Friday, September 17, 2010

Is the Runner’s High a Quick Buzz or a Long-Term Benefit?

Methinks that the moment my legs began to move, my thoughts began to flow.

- Henry David Thoreau

Every day I have patients who come to me asking what they should take to help prevent memory loss or to treat depression or “brain fog” – a loss of ability to concentrate fully. I have several supplements that can help those things, but there is one prescription that is more proven, consistently helpful and accessible than any pill – prescription or over the counter supplement. It’s called exercise.

Evidence is mounting that physical exercise is good for the brain as well as the body. Of course we know that vigorous cardiovascular exercise, like running, elicits an increase in endorphin production, those feel-good chemicals made by our brain that elevate our emotions. But we also know that there are other, longer term, neurologic benefits of exercise.

It turns out that aerobic exercise slows the loss of gray matter, the part of the brain that atrophies as we age. This is one way in which exercise keeps us mentally young. Gray matter makes up the cerebral cortex, the part of the brain that allows for processing of information. Research shows that the more dense the gray matter is in a particular region of the brain, the more intelligence or skill the brain's owner is likely to have.

While such aerobic exercise like running or using the elliptical machine prevents brain aging, scientists have found that anaerobic exercise, such as working out with weights, stimulates the creation of new brain cells in the part of the brain responsible for memory and learning – the dentate gyrus (part of the hippocampus). Many people think that the brain stops growing by adulthood, but new nerve cells continue to be generated in the hippocampus throughout our lives. Exercise can help stimulate the growth of such cells, which are essential to learning.

On the flip side, stressful events have been shown to destroy these newly developed nerve cells in the hippocampus, making it harder to retain new lessons learned or memories created. This is how those stress-reducing endorphins that get stimulated by vigorous exercise can help protect your brain.

There are other ways in which exercise is neuroprotective, meaning it builds up our ability to defend ourselves against neurologic decline. Exercise causes levels of a substance called Brain Derived Neurotrophic Factor (BDNF) to increase. BDNF has been called “Miracle-Gro for the brain” by Harvard Psychiatrist John J Ratey, MD in his book Spark: The Revolutionary New Science of Exercise and the Brain because it helps nerve cells transmit information better. In fact, low levels of BDNF are associated with depression; so increasing BDNF through exercise can be a natural anti-depressant in a more permanent way than that surge of endorphins.

One more way that exercise helps the brain is by preventing brain damage from stroke. Many studies attest to the benefit of cardiovascular exercise in preventing or minimizing atherosclerosis, the process by which arteries get clogged with plaque. Strokes occur when such plaque-ridden arteries interfere with blood flow to the brain. One recent study showed that men engaging in intense physical activity had less than half the risk of stroke as those who did not engage in such activities. Furthermore, for those who did have a stroke, the ones who had been exercising before the stroke recovered greater and faster than those who were not physically active. So, exercise was like a great insurance policy that protected people from having stroke and helped them get better even if they did have one.

People spend enormous resources investigating and purchasing supplements that have far less evidence supporting their use in preventing neurological decline than does simple exercise. It may be easier to pop a pill than to go for a run, but the benefits – both short and long term – are more predictable with the running than with the pill.

Thursday, March 4, 2010

Testosterone: Friend or Foe?

“He's a guy. They don't talk, they fight. It's all that crazy testosterone.”
Kim Cattrall as Samantha Jones on Sex in the City

If testosterone is responsible for all of the negative behaviors among men, wouldn’t that mean that men with lower levels are healthier than those with normal or high levels of testosterone?

Most people know that testosterone (T) is responsible for sexual development in men and is important for libido and sexual function. However hormones, by definition, have effects throughout the body. There are testosterone receptors in nearly all tissues in the body, so this primary male hormone impacts nearly every organ system. We know that testosterone impacts hair growth in some areas (face, chest) and loss in others (scalp). It is also especially important in muscle and bone growth, impacts cardiac function and affects the central nervous system. Truth be told, it is linked to behaviors such as aggression, risk-taking and territoriality.

As a counter-point, the central nervous system effects of testosterone are not all negative. Testosterone has positive effects on mood, energy levels, feelings of well-being and vitality. Low T is associated with depression and with poor brain function on tests of memory and comprehension. Testosterone also has been shown to be an important anti-oxidant, protecting nerve cells against oxidative damage. In fact, low levels may make diseases like Alzheimer’s worse.

Most testosterone is produced in the testes with stimulation from hormones secreted by the hypothalamus (GnRH) and pituitary glands (LH). The adrenal gland also produces some testosterone as well as other androgens (male hormones) such as DHEA. These other androgens are also important for libido and energy.

More and more, we are finding low T in our male patients. This does not appear to be only because we are checking levels more often. A large study showed that average T levels have fallen from 1987 to 2007. Among 1532 randomly selected men at three time periods between those years, there was a slow, steady decline in T levels such that a 65 year old in 2007 had 15% lower T than a 65 year old in 1987 – even correcting for being over weight or smoking.

Symptoms of low Testosterone
Low libido
Decreased morning erections
Low energy or fatigue
Depressed mood
Shrinking testicles
Loss of muscle mass or failure to gain muscle despite working out

Low testosterone may be caused by diseases of the hypothalamus, pituitary gland or testicles. Usually, however, low levels are the result of a natural decline with age (after the age of 40 or so) and/or lifestyle factors such as stress, physical inactivity, chronic illness, poor sleep or substance abuse (including tobacco and alcohol). To some degree this decrease in testosterone due to stress is evolutionary. The body’s production of sex hormones is exquisitely sensitive to stress – be it physical or emotional. Testosterone in men drops in the face of chronic stress or anxiety, partly because the primal role of the sex hormone system is to drive reproduction. If the body senses an inability to care for itself, the last thing it wants is to produce a child needing to be taken care of in the face of such external stress. This system can’t differentiate attack by tigers from the daily grind in an unhappy job – it is all translated chemically in the body and ends in low testosterone production.

Coming back to the initial question – is it better for men to have low T so that they will talk more and fight less? Unfortunately, such a trade-off has its cost.

Cardiovascular disease is the number one killer in men in the United States. Men with subnormal T levels have higher cholesterol and an increased risk of diabetes, both of which are significant risk factors for heart disease. Obesity also increases the risk for diabetes and heart disease, and men with low T have more body fat. In fact, the obesity-low T link manifests as a vicious cycle. Body fat causes an increase in the conversion of testosterone into estrogen – yes, men have estrogen. In fact, a 50-year-old man has, on average, more estrogen than a post-menopausal 50-year-old woman. The more T that gets converted, the lower is the ratio of testosterone to estrogen and the more muscle mass is lost and fat is gained. This gets to be self-perpetuating.

So, it appears that while testosterone is associated with riskier health behaviors, low T is associated with serious diseases like osteoporosis, Alzheimer’s, depression, diabetes and heart disease. Therefore it is unhealthy to leave low T untreated. While elevating levels of T above physiologic levels, as is done by some body builders and athletes, has been associated with enlarged hearts (cardiomyopathy) and higher risk of heart attacks, high blood pressure and stroke, replacing low testosterone to achieve normal values has not been associated with such negative outcomes.

Men over 40 should have their levels of testosterone checked regularly, especially if they are experiencing any of the symptoms listed above. That level may be as important to overall health as cholesterol number or blood pressure. There are many proven ways to treat low T, under a doctor’s supervision. Testosterone may make us fight more and talk less, but it also keeps us going in many healthy ways.

Wednesday, January 20, 2010

We Cannot Abandon Health Care Reform

Michael, a struggling actor, came to see me at the free clinic yesterday. He had been in a car accident many years ago and has suffered with chronic neck and back pain ever since. He has had physical therapy, chiropractic care and acupuncture, but still he suffers. For 8 years his pain has been under control with a combination of Vicodin, Xanax and Soma prescribed by a chronic pain specialist. This combination allows him to continue to work and to function. But, Michael doesn’t have insurance. The visit to the doctor is $100 a month. His medications (all of them, generic) costs $140 a month. He has finally reached a point where he cannot continue to afford them. He had two Vicodin left when I saw him last night – he had been taking less in order to make his bottle last a while longer, but now he was in severe pain and needing some help.

We don’t carry any of his medications at the free clinic. Our policy is to not carry narcotics. I could refer him to the county hospital pain management program, but that takes about 9 months to get an appointment. In the meantime, Michael will be suffering from extreme pain plus withdrawal and not be able to work or function.

During the same shift, Elizabeth came in. She is a professional dancer and had a fall while rehearsing. Her knee has been in pain for 7 months, limiting her ability to dance, so she has not been able to get any gigs since the fall. She had an x-ray and physical therapy, but needs an MRI to see if there is a tear. We have no ability to order MRI’s at the free clinic. I can refer her to the county orthopedics specialist, but that takes about 12 months before they will send her an appointment.

Ken sees me in my private clinic. He has high blood pressure and high cholesterol. He takes his medications regularly, but has a strong family history of heart disease. He needs routine blood tests to check his cholesterol, his kidney (make sure the medications aren’t causing any problems there) and general chemistries. His deductible with his insurance is so high, that he can’t afford to have his labs done. I have to decide between continuing his medications (for which he pays a reasonable copay not affected by the deductible) and potentially causing harm to his system that I can’t detect because he can’t have the blood work OR I can insist that I cannot prescribe refills unless he gets the labs done, in which he case he will probably just stop his meds.

Meanwhile, in my private practice, I can’t afford to stay in network. I want to see patients for 30 minutes, not for 10. I want to get to know my patients and discuss what they are eating, how much exercise they are doing and what might be bothering them at home or work that could be contributing to ill health. I want to discuss prevention and treatment options. I can’t do that in 10 minutes. Insurance reimbursement is based on a full billing staff and a high volume of patients booked every 10-15 minutes. The amount they pay cannot support a practice that allows for 30-minute visits.

This is our health care system. It is not working for Michael or Elizabeth or Ken. It is not working for my colleagues or me. It is not working for people with insurance (because of huge deductibles an copays) or people without insurance.

We cannot give up on reform.

Friday, January 15, 2010

Earthquake in Haiti

As a former volunteer and baord member with Medecins sans Frontieres/Doctors without Borders (MSF) , I assure you they are doing an efficient and masterful job at helping with the huge need for medical care in Port au Prince. I encourage you to support their efforts if you can.

Just click on the photo below to donate.

MSF has hospitals up and running and is providing surgical and emergency care now. They need your help to ramp up the efforts.

In gratitude and prayer for those suffering,
Myles Spar, MD

Support Doctors Without Borders in Haiti

Wednesday, November 4, 2009

Why Men Die Earlier Than Women

Why Men Die Earlier And Suffer More – this was the theme of the World Congress on Men’s Health in Vienna where I was a presenter and attendee last month. Certainly there are many arguments against the idea that men suffer more than women, but it is a fact that men die earlier. In fact, for every major cause of mortality that affects both men and women, men die faster.

When you look at cancer, not including gender-specific cancers like Breast and Cervical, men have a 60% higher chance of developing the disease and a 40% higher chance of dying from cancer than women. In fact, men have an increased risk of mortality at all ages, increased risk of heart disease and increased risk of alcoholism, suicide and homicide. In the top 10 causes of death, men are winning in 9 of them.

Why is this? Are men genetically programmed to die sooner then women? Is the joke true that married men die before their wives “because they want to?” The difference in life span between men and women has been relatively unexamined because it has been assumed to be based on biology. But this does not appear to be the case. For one, the gender gap in life expectancy changes across countries and across time as well as by age. The gap was only 1 year at the beginning of the 20th century, but grew to over 5 years by 2004. The gender difference is much larger in African countries where AIDS strikes men at higher rates than women and in countries of the former Soviet Union, where the differences in average age of deaths are even more pronounced than in the US.

Perhaps masculinity itself is killing us. It seems that risk-taking behavior, stress and doctor-avoidance may be the best explanations for the gender gap. It is true that men just don’t go to the doctor. Men are twice as likely as women to say they do not have a usual source of health care, and men attend half as many preventive care visits. This leads to half the opportunities to screen men who for disease processes and risk factors for disease such as high blood pressure, obesity, high cholesterol, high blood sugar, substance abuse, cigarette smoking and depression or anxiety. Lack of identification of such risks leads to diseases presenting more often and in more advanced stages than among those who are treated sooner.

Male gender roles may play a part in making men feel that they should deal with symptoms or illness on their own. Just as men typically don’t ask for directions when lost, the male may feel it is not “masculine” to seek help for potentially serious medical symptoms. It remains to be seen whether the metrosexual movement will improve the rate at which men seek care for potentially dangerous conditions. However, to the extent that higher mortality can be explained by avoidance of the health care system, it is incumbent upon creators of health policy and providers of health care to make such services more attractive and accessible to men.

Men’s habits and roles also impact their rates of disease incidence, While women are taking on more and more professional roles previously held by men, in the US, 95% of workers in the 10 most hazardous occupations are still men. Men die in workplace accidents at much higher rates as women, even excluding combat deaths, which were the leading cause of occupational deaths in the US when last reported in 2005.

Then there are non-occupational risks that men take. Men have higher rates of alcohol abuse, drive faster and are more likely to eat an unhealthy diet. Men report higher levels of stress and lower rates of stress-reducing activities. Well, then, one might say that men deserve to die younger. However, when disparities are found in risk-taking among ethnic or socioeconomic groups, the usual response is not to blame the group at risk. The socially responsible response is to take a hard look at how the educational and health care systems may have failed that group and what can be done to change that, which promotes risk-taking.

Social policy also impacts the rate at which men access the healthcare system. There are fewer programs that target men as specifically as women. Men are less likely to be insured and are less able to qualify for public insurance, such as Medicaid, than women with children.

It is dangerous to assume that the gap in life expectancy between men and women is biological. Such an assumption stops us from examining social, economic, behavioral, or public policies that may be contributing to higher mortality. In the United States, Men’s health is largely neglected when looking at health policy. This is not as much the case in Europe and Australia, where entire departments of Andrology exist at many academic and governmental health institutions. Such departments include anthropologists and sociologists, policy advisors and health service researchers. Women have strongly advocated for their own health, leading to increased research, public policies favorable to women’s health concerns and health care delivery approaches that specifically address women’s health issues. Men need to do the same, not to take away such programs for women, but to add years to the lives of their fellow man.

Friday, March 13, 2009

How to Avoid Recession Depression Naturally

Has the economic crisis got you down? A recent National Sleep Foundation poll found that one-third of Americans are losing sleep over the faltering economy. As the economy continues to spiral downward, more people are experiencing economic anxiety which can easily turn into clinical depression – and, unfortunately, experts predict that the economy will only get worse before it begins to improve.

This wave of "recession depression" is creating a plethora of new patients for doctors, who typically treat depression with a drug like Prozac or Cymbalta. Such medications, however, may cause unpleasant side effects such as sexual dysfunction. Fortunately, there are several ways to elevate your mood and prevent depression naturally.

Herbs & Supplements for Depression

St. John's Wort, for example, is a natural herb that increases serotonin levels in the brain – which is the same mechanism of drugs like Prozac. Last year, Science Daily reported that a Cochrane Systematic Review of 29 medical trials found that St. John's Wort is just as effective as standard antidepressants with fewer side effects. The recommended dosage for the treatment of mild to moderate depression is 200 to 1,000 milligrams per day.

SAMe is another popular supplement for depression. As the synthetic form of a compound formed naturally in the body, SAMe elevates mood by increasing levels of serotonin and dopamine. Since SAMe is a natural compound present in every living cell, it has very few side effects. It normally increases energy levels; therefore, it should be used with caution by those suffering from bipolar disorder, as it may induce mania or hypomania. People with Parkinson's disease should avoid SAMe. The standard dose of SAMe is 800 – 1600 milligrams per day. Keep in mind that not all supplements are created equally. Read all labels carefully and discuss the dosage with your healthcare provider.

Nutrition and Depression

Your diet can have a tremendous impact on your serotonin levels and your mood. Too much protein, for instance, may suppress serotonin. Likewise, excessive consumption of alcohol or caffeine often leads to anxiety and depression. Choosing the right fats, avoiding simple sugars and getting checked for food sensitivities can minimize the chances that you will suffer from depression even during stressful times.

   Omega-3 Polyunsaturated Fatty Acids and Depression

The typical American diet is high in omega-6 fatty acids (found in refined vegetable oils and processed foods) and low in omega-3 fatty acids (found in walnuts, flaxseed, and cold-water fish). In 2004, Prevention magazine reported that six out of ten people suffering from depression found relief by taking fish oil supplements rich in omega-3 fats, according to a study published in the American Journal of Psychiatry. Psychiatrist Andrew Stoll, MD, of Harvard Medical School said, "These results were huge, and the improvements were obvious. Those who got the supplements slept better and felt less worthlessness and guilt. We think omega-3s help your brain use a feel-good chemical called serotonin."

The participants in the study took 2,000 milligrams of an omega-3 fatty acid called EPA daily. You can get EPA from cold-water fish like salmon, but you'll need to take supplements to get 2,000 milligrams a day. Note: You shouldn't take EPA if you're taking Coumadin or fat-blocking medications.

   The Effects of Sugar on Depression

In her book Food Addiction, former food addict Kay Sheppard, MA, explains, "Gummy bears and marshmallow chicks can be vicious killers whose effects can lead to depression, irritability, and even suicide. The terrible truth is that for certain individuals, refined carbohydrates can trigger the addictive process."

Refined sugar is an addictive chemical with no nutritional value. Upon consumption, it elevates insulin levels, which in turn elevate endorphin levels. Like serotonin, endorphins are "feel-good" chemicals. However, continuous, excessive consumption of sugar and carbohydrates will cause the body to scale back its own production of endorphins, causing depression. The body will then crave more sugar and carbs in an effort to get those feel-good endorphins back, but you end up feeling like you're chasing your own tail. Meanwhile, high blood sugar levels lead to heart disease, nerve damage, and kidney disorders. To avoid this vicious cycle, reduce consumption of refined sugars and processed foods and opt for more long-term energy producers like complex carbs found in fruits and vegetables.

   Food Allergies and Depression

Food allergies can affect your mood as well. Not all food allergies cause immediate reactions. Delayed food allergies, or food sensitivities, are often difficult to detect, but they can have a devastating impact on your mood. For instance, many people have sensitivities to casein (milk protein) and gluten (a protein in wheat, rye, and barley). Eating foods to which you are sensitive can cause mood changes as well as other symptoms such as fatigue, headaches, and digestive problems. A simple blood test will let you know which foods, if any, you should avoid.

   Heavy Metal Toxicity, High Fructose Corn Syrup and Depression

Heavy metal toxicity is another common cause of depression and fatigue. Metals like mercury, lead, and arsenic may enter our bodies via the air we breathe, the water we drink, and the food we eat. Tuna, halibut, and swordfish, for example, typically contain high levels of mercury.

In January, Environmental Health published a study which found that nearly half of commercial samples of high-fructose corn syrup contain mercury. High-fructose corn syrup (HFCS) is a main ingredient in many popular processed foods, from soda pop to bread. Even many "juices" consist primarily of water and high-fructose corn syrup. HFCS causes many, many health problems and can worsen depression just like simple sugars do. (HFCS is like a turbo-boosted simple sugar). Add the concern about mercury, and you should have no reason to consume any of this dangerous substance.

When heavy metals and other toxins build up in your body, they eventually cause toxic overload, which affects the immune, endocrine, neurological, and cardiovascular systems. Unfortunately, in our modern society, it's impossible to completely avoid exposure to toxins like heavy metals. That's why it's helpful to detoxify your body under the supervision of a healthcare provider at least once a year.

   Vitamin and Mineral Deficiencies and Depression

Too many processed foods not only contain toxic chemicals, but they also lack the natural vitamins and minerals present in whole foods. When you eat a diet consisting of organic, whole foods, you're less likely to suffer from depression.

"Fatigue, irritability, poor concentration, anxiety and depression – all can be signs of a B vitamin deficiency," reported Psychology Today in 2004. Alcohol, refined sugar, nicotine, and caffeine all destroy B vitamins. Good dietary sources of B vitamins include dark leafy greens, sea vegetables, nuts, eggs, chicken, liver, and fish. Brewer's yeast enriched with B vitamins is a great supplement; dosages vary depending on the supplement.

A lack of vitamin D can lead to depression, too. Last year a study published in the Archives of Pediatric and Adolescent Medicine found that two out of five small children have less than optimal levels of vitamin D. While you can get vitamin D from supplements and fortified foods like milk, the best source of vitamin D is sunshine, which produces the ideal form of vitamin D when it hits your skin. So don't let your kids play video games all day! Make sure that they get healthy sun exposure.

Mineral deficiencies may also cause anxiety and depression as well as sleep disorders. Several nationwide studies have concluded that the typical American diet does not include enough magnesium, and stress further depletes magnesium. A deficiency in magnesium can cause depressive symptoms as well as confusion, agitation, and a host of physical problems. To get sufficient levels of magnesium, eat plenty of dark green leafy vegetables, legumes, and fish, plus at least five servings of fruits and vegetables a day. Pumpkin seeds are also a rich source of magnesium.

Calcium deficiency has been implicated in depression too. Foods high in calcium include dairy products, green leafy vegetables, nuts, and legumes. Your doctor may suggest mineral supplementation; the ideal dosage varies with sex and age.

Candida and Depression

Candida are yeast-like fungal organisms that are normally present in the digestive system. For most people, candida are harmless. But sometimes, usually because of poor diet or use of certain medications, candida can grow out of control, causing a condition called candidiasis. Toxic candida byproducts then enter the bloodstream, where they may affect the brain and cause depression. Candida overgrowth may also reduce magnesium absorption in the intestine, which can lead to depression. Signs of candidiasis include oral thrush, white patches inside the cheeks, and frequent yeast infections. If you suffer from candidiasis, ask your healthcare provider about cadida detox options.

Avoid Depression with a Naturally Healthy Lifestyle

If you want to avoid the rapidly spreading recession depression, it's important to maintain a positive state of mind during these tough times. In addition to the suggestions above, you should exercise regularly, drink plenty of pure water, and stick to a regular sleep schedule. It is vitally important to get a handle on your stress level. Meditation or yoga can help with this. Finally, everybody needs healthy emotional support. When you're faced with a stressful problem, talk to a friend or family member about it. Simply getting your problem off your chest will relieve a great deal of anxiety.

The Akasha Center offers several modalities to help alleviate depression, such as nutritional counseling, serotonin testing, food allergy testing, and several detox programs, including candida detox, sugar balancing detox, and heavy metal detox. Schedule your appointment today, and our experienced staff will help you achieve the happiness and peace of mind that you deserve.