Drug Free Mental Health Solutions

 

BHB (ketone) Supplement Rationale

Mark P. Mattson, Ph.D.
Department of Neuroscience
Johns Hopkins University School of Medicine                                                                                          November 16^th, 2021

 Regular exercise and intermittent fasting each improve a wide range of health indicators including reduced abdominal fat and inflammation, and improvements in glucose regulation, cardiovascular risk factors, mood, and cognition (Neufer et al., 2015; deCabo and Mattson, 2019). These health benefits are associated with a metabolic switch from the utilization of glucose to the utilization of the ketone body beta-hydroxybutyrate (BHB) as a cellular energy source. Compared to glucose, BHB is a more efficient fuel source for cells – more ATP (adenosine triphosphate) is generated per molecule of BHB compared to glucose. In addition, fewer free radicals are generated during the metabolism of BHB compared to glucose. During fasting or oral supplementation with BHB and/or its precursors (salt, ester, Kenetik, MCT oil,), plasma BHB concentrations rise from a baseline of less than 20 micromolar to levels of 1 millimolar or more.

Figure 1: Source – American Brain Council market research data. Error bars = 95% confidence interval for the sample mean. N sizes: Kenetik = 24, Mono Ester = 19, D-BHB Salts = 14, C8 MCT Oil = 4. Participants: men and women ages 40-80 years, body mass 50-94kg

Ketone bodies are particularly beneficial for cells with a high metabolic demand such as neurons and muscle cells. These excitable cells readily use ketones as fuels. For example, PET (positron emission tomography) studies have shown that brain cells switch their fuel source from glucose to ketones when humans consume a ketogenic diet (Courchesne-Loyer et al., 2017). Evidence summarized below suggests that oral supplementation with BHB is beneficial for healthy people as well as for those with several common chronic diseases.

Athletic Performance

As with many other species humans evolved in environments where food was sparse and competition intense. Accordingly, natural selection favored individuals that functioned well in a food deprived – ketogenic – state (Mattson, 2022). During periods of food deprivation, BHB, derived from fat stores, fuels cells of the body and brain. This enables them to sustain their performance for extended periods of time. In addition, evidence suggests that BHB can activate signaling pathways that bolster cellular growth and resilience (Newman and Verdin, 2017). Oral supplementation with BHB has been shown to enhance endurance and recovery from exercise in humans. A study of elite British cyclists showed that their performance improves when they consume a BHB ester (Cox et al., 2016). In the latter cross-over design study the cyclists consumed ~40 grams of BHB prior to a bout of vigorous cycling. The distance they were able to travel during the 30-minute time trial was significantly greater when they consumed the BHB compared to when they did not. Additional analyses showed that BHB supplementation resulted in a decrease in muscle glycolysis and plasma lactate concentrations. Moreover, BHB supplementation resulted in increased intramuscular triglyceride oxidation during exercise. Another study showed that BHB supplementation in the fed state following exercise significantly enhances muscle glycogen synthesis consistent with improved recovery (Holdsworth et al., 2017). Kackley et al. (2017) reported that ingestion of BHB salts prior to a cycling to exhaustion trial significantly improved endurance. However, the latter study also included ingestion of caffeine and amino acids together with BHB in the pretrial treatment, making conclusions regarding the relative contribution of the BHB to the improved performance problematic.

 Results from animal studies support the notion that BHB can enhance endurance performance. Compared to mice fed ad libitum, those on an every-other-day fasting regimen exhibited elevated plasma ketone levels and significantly greater endurance after a 2-month period of daily treadmill running (Marosi et al., 2018). This improved endurance was not associated with an increase in the utilization of endogenous ketones without an increase in VO2 max. Analyses of leg muscles provided evidence that intermittent fasting enhances exercise-induced mitochondrial biogenesis which would be expected to increase ATP availability during exercise. In another study rats fed a diet supplemented with BHB ester ran more than 30 percent further than did rats fed an isocaloric diet supplemented with either palm oil or starch (Murray et al., 2016).

Cognition and Mood

The results of multiple human and animal studies support a benefit of BHB supplementation as one method of enhancing learning and memory and improving mood. One study showed that 14 days of supplementation with BHB monoester improved short-term memory in a digit symbol substitution test (Walsh et al., 2021). The improved memory was associated with increased cerebral blood flow. In a study of more than 900 healthy subjects that included those of ages ranging from 18 to 88, functional brain imaging demonstrated an increase in brain network instability increasing with age (Mujica-Parodi et al., 2020). The neuronal network instability was correlated with poorer performance on cognitive tests. A subset of subjects was administered either BHB ester or calorie-matched glucose. BHB supplementation stabilized neuronal network activity whereas glucose destabilized neuronal network activity. The results of animal studies have confirmed that BHB can enhance learning and memory. Murray et al., (2016) found that BHB ester supplementation for 5 days improved performance of rats on an 8-arm radial arm maze test. They solved the maze more quickly and made fewer errors in doing so.

Exercise and fasting, both of which elevate endogenous BHB levels, can reduce anxiety and relieve depression in humans (Ashdown-Franks et al., 2020). Dietary supplementation with BHB in either salt or ester form reduced anxiety levels in rats in an elevated plus maze test (Ari et al., 2016). Studies have shown that BHB administration reduces anxiety levels in rats subjected to either one prolonged stress or chronic unpredictable stress (Yamanashi et al., 2017; 2020). Human studies evaluating the potential benefits of BHB on mood remain to be performed.

Animal studies have elucidated the cellular and molecular mechanisms by which BHB enhances cognition and improves mood. In addition to providing an efficient energy source for neurons, BHB stimulates the production of BDNF (brain-derived neurotrophic factor) in neurons in the brain (Marosi et al., 2016; Sleiman et al., 2016). BDNF is known to play important roles in learning and memory and can protect neurons against damage in experimental models of epilepsy, Alzheimer’s disease, and Parkinson’s disease (Marosi and Mattson, 2014). In addition to BDNF there are likely many other beneficial effects of BHB on neurons. Indeed, BHB has been reported to activate two transcription factors – CREB and NF-kB – that are known to play important roles in synaptic plasticity and cellular stress resistance (Marosi et al., 2016; Li et al., 2021).

Diabetes and Cardiovascular Disease

Fasting and exercise increase endogenous BHB levels and enhance insulin sensitivity. Findings from a randomized controlled trial on people with obesity demonstrated that consumption of BHB ester reduces the glycemic response to an oral glucose challenge (Myette-Cote et al., 2019). Another study showed that BHB supplementation reduces fasting glucose and hemoglobin A1C lc levels in patients with type 2 diabetes (Thai et al., 2021). Dietary supplementation with BHB was reported to be effective in both the prevention and treatment of heart failure in a mouse model (Yurista et al., 2021). Altogether the available evidence suggests potential benefits of BHB supplementation in prevention and treatment of diabetes and cardiovascular disease.

Epilepsy, Alzheimer’s Disease and Parkinson’s Disease

Animal studies have shown that BHB administration can protect neurons in the brain against dysfunction in experimental models of epilepsy, Alzheimer’s disease (AD), and Parkinson’s disease (PD). It is well known that a ketogenic diet can reduce seizure occurrence and severity in patients with epilepsy. Evidence suggests that BHB mediates these beneficial effects of ketogenic diets. Dietary supplementation with BHB ester prevented seizures in a mouse model (Cheng et al., 2020). AD is characterized by progressive impairment in short-term memory which is associated with the accumulation of extracellular accumulation of aggregated amyloid beta-peptide plaques and intracellular accumulation of aggregates of hyperphosphorylated Tau in the hippocampus and cerebral cortex. These cognitive and pathological features are replicated in the 3xTgAD mouse model (Oddo et al., 2003). Dietary supplementation with BHB ester ameliorates cognitive deficits and lessens the accumulation of amyloid plaques and hyperphosphorylated Tau in in hippocampal and cerebral cortical neurons (Kashiwaya et al., 2013). Cell culture studies have shown that BHB can protect neurons against death in models relevant to AD and PD (Kashiwaya et al., 2000). Infusion of BHB preserved dopamergic neurons and ameliorated motor impairment in a mouse model of PD (Tieu et al., 2003).

Mild cognitive impairment is often prodromal of AD. Supplementation with medium chain triglycerides (MCTs) which are fatty acid precursors to BHB can improve cognition in elderly people with mild cognitive impairment (Fortier et al., 2021). Another study of 20 subjects with mild cognitive impairment or early AD showed that MCT oil supplementation increased plasma BHB levels and improved performance in a paragraph recall test (Reger et al., 2004). Eight weeks of dietary ketosis improved cognitive performance in PD patients (Krikorian et al., 2019). A recent study showed that consumption of a BHB ester enhances endurance performance in PD patients (Norwitz et al., 2020).

Ketogenic diets can elevate plasma BHB levels, but such diets typically contain excessive amounts of saturated fats, cholesterol and proteins, and may lack health-promoting nutrients provided by vegetables and fruits. In addition, ketogenic diets are often less palatable than diets containing carbohydrates. BHB has very bitter taste which has been problematic in the development of dietary BHB supplements.

Kenetik, the proprietary VitaNav BHB preparation, has a pleasant citrus taste and effectively elevates circulating BHB levels, thereby making it an attractive supplement for people interested in improving their physical and mental performance and reducing their risk for chronic diseases.

See more articles on Drug Free Solutions for Anxiety and Depression below the following references. 

REFERENCES

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Li Y, Zhang X, Ma A, Kang Y.Rational Application of beta-Hydroxybutyrate Attenuates Ischemic Stroke by Suppressing Oxidative Stress and Mitochondrial-Dependent Apoptosis via Activation of the Erk/CREB/eNOSPathway.ACSChemNeurosci. 2021 Apr 7;12(7):1219-1227.

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Drug Free Solutions for Overcoming Anxiety & Depression

 Is anxiety an issue for you? For a lot of people that’s becoming more of an issue. A new study found 4.3 million Americans with “full-time jobs” had an anxiety disorder. If you think that’s bad consider all those who don’t have a full time job, but need one! Plus all the retired seniors living on a fixed income.

What makes this worse is the fact that we know anxiety can elevate cortisol, which over time, if unchecked, can damage areas of the brain where memories are made — and thus increase one’s risk for cognitive decline.

Moreover, most medications for anxiety are addicting, requiring more and more to get the same effect, often with some nasty side effects. As we reported last October, another new study found a popular class of medications for anxiety, called Benzodiazepines — which include Xanax (alprazolam), Valium (diazepam), Restoril (temazepam) and Ativan (lorazepam) – can hasten the onset of Alzheimer’s.

Moreover, according to a study published in the February 2015 journal JAMA Psychiatry, seniors are even more likely to use these — about 7.4 percent of those 51 to 64 and 8.7 percent of seniors 65 to 80. So what are some healthier alternatives?

Pause to ID the Cause?
Unfortunately the feed-ins to an anxiety disorder can be rather complex. These may involve genetics, early childhood nutrient intake and experiences that feed current perceptions of self and others, that interact with a plethora of stressors that may include environmental toxins, allergins, addictions, others, dietary deficiencies, infections, food sensitivities, low blood sugar, hormones, etc.

All of these and more, feed disturbances in our body’s chemistry, as we struggle to cope. But at the heart of the problem are a host of fight or flight hormones like adrenalin and it’s cousin cortisol, defended against by two chemical messengers – serotonin, and GABA. These we call the chemistry of calm.

How to Foster The Chemistry of Calm

We obviously don’t have the time or room to discuss all of these various influences. What I want to share with you here, are six ways to safely and effectively boost your chemistry of calm, to counteract this anxiety producing onslaught. These are somewhat in the order of ease and expense.

First is deeper slower breathing. For years I facilitated a course on depression recovery, and was amazed to see how effective this simple strategy was for many people. Almost any strategy that will slow and deepen your breathing may help. For example, simply counting to four while you breathe in, and again counting to four while you breathe out, can help. It’s also helpful to breathe from deep down using your diaphragm, rather than using just the top of your lungs. It may help to imagine you have a balloon in your tummy, that expands as you breathe in and count to four, and deflates as you breathe out and count to four. Simply doing half a dozen or so repetitions of this deep breathing can do much to reduce the tension in your body, and oxygenate your brain. One of the best validated techniques is Kriya breathing learn more at http://www.artofliving.org/sudarshan-kriya

Go for a walk or gentle jog. Almost any physical activity will deepen our breathing, but walking also helps to pump adrenalin out of our system, and create more serotonin to allow our muscles and nerves to calm down and relax. It also improves digestion, and the circulation of oxygen and nutrients to the brain, to enable us to think better.

Consider tapping. I don’t have the space to explain that here, but it’s a simple activity that is extraordinarily effective for many in reducing anxiety. Go here or simply google “tapping anxiety” to learn how to do this free and effective technique.

Eat your vegetables. A growing number of studies, both in the US and Europe are showing that when anxious or depressed people increase their consumption of foods rich in B-vitamins, complex carbs, specific amino acids (proteins) and essential minerals like magnesium, they both feel better and are able to think better. Their psychological stress is alleviated.
Vitamins B-9 (folate), and B-12 help our body create SAMe (S-adenosylmethionine), which both increases and makes our nerves more receptive to serotonin. The result is much more powerful as a mood elevator than any vitamin. In fact, in a 2009 Harvard study SAMe was found to be as effective—if not more effective—than pharmaceutical drugs for “treatment-resistant” patients, without the side effects often associated with such drugs.

The one contraindication for SAMe is that it should not be taken by those with a history of mania or a “bi-polar” disorder. Fish oil high in DHA and EPA may be more helpful for them.

Folate sources are foliage like green leafy vegetables such as spinach, chard, kale, mustard greens, parsley, and broccoli, as well as beets, beans, and lentils. Additionally, these vegetables contain carbs, fiber, protein and magnesium to sustain healthy blood sugar levels blood. Magnesium also facilitates serotonin production, and has a relaxing effect on muscles and nerves.

It’s no wonder then that a recent major study in Great Britain with more than 8,000 subjects showed that the consumption of seven or more servings of vegetables and fruit per day was more strongly associated with well-being and satisfaction than either income or exercise.

Go light on the meat. Red meat contains methionine, iron, and other amino acids which can increase energy and alertness, but in excess may contribute to inflammation and inhibit relaxation. So eat red meat sparingly.
However, some fish or animal products, like milk and eggs, may be necessary as they contain B12 not found in fruit or vegetables. Additionally B-12 is sometimes hard to assimilate from food, especially for seniors. Therefore the sublingual methylcobalamine form of B12 is often recommended for best results—especially for strict vegetarians (vegans)—and can often effect a significant improvement in mood and energy within days.

Consider food supplements that enhance serotonin and GABA. This is especially important for those trying to break an addiction to antianxiety drugs, like Xanax, Ativan, or smoking. The most imporant for serotonin production are the amino acid L-tryptophan, and the herbs valerian and St. John’s wort. L-tryptophan provides the basic building blocks to make serotonin, and the other two herbs boost it’s production.
Theanine, is a protein contained in green tea that helps create GABA in the body, but GABA is also now available, which may work even better, when taken in combination with other calming agents.

Ashwaganda and Rhodiola are two powerful herbs referred to as adaptogens. They both have been shown to help control cortisol, and strengthen the body’s ability to adapt or respond appropriately to physical, mental, and emotional stressors. Both have also been shown to promote a healthy brain and memory.

My personal preference for anxiety reduction is the serenity prayer, “God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.” Many things I cannot change, but fortunately my body chemistry is not one of them.

Dave Larsen

Growing Your Brain with Meditation
Lynn Johnson, PhD
Positive Psychology Instructor 

I am getting old. As a Baby Boomer, I am interested in how to get myself back to feeling young, energetic, and healthy. I am grateful to live in this amazing world and want to stick around and continue to contribute.

Meditation is turning out to be one of the best ways to improve and enhance my life. I use Autogenic Training and try to do 15 – 20 minutes every day at noon. I have been doing that for thirty years, more the past few years. You can get my audio file on how to do Autogenic Training here.

There are lots of other ways to meditate. YouTube has many many good videos.

Richie Davidson is perhaps the premier researcher on meditation and the brain. Here is a new article on his findings:

Here is a short link: http://bit.ly/k9sUcg

The core finding is that while most training develops a specific part of the brain, meditation seems to grow the entire brain. So learning a new language or how to play a musical instrument develop those particular parts of the brain that are involved, they do no good for other parts.

Here is an excerpt: “To summarize, mental training of cognitive skills as cultivated by FA and OM meditation has been associated with changes in brain structure and function, as well as improved task performance. These findings provide initial support for the idea that systematic mental training of cognitive skills, as cultivated by meditation, can improve performance on external tasks that call upon the trained skills, and hence can strengthen specific cognitive processes. These findings also add to a growing body of literature demonstrating plasticity in the adult brain, and may provide initial insights into the basic mechanisms that underlie cognitive process-specific learning.”

Tackle this report. Read it yourself and ponder. I so appreciate open source publishing, where I can download the whole report and read it.

ANOTHER RECENT REPORT: While many reports on meditation tell us it makes us happier (higher energy in the left prefrontal lobe, the happiness center), usually subjects meditate for an hour a day for eight to twelve weeks. Lots of practice. Many expert meditators have ten thousand hours or more of practice.

A new report is “Frontal Electroencephalographic Asymmetry Associated With Positive Emotion Is Produced by Very Brief Meditation Training.” by Christopher A. Moyer, Michael P. W. Donnelly, Jane C. Anderson, Kally C. Valek, Sarah J. Huckaby, Derek A. Wiederholt, Rachel L. Doty, Aaron S. Rehlinger, and Brianna L. Rice.

The findings tell us that 5 – 16 minutes a day for five weeks produce a significant increase on the left prefrontal activity, and that means increased happiness. In only five weeks! This is very encouraging.

There are lots of ways to meditate. They all work. I use Autogenic Training. I have never been associated with Buddhists. But all these mental disciplines help grow your brain and make you happier and more effective. Whatever model you want to follow, develop your brain, develop your capacity. You won’t be sorry.

You can request a copy of this article from the first author. Christopher A. Moyer, University of Wisconsin-Stout, 220 10th Ave. East, Menomonie, WI 54751 E-mail: christopher.a.moyer@gmail.com

DOES SUGAR MAKE YOU STUPID?
sugar

IN MY LAST POST I talked about eating patterns. I’d like to say a bit more about that. Let’s talk about Omgea-3 fatty acids.

Let’s review some new research on DHA. DHA, docosahexanoic acid, is a PUFA, an Omega-3 poly-unsaturated fatty acid (PUFA). It is an essential acid, or in other words, we cannot manufacture that in our own bodies. We have to consume it. We get it from animal sources, or we can consume ALA, alpha linolenic acid. ALA is a short-chain PUFA that our bodies can convert into DHA and EPA, eicosapenanoic acid. They are anti-inflammatory, in that they quench the inflammation that can cause heart disease, asthma, arthritis, strokes, all of the inflammations that end with “itis” like dermatitis. Many psychiatrists are looking at depression as an inflammatory disease.

Most people don’t know anything about DHA, but it is vital for a high functioning brain. And we aren’t getting much of it at all. That is because over the past fifty years, the content of our food has dramatically changed. ALA is present in green vegetation, and throughout most of human existence, we ate animals that had eaten grass and browse (shrubs). Milk, meat, cheese, and eggs were all rich in DHA and EPA because they came from animals fed on grass. Those animals did a good job of changing ALA into DHA and EPA, and we were more healthy because of it.

But in the 1970s we began to eat animals that were fed not on grass and greens but rather on corn and soy. Those are high in Omega-6 fatty acids, which are pro-inflammatory. Our body needs inflammation so as to deal with injuries and infection. But because we feed our food animals such huge amounts of grains and soy, we consume huge doses of Omega-6 and little Omega-3. We are in a continual state of inflammation. Wikipedia on inflammation: http://en.wikipedia.org/wiki/Inflammation.

So I encourage people to shift their diets much more toward healthy sources of Omega-3s, including fatty ocean fish, the best being Alaska salmon, since it is against the law in Alaska to farm-raise salmon. Mackerel, sardines, tuna, all fish that are darker in color are good Omega-3 sources. Of course, if you eat grass-fed beef, if you can find a local source of “pastured”chicken (not organic, which are simply chickens fed organic corn), your diet will be much healthier.

A new study from UCLA shows that high-fructose corn syrup (the sweetener that is widely used in all manufactured foods) makes us stupid. A high sugar diet (table sugar is about 40% fructose, and high fructose corn syrup is about 55% fructose) slows down the brain and hampers learning and memory. Fructose is in baby food, applesauce, ketchup and other condiments, soft drinks . . . in fact, if you buy a manufactured food, it is everywhere. Now we know why we keep eating it. It is everywhere. We eat it. Our brains don’t work as well. We are made more dumb, so we don’t notice how bad it is for us.

“Our findings illustrate that what you eat affects how you think,” said Fernando Gomez-Pinilla, a professor of neurosurgery at the David Geffen School of Medicine at UCLA and a professor of integrative biology and physiology in the UCLA College of Letters and Science. “Eating a high-fructose diet over the long term alters your brain’s ability to learn and remember information. But adding omega-3 fatty acids to your meals can help minimize the damage.”

So if you want to eat sugary foods, at least eat some salmon to go with it. But even with the omega-3, you are doing some damage. The better path is to avoid all sweets. All those years ago my mother told me that sugar was bad for me. As it happens, she was right.

If you want to read the study’s press release, here is it: http://bit.ly/Ja70nT

So shift your eating to locally produced pastured chickens and grass-fed beef, local vegetables, and whole grains. In the words of the great poet/singer/songwriter, Joni Mitchell, “And we’ve got to get ourselves back to the garden.”

DO STATINS DAMAGE MENTAL HEALTH?
I just read a new report. It turns out that drugs that lower cholesterol, including statins, damage memory.

The article appears in JAMA, the Journal of the American Medical Association. The lead author is Brian Strom.|
http://www.ncbi.nlm.nih.gov/pubmed/26054031

The findings are fairly straightforward: If you take any drug, statins or non-statins, for lowering cholesterol, your memory will suffer. This is significant and alarming. Memory problems worry us old fogies, and even if they don’t mean that we are developing Alzheimer’s, they are very distracting and upsetting. They can trigger depression and anxiety states, depending on how we view the memory lapses.

The article itself is behind a paywall. Here’s how you get a reprint: Brian L. Strom, MD, MPH, Rutgers Biomedical and Health Sciences, Rutgers University, 65 Bergen St, Ste 1535, Newark, NJ 07103 chancellor@rbhs.rutgers.edu

We already know that benzodiazepines will damage memory, and we also know that use of benzos in older people is a risk factor for developing Alzheimer’s. Is it the drug, or is it the underlying anxiety that triggers dementia? I don’t know. I used to know but I forgot. OK, that is a cheap joke.

But The BMJ (formerly, British Medical Journal) published an editorial in 2014 warning of the trend toward Alzheimer’s in patients taking benzodiazepines, especially the long-acting versions. The fact that the type of drug influences how likely Alzheimer’s becomes, makes me think that perhaps it is in fact the drug, and not the underlying anxiety, that drives the dementia. The BMJ is open, no paywalls, so you can read the article from their website.

http://press.psprings.co.uk/bmj/september/benzodiazepineedit.pdf

(Read it yourself and decide.)

So benzos, that do acutely influence / damage memory, also trigger Alzheimer’s. Could statins do the same? Fortunately there are studies suggesting that perhaps statins reduce the risk of dementia. I am somewhat less concerned, although memory problems always do concern me. At least we seem to dodge the dementia bullet if we take statins. Do they?

But the statins aren’t out of the woods yet. We also know for sure that statins raise the risk of several other emotional disorders. In 2010, the online version of Psychiatric Times published a review article by Arlene Kaplan. We learn from that statins do raise the risk of both anxiety and depression, and fairly substantially.

Kaplan reports: ““It has long been reported that total serum cholesterol levels are consistently lower in more severely depressed and more aggressive patients,” said James Lake, MD, chair of the APA’s Caucus on Complementary and Integrative Medicine, and visiting assistant professor of medicine at the Center for Integrative Medicine at the University of Arizona School of Medicine in Tucson. “Because of these findings, it has been suggested that total cholesterol might be a clinically useful biological marker for predicting the risk of suicide and that it may be of prognostic value in managing severely depressed patients.” – See more at: http://www.psychiatrictimes.com/mood-disorders/statins-cholesterol-depletion%E2%80%94and-mood-disorders-what%E2%80%99s-link#sthash.gyDMx4xb.dpuf”

http://www.psychiatrictimes.com/mood-disorders/statins-cholesterol-depletion%E2%80%94and-mood-disorders-what%E2%80%99s-link

The surprising implication is that low cholesterol may be a marker for suicidality.

The bottom line is that both depression / irritability and anxiety are raised by statins, likely because the statins interfere with serotonin.

Are we in mental health asking about statins as a factor in irritability, depression, and anxiety? I doubt it. I know I haven’t been, and likely many in the shrink community don’t.

Finally, what if you have high cholesterol and are taking statins? We need always to consult with our MDs, but frankly, many MDs are far too loyal to statins and don’t want to consider the low-hanging lifestyle change fruit. Statins are a huge money maker for the pharmaceutical houses, and there are equally huge budgets for promoting them to the MDs. Consider a second opinion, ideally from someone in a teaching hospital or at a medical school. There is a lot of evidence that statins are not terribly helpful drugs, and likely they do not reduce total all-cause deaths. They can reduce heart attack risk, but they raise risk of other problems, so some MDs consider it a wash.

For example, in a recent meta-analysis, reviewing the researcher up to date, the authors said:

“There is a categorical lack of clinical evidence to support the use of statin therapy in primary prevention. Not only is there a dearth of evidence for primary cardiovascular protection, there is ample evidence to show that statins actually augment cardiovascular risk in women, patients with Diabetes Mellitus and in the young. Furthermore statins are associated with triple the risk of coronary artery and aortic artery calcification. Cardiovascular primary prevention and regeneration programmes, through life style changes and abstaining from tobacco use have enhanced clinical efficacy and quality of life over any pharmaceutical or other conventional intervention.”

http://www.scirp.org/journal/PaperInformation.aspx?PaperID=34065

S. Sultan and N. Hynes, “The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns,” Open Journal of Endocrine and Metabolic Diseases, Vol. 3 No. 3, 2013, pp. 179-185. doi:10.4236/ojemd.2013.33025.

When someone who has no history of heart disease is given a statin, it is for prevention, not so much treatment. The truth is that a drug is not an ideal primary prevention strategy. Lifestyle changes are what will work in prevention., as Sultan and Hynes say above. Which?

For instance:
– Quit smoking. There are many excellent pathways to a tobacco free life.
– Step up your exercise. Shoot for 150 minutes a week. Interval training likely does more good.
– Change your diet: Mediterranean / “rainbow” diet will boost the HDL (good cholesterol) and likely lower the bad. Eat only whole grains, high omega-3 foods such as grass-fed beef and wild caught salmon, mackerel, sardines, green leafy vegetables, and the like. There are eggs with high levels of omega-3.
– Especially in terms of diet, eliminate all sugar and simple carbs. Those raise the “bad” LDL. Eat oats. Lower your intake of white rice, potatoes, and bread.
– Junk food contains fats called “transfats” and they are extremely bad for your heart. Stop! No fast foods, convenience foods, packaged foods.
– Get some sun! Vitamin D can help in many ways.
– Sleep at least 7 hours a day.
– Cultivate happiness, optimism, and gratitude. Practice meditation.

Leave your opinion below. If you find this post thought-provoking, please share it. I hope this helps alert us to mental health factors that we might overlook.

GROW YOUR BRAIN
Lynn and two oldest sons at the end of a 110 mile mountain bike ride.
Lynn and two oldest sons at the end of a 110 mile mountain bike ride.

WHAT IF WE HAD A SIMPLE HABIT that would grow our brain, lengthen our life, and help eliminate depression?

Would you be interested? Maybe not, because few people are actually doing it. Only about one person in four.

I am talking about exercise, of course. I am particularly interested in intense exercise, the kind that leaves your heart pounding and your lungs clamoring for more air. I am seeing more and more evidence for the widespread value of intense exercise. It helps you in so many ways.

Here is a fascinating abstract from The Journal of Psychiatric Research.
(link: http://www.sciencedirect.com/science/article/pii/S0022395616300383)

Exercise as a treatment for depression:
A meta-analysis adjusting for publication bias
ABSTRACT

The effects of exercise on depression have been a source of contentious debate. Meta-analyses have demonstrated a range of effect sizes. Both inclusion criteria and heterogeneity may influence the effect sizes reported. The extent and influence of publication bias is also unknown. Randomized controlled trials (RCTs) were identified from a recent Cochrane review and searches of major electronic databases from 01/2013 to 08/2015. We included RCTs of exercise interventions in people with depression (including those with a diagnosis of major depressive disorder (MDD) or ratings on depressive symptoms), comparing exercise versus control conditions. A random effects meta-analysis calculating the standardized mean difference (SMD, 95% confidence interval; CI), meta-regressions, trim and fill and failsafe n analyses were conducted. Twenty-five RCTs were included comparing exercise versus control comparison groups, including 9 examining participants with MDD. Overall, exercise had a large and significant effect on depression (SMD adjusted for publication bias = 1.11 (95% CI 0.79-1.43)) with a failsafe number of 1057. Most adjusted analyses suggested publication bias led to an underestimated SMD. Larger effects were found for interventions in MDD, utilising aerobic exercise, at moderate and vigorous intensities, in a supervised and unsupervised format. In MDD, larger effects were found for moderate intensity, aerobic exercise, and interventions supervised by exercise professionals. Exercise has a large and significant antidepressant effect in people with depression (including MDD). Previous meta-analyses may have underestimated the benefits of exercise due to publication bias. Our data strongly support the claim that exercise is an evidence-based treatment for depression.

What do you think of that last sentence? Exercise cures! Well, that may be too strong, but it is clear that we can achieve recovery, that is, a Beck / CES-D score of less than 10 by using vigorous exercise. I asked Dr. Schuch to comment on this post, as he is the lead researcher for the article. He points out that depression is generally a chronic condition, and as such, the “cure” of exercise needs to be ongoing. So let’s say this: Exercise is a dramatic help for treating depression.The effect size, what they here call the standardized mean difference (SMD), also known as Hedges G, is simply a measure of how far the distribution has moved. The reported SMD in this meta-analysis is 1.11. That is huge. That means that the whole group has moved 1.11 standard deviations toward the healthy side. Most psychotherapy SMDs run about .7 to around 1. That is very good.

If you wonder what the SMD of antidepressant drugs is, it runs about .2 to .4. There is no drug trial I am aware of that shows an effect size, or SMD of .5 or greater. Kirsch and others point out that the placebo response is very large with antidepressants, so people receiving those drugs have a difficult time knowing whether it is the drug or the placebo effect making them feel better.

See: https://www.sciencebasedmedicine.org/antidepressants-and-effect-size/

Now we see from this comparison that exercise is a remarkably effective intervention with depression.

(Psychiary has tried over and over to discount Irving Kirsch and others who point out the limits and failings of antidepressant medication. Their argument boils down to “Who are you going to trust, me or your own lying eyes?” Their arguments aren’t convincing. I do not say that there is no effect from taking antidepressants, but the effect is small. There is no antidepressant effect in mild and moderate depression. There is a good effect in severe and very severe depression, well above 30 on the Beck or the CES-D. Some people recover completely with drugs alone, about 30% at the most (at least in the STAR*D study), but the rest are either not helped or only partially helped.)

https://en.wikipedia.org/wiki/STAR*D

So rigorous exercise is much better than taking an antidepressant. You can also use it to enhance medication. Why weren’t you told this a long time ago? The authors of the current meta-analysis argue that it is publication bias.

That means that the authors and editors of journals don’t want it to be true. For example, Cooney et al. 2013 Cochrane review of exercise and depression was not encouraging. They argued that exercise wasn’t any better than medication. I thought it an odd way to state something. Why not say that exercise is every bit as good as medication, cheaper, and without the potential side effects? Frankly, it bothered me that the Cooney et al. report was so dismissive, when I had seen some individual studies that were much more supportive.

That’s why I thought there was a slant in the Cochrane report. This current study finds good evidence for publication bias. I personally see some bias there. You decide: http://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depression

Why does exercise help so much? Here’s my opinion: Because it stimulates BDNF, brain-derived neurotropic factor. Break it down. The brain makes a factor, like a hormone, that makes the brain itself grow. Exercise stimulates BDNF. As also, eating a vegetable-based diet, higher in fat, lower in protein, and very low in simple carbs. Sugar is a poison to your brain, and if you brain dies, your body will soon follow.

Untreated depression shrinks the brain. The BDNF drops off. Particularly hard hit is the hippocampus, the memory center. Untreated severe depression is also a risk factor for Alzheimer’s. But when you exercise, or eat far more vegetables, or when you do things that make you feel socially connected, or when you are learning, all such lifestyle changes boost BDNF and grow the brain. Or, if you take antidepressants or get into psychotherapy or both, BDNF also goes up. We shrinks are preventing Alzheimer’s!

How many of you therapists are promoting simple vigorous physical activity as a pathway to recovery? Probably not enough. One survey found about 20% of therapists were promoting exercise, in spite of research and experience supporting it. Lifestyle changes can promote physical and emotional health. The two are linked. Strong body, strong mind.

Take a look at the authors and nationalities of this study:

Felipe B. Schuch a, b, * , Davy Vancampfort c, d , Justin Richards e , Simon Rosenbaum f , Philip B. Ward f , Brendon Stubbs g, h

a. Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
b. Programa de Pos Graduaçao em Ciencias M
edicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
c. KU Leuven e University of Leuven Department of Rehabilitation Sciences, Leuven, Belgium
d. KU Leuven e University of Leuven, Z.org Leuven, Campus Kortenberg, Kortenberg, Belgium
e. School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
f. School of Psychiatry, University of New South Wales, Sydney, Australia and Ingham Institute for Applied Medical Research, Liverpool, Australia
g. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
h. Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom

Wasn’t that fun? How do six authors from Brasil, Belgium, Australia, and the United Kingdom get together for an article like this? Dr. Schuch offered this:

We have formed a small group or researchers to develop a really important multicentric study including people from several places of the 5 continents. Interestingly, from that meeting, we found that we could great a small, but productive group (the six authors). We have been working in several projects and reviews. Maybe you can find many others papers that can be interesting, related to exercise and mental health.
Please, find the links of the authors google scholar, in case you have interest.
https://scholar.google.com/citations?user=TtHRhDEAAAAJ&hl=nl
https://scholar.google.com/citations?user=WjhxXf4AAAAJ&hl=nl
https://scholar.google.com/citations?user=umTK08kAAAAJ&hl=nl
https://scholar.google.com/citations?user=lx4BXKsAAAAJ&hl=nl
https://scholar.google.com/citations?user=Jbu489QAAAAJ&hl=nl
https://scholar.google.com/citations?user=IInWrl0AAAAJ&hl=nl

If you want your own copy of this article, and don’t want to pay the paywall fee, email the first author: felipe.schuch@ufrgs.br

THE LIFESTYLE TREATMENT

A recent report in The American Journal of Public Health shows that social isolation is as dangerous for our health, as we age, as smoking or weight problems. Social isolation is a lifestyle issue. Some people turn away from others, and some turn towards others. Mike Lambert has argued in some of his research that therapists can and should change social isolation into connection habits. He further argues that it should be one of a therapist’s core skills. Do therapists actually know how to coach people toward better connection?

Another lifestyle issue that was just published in The Journal of Affective Disorders is the amount of light in the bedroom is related, at least in the aged, to the risk of developing depression. That is, people sleeping in bedrooms with more ambient light are almost twice as likely to develop a depression as people sleeping in bedrooms that are very dark.

Both of these studies focus on issues that I think of as lifestyle interventions. Why would I bring two such different articles together into this post? Simply because lifestyle interventions are an unknown country, and an exciting one at that. We don’t know how much difference a more comprehensive approach to lifestyle coaching would make. Would it be as good as or better than psychotherapy or medication? We don’t know but it would be important to find out.

Michael Frisch has a lifestyle approach to treating mental illness that has been shown as somewhat better than treatment as usual, or TAU. If changing the ambient light in a patient’s bedroom has a positive effect on mental health, what will happen if we change several lifestyle issues? These are studies on components of a mentally healthy lifestyle. A broader view would see lifestyle change interventions as a sea change in counseling and therapy.

Another example comes to mind. A recent Cochrane report (Cochrane reports are about evidence-based interventions in medicine) showed that exercise is not better than meds or psychotherapy for depression. Conversely, exercise is statistically as good as depression, and I found the authors’ emphasis on it being no better than TAU to be passing strange. If a single lifestyle change produces as much benefit as either therapy or medication, I find that rather extraordinary. This means that all of the emphasis on changing thinking patterns, cognitive restructuring, might be only one pathway to mental health.

Since Freud, the unquestioned assumption is that our thinking creates our world. It is an attractive understanding. If you are psychoanalytic or if you are cognitive-behavioral, the assumption is the same. Naturally, to change our thinking is assumed to be a royal road to better mental health. It is a premise that no one has systematically checked.

Now there is this developing area of lifestyle changes as pathways to mental health. Yet lifestyle changes are entirely focused on behavior, not on thought. So the question is whether our thinking patterns are as important as we have believed.

To be fair, the history of psychotherapy shows that changing our thinking does actually change our emotions. Again, Freud showed that clearly, and since then, changing how we talk about our problems does change how we experience them. In that way, there is absolutely nothing surprising about several recent studies comparing psychoanalytic and cognitive treatment of obsessive-compulsive disorder, depression, and other complaints, showing equal effectiveness. Why wouldn’t they? They both rest on that same foundation.

But lifestyle is another pathway, and it makes us wonder whether acting in healthier ways changes our self-talk and reactions to the world. My final editorial comment is simple. If you will use a consistent measurement, you will know what is working. Use the CES-D, a free, public-domain instrument. I recommend the OQ-45, a checklist of 45 items that is widely used, clinically and in research. Use Scott Miller’s four item checklists. Use Goal Attainment Scaling. But use something. Then you can do your own experiments. Flip a coin when a problem comes up. Heads, apply Lifestyle Interventions. Tails, change your thinking. See what works.

BLOOD SUGAR AND BREATHING

When you are fasting, like when you get up early in the morning and haven’t eaten since your evening meal, your blood glucose should be under 100. If you consume any kind of food, especially food high in sugar, that glucose level should rise.

If the blood glucose is low and if it doesn’t go up a lot after you eat, that suggests a healthy state. The person’s body is metabolizing the sugar well, and the tissues are able to take up the sugar easily.

Contrary, if your fasting blood glucose is higher that one hundred and if it shoots up after you eat, your body has become resistant to insulin. That means you are on a path toward type two diabetes, what used to be called “adult onset” diabetes.

Sadly, today it is not an adult disease. Even our children are at considerable risk. Our bodies become resistant to insulin by eating too much sugar and by not maintaining a high level of physical exercise. The pancreas is forced to pump out more and more insulin, which in turn, makes the tissues less and less responsive to insulin.

Ted Wilson and colleagues have shown that relaxation breathing, such as breathing in to a count of three and out to a count of six, emphasizing diaphragmatic breathing, reduces blood sugar. This could be a useful clinical tool to help people manage blood sugar. It wouldn’t allow us to eat sugary foods, and it doesn’t eliminate the need to exercise vigorously, but it is a help.

Here is the study abstract: http://tinyurl.com/mlmx852 This is one of those “subscribe to get the article” sites, but you can see Wilson’s email address and write to him for a reprint.

The majority of my readers are in the mental health field. The reason this blood glucose finding might be important to you is because Malcom Peet, a British psychiatry researcher, has shown that the more sugar a population consumes, the more depression and schizophrenia rises. That study is here: http://tinyurl.com/lsrsprk

That link takes you to the abstract. Unfortunately, the link to the full text is broken. The point is that blood sugar can apparently influence our mental health.

You see, inflammation can trigger symptoms in some people, and a high level of sugar intake raises your inflammatory response. In everyone, higher inflammatory states (high levels of c-reactive protein, cortisol, and other markers of inflammation) makes us more irritable and emotionally reactive.

Relaxation breathing also lowers blood pressure. As I am writing this, my blood pressure is 133 / 78, a bit on the high side. After two minutes of relaxation breathing, the blood pressure is 122 / 74. I am a bit distracted because Ruby The Dog is dropping tennis balls in my lap, and that may have boosted the BP a bit.

(We are dog-sitting. To learn more about the Amazing Ruby The Dog, please go to http://enjoylifebook.com and watch the video.)

Bottom line: Breathing in a meditative or mindful manner, what Wilson et al. call Relaxation Breathing, has many benefits. It doesn’t take long, and it easy to learn. Hard to see how you go wrong with that.