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Diabetes and Omega-3’s

Diabetes, Omega-3 fatty acids Super FoodsReading, interpreting and understanding scientific literature can be tedious because the authors often find that their previous paper on the subject missed its mark or was completely wrong. Easy to do when you are blazing new trails; however, the caution they go through to cover their tracks oftentimes makes for difficult reading. Luc Djousse and his colleagues at the U of Washington reported in the May 18, 2011 edition of the American Journal of Clinical Nutrition that, “With the use of objective biomarkers, long-chain omega 3 Fatty Acids (FAs) and Alpha-Linolenic Acid (ALA) were not associated with a higher incidence of diabetes. Individuals with the highest concentrations of both types of FAs had lower risk of diabetes.”

Speed reading is absolutely out of place. Omega-3 fatty acids in the body help to control the inflammation process, which is a benefit because the start of the healing process—initiated by the omega-6 arachidonic acid—also involves the possibility of getting carried away with the exercise. Say you have a cut or abrasion. The key activity that ensues is to stop the loss of fluids – save the blood.  It is that process which tells the body to start the healing by sending white blood cells and platelets to the site of the wound and to agglomerate and close the exit door by swelling the tissues, which is also another way of looking at inflammation. To inflame can be life saving. The omega-3’s are then involved in the work of modulating the activity helping to ease the inflammation that comes with the correction process.

Fatty acids, especially those that are long and highly unsaturated, increase cell membrane fluidity and functionality. Fatty acids are essential to membrane activity at the location of hormone receptors. Insulin resistance in adult-onset diabetes is directly associated with fewer membrane enhancing long-chain fatty acids, largely due to impaired function of desaturase and elongase enzymes needed for a healthy membrane. Ruiz-Gutierrez 1993, “We have studied the fatty acid composition of erythrocyte membrane phospholipids in nine Type 1 (insulin-dependent) diabetic patients and nine healthy control subjects. Cell membranes from the diabetic patients showed a marked decrease in the total amount of polyunsaturated fatty acids mainly at the expense of docosahexaenoic acid, DHA, and arachidonic acid C20:4n6”.

Cell membrane abnormalities in lipid content are found to be related to poor metabolic control, which is a characteristic of diabetes. Diet is a very important  factor, and interventions with dietary essential fatty acids (EFAs) in the correct ratio (found to be 4:1, omega-6:omega-3), can make a difference. Decsif  T., 2002, “Reduced availability of long-chain polyunsaturates in diabetic children suggests that an enhanced dietary supply of long-chain polyunsaturates may be beneficial”. Children with diabetes demonstrate a deficit of long-chain fatty acids, so incorporating them into a child’s diet is prudent. An unspoken benefit in the application of EFA’s to diabetes treatment is the decrease in triglyceride levels, themselves striking indicators of the potential for cardiovascular issues and very often appearing in persons with diabetes.

Herein resides the prolonged physiological support of the EFAs. For those who lack the efficient conversion of the omega-3 alpha linolenic acid from plant sources (notably flaxseeds and their oil) to EPA and DHA, fish oil may be a viable alternative. In fact the the FA conversion process with diabetes is almost non-existent, but also common with aging.

For quite some time the essential fatty acids have been misunderstood. Of the types of fatty acids, the omega-3’s have received the most publicity, having been applauded for positive health effects, principally, because over the last century the general population ate little fish and had little or no n-3s in the diet. Unless they were more or less health nuts, few did not have any exposure to omega 3s as in flax, and even if they did their ability to elevate up to EPA and DHA was minimal. Fish oil was the answer but the explosion that ensued caused over-consumption and still does.

Hence the comments of Djousse et al that n-3 FAs did not increase diabetes but if both the omega 6s and the 3 s were added together there was marked improvements. There is an inference that n-3s were of no benefit and needed the balance of both EFAs, which we applaud and so should you. Balance is paramount.

References

Djoussé L, Biggs ML, Lemaitre RN, King IB, Song X, Ix JH, Mukamal KJ, Siscovick DS, Mozaffarian D. Plasma omega-3 fatty acids and incident diabetes in older adults. Am J Clin Nutr. 2011 May 18.

Ruiz-Gutierrez V, Stiefel P, Villar J, García-Donas MA, Acosta D, Carneado J.  Cell membrane fatty acid composition in type 1 (insulin-dependent) diabetic patients: relationship with sodium transport abnormalities and metabolic control.  Diabetologia. 1993 Sep;36(9):850-6.

T. Decsif, H. Minda, R. Hermann, A. Kozári, É. Erhardt, I. Burus, Sz. Molnár and Gy. Soltész  Polyunsaturated fatty acids in plasma and erythrocyte membrane lipids of diabetic children  Prostaglandins, Leukotrienes and Essential Fatty Acids. 67(4); Oct 2002: 203-210

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Yoga

yogawomanIf there exists such a philosophical regime that can bring a person closer to Elysium in every aspect of life—balance, health, aging—its enthusiasts argue that it is yoga.  Investigations into the complexities of this physical / mental / spiritual discipline have focused on the almost inexplicable efficacy of its practice.  That it is conjectured to effect a return to normal following a physical or mental derangement deserves at least a little attention.

The cognitive behaviors of yoga entail calorie restriction, meditation, breathing techniques and additional practices that separate it from other holistic modalities, and have a distinct affect on the function of the human body.  Research at the Albert Einstein College of Medicine, in New York, has classified yoga’s influence on human physiology into four categories that encompass humoral factors (affecting immunity), CNS activity, cell trafficking, and bioelectromagnetism (the study of membrane and action potential).  The investigators allowed that, “…yogic practices might optimize health, delay aging, and ameliorate chronic illness and stress from disability.”  (Kuntsevich. 2010)  A reductionist approach tries to explain complex matters by using the simplest of its facets and nomenclature, but this cannot address the intricacy of yoga and its long-term benefits to the whole person.

From lower back pain, arthritis and carpal tunnel syndrome, all the way to functional development in children, yoga has been an oft-visited body of knowledge.  Practicing yoga increases flexibility, strength and stamina, and can do that in the gentlest of manners using Hatha techniques, or by employing the more explosive Ashtanga form, which relies on quick movements from one pose to another.

Because lower back pain cannot satisfactorily be treated with surgery and injections, other interventions have been pursued, yoga paramount among them.  Chronic back pain has a significant impact on a person’s ability to work and perform daily tasks.  The fact that pain is non-specific makes some therapies uncertain, but the physical motions of yoga meet the need for non-invasive remediation.  (Carter. 2011)  Perhaps it is such that synovial lubrication is enhanced, or that directed movements create healing substances at the cellular level.  Whatever the reason, it works.

If yoga intensifies a person’s awareness of his body and helps him to understand his relationship to a body in pain, with the expectation of attenuating discomfort, then the discipline has been effective, particularly in changing cognitions and behaviors towards nociception.  (Tul. 2011)  Modified forms of Hatha yoga have been tested on such patients with outcomes that were not surprising.  Not only were flexibility and reach improved, but also the emotional insults that accompany refractory pain, such as anxiety and mild depression, were reduced, as reported in a study performed at the Richard Stockton College of New Jersey, providing renewed interest in additional study on the salubrious nature of yoga.  (Galantino.  2004)

Recent work at Johns Hopkins examined prior studies on yoga’s application to arthritis, and found that evidence was strong for reduced disease symptoms and disability, especially the tender and swollen joints that characterize the condition.  (Haaz.  2011)  Noting that it can be tailored to the specific needs of the geriatric population, investigators at the University of Pittsburgh concluded that yoga is among the mind-body interventions associated with reduced pain perception.  (Morone.  2007)

Executive function in a human being is that capacity to make decisions in novel situations, outside the domain of normal automatic processes.  This is tantamount to thinking outside the box, and appears to be a desirable developmental milestone in children.  Yoga is just one of the activities that can help to develop such a trait, one that telegraphs creativity, flexibility, self-control, and self-discipline.  The physical benefits are the cherry on top.  (Diamond. 2011)

It is accepted that what enters a pregnant woman’s digestive system has an effect on the neonate, as well as on the mother.  Could mind-body processes do the same?  There is evidence that improvement in perceived stress, mood, and perinatal outcomes may be realized from practicing yoga.  Not only that, but also it was found that such practices resulted in higher birth weight, less time in labor, and fewer instrument-assisted births, accompanied by lower stress and anxiety levels in both mother and child.  (Beddoe. 2008)  Good news, eh?

Other health issues that benefit from yogic practices include metabolic syndrome (Anderson.  2011), chronic obstructive pulmonary disease (Fulambarker.  2010), and essential hypertension (Anand.  1999).  Each deserves additional attention.

References

Kuntsevich V, Bushell WC, Theise ND.
Mechanisms of yogic practices in health, aging, and disease.
Mt Sinai J Med. 2010 Sep-Oct;77(5):559-69.

Carter C, Stratton C, Mallory D.
Yoga to treat nonspecific low back pain.
AAOHN J. 2011 Aug;59(8):355-61; quiz 362.

Tul Y, Unruh A, Dick BD.
Yoga for chronic pain management: a qualitative exploration.
Scand J Caring Sci. 2011 Sep;25(3):435-43. doi: 10.1111/j.1471-6712.2010.00842.x.

Galantino ML, Bzdewka TM, Eissler-Russo JL, Holbrook ML, Mogck EP, Geigle P, Farrar JT.
The impact of modified Hatha yoga on chronic low back pain: a pilot study.
Altern Ther Health Med. 2004 Mar-Apr;10(2):56-9.

Haaz S, Bartlett SJ.
Yoga for arthritis: a scoping review.
Rheum Dis Clin North Am. 2011 Feb;37(1):33-46.

Morone NE, Greco CM.
Mind-body interventions for chronic pain in older adults: a structured review.
Pain Med. 2007 May-Jun;8(4):359-75.

Diamond A, Lee K.
Interventions shown to aid executive function development in children 4 to 12 years old.
Science. 2011 Aug 19;333(6045):959-64.

Beddoe AE, Lee KA.
Mind-body interventions during pregnancy.
J Obstet Gynecol Neonatal Nurs. 2008 Mar-Apr;37(2):165-75.

Anderson JG, Taylor AG.
The metabolic syndrome and mind-body therapies: a systematic review.
J Nutr Metab. 2011;2011:276419.

Fulambarker A, Farooki B, Kheir F, Copur AS, Srinivasan L, Schultz S.
Effect of Yoga in Chronic Obstructive Pulmonary Disease
Am J Ther. 2010 Oct 22.

Anand MP.
Non-pharmacological management of essential hypertension.
J Indian Med Assoc. 1999 Jun;97(6):220-5.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Child Athletes Nutrition

children-sportsA child is not a miniature adult. His or her nutrition and hydration needs are not exactly the same, especially in sports participation.  With the growth and availability of sports opportunities, you’d think that related nutrition needs would be a concern. To the contrary, sports nutrition for youngsters receives less attention than it deserves.

“Most children and adolescents who are strongly committed to sports are not concerned about nutrition as it relates to energy balance and obesity,” states a report from a 2004 issue of Nutrition.  The interactions among nutrition, growth, and development deserve attention if a participant expects to achieve optimal performance and to avoid the injuries and problems that stem from nutritional deficiencies.   Daily fluid turnover in adult athletes has received intense study, but that for children and adolescents hasn’t.  That of adults may be two to three liters a day, but in youngsters has only been estimated at half that—and that has been based on sedentary youth.  Although “sweating capacity is typically reported to be lower in children,” there is an increase in sweat rate when adjusted for body surface area.  Besides the energy needed for normal growth and development, children athletes need to accommodate the greater expenditure from physical activity.  That can vary from one sport to another.  (Petrie. 2004).

Besides the fun, kids participate in sports to hone their skills, to experience the excitement of competition, to be part of a team, and to stay in shape, among other reasons.  But they pay little or no attention to fuel and hydration needs.  Parents and coaches, on the other hand, do.  At least they should.  Hectic schedules, availability of foods, limited time and extended days interfere with choices and timing.

Even though the number of kids playing organized sports is on the rise, fitness levels are on the decline, and are much lower than in previous decades.  This partially explains the spate of sports-related injuries.  (Cordelia. 2011).  Targeted intervention strategies include ample hydration and nutrition.  Because of maturation differences, kids need more protein to support growth, more calcium to support bone, and more attention to the prevention of hypohydration.  (Bar-Or. 2001).

Sweat helps to cool the body, and what comes out has to be replaced, otherwise performance suffers and health is at risk.  To prevent the dizziness, fatigue, nausea, and cramps that characterize dehydration, the young athlete should drink one or two cups of water or electrolyte within four hours of an event.  If no urine has been passed, or if urine is bright yellow and minimal, another 1 ½ cups is suggested within two hours of the game.  During the event, try to replace fluids as they are lost to sweat, about a cup every fifteen or twenty minutes if possible.  Plain water will do, but if the event is longer than an hour, use an electrolyte replacement.  Recovery is just as important to a preteen or teen as it is to an adult.  The best way to determine post-exercise hydration needs is to weigh the child to compute weight loss, and to replace fluid at one and a half times the volume lost to sweat.  One ounce of water (sweat) weighs one ounce, so the math is simple.  A kid’s thirst mechanism is not well-developed, so you’ll almost have to force him to drink…but do it.

The nutrients in which young athletes are most deficient include carbohydrates, calcium, vitamin B6, folate and iron, the last being especially important to girls.  Carbohydrate inadequacy leads to shortened glycogen stores and premature fatigue, especially if the game is sixty minutes or longer.  Once glycogen is gone, fat gets mobilized and the child will “bonk.”  The last thing you want is for the young athlete to burn protein for fuel. An active child will need as many as 500 to 1500 more calories a day than his inert peers.

Two to three hours before an event, give your athlete a light, carb-rich meal:  carrot sticks and a piece of cheese; a little pasta; a small sandwich.  Have him exert himself on a slightly empty stomach to avoid cramping, even fatigue.  Chips, cakes or cookies, and candy are out.  The protein your child needs will not build bulk.  That comes with age.  Normal muscle development will require as much as one and a half grams of protein for each kilogram of body weight, but need not be much more than fifteen to twenty percent of daily calorie intake.  Reduce that during the off season. Thirty percent fat in the daily intake will help to supply needed calories.  Reduce that off-season, too, lest you greet Tweedledee one morning.

The matter of iron deficiency is a particular concern for girls, especially after the onset of menarche, which can be a couple of years late for an iron-fisted ball player.  Iron-deficiency anemia is a real threat for female athletes.  Besides affecting performance and recovery, low iron stores impair immune function and may initiate other physiological problems.  Supplementation is not intended to replace food as a source of nutrients, but in the case of iron deficit, it may be recommended.  (Beard. 2000).  There’s no need for your daughter to join the 50% of the world population who are deficient in iron.  (Ahmadi. 2010).  Raw meat probably won’t help, but getting 15 mg a day from supervised supplementation will.

Youngsters are often grossly misinformed about what they need and don’t need.  Their peers and the internet are not always reliable sources of information.  Some young athletes need only a minor tweak to their diets; others need a complete overhaul.  If you feel inadequate, don’t be embarrassed.  There are dietitians and sports nutritionists who can help.

References

Petrie HJ, Stover EA, Horswill CA.
Nutritional concerns for the child and adolescent competitor.
Nutrition. 2004 Jul-Aug;20(7-8):620-31.

Cordelia W Carter, Lyle J Micheli
Training the child athlete: physical fitness, health and injury
Br J Sports Med 2011;45:880-885

Bar-Or O.
Nutritional considerations for the child athlete
Can J Appl Physiol. 2001;26 Suppl:S186-91.

Beard J, Tobin B.
Iron status and exercise.
Am J Clin Nutr. 2000 Aug;72(2 Suppl):594S-7S.

Ahmadi A, Enayatizadeh N, Akbarzadeh M, Asadi S, Tabatabaee SH.
Iron status in female athletes participating in team ball-sports.
Pak J Biol Sci. 2010 Jan 15;13(2):93-6.

Koehler K, Braun H, Achtzehn S, Hildebrand U, Predel HG, Mester J, Schänzer W.
Eur J Appl Physiol. 2011 May 19. [Epub ahead of print]
Iron status in elite young athletes: gender-dependent influences of diet and exercise.

Committee on Sports Medicine and Fitness
AMERICAN ACADEMY OF PEDIATRICS
Intensive Training and Sports Specialization in Young Athletes
Pediatrics Vol. 106 No. 1 July 1, 2000 : pp. 154 -157

Martinez LR, Haymes EM.
Substrate utilization during treadmill running in prepubertal girls and women.
Med Sci Sports Exerc. 1992 Sep;24(9):975-83.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Athletes And Fuel – Feeling Fuelish?

runnerWhen it comes to fueling an athlete, there had been as many approaches as there are sports to play. Several respected bodies have merged philosophies to incorporate and publicize nutritional recommendations that can be adapted to most athletic pursuits. There is much about diet that is common sense, but the habits cultivated from family traditions just might fly in the face of that. Ethnic or regional cuisines may feature foods that upset the balance of both macro- and micro-nutrient intake. There is no doubt that the physiological needs of serious athletes have to be the first consideration in finding and combining the right fuels.

Optimal nutrition is mandatory if an athlete wants to realize his full potential during an event. Not only performance, but also recovery, is enhanced by food intake. A position paper issued jointly by the American Dietetic Association, the Dietitians of Canada, and the American College of Sports Medicine, states, “Energy and macronutrient needs, especially carbohydrate and protein, must be met during times of high physical activity to maintain body weight, replenish glycogen stores, and provide adequate protein to build and repair tissue,” continuing that, “Adequate food and fluid should be consumed before, during, and after exercise to help maintain blood glucose concentration during exercise, maximize exercise performance, and improve recovery time. Athletes should be well hydrated before exercise and drink enough fluid during and after exercise to balance fluid losses.”  (Rodriguez. 2009)

Your performance will be affected by genetics (over which you have zero control), training (over which you have total control), and diet (ditto). If you fail to consume enough energy, the body will use both fat and lean tissue as fuel. Strength and endurance will then suffer, and the immune system and endocrine glands will pay a stiff price. If you’re trying to lose weight, you still have to pay attention to energy intake. It takes calories to burn calories. This is especially true for women, who may experience amenorrhea and osteoporosis if they aren’t careful.

You can store about 400 to 600 grams of carbohydrates, or 1600 to 2400 calories’ worth. These glycogen stores can be burned in 1 ½ to 2 hours, after which fat is mobilized and you “hit the wall.”  You don’t want to get more than about 60 grams of carbohydrates (CHO) an hour while in a marathon, for example, or you might cramp, but your daily intake could be 5-7 grams per kilogram a day (about 3 grams per pound) for moderate exercise that lasts less than 1 ½ hours. For more intense exercise, like that marathon or a cycling event, that lasts more than a couple hours, you’ll need 8-12 grams of CHO a day per kilogram of body weight. Do this prior to, not during, an event. (Burke. 2011)  You might as well convert your body weight to kilograms now. Divide pounds by 2.2 and you’ll have it.

Eating before an event will enhance performance compared to fasting. Common sense says to eat lesser amounts an hour before an event than you would eat four hours ahead of a strenuous workout. Traditional wisdom says that consuming up to 1 gram of CHO per kg is fine one hour before the start; Consuming 4.5 gm/kg is O.K. four hours before. Take it easy on the fiber and fat, though, or you might experience GI distress. During practice sessions is the time to experiment with different foods to come up with effective refueling strategies that fit you.

Protein intake depends on the type and duration of exercise. 0.8 gm/kg/day is fine for the general public, but you’ll probably need more. An endurance athlete will need 1.2-1.4 gm/kg/day, while a weight lifter needs up to 1.7 gm/kg/day. More than 2.0 mg/kg can tax the kidneys and won’t make much physiological difference. It’s important to get protein right after exercise. There’s a 15 minute to 2-hour window during which muscle balance can be increased and muscle tissue can be repaired. Protein supplements are nothing more than a convenience. Besides, such supplements can become delivery systems for things you neither want nor need, like steroids and other illicit substances.

At the end of your performance you need to refill your buckets. That’s called recovery. Adding protein to your carbohydrate intake at a ratio of 3:1 or 4:1, CHO:Pro, can enhance recovery. (Ivy. 2001)  We know of a few marathoners who eat tuna sandwiches with chocolate milk. You might opt for a bowl of Cheerios and a banana, or a yogurt-fruit smoothie and pretzels. Listen to your body. You might end with steak and potatoes. Lemon meringue pie, and carrot cake, and oatmeal cookies, and…  Dream on….PSST, you can do without the sugar.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Low Cholesterol And Mental Health

sad-eggsIf mental health is defined as a state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life, then we need to take care of the garage in which this vehicle is kept.  Measures of depression and anxiety assess things such as self-disparagement, pessimism, lack of drive, apprehension, inability to relax, and irritability, to name a few.  Interestingly, these evaluations have demonstrated a relationship to low lipid and lipoprotein concentrations.

In work done at the end of the last century, an inverse association between mental challenges and total cholesterol and lipids was found.  That means when one goes up, the other goes down.  Testing young adult females, Duke University Medical Center discovered that women “…with low total cholesterol concentrations (<4.14 mmol/liter) relative to those with moderate to high cholesterol levels, were more likely to have higher scores on the NEO depression subscale…and anxiety subscale…” after adjustments were made for age, body mass index, oral contraceptive use and physical activity.  (Suarez.  1999)

Before we got too involved, it pays to know that 4.14 mmol/liter is equal to a cholesterol level of 160 mg/dL, or just plain 160.  Cholesterol is a steroid substance necessary to human life.  It forms the cell membranes in all organs and tissues of the body, is essential to the production of the hormones we need for growth, development, and reproduction, and it makes the bile acids necessary for absorption of nutrients.  Very little, if any, dietary cholesterol becomes serum cholesterol.

Back in the 1990’s it was noted that cholesterol levels below 160 were tied to excess mortality from all causes, primarily from a variety of cancers, respiratory and digestive diseases, and violent deaths from suicide and trauma.  Reasons behind low cholesterol have been ascribed to genetics, resistance to dietary sources, acute infections, and alcohol use/abuse.  (Meilahn.  1995)  If suicide is tied to depression, then it may be a legitimate effect.  Depression is twice as common among women as men, with about one in four suffering at some point in her lifetime.  The greatest vulnerability appears during the childbearing years, the time when its diagnosis is often overlooked.  The turbulence of hormones flooding a woman’s system at different times and in differing amounts can surely be a potent stressor.

Scientists in Barcelona, Spain, realized the connection of cholesterol to neuropsychiatric disease in a review of related literature that preceded their interest.  They found a link to early death, suicide and aggression, and personality disorders and dementia. (Martinez-Carpio.  2009). It appears that the good intentions of reducing what was thought to be the cause of cardiac mortality opened a different can of worms.  The Japanese explored the intrigue that was sparked when total mortality was not reduced despite reduction of mortality due to coronary heart disease, and found an increase in death rates due to suicide and accidents, many of which were tied to risky behaviors in persons with low cholesterol levels.  (Kunugi.  2001)  Does low cholesterol compromise judgment?  The U. of California conducted trials in the early 90’s to determine the cause behind the rise in suicides in men older than fifty years, and found that depression was three times more prevalent in those whose cholesterol was lower than 160.  Health status, number of chronic diseases, number of medications, and exercise seemed not to have had an adverse effect on depressive signs and symptoms. This led to the suggestion that the intentional lowering of cholesterol be more deliberate.  (Morgan. 1993)

Cedars-Sinai Medical Center, in Los Angeles, reported that serotonin, a neurotransmitter that controls impulsive behaviors, is tied to cholesterol levels at the synapses.  Low membrane cholesterol decreases the number of serotonin receptors, thereby reducing suppression of aggressive and destructive behaviors.  (Engelberg. 1992)  That magic number, 160, once again made headlines in the Netherlands, where epidemiologists discovered a higher prevalence of depression in males whose cholesterol was below that level.  (Steegmans. 2000)  Low cholesterol was cited as causative to rises in criminal violence in Sweden, following the association of reduced cholesterol values to low serotonin activity. (Golomb. 2000)  Reduced levels of total cholesterol, LDL, and HDL resulted in minimized serotonin values in personality disordered cocaine users, as reported by addiction researchers in their journal. (Buydens-Branchey. 2000)  In school-aged children, those with cholesterol values lower than 145 were three times more likely to have been suspended or expelled from school.  This is an absolute consideration, and has nothing to do with socio-economic status or ethnic background, nor with nutrition status or academic achievement.  (Zhang. 2005)

Life is supposed to be a balancing act.  Lots of us overdo something.  The balance between total cholesterol and HDL can allay fears of cardiovascular disease, despite cholesterol in the 200 range.  Cholesterol levels below 170 can make us irritable…and irritating.

References

Suarez EC.
Relations of trait depression and anxiety to low lipid and lipoprotein concentrations in healthy young adult women.
Psychosom Med. 1999 May-Jun;61(3):273-9.

Elaine N. Meilahn, MD
Low Serum Cholesterol  Hazardous to Health?
Circulation. 1995;92:2365-2366

Martínez-Carpio PA, Barba J, Bedoya-Del Campillo A.
[Relation between cholesterol levels and neuropsychiatric disorders].  [Article in Spanish]
Rev Neurol. 2009 Mar 1-15;48(5):261-4.

Kunugi H.
[Low serum cholesterol and suicidal behavior].  [Article in Japanese]
Nihon Rinsho. 2001 Aug;59(8):1599-604.

Morgan RE, Palinkas LA, Barrett-Connor EL, Wingard DL.
Plasma cholesterol and depressive symptoms in older men.
Lancet. 1993 Jan 9;341(8837):75-9.

Engelberg H.
Low serum cholesterol and suicide.
Lancet. 1992 Mar 21;339(8795):727-9.

Paul H. A. Steegmans, MD, Arno W. Hoes, MD, PhD, Annette A. A. Bak, MD, PhD, Emiel van der Does, MD, PhD and Diederick E. Grobbee, MD, PhD
Higher Prevalence of Depressive Symptoms in Middle-Aged Men With Low Serum Cholesterol Levels
Psychosomatic Medicine 62:205-211 (2000)

Beatrice A Golomb, Håkan Stattin, Sarnoff Mednick
Low cholesterol and violent crime
Journal of Psychiatric Research. Volume 34, Issue 4 , Pages 301-309, July 2000

Laure Buydens-Branchey, Marc Branchey, Jeffrey Hudson, Paul Fergeson
Low HDL cholesterol, aggression and altered central serotonergic activity
Psychiatry Research. Volume 93, Issue 2 , Pages 93-102, 6 March 2000

Zhang J, Muldoon MF, McKeown RE, Cuffe SP
Association of serum cholesterol and history of school suspension among school-age children and adolescents in the United States.
Am J Epidemiol 2005; 161:691-9.

Scanlon SM, Williams DC, Schloss P.
Membrane cholesterol modulates serotonin transporter activity
Biochemistry. 2001 Sep 4;40(35):10507-13.

Laure Buydens-Branchey,a Marc Branchey,a and Joseph R. Hibbelnb
ASSOCIATIONS BETWEEN INCREASES IN PLASMA N-3 POLYUNSATURATED FATTY ACIDS FOLLOWING SUPPLEMENTATION AND DECREASES IN ANGER AND ANXIETY IN SUBSTANCE ABUSERS
Prog Neuropsychopharmacol Biol Psychiatry. 2008 February 15; 32(2): 568–575.

BRIAN HALLAHAN, MRCPsych and MALCOLM R. GARLAND, MRCPsych
Essential fatty acids and mental health
The British Journal of Psychiatry (2005) 186: 275-277

Hillbrand M, Waite BM, Miller DS, Spitz RT, Lingswiler VM
Serum cholesterol concentrations and mood states in violent psychiatric patients: an experience sampling study.
J Behav Med 2000; 23:519-29.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Anxious About Anxiety?

mid-adult-male-portraitYou’re not anxious about going on vacation or performing a pleasant task. You’re enthusiastic (but not enthused). You could be anxious about going to the dentist or to defend your last income tax return. Here, you’re entertaining a feeling of dread or apprehension, probably lacking clear justification.  Anxiety results from a subjective way of looking at a situation in the absence of a clear and actual danger. Of course, the sweating, increased pulse, and tension coupled with self-doubt about being able to handle the matter tell a different story. Sometimes respirations increase, the mouth gets dry and the intestines gurgle. All this is part of a defense mechanism. Anxiety can be particular, such as a panic attack in a crowd of people, in which case the stimulus can be identified. Or it may be generalized, being a long-term experience with no explanation of its cause. Obsessive-compulsory disorder (OCD) is an anxious state characterized by quandaries of uncertainty and compulsions to act. If the act is frustrated, the uncertainty remains and anxiety is intensified. Anxiety is considered a normal, but transient, response to stress, encouraging a person to take action in order to deal with what is perceived to be a difficult situation.

What’s The Risk?

Women are twice as likely as men to become anxious, mostly because of hormones and the archaic expectations that women are supposed to take care of everybody else before themselves. Age plays a minor role, in that OCD, separation anxiety and social phobias that include panic disorder show up in childhood and the teenage years. Early identification and treatment can forestall later problems. Certain environmental factors, such as poverty, separation from family, overly strict parents, family conflicts, anxious family members and lack of support can induce anxiety disorders. That anxiety runs in families is accepted, but it’s not known if the onset is genetic or learned, or both.

Physiologically, anxiety may be prompted by faulty brain chemistry, where an imbalance of serotonin, for instance, may result in irregular moods and emotions. There may be a structural fault, too.  The amygdala is the part of the brain in charge of processing emotional reactions and memory consolidation, including the recollection of fear.  If it’s overactive, this structure will heighten the fear response and increase anxiety in social situations.   Non-structural physical concerns, such as health problems, can cause anxiety.  Diabetes, alcoholism, heart disease, odd sensations that have no apparent cause, and thyroid disease are a few.

How Do I Handle Anxiety?

Besides the traditional psychotherapy practices and anti-anxiety medications, there are a few things you can do to take charge. First, you need to know that withdrawal from a psychoactive drug can cause anxiety. So, weaning from benzodiazepines causes the thing for which you took the drug in the first place. But beta-blockers, typically used for blood pressure control, have no such effect. They’re used off label to control rapid heartbeat, nervousness, trembling voice and shaky hands that accompany anxiety attacks. Alcohol withdrawal causes anxiety in many people.

Alternative approaches to anxiety treatment include things you can do and things you can swallow. Some modalities that require active participation include music therapy, art therapy, aromatherapy and meditation. With these you have to turn the music on, wield a paintbrush, light a candle, or think about pleasant things. But many people are unwilling or unable to be so engaged because of time constraints, family and job obligations, or simple faineance. Deglutition is the answer.

Options to psychological interventions for anxiety were sought in order to overcome limitations on time and resources. Because of adverse side-effects, alternatives to anxiolytic drugs also were explored. There is a shrub from the South Pacific islands that’s been used for centuries to calm the nerves, Piper methysticum, commonly known as kava kava. In a meta-analysis performed by the Cochrane Database at England’s Exeter University, researchers found that anxious subjects who took kava extract as a sole constituent in their treatment experienced a substantial reduction in symptoms compared to those taking a placebo (Pittler, 2000, 2003). One of the differences between a natural substance and a synthetic one is the time it takes to demonstrate effectiveness.  With a natural substance—in this example, herbal—you get the active ingredient and all the supportive components of the plant. Many enjoy an unexplainable synergy.  With a synthetic one—a drug—you get an isolated chemical that is not toned down by collaborative elements. Although earlier study found kava to be effective at taming anxious moments, it took eight weeks for kava’s superiority to placebo to be displayed (Volz, 1997).

Benzodiazepines are the drugs commonly used to treat anxiety. Their side effects, besides excessive drowsiness and decreased alertness, include paradoxical consequences, such as aggression, impulsivity, and irritability. Cognitive impairment and tolerance can result, as well. Tapering off these medications requires deliberation and a watchful eye. Using kava kava during such an ordeal, patients who were weaned from the drugs while being introduced to the herbal showed good tolerance and improved symptoms over a period of two weeks in a five-week trial in Germany (Malsch, 2001).

Generalized anxiety disorder has responded well to another folk remedy, passion flower. In a study comprising three dozen individuals, half received passion flower plus placebo and half received a benzodiazepine plus placebo in a one-month trial. The outcome showed both the herb and the drug to be effective in controlling anxiety symptoms. The drug, with rapid onset of action, impaired job performance (Akhondzadeh, 2001). The herb did not. Pharmacologically, extracts of the upper parts of the passion flower plant are most dynamic (Dhawan, 2001).

If you’ve taken fish oil for heart and brain health, that’s good. It’s been discovered that low levels of omega-3 fatty acids play a significant role in a number of mental irregularities (Buydens-Branchley, 2008) and that mood disorders respond especially well to omega-3 supplementation, with EPA getting better press than its companion, DHA (Ross, 2007). With a ratio of 3 to I, EPA to DHA, a fish oil product called Kirunal appears more than adequate to satisfy the mono- or adjunctive therapy approach in treating mood anomalies. For decades it’s been given that omega-3 fats are effective in the treatment of major depressive disorders, so it is reasonable to submit that they be likewise in anxiety disorders (Ross, 2009). If the presence of a substance yields a specific result, then the absence of that substance should yield the opposite. A deficit of n-3 fats has been identified in the red cell membranes of anxious persons (Greena, 2006), specifically those with social anxieties. Overall, it’s been proposed that human foods be supplemented with omega-3 fats as a strategy to improve behaviors and cognitive functions (Vinot, 2011). This makes one wonder if the education community needs to sit up and take notice. If that’s an inflammatory statement, n-3 supplementation can ameliorate that while reducing self-induced anxiety (Kiecolt-Glaser, 2011).

A relative newcomer on the anti-anxiety supplement stage is curcumin, the active ingredient of the turmeric spice common to Southern Asian and Middle Eastern cuisine.  Known predominantly as an anti-inflammatory agent, curcumin was found to have antidepressant like activity similar to tricyclic antidepressants, such as fluoxetine and imipramine (Sanmukhani, 2011). Because it is a natural substance, doses of curcumin used in an Indian trial were extraordinarily high, at 100 mg per kilogram of body weight, which equates to about 6,800 mg (6.8 grams) for a 150-pound person. Lesser dosages, from 10 to 80 mg/kg, demonstrated a positive effect on serotonin and dopamine activity, acting similarly to commonly prescribed drugs (Kulkami, 2008).

If you maintain a healthy diet, making sure to get the full array of macro and micro minerals, especially magnesium and zinc, as well as sufficient B vitamins, focusing on B 12, you’ll be able to avoid at least one cause of anxiety. Cutting back on alcohol and caffeine, and getting ample sleep are others. A caveat: before embarking on a supplement regimen to address anxiety, check with a healthcare professional to look for interactions with medicines and foods.

References

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Dhawan K, Kumar S, Sharma A.
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Dhawan K, Kumar S, Sharma A.
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Ernst E.
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Pnina Greena, Haggai Hermeshb, Assaf Monselisec, Sofi Marom, Gadi Presburger, Abraham Weizman
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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

How Balanced Are You?

balancing-actYour checkbook might be. Your diet should be. If you walk a fine line, you must be. The national budget isn’t. Mental stability might be. Balanced, that is. Physical equilibrium, called equilibrioception among the experts, is what we mean here. It’s that state required for walking or standing, and is achieved by a complex interplay of opposing sets of muscles. That—opposition—is a good thing because, if muscles all pulled in the same direction, nothing would get done and you really couldn’t get up after a fall.

In order to maintain balance, the eyes, ears and sense of place work together. The eyes identify where you are and your relationship to your surroundings. The ears contain the vestibular system, in which the semi-circular canals detect rotational movement, and the otoliths (also called statoliths) that send messages of linear motion to the brain. Interestingly, the “-lith” suffix means “stone,” so we really do have rocks in our heads. In this case they’re tiny granules of calcium carbonate that impinge upon the nerve fibers connected to the brain’s center for balance, the cerebellum. The cerebellum works like a computer, continuously comparing actual movement of a muscle group with the motions intended by the motor cortex. Input comes from the eyes. The sense of place is called proprioception, which is sensing the positions of parts of the body in relation to each other. It’s this system that allows you to look at the pencil you laid on the table and to retrieve it without having to look back at the table. It’s this system that lets a person know where his feet are in relation to the rest of his body as he looks at a scene outside the house and then turns to go back to the kitchen. It helps you to put one foot in front of the other when you walk, in the direction you want to go, without your torso going elsewhere.

In walking, our motions emulate an upside down pendulum, hesitating at the peak of its arc before using its stored energy to swing back again. We pivot on the foot that’s on the floor and then thrust our center of balance forward. When the front foot hits the floor, the floor pushes back, slowing us down, which continues as we rise up on that foot to the top of our arc. At that point, we fall (in truth) forward into the next step, and we accelerate again. None of this is energy efficient. It takes about a third of the energy we consume to perform this acrobatic extravaganza. In the meanwhile, muscles are pulling against each other, wasting heat. The imperceptible pause between motions causes a loss of potential energy. During this interval we are actually falling. It’s the brain-as-computer that prevents a mishap. The optimum speed for walking, by the way, is about three miles an hour.

If any of the players in this orchestration malfunction or become impaired, things become unpredictable. This can creep up on us as we age, often without our knowledge and always without our sanction, and set the stage for falls, the leading cause of injury-related visits to the ER, and the primary cause of accidental deaths in people older than 65. It only worsens with advanced age, accounting for 70 percent of accidental deaths in those over 75 (Burt, 1998). Falls and concomitant instability are markers of poor health and declining function, and may signal the presence of acute illnesses that include pneumonia, urinary tract infections or the exacerbation of a chronic condition. Although most falls are not lethal or significantly injurious, they have a psychological side that instills a fear of falling and an increase in self-restriction of activity. This can lead to dependence and institutionalization, followed by a greater risk of falling. What a vicious circle!

The factors that increase the risk for falls among the elderly may revolve around an attitude that pushes the envelope of independence. Seniors are less likely to ask for help in their quest to test their physical boundaries, as their communications skills wane in the golden years (Haines, 2012). Aside from acute or chronic illnesses, using a walker, living alone, being housebound, or being cognitively challenged add to the list of risk factors, which also includes polypharmacy, sensory deficits and being Caucasian (Fuller, 2000). The time to prevent falls begins at a younger age, when flexibility still remains and exercise is doable. An even simpler preventive step is taking vitamin D, a sterol-like compound that reduces risk for falling by a substantial margin (Bischoff-Ferrari, 2004) (Fosnight, 2008) (Bischoff-Ferrari, 2009).

A simple, low-stress exercise that has powerful benefits on physical condition and one that can substantially reduce the risk for falls is Tai Chi Chuan, an ancient Chinese modality that offers relaxation in the process of conditioning. Although considered a martial art, its moderate intensity has considerable positive effect on balance, flexibility and cardiovascular fitness (Hong, 2000), while fine tuning strength and mental control (Li, 2001). As with any exercise regimen, there is the matter of compliance/adherence. Among the elderly, compliance is a serious issue, even after having started a supervised home exercise program perscribed by their doctor (Forkan, 2006). There seem to be more barriers than motivators. From “I don’t have the time,” through “It’s no fun,” to “I’m afraid of getting hurt,” excuses abound (CDC, 1999). Forcing oneself to recruit the energy presently in short supply will help to guarantee the energy needed to continue with an exercise program.

Physical activity that requires standing, reaching, turning and bending, such as occur in housework, cooking and shopping, can improve balance and proprioception. If you think this is sissy stuff, challenge a domestic engineer to a heel-to-toe straight-line race across the family room. One foot directly in front of the other, now, heel touching the toe, no cheating. Of course, if this exercise is part of your daily routine…

The task at hand and the environment in which it is to be performed play a role in keeping one’s balance. Have you ever seen a pro football player run sideways through an obstacle of old tires during practice?  Not that you should try this on the driveway, but at least you should try doing something that’s not common to your comfort zone, like yoga or dancing or aerobics or using a balance ball or standing on one foot with eyes shut or just standing on your toes with eyes closed or doing something, anything to keep yourself off the floor unintentionally. Regarding aging, moving from zero to 60 happens a lot faster than you think. You might not be able to change that, but you can modify the ride.

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*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.