Friday, July 25, 2014

Elemental Health

New post on minerals at Psychology Today...expecting to write some new ones on magnesium and some more on genetics here or at Psych Today in the near future.

Ele-mental Health

Here's a new song by Spoon, which I believe is Austin, Texas' most commercially successful band:

Do You

Drink your mineral water!

Monday, June 30, 2014

Human Microbiota and Depression

Several weeks ago, I got an email from one of my best friends from medical school. She graduated top honors in the class and went on to Johns Hopkins, where she was a chief resident, then a fellowship, and basically has torn her way through the ranks in academic medicine like the firecracker. She told me once I ought to be in academic medicine (other than my tiny finger hold teaching a section of one class), but I’m not all that great dealing with something called a “boss,” so let’s just say I’m better off where I am. It’s very handy to have a crackerjack gastroenterologist as a friend when one is interested in the gut brain connection. Ergo…her email started off: “Saw this paper and I thought of you.”

Now we know what my friends think of me!

There is a new article at Psychology Today based on the paper: Human Microbiota and Depression

Next I’m determined to look more into genetics and mental illness, also, I have to dig deeper into something my friend Drew Ramsey found, magnesium as “paleo ketamine.” 

In other news, my baby graduated from pre-school and will start kindergarten in the fall. Here's the class waiting to get their "diplomas." Sob.

Friday, May 9, 2014

Lessons from the APA 2014

Last weekend, I presented a workshop and symposium at the American Psychiatric Association Annual Meeting in New York City. This meeting is enormous…as many as 15,000 psychiatrists and researchers come from all over the world to these events. It’s a conservative psychiatric event, with the stress on biology and the evidence-base.  In my residency years I remember fancy pharmaceutical company galas and exhibitions. That is all toned down now, with the companies situated at the back of the exhibition hall, and more prominent in the cabs and buses used to get to the convention center than at the event. The program is enormous, with 250 pdf pages, and the speakers as grand as Bill Clinton last year, and Vice President Biden this year. It’s the largest psychiatric stage in the world. So big, though, that you can get lost in the shuffle. Some great symposiums and workshops are sparsely attended.

Heavy English: 21 Flights (music)

Last year, thanks to the invitation of Drew Ramsey, MD, I was part of a Prescription Brain Food, From Bench to Table workshop that had attendance out the door. The chair of the scientific committee of the APA, Phil Muskin, introduced us, and each presenter had 15 minutes to make a point, with a long Q&A. Drew and I took advantage of the popularity of last year’s workshop to offer both a 1.5 hour workshop and the Evolutionary Psychiatry three hour symposium this year, both of which (much to my surprise, frankly) were accepted as part of the program. Both were heavily attended, the workshop, in a smaller room (250+ people) was filled to the brim, with many people turned away. People were standing at the back of Evolutionary Psychiatry as well, proving that psychiatrists are hungry for alternatives and preventative psychiatry.
The most important part of the weekend was being introduced to the folks from the international sociaety for nutritional psychiatry research. These are the people on the front lines, the masterminds of many of the studies I've discussed in this blog, who are devoting lives and careers to answering the questions about nutrition, the microbiome, and psychiatric disease that we all hold dear. 
But with so many people (and many psychiatrists newly approached) interested in both nutritional psychiatry and evolutionary psychiatry, I thought I should write another “start here” post to get everyone going and not feeling too overwhelmed. So head over to the Psychology Today blog for the basics:

Sunday, April 6, 2014

More on the Gut-Brain Connection

I'm still in the midst of reviewing a ton of literature on psychobiotics in time for the APA Annual Meeting in New York City this year. Our Evolutionary Psychiatry talk has been moved from two to three pm on Monday May 5th, as the Vice President will be speaking at 2pm. (Attendees can watch the VP on close caption so you can run to our room to beat the crowds ;-)

Anyway, I've written a layperson's version of my portion of the talk on the Gut and Brain, probiotics, etc. which I just put up over at Psychology Today. My academic talk will have a lot more details about the immunological effects, cytokines, hormonal regulation, etc.

New Music: Cherub: Doses and Mimosas (not exactly my usual style, but catchy, particularly the chorus.)

Head of a pinworm, major immune system regulator. From wikimedia commons.

Sunday, March 30, 2014

Tylenol in Pregnancy and ADHD in Offspring

Excuses, excuses...haven't blogged in a while. The kids keep me busy, and I've been working on some personal projects that make me happy, not to mention some major work going on with the practice, which, since it pays the bills, takes a good deal of my attention.

However, I do have a new article up at Psychology Today, about the recent JAMA Pediatrics article linking acetaminophen use and the risk of ADHD in offspring. It's an observational study, but the best sort of observational study. However let me warn you, I'm biased against acetaminophen from my experience working the ERs and ICUs. I do feel for pregnant women suffering pain or inflammation...what are they to use? If aspirin, other NSAIDs, and acetaminophen are all off the table... 

I've been hiding from conferences since AHS last August, but I'll be at PaleoFx (briefly) in mid April, on the Thrive Show (a google hangout) with Jennifer Brea (producer of what looks to be an amazing film called Canary in a Coal Mine) on April 22nd, and doing a couple presentations at the American Psychiatric Association Annual Meeting in New York City the first weekend in May. I'm teaming up with Drew Ramsey that Sunday to do a practical workshop for the practicing clinician on Food and Mood, and then Georgia Ede will join us on Monday for a full three hour symposium on Evolutionary Psychiatry. I'm very excited about both these presentations, and not just because Georgia and Drew are some of my favorite psychiatrists and people in general. 

The Evolutionary Psychiatry symposium will include sections on the gut/brain connection, all the latest data about the micorbiota and parasites, the immune system, and psychiatric disorders, but also reviews of minerals and hormesis/fasting and ketosis. If you are going to the APA, be sure to come out to see us, and come early, because last year our workshop was filled to the brim with some folks refused entry. We are planning exciting, interactive presentations that may be a little different from the typical dry academic talk, but still on point and evidence-based, of course. 

I will have a few more blog articles coming out at Psychology keep on checking back!

Sunday, February 16, 2014

Here We Go Again: Vegetarian Diets and Mental Health

One of the primary messages out of public health agencies and nutrition gurus from Walter Willett to Michael Pollan is to eat more plants. And, indeed, in many studies, vegetarian* diets are associated with better cardiovascular health, lower BMI, and better health behaviors (less likely to smoke, drink, and participate in shady Rock and Roll activities).

*In most of these studies, vegetarian does not mean vegan, but usually includes the addition of dairy and eggs, and in some cases, also fish and chicken. Many of these studies use the metric of what people self-identify as, rather than what people actually eat. And the large ones are cross-sectional observational studies, which don't give us causation.

Studies have mostly (but not always) shown that vegetarian diets are associated with poorer mental health, particularly when it comes to anxiety, eating disorders, and depression (See You're A Vegetarian. Have You Lost Your Mind?). This correlation makes sense due to the particular nutrients mostly vegetarian diets are low in (B12, long chain omega 3s, choline, and zinc among others) are particularly important to the brain and nervous system. Mediterranean diets, on the other hand, rich in fruits, vegetables, and whole grains, but also in fish and poultry, are associated with better mental health, and a randomized trial of men with type II diabetes assigned to a Mediterranean diet for several years had lower incidence of depression than controls (1). 

In the face of a lot of messy data, Austrian researchers took a cross section of the population to learn more about self-reported diet and health. The paper is free full text and available here:

I tweeted the paper yesterday, proving that there's nothing a paleo-leaning audience loves more than a study inconsistent with the notion that vegetarian diets are the elixir of eternal health and happiness, at least for humans.

There was also a little twitter skirmish of vegetarian protest. "Correlation doesn't mean causation" one told me. (Yes indeedy! That's why I used the word 'correlates'). Another accused me of being misleading #shame:

I'm happy to let each of you in the twitterverse determine how misleading I am. It would be too cumbersome to define each verb each and every time I use them in 140 characters. Let me qualify that I'm sure there are happy and healthy vegetarians out there, and all my best to continued health and happiness; be sure to get your B12 from somewhere!

Anyway, the researchers did a decent job of getting a nice cross section of people in Austria from all levels of health and socioeconomic classes. Then they pulled out all 343 "vegetarians" (which were vegans, lacto-ovo vegetarians, and lacto-ovo-pescatarians) and matched them with folks from three other self-identified groups that we shall call the virtuous carnivores (lots of fruits and veggies + meat), the carnivores who eat less meat, and the shameless meat-eaters. Then the researchers measured (or asked about) a lot of health factors using trained interviewers. Body mass index, smoking, alcohol use, how many times a person visited the doctor, whether they got their preventative health care, and what sort of medical conditions and health complains they had.

After a lot of number-crunching, the results were as follows: Self-identified vegetarians had poorer mental health (defined as depression and anxiety), poorer overall health, and poorer quality of life. The other finding was that BMI correlated linearly with the consumption of animal fat (with the shameless carnivores having the highest BMI, the vegetarians the lowest). 

What can we learn from this study? Are vegetarians are more likely to be neurotic sick people looking for dietary cures for what ails them, thus come out of the study looking more skinny, unhappy, and unsatisfied? Or are vegetarian diets nutritionally bereft leading to health problems, mental health problems in particular? We will never be able to get that answer from a study of this design.

The Mediterranean diet, as always, has more consistent data for positive benefits for mental and physical health. I tend to think that the diet with a bit of variety and the least processed food will be the healthiest and simplest to explain.

Wednesday, February 5, 2014

New Directions in Autism

Last Sunday I put out yet another new post on Psychology Today, but failed to link it here. It is a discussion of a very interesting long term cohort study in Crete, where the researchers used a sifting haystack approach to find some metabolic problems that might be causing the symptoms, then, in certain cases, presumptively treating the problem, leading to two successful remissions of severe autistic symptoms. While the methods are too cumbersome and there isn't enough data to use the approach on everyone, I can't help but think we are looking at the next iteration of the future of medicine. Better knowledge of what different organic acids mean when found in the urine, and how different metabolites present in the blood after a fast or a glucose bolus tell us something about the overall functioning of the metabolism…then a tailored approach. Those who had trouble with fat metabolism were on high carb diets and reported decreased symptoms. Those who had trouble with glucose metabolism went on ketogenic diets…etc. etc. It's a smart and forward-thinking approach that makes sense in research and in these devastating conditions for which there is no treatment or cure. (Yet more data would be nice!)

Song: Big Data, Dangerous

But when does the needle in a haystack approach go to far? It's common for someone to go to a naturopath and get full blood, urine organic acids, and stool samples for fatigue, poor skin, lack of ability to lose weight, or constipation (or insert other chronic difficult to treat condition here.) In the case of the naturopath, the patient is paying out of pocket for this sort of treatment and that's free market health care. In the case of large population medicine and insurance/medicare/medicaid, there are not the resources for such an approach. Also, the most bang for the buck in the general population has to come from cheaper, more generic approaches, such as education and motivational interviewing about exercise, proper eating, and sleep…then if everything is more or less ship shape (or if the problem is disastrous), more investigation is warranted. My bias tends to be toward *less* testing and more listening, common sense, and empirical treatment (with the caveat that you don't want to miss the life-threatening condition, for example, my first break psychosis patients will get directed toward that MRI, low yield though it may be, so as not to miss the occasional brain tumor).

With no further ado:

Targeted Diet Interventions in Autistic Spectrum Disorders

And via Paul Whiteley: Autism, Treating the Whole Person