Perhaps the most important point, and applicable to most children, and, in truth, to most of us!
          • Avoidance breeds worsened avoidance, and worsened anxiety.
          • Facing fears diminishes fears.
          • It is really that simple, but not simple to achieve!  
            • Often baby steps are the way to go.  
              • If afraid of water, don't start facing water via swimming in the ocean. Rather start by facing a drop of water. 
            • Our instinct is to protect those we love -- a wonderful and noble wish -- yet if we protect children from things that are not actually dangerous, we may feed anxiety disorders. 
            • Instead modeling that its good to lean into anxiety and do what makes us anxious (as long as it is safe and reasonable!) as much as we can and as often as we can and with all of our hearts!  
              • One example that can be helpful: Leaning into anxiety is uncomfortable like weight lifting or running because we are working hard, but, also like those activities, it makes us grow stronger.
          • Help children decrease avoidance behaviors! 
            • Sounds simple, but can be challenging. 
            • Doing this gently and consistently is key. 
            •  Working with therapists can be of help!
      • Diet 
        • Psychonutrition is no longer a fringe thing! Food matters for mental health! Decreasing caffeine often is a good idea, as caffeine can make the heart race and can feed anxiety. 
        • Brains are a part of bodies, so maximizing health in all ways makes sense. 
          • Maximizing whole foods -- fruits, vegetables, legumes and so on! 
          • Avoiding processed foods! 
        • Including omega three rich foods in small dietary amounts might make sense. 
          • Omega threes seem to help the same BDNF levels that exercise works on. 
          • And omega threes at least help adult anxiety, according to a recent review from JAMA.
          • Sources include chia seeds, flaxseeds, and for non-vegans, fish. 
            • Sticking with low mercury content fish makes sense, as mercury is toxic. 
        • Keeping kids hydrated makes common sense, as dehydration makes the heart race, which can feed anxiety. 
        • And, plates full of healthy vegetable and bean and seed rich meals will tend to provide a diet rich in good stuff like magnesium, zinc and B vitamins, that might help anxiety. 
        • A cup of chamomile tea can feel calming per Harvard's integrative doc, Dr. Milosavlijevic in her Holistic Health for Adolescents book, although those with ragweed allergy may want to steer clear; chamomile can cause an allergic reaction.
      • Exercise 
      • Social 
        • Social interaction lowers stress hormone levels! 
        • So helping kiddos fold in social interaction where doable makes sense. 
          • Often parents' offering a hand with drop off or scheduling can help socializing feel less overwhelming and so help it happen. 
      • Sleep 
        • Support good sleep hygiene! 
          • Helping kids wake up at the same time every day and turn off screens at least an hour before bedtime and throwing in a soothing non-screen bedtime routine (like reading something non-stressful or listening to music) are superb steps to include! 
        • And if shut eye isn't happening, talk to your kids' doctors! 
        • And if not nut allergic, 2 pistachios evenings is worth a try. 
          • Oddly enough, pistachios have stunning amounts of melatonin (that chemical that helps set circadian rhythm and sleep). 
            • Mushrooms, beans, other nuts, mustards and other foods have some melatonin too, and can be worth looking up and considering.
      • Light 
      • Psychological testing
        • Consider obtaining psychological testing if things don't move in the right direction, to make sure other issues aren't being missed and meriting attention! 

Thursday, October 3, 2019

Skip the tea bag?!

Ack! As the brilliant Dr David Sinclair from Harvard observed, "I thought 100 plastic Microparticles in bottled water was bad, but 11 billion leaching into hot tea!...not using plastic teabags again." Time to brew with loose leaf tea!

Thursday, September 26, 2019

Red, red wine... nope.

Red wine for health? Er, sorry, maybe not per the ramblings of Dr. Ede's post on red wine. She sadly (for those who enjoy a glass of red) makes sense this time.  Worth a read.

Thursday, September 19, 2019

3 ingredient sweet potato vanilla smoothie anyone?

Real vanilla's primary chemical compound -- vanillin -- has antioxidant activity,  anti-tumor activity and anti-cancer potential. And I know you know you should be eating more sweet potatoes. (They are full of: fiber, beta-carotene, vitamin C, vitamin E, vitamin B6, potassium, choline, iron, calcium, magnesium, phosphorus, zinc, thiamine, riboflavin, folate and so on.)

So how about a non-recipe rich in these health-promoting items?  So here you go: Throw frozen banana slices, sweet potatoes (after microwaving 5 min-ish and cooling) , non-dairy milk  plus a generous glug of real vanilla extract in the Vitamix (or any high-speed blender) for a sweet treat.

(And yes that's 4 ingredients, but vanilla is so little.)

(And sure, you can add kale or other greens to up the nutrient punch.)
Enjoy.

Wednesday, September 18, 2019

Nutrition for anxiety

Updated just a couple of weeks ago, here's Harvard's Dr. Uma Naidoo's ever wonderful blog post on how to utilize nutrition to ease anxiety.

Or, here's the anxiety-fighting-foods-skinny from her blog: Chow down on: beans, fruits, berries, nuts, seeds, vegetables, turmeric, ginger, asparagus, whole grains, fatty fish (or algae omega threes?), pickles, sauerkraut, leafy greens like spinach and Swiss chard, and cashews.  And drink plenty of water. And there you go. Enjoy.

 (And, yes, I admit; I left out all but one of her non-vegan ideas.)

Monday, September 16, 2019

Go chocolate!

OK, chocolate loving people, don't go nuts, as I'm reporting only a study looking at the imperfect world of correlation, not causation; so more studies are needed.  However, the subject is intriguing... Drum roll... Dark chocolate was found correlated with fewer depressive symptoms in a recent a humungous study, the more the merrier.

As reported by Dr. Sarah Jackson and friends in Depression and Anxiety journal this summer, of 13,000 plus adults who participated in the National Health and Nutrition Survey (between 2007-8 and 2013-14), those who ate more dark chocolate in the 24 hour food recall surveys reported fewer depressive symptoms.

Of these survey-fillers, 11% had chowed down on any chocolate in the prior 24 hours, and 1.4% dark chocolate. Those who ate dark chocolate had significantly lower odds of depressive symptoms!  Also, those who ate the most chocolate had significantly lower odds of depressive symptoms than those who had had the least chocolate.  (I can just about hear cheering in the streets!)

Still read on if you want to hear the article's authors share their fascinating chocolate theories. So how can chocolate do good things for mood? They posit several ways:

...Chocolate contains a number of psychoactive ingredients, including two analogs of anandamine (which produce effects similar to the cannabinoid responsible for euphoria from cannabis) and ...phenylethylamine, a neuromodulator ... important for mood regulation and implicated in the pathogenesis of depression 
...Chocolate consumption, as a pleasurable experience, may interact with several neurotransmitter systems implicated in reward pathways and mood regulation (e.g. dopamine, serotonin, and endorphins) ...improvements in mood ... is likely attributable to the chocolate's palatability ... In a study that compared effects of eating palatable chocolate, unpalatable chocolate, and nothing ... an immediate benefit was only seen after consumption of palatable chocolate... 
... It is possible that the rich concentration of flavonoids in the dark chocolate may be important...flavonoids have been shown to improve ... inflammatory profiles and unfavorable inflammatory profiles have been shown to play a role in the onset of depression...
Nice theories. Enough for me to rationalize a square of the dark sweet stuff for my high schooler after an inevitably rough Monday.  However, this does NOT mean chocolate is suddenly a health food.  Take care out there.



Sunday, September 15, 2019

The Use of Natural Herbs & Supplements for Treating Mental Illness


Dr. David Mischoulon MD, PhD, of Harvard's MGH gives a super talk on The Use of Natural Herbs & Supplements for Treating Mental Illness. Worth a listen!  However, no time to listen to the whole kit-n-kaboodle? Just breeze through my old fashioned, (admittedly imperfect), lecture notes below! I take much wording right off of his better slides or utterances, so consider it largely quoted!!

However, no matter Dr. Mischoulon's brilliance, I do NOT endorse or agree with everything he (or anyone) utters! Specifically, I'm more cautious in my prescribing. (For example, I do not suggest Kava to anyone! Livers are too nice to risk!)

So here you go, my notes from The Use of Natural Herbs & Supplements for Treating Mental Illness. Enjoy:

  1. PROS AND CONS OF CAM (complimentary and alternative medicine)

    • More than 60 % of the world uses CAM.
    • There's easy access and often good tolerability.
    • Used by many who haven't responded to standard therapies.
    • But(!)there's limited research. (Huge problem!)
      • So hard to make confident recommendations. (True!)
      • So effectiveness CAM often unclear.(!)
    • Natural does NOT mean safe.(!)
      • Many wrongly assume otherwise
      • There's toxicity, side effects, & drug interactions for CAM, just like any medications.
    • CAM preparations/purity varies!(Ack! What brand is best?!)
    • Insurance won't cover.
  • ST JOHN'S WORT(SJW)
    • 300-1800mg/day
      • usually this dose broken up into 2-3 times/day
    • Probably helpful for mild to moderate depression.
      • Results encouraging but inconsistent
      • And a good number of studies including placebo controlled but most short and with limitations.
      • Looks about as effective as low dose tricyclic antidepressant(TCA) for mild to moderate depression.
      • Anti-inflammatory effect?
    • May help atypical depression, PMS, Minor depression.
    • Might benefit Alzheimer's?
    • Does NOT help attention deficit disorder, anxiety disorders
    • INTERACTS WITH OTHER MEDICATIONS!
      • DO NOT COMBINE WITH SSRIS (serotonin reuptake inhibitors like Prozac, Celexa, Lexapro, Paxil, Zoloft and so on!) - RISK OF SEROTONIN SYNDROME!
        • OR MONOAMINE OXIDASE INHIBITORS (MAOI) OR OTHER SEROTONERGIC MEDICATIONS!  
    • IMPACTS METABOLISM OF OTHER MEDICATIONS!
      • SJW induces the liver enzyme CYP3A4
        • Those on SJW will be chewing up medications broken down by CYP3A4 like crazy! 
        • I.e. SJW reduces activity of other drugs including:
          • Warfarin, cyclosporinoral contraceptiveS, theophylline, digoxin
          • Talk to gynecologist if on SJW BECAUSE Birth control pills likely will not protect against pregnancy if on SJW!
    • Side effects 
      • Often mild, like constipation.  
      • Also photo-toxicity (sensitivity to sunlight). 
        • wear sunscreen, a hat and so on!
      • Can cycle bipolar patients into mania (like antidepressants do).
      • Risk of cataracts?
      • Re Babies whose mom use SJW...
        • Colic, drowsiness, lethargy?
        • No fetal malformations found in one human study?
        • (It's hard to imagine any time I'd recommend ANY supplements to someone pregnant/breastfeeding INCLUDING THIS ONE, beyond those OB prescribed, like folate sometimes.)
    • Note, different preparations vary in strength.
  • SAMEe (S-Adenosylmethionine)
    • 400-1600mg/day
    • Antidepressant as mono therapy or augmentation, results encouraging 
      • SAMe better than placebo in 6 studies, equivalent to placebo in 2
      • SAMe equal to TCA in 6 studies, better than TCA in 1
      • For 189, after 12 weeks SAMe vs Escitalopram vs placebo -> Benefit in all 3 treatment arms, no significant differences.  
      • 30 SSRI partial/non responders supplemented and those with SAMe 800-1600mg/d did much better
      • better sooner when combined with TCAs
    • Acts as methyl donor, especially important in neurotransmitter synthesis
    • Side effects include:
      • insomnia, anorexia, constipation, nausea, dry mouth, sweating, dizziness, anxiety
      • Mania or hypomania in bipolar depression
    • Doesn't have a lot of interactions. 
      • SAMe has been combined safely with TCAs, SSRIs, SNRIs
      • Combo SJW+SAMe has worked.
  • L-METHYLFOLATE
    • 15mg a day (typical Deplin dose!)
    • polymorphisms (genetic variations so different kinds) in MTHFR (key enzyme for making L-methylfolate). So some have lousy MTHFR -> don't get enough L-methylfolate made!
    • Those who had an inadequate response to SSRI were randomized to placebo or L-methylolate. L methylfolate was found more helpful for depression than placebo!
  • OMEGA THREE FATTY ACIDS
    • 1-2g/day of EPA/DHA combo for depression (I prefer 1g!)
      • with more than 60% EPA 
    • Long chain polyunsaturated fatty acids
      • DHA, EPA thought most psychotropically active  omega three fatty acids!
    • How does it help? 
      • Neuronal membrane (nerve cell wall) stabilization and anti-inflammatory effect?
        • Very flexible molecules so can stabilize cell membranes (layers of lipids (fats) and proteins that surround cells)?
    • Primarily found in fish
      • Fish get omega threes from algae (which vegans like me can eat algae sourced omega threes instead of fish oil! Yay!)
    • Omega threes have been pretty well studied
    • A cool study showed taking EPA before interferon alpha prevented depression. 
      • Interferon alpha is a pro-inflammatory medication used for autoimmune, infectious and malignant diseases with side effect of causing depression. 
    • Mixed evidence for DHA. 
      • 1 gram a day helpful but higher doses not helpful in other studies, so perhaps a helpful dosing window?
      • DHA protective against suicide, per 1 study?
    • Might help postpartum depression? but studies are small. (I'm wary here!)
    • Might help bipolar disorder?
      • Best for depressed phase? 
      • Take mood stabilizers too!  
      • flax oil (ALA) in pedi bipolar? 
        • Flaxseed oil is another kind of omega three
          • traditionally not thought psychoactive, ie no benefit mood?
          • but one study in kids with bipolar showed some improvement 
            • not reaching statistical improvement.
    • Weak results in borderline personality, schizophrenia 
    • Those without elevated inflammatory markers didn't respond to EPA, but those who did have elevated inflammatory markers responded.
      • those overweight more often have
        • higher inflammatory markers.
        • Omega 3s might be more helpful for them
    • Side effects include 
      • stomach upset, fishy taste
      • bleeding -- risk of bleeding may have been exaggerated. 
        • Still avoid if having surgery etc.! And avoid anything else that increases bleeding at the same time like NSAIDs and so on!
    • Perhaps benefit to expectant mothers, fetus, and infants?
      • for neural development, allergy prevention? 
      • BUT Safe dose in pregnancy unknown?! 
  • KAVA (PIPER METHYSTICUM)
    • (I do NOT like this supplement for anyone!)
    • 60-300mg/day
    • Effective for mild anxiety
      • but not for panic attacks 
    • Possibly some antidepressant effect? 
    • Anxiolytic, anticonvulsant, and muscle relaxant
    • Similar efficacy to venlafaxine, buspirone, opipramol (sigma antagonist)
    • Side effects
      • side effects: stomach upset, headaches, dizziness
      • Toxic reactions with high doses, prolonged use
      • Unsteadiness, hair loss, visual problems, respiratory problems, kava dermaopathy
      • 78 cases of liver toxicity, 11 cases of liver failure requiring transplant, 4 deaths, banned in parts of Europe (I DO NOT PRESCRIBE KAVA!)
        • Most were taking high doses, might be related to hepatotoxic molds that grew on the stuff...
      • At least, avoid if there's a history of liver disease, alcohol use, concurrent medications with liver toxicity, pregnancy, breast feeding (!!!)
      • Use only under physician supervision.(!) Monitor liver enzymes regularly
      • Use for 1-3 months at most
  • VALERIAN (VALERIANA OFFICINALIS)
    • 450 to 600mg 2 hours before bedtime
    • Oldie. Used as a drug for over 1000 years.
    • Appears to be a promising hypnotic, as it decreases sleep latency (time to fall asleep) and improves sleep quality.
    • May work as well as benzodiazepines (like valium), although not ideal for acute treatment of insomnia
    • No dependence or daytime drowsiness?
    • No increased benefit from higher doses
    • not optimal for acute treatment of insomnia; may promote natural sleep over several weeks of use
    • Active ingredients may function like benzodiazepine
      • Direct GABAergic activity
        • GABA is neurotransmitter that chills the neural system.
      • Decrease GABA breakdown
      • Changes sleep architecture (pattern of sleep so-called stages that have different brain activities etc.)
    • Popular worldwide as sedative 
    • 7 studies suggest comparable efficacy to benzodiazepines, fewer side effects and no tolerance
    • Meta analysis suggested lack of objective evidence of efficacy.
    • Hard to study, because has a powerful smell, so how to have a convincing placebo?
    • Headaches and GI complaints are common
    • No hangover effect in morning?
    • Has been combined with SJW ok
    • Rare toxic reactions: blurry vision, hepatotoxicity, withdrawal and delirium
    • Some preparations may contain mutagens (!)(Mutagens cause genetic mutations (i.e. changes DNA etc., can cause disease like cancer!)
    • Unclear safety in pregnancy(!)
  • MELATONIN
    • 0.025-0.30 mg/day
    • Sleep inducing drug
    • Can decrease the time it takes to fall asleep
    • Note that commercial preparations may have up to 5mg melatonin. (Ack!)  
      • High doses may cause daytime sleepiness or confusion
      • Best to begin with low doses
    • Potentially useful in children
    • Popular with travelers to reset circadian rhythm.
    • Few studies in psychiatric populations
    • Resets circadian rhythm, direct sedative effect
    • Adverse effects (not common): inhibition of fertility, decreased sex drive, lowers body temperature, retinal damage, immunosuppression (watch out in HIV), unknown risk to fetus (Like I said, I generally would not give supplements to those who are pregnant!)
  • GINGKO BILOBA
    • 120-240mg/day 
    • Cognition (thinking) enhancer? 
      • May slow cognitive decline in dementia
      • Better for Alzheimer's than vascular dementias
        • may take a year, minimum 8 weeks, start early
    • No data on longer term impact on illness
    • May alleviate antidepressant induced sexual dysfunction?(?)
    • Stabilizes neuronal membranes, scavenges free radicals?
    • Side effects
      • mild GI upset, headache, irritability, dizziness, seizures in epileptics, bleeding (via inhibition of platelet activating factor (PAF)) 
      • AVOID THOSE WITH RISK OF BLEEDING
        • don't take if having surgery or have bleeding disorder. Or pregnant or breastfeeding.(!) 
    • Unclear if helpful to those who are younger and in good health. Mixed results.
    • In healthy middle-aged people with mild cognitive effects it might be helpful?
    • Not preventative for Alzheimer's (Ack!)
    • Dementia meta-analyses found Cholinesterase Inhibitors (ChE) more effective than GB that was in turn more effective than placebo. 
      • But GB more tolerable than ChE
  • WHO TO USE CAM FOR?
    • Generally, CAM for those who have mild illnesses + have strong interest in CAM + who don't mind the extra cost.
    • Not for acutely suicidal (or acutely anything!) 
    • From elsewhere: "... the body of knowledge about these therapies is limited. We don't have as much systematic research or rigorous clinical trials... so as clinicians who are put in the position of making recommendations, we don't know how effective these treatments are compared to placebo or standard therapies."

What is Wellness Anyway?

"The state of being in good health, especially as an actively pursued goal."