Krill Oil 48x Better Than Fish Oil?

Did you take your omega 3s today? There is no better proven supplement. Prevents ADD, depression, bipolar, heart disease, and painful periods. New insights - totally dug this article I found on Tim Ferriss' blog - check it out: Krill Oil 48x Better Than Fish Oil?

Women Becoming Unstuck

A wonderful patient of mine is particularly connected to her intuitive power and deep feminine, and I wanted to share her insightful response to an eblast I sent out several months ago in which I recommended a book - Unstuck by Dr. Jim Gordon, MD.

My patient, let's call her Fleur, was willing to let me post her response to my query: What about the book worked for you? How does it help you buffer your mood? I loved what she wrote and asked her permission to share it with you. Here's her response:

 I wanted to answer you about your question what worked for me in this book, Unstuck.

Here's what I found:

I like that the author asks you to tap into your creative/intuitive sides. Some of what he suggests is downright odd, but maybe I don't resist this kind of thing as much as I once did because I see it can work. I am willing to try dancing and shaking and asking an inner guide for help and these various other methods he suggests. He balances it out, too, by referring to scientific studies and his writing has a rational sounding voice, so it doesn't go overboard in this direction.

He says a lot of the same things I read/hear you say, and it helps to have the messages reinforced. His vitamin/supplement suggestions are quite close to yours. He is a believer in healthy bowels as a way to good physical and mental health, and he doesn't shy away from saying it.

Other suggestions of Gordon's I liked were to write in a journal every day and to look toward your dreams for clues.

What may have been the most help for me is his attitude that there is hope for recovery from depression, and that the changes in one's brain from depression can be reversed. He believes the brain has a lot of capacity for healing and growth and that this can be done without drugs. Let's hear it for neuroplasticity.

I am in agreement and inspired by this book, but I still don't know how to shift the external stresses in my life and in living in general so that I can really make these suggestions work, but that is where the challenge lies... probably not just for me.

Dr. Sara Gottfried MD on Women & Depression

Brief, 2-minute clip of my thoughts on how conventional medicine has failed moody and depressed women. Let's turn our attention to root cause analysis and how best to approach depression naturally, with inquiry and effective but integrative treatments.

This is an interview from an upcoming film by Second Nature Films on Women & Yoga.

Methylation Masta

How's your methylation? "Methylation" is a key control dial that permits your body to respond to environmental change. If your body’s methylation is not working at an optimal level, this may translate into many different health issues and accelerate your aging process. Methylation is the only cellular pathway that effects both structural integrity and adaptability of your body. You may assess your genetics along with our knowledge of the methylation pathway to support your optimal body and mind.  To learn more about the methylation pathway, email or call us at the Gottfried Center to test your pathway.

Chemically, methylation is a simple process in which a methyl group (remember CH3?) are added to proteins, DNA and other molecules. This step is often required to keep them in good condition.

For instance, if mood-enhancing serotonin is not methylated, it will become inactive, and this condition is associated with depression. Another key methylation process involves the amino acid homocysteine, which forms when methionine methylates your DNA. Homocysteine must be methylated to convert it back to methionine. If you are a lousy methylator, you can develop problems such as:

• Heart disease and stroke as a result of clumping platelets
• Increased LDL (bad) cholesterol 
• Depression
• Accelerated aging, particularly by damaging telomeres, which help cells divide cleanly
• Dementia and Alzheimer's disease

Psychiatric Medications - Effects on Breastfeeding

Fantastic compilation of what psych drugs can do to our babies and how much gets in our breastmilk by Dr. Richard Oliva at UCSF.

	Summary of Data published on LactMed (http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT) as of 02/01/10
Drug	Into Breastmilk?	Effect on Infant/Safety/ Summary
Fluoxetine	The average amount of drug in breastmilk is higher with fluoxetine than with most other SSRIs and the long-acting, active metabolite, norfluoxetine, is detectable in the serum of most breastfed infants during the first 2 months postpartum and in a few thereafter.	Adverse effects such as colic, fussiness, and drowsiness have been reported in some breastfed infants. Decreased infant weight gain was found in one study, but not in others. No adverse effects on development have been found in a few infants followed for up to a year. If fluoxetine is required by the mother, it is not a reason to discontinue breastfeeding. If the mother was taking fluoxetine during pregnancy or if other antidepressants have been ineffective, most experts recommend against changing medications during breastfeeding.
Paroxetine	Because of the low levels of paroxetine in breastmilk, amounts ingested by the infant are small and paroxetine has not been detected in the serum of most infants tested.	Occasional mild side effects (alertness, constipation, sleepiness and irritability) have been reported, especially in the infants of mothers who took paroxetine during the third trimester of pregnancy, but the contribution of the drug in breastmilk is not clear. Most authoritative reviewers consider paroxetine one of the preferred antidepressants during breastfeeding.
Sertraline	Because of the low levels of sertraline in breastmilk, amounts ingested by the infant are small and is usually not detected in the serum of the infant, although the weakly active metabolite desmethylsertraline is often detectable in low levels in infant serum.	Most authoritative reviewers consider sertraline one of the preferred antidepressants during breastfeeding.
Citalopram	Infants receive citalopram in breastmilk and it is detectable in low levels in the serum of some. The dosage that the infant receives and serum level achieved are probably related to the genetic metabolic capacity of the mother and infant.	A few cases of minor behavioral side effects such as drowsiness or fussiness have been reported, but no adverse effects on development have been found in infants followed for up to a year. If citalopram is required by the mother, it is not a reason to discontinue breastfeeding. If the mother was taking citalopram during pregnancy or if other antidepressants have been ineffective, most experts recommend against changing medications during breastfeeding.
Escitalopram	Limited information indicates that maternal doses of escitalopram up to 20 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.	Based on limited data, escitalopram appears to be preferable to racemic citalopram during breastfeeding because of the lower dosage and milk levels and general lack of adverse reactions in breastfed infants. Monitor the infant for drowsiness, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs.
Bupropion	Limited information indicates that maternal bupropion doses of up to 300 mg daily produce low levels in breastmilk and would not be expected to cause any adverse effects in breastfed infants.	There is little reported use in breastfed newborn infants and one case report of a possible seizure in a partially breastfed 6-month-old. If bupropion is required by a nursing mother, it is not a reason to discontinue breastfeeding. However, another drug may be preferred, especially while nursing a newborn or preterm infant. Exclusively breastfed infants should be monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern.
Duloxetine	No published information is available on the use of duloxetine during breastfeeding; however, the dose in milk is low.	An alternate drug that has been better studied may be preferred, especially while nursing a newborn or preterm infant. If duloxetine is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs.
Venlafaxine	Infants receive venlafaxine and its active metabolite in breastmilk, and the metabolite of the drug can be found in the plasma of most breastfed infants, but no proven drug-related side effects have been reported.	Breastfed infants, especially newborn or preterm infants, should be monitored for excessive sedation and adequate weight gain if this drug is used during lactation, possibly including measurement of serum levels of desvenlafaxine [O-desmethylvenlafaxine], to rule out toxicity if there is a concern. However, newborn infants of mothers who took the drug during pregnancy may experience poor neonatal adaptation syndrome as seen with other antidepressants such as SSRIs or SNRIs. Use of venlafaxine during breastfeeding has been proposed as a method of mitigating infant venlafaxine withdrawal symptoms,[1] but only one apparently successful case of this use has been reported.
Desvenlafaxine	Although no data are available for the use of desvenlafaxine during breastfeeding, it is the active metabolite of venlafaxine. Venlafaxine study data indicate that relatively large amounts of desvenlafaxine are likely to be excreted into breastmilk.	Other agents may be preferred, especially while nursing a newborn or preterm infant. Breastfed infants should be monitored for excessive sedation and adequate weight gain if this drug is used during lactation, possibly including measurement of serum levels of desvenlafaxine to rule out toxicity if there is a concern. Because desvenlafaxine is available only as a sustained-release product, timing of nursing with respect to doses would not be useful.
Lithium	Random milk levels have been reported to range from 0.12 to 0.7 mEq/L and appear to be rather consistent at about 40 to 45% of the simultaneous maternal serum level.	Limited data suggest that lithium in milk can adversely affect the infant when its elimination is impaired, as in dehydration or in newborn or premature infants. Neonates may also have transplacentally acquired serum lithium levels. The long-term effects of lithium on infants are not known, but limited data indicate no obvious problems in growth and development. Although lithium appears on many lists of drugs contraindicated during breastfeeding, other sources do not consider it a contraindication, especially in infants over 2 months of age and during lithium monotherapy. Lithium may be used in mothers of full-term infants who are willing and able to monitor their infants. Some investigators recommend monitoring infant serum lithium, serum creatinine, BUN, and TSH every 4 to 12 weeks during breastfeeding and maternal lithium therapy.[2][3] Breastfeeding should be discontinued immediately if the infant appears restless or looks ill.
Valproic Acid	Because of the low levels of valproic acid in breastmilk and infant serum, no unquestionable adverse reactions to valproic acid during breastfeeding have been reported.	Theoretically, breastfed infants are at risk for valproic acid-induced hepatotoxicity, so infants should be monitored for jaundice and other signs of liver damage during maternal therapy. A questionable case of thrombocytopenia has been reported, so monitor the infant for unusual bruising or bleeding. One author recommends monitoring infant serum valproate levels, platelets and liver enzymes during therapy. Combination therapy with sedating anticonvulsants or psychotropics may result in infant sedation or withdrawal reactions.
Carbamazepine	Carbamazepine has relatively high levels in breastmilk and breastfed infants have serum levels that are measurable, but usually below the anticonvulsant therapeutic range.	Most infants have had no adverse reactions, but sedation, poor sucking, withdrawal reactions and 3 cases of hepatic dysfunction have been reported. These have all been complicated because of intrauterine exposure and, in some cases, concurrent drug therapy. If carbamazepine is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for jaundice, drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs.
Oxcarbazepine	The relationship of the maternal dosage to the concentration in breastmilk can be quite variable, making calculation of the weight-adjusted percentage of maternal dosage less meaningful than usual.	Limited information indicates that oxcarbazepine would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsants.
Lamotrigine	Breastfed infants whose mothers are taking lamotrigine have relatively high plasma lamotrigine levels, averaging 30 to 35% of maternal serum levels; infant plasma levels up to 50% of maternal levels have been reported. Neonates are particularly at risk for high plasma levels because their ability to metabolize the drug by glucuronidation is limited and maternal plasma and milk levels can rise dramatically in the immediate postpartum period if the dosage is not reduced to the prepregnancy dosage.	Additionally, lamotrigine can cause rare, but potentially fatal skin reactions. If lamotrigine is required by the mother, it is not necessarily a reason to discontinue breastfeeding, because many infants have been breastfed without adverse reactions. However, breastfed infants should be carefully monitored for side effects such as rash, drowsiness or poor sucking, including measurement of serum levels to rule out toxicity if there is a concern. If an infant rash occurs, breastfeeding should be discontinued until the cause can be established.
Gabapentin	Limited information indicates that maternal doses of gabapentin up to 2.1 grams daily produce relatively low levels in infant serum.	Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of anticonvulsant or psychotropic drugs.
Haloperidol	Limited information indicates that maternal doses of haloperidol up to 10 mg daily produce low levels in milk and do not affect the breastfed infant.	Very limited long-term follow-up data indicate no adverse developmental effects when haloperidol is used alone. However, combinations of antipsychotic agents can negatively affect development. Monitor the infant for developmental milestones, especially if other antipsychotics are used concurrently. In a small prospective study on the long-term effects of antipsychotics in breastfed infants, a decline in developmental scores was found at 12 to 18 months of age in 2 of the 4 the infants of mothers taking both chlorpromazine and haloperidol. The other 2 infants and all infants exposed to either drug alone developed normally.
Risperidone	Limited information indicates that maternal risperidone doses of up to 6 mg daily produce low levels in milk.	Because there is little published experience with risperidone during breastfeeding and few long-term follow-up data, other agents may be preferred, especially while nursing a newborn or preterm infant.
Olanzapine	Limited information indicates that maternal doses of olanzapine up to 20 mg daily produce low levels in milk and undetectectable levels in the serum of breastfed infants.	In most cases, short-term side effects have not been reported, but sedation has occurred. Very limited long-term follow-up of infants exposed to olanzapine indicates that infants generally developed normally, but combinations of antipsychotic agents can negatively affect development. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
Quetiapine	Limited information indicates that maternal quetiapine oral doses of up to 400 mg daily produce low levels in milk. A 3-month-old infant who was breastfed 6 to 7 times daily during maternal use of 400 mg daily of quetiapine had a plasma quetiapine level of 1.4 mcg/L. This level was 6% of the mother's quetiapine plasma level at the same time.	Because there is little published experience with quetiapine during breastfeeding and little long-term follow-up data, other agents may be preferred, especially while nursing a newborn or preterm infant.
Clozapine	A woman taking oral clozapine 50 mg daily had a milk clozapine level of 63.5 mcg/L one day postpartum. At 3 days postpartum her dose was increased to 100 mg daily, and at 7 days postpartum clozapine in milk was 115.6 mcg/L. Her infant was not breastfed and timing of the samples with respect to the doses was not stated.	Because there is little published experience with clozapine during breastfeeding, and sedation and adverse hematologic effects have been reported in breastfed infants, other agents are preferred. If breastfeeding is undertaken by a mother who is taking clozapine, close monitoring of the infant for excessive sedation and periodic monitoring of the infant's white blood cell count is advisable.
Aripirazole	A women who was 6 months postpartum was taking aripiprazole 15 mg by mouth daily. Milk levels after 11 and 12 days of therapy (times not stated) at that dose were 13 and 14 mcg/L.	Because there is little published experience with aripiprazole during breastfeeding, other antipsychotic agents are preferred.
Ziprazidone	Relevant published information was not found as of the revision date.	Because there is no published experience with ziprasidone during breastfeeding, other antipsychotic agents are preferred.
Clonazepam	A mother taking clonazepam 2 mg twice daily had several milk level measurements on days 2 to 4 postpartum. The highest milk level was 10.7 mcg/L 4 hours after a dose. The authors calculated that an exclusively breastfed infant would receive a maximum of 2.5% of the maternal weight-adjusted dosage of clonazepam.	Only a small number of cases of breastfeeding with clonazepam have been reported. If clonazepam is required by the mother, it is not a reason to discontinue breastfeeding. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants and when using combinations of psychotropic drugs. Monitoring of the infant's serum concentration may be indicated if excessive sedation occurs.
Diazepam	Diazepam is excreted into breastmilk and it and its active metabolite, nordiazepam, accumulate in the serum of breastfed infants with repeated doses. Because the half-life of diazepam and nordiazepam are long, timing breastfeeding with respect to the dose is of little or no benefit in reducing infant exposure.	Other agents are preferred, especially while nursing a newborn or preterm infant. After a single dose of diazepam, as for sedation before a procedure, there is usually no need to wait to resume breastfeeding, although with a newborn or preterm infant, a cautious approach would be to wait a period of 6 to 8 hours before resuming nursing.
Alprazolam	The authors calculated that an exclusively breastfed infant whose mother was taking alprazolam in the normal dosage range would receive a dose of 0.5 to 5 mcg/kg/day or about 3% of the maternal weight-adjusted dosage.	Because of reports of effects in infants, including sedation, alprazolam is probably not the best benzodiazepine for repeated use during nursing, especially with a neonate or premature infant. A shorter-acting benzodiazepine without active metabolites is preferred. After a single dose of alprazolam, there is usually no need to wait to resume breastfeeding.
Lorazepam	Lorazepam has low levels in breastmilk, a short half-life relative to many other benzodiazepines, and is administered directly to infants.	Lorazepam would not be expected to cause any adverse effects in breastfed infants with usual maternal dosages. No special precautions are required.
Trazodone	Trazodone levels in milk are low	Limited information indicates that trazodone levels in milk are low and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months or when doses of 100 mg or less are used at bedtime for sleep.
Clonidine	Using the average milk level data from this study, an exclusively breastfed infant would receive an estimated 4.1 to 8.4% of the maternal weight-adjusted dosage.	Because of the high serum levels found in breastfed infants and the possible negative effects on lactation, other agents may be preferred, especially while nursing a newborn or preterm infant. Clonidine has complex, dose-related actions on both oxytocin and prolactin secretion. The net effect of the drug on nursing mothers has not been well studied. A case of hyperprolactinemia and gynecomastia occurred in a 6-year-old boy taking clonidine for hyperactivity and valproic acid for a seizure disorder. Galactorrhea ceased within 3 weeks of discontinuing clonidine. A case of clonidine-induced postpartum galactorrhea has also been reported.
Prazosin	Relevant published information was not found as of the revision date.	Because no information is available on the use of prazosin during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
Hydroxyzine	Relevant published information was not found as of the revision date.	Small occasional doses of hydroxyzine would not be expected to cause any adverse effects in breastfed infants. Larger doses or more prolonged use may cause drowsiness and other effects in the infant or decrease the milk supply, particularly in combination with a sympathomimetic or before lactation is well established. Single bedtime doses after the last feeding of the day may be adequate for many women and will minimize any effects of the drug. The nonsedating antihistamines are preferred alternatives.
Imipramine	Milk levels of imipramine and its metabolite are low and have been detected in only small quantities in the serum of breastfed infants.	Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Imipramine use during breastfeeding would usually not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Other agents may be preferred when large doses are required or while nursing a newborn or preterm infant.
Clomipramine	Using the average of the above concentrations, a fully breastfed infant would receive about 2.2% of the maternal weight-adjusted dosage of clomipramine in breastmilk.	Limited evidence indicates that use of clomipramine during breastfeeding is acceptable. For use as an antidepressant, clomipramine may be less desirable than other tricyclic antidepressants that have been studied more thoroughly.
Nortriptyline	Because of the low levels of nortriptyline in breastmilk, amounts ingested by the infant are small and usually not been detected in the serum of the infant, although the less active metabolites are often detectable in low levels in infant serum.	Immediate side effects have not been reported and a limited amount of follow-up has found no adverse effects on infant growth and development. Most authoritative reviewers consider nortriptyline one of the preferred antidepressants during breastfeeding.

Heed the Call

I've been thinking for a few years about writing a book for women about Joseph Campbell's Journey of the Hero, but hip & irreverent and aimed at helping us transform our lives, find deeper meaning, sustain us through the depletion of motherhood, etc.

A new book comes close: Jim Gordon, MD's Unstuck: Your Guide to the Seven-Stage Journey Out of Depression. But many women won't read it because it's about depression, so I still need to write my book.

In the meantime, let's talk about that seven-stage trip of the heroine. Here it is, paraphrased from Joe Campbell (who discerned these steps from scriptures and myths) and Jim Gordon, MD.

1. The Call: Awareness that we need to change, not in a small way but a huge way. We realize we're 20-50 pounds overweight. We get diagnosed with pre-cancer of the breast. We tired of being chronically overwhelmed and overbusy. We can't take another day of PMS. Some kind of journey is ahead.
   
2. Guides: Finding and selecting those who can help, can augment our recovery; those people that provide synergy to the development of our own intuition and inner wisdom.
3. Surrender to Change: Figuring out what we need to let go more fully, how to take off the shoes that are too tight and get a pair that actually serve you....
4. Demon Facing: How do we identify the challenges - the reasons we overeat, the reasons we don't nurture ourselves, the reasons we overschedule. Perfectionism, being ruled by the inner authoritarian, the erosive effects of resentment. Identifying through this process "the unique daimon, the source of our own meaning, purpose and direction," according to Jim Gordon, MD.
5. The Dark Night of the Soul: the only way to heal the pain is to go straight through it - as Jim writes, "Allowing and inviting the deepest life-giving freedom to emerge  as we move through the despair that may come to any of us."
6. Spirituality: The Blessing - this is the realization that a power greater than ourselves can restore us to sanity and transform our lives. Does not require belief in God, can be a belief in Unity, Peace, Higher Self, or whatever your conception of a higher power is.
7. The Return: Re-learning how to live abundantly, joyously, drunkenly alive once again, consciously connected to ourselves and others.

Jim Gordon then provides a chapter on each of these steps in a path toward healing from depression. I'm using this 7-Step Healing Journey to perform a full-body cleanse. What is your Call to Action?

Yoga: Proven Benefits for Anxiety, Depression & Adrenal Dysregulation

If you practiced yoga daily, you wouldn’t need us doctors at the Gottfried Center to help you feel optimized. Yoga will change your life, for the good, but only if you commit deeply. You cannot proceed casually and expect transformation. Part of my job is to provide evidence to you – evidence that, in this case, yoga heals and transforms. What follows is the science supporting yoga for anxiety, depression and adrenal dysregulation, conditions that affect 100% of you. Please also keep in mind the wise words of BKS Iyengar:

“Words fail to convey the total value of yoga. It has to be experienced.”

Anxiety. There is 100% incidence of anxiety in our culture. There is a broad spectrum here from a little worry to the more debilitating problems such as obsessive thinking, insomnia, migraines, panic attacks, shortness of breath and palpitations. Excessive worry blocks healing. Simple tools such as deeper, belly breathing can help. Specifically, deep, slow breathing activates the Parasympathetic nervous system and releases the body’s own valium – GABA. Generally, we know that yoga increases our GABA levels. Other scientific evidence? Two studies show that yoga is as or more effective than tranquilizers such as Xanax or Ativan. In Germany, a group of 24 women with anxiety were randomized to two 90-minute yoga classes per week for 3 months or a waitlist. Significant reductions in both anxiety symptoms and salivary cortisol levels were found in the yoga group. Also interesting was that the women who reported headaches or back pain noted marked relief from pain.

Depression. Don’t co-opt the message from your conventional doctor that the answer to your sluggish mood and lack of joy can be found in a pill. Here’s the science: (1) A randomized trial from UCLA of 28 women with mild depression were treated with yoga twice/week compared to a control group placed on a waitlist. The yoga group had significant improvements in mood and anxiety, after only 2.5 weeks in class. (2) Another study of 80 people found that yoga for 3 to 6 months was as effective as a older treatment for depression – a tricyclic antidepressant (TCA), imiprimaine. Both yoga and the TCA raised serotonin and resolved symptoms, and while yoga took a little longer to have a significant effect, the effect lasted longer when patients stopped the therapies. Another randomized trial of Mindfulness-Based Stress Reduction showed it cut the recurrence rate for depression in half.

Adrenal dysregulation. If you have high cortisol levels, yoga has been shown to lower cortisol. High cortisol can cause depression, bone loss, poor memory and thick waistlines. Yoga activates the parasympathetic nervous system, which balances our chronically-activated sympathetic nervous system, or “fight or flight.”

Many of us look for a quick fix for depression, anxiety, fear, insecurity, stress, relationship problems, feeling numb, and emotional immaturity. Go with the long view: figure out what's not working for you and slowly manifest what would suit you better. Yoga helps you cultivate joy, peace, radical self-acceptance and vibrant health. It's proven.

Stress, Neurotransmitters, Hormones & YOU!

Are you less stress resilient than you used to be? More overwhelmed by your demands? Irritable and burned out?

The four of us, Drs. Abbassi, Nunley, Massey and me, have been discussing this a lot as we have seen many patients recently who have been under chronic stress for a long, long time. They have sleep problems, brain fog, and do not wake up restored in the morning.

We have many patients who recall life in their 20s: able to focus, concentrate, stay on task, cope with the exigencies of daily life. They rested and relaxed when they could, and enjoyed their time off. Now the weekend is not enough: relationships are more conflictual, home life is not the respite it used to be, achievement doesn't come as easily, which only adds to the stress.

Here are some of the results of chronic stress:

• Insomnia
• Autism
• Poor mood, mood swings
• Anxiousness, irritability, agitation, tension, panic attacks
• Difficulty concentrating, focusing or remembering
• Headaches
• Fatigue, lack of energy
• Weight issues, especially food cravings

Often these symptoms are a result of the body's difficulty responding to chronic stress. The adrenals and brain just can't keep up with the demand. The supply of feel-good neurotransmitters and hormones are limited by diet, genetics and often exposure to toxins.

One helpful approach we've found is to take the following approach:
1. Replace the hormones that are depleted or out of balance, all with bioidentical hormones, all tailored to you and your particular physiology and integrated with your risk factors and genetic disposition. This includes estrogen, progesterone, DHEA, testosterone, cortisol, and thyroid. We often use supplements and nutrition to optimize results.
2. Measure neurotransmitters and develop a customized amino acid protocol based on your results.
3. Make lifestyle and nutritional adjustments, along with refinement of bioidentical hormones and amino acids as needed in the long-term.

We've found this is the best approach for reversing the impact of chronic stress. The result? Vitality. Joy. Love. Less conflict. Connectedness to True Self. Satisfaction. Contentment.

Maca Improves Anxiety, Depression & Lagging Libido

A new study just published in Menopause showed that in a small group of post-menopausal women, a botanical named Maca, also known as Peruvian Ginseng, improved many of the issues our patients at the Gottfried Center complain of, namely anxiety, depression and low libido. Maca was also shown not to affect estrogen or androgen levels. The study was a randomized, controlled clinical trial, the "gold standard" in terms of high quality evidence.

Maca is thought to influence monoamine oxidase levels, one of the targets of prescription anti-depressants. However, as we all know, prescription antidepressants lower libido, whereas maca seems to improve it.

The improvement in libido I think may also be related to effects on the adrenals. This study confirms a previous study showing improved libido in both men and rodents with maca.

We treat both men and women now with symptoms of andropause and menopause, often with bioidentical hormones. In some, it may be more prudent to try proven botanicals first, such as maca.

Food Addiction = Disease: Stages & Consequences

I'm going to draw heavily again from Kay Sheppard's book on food addiction along with my professional and personal experience to lay out for you the stages and consequences of the disease of food addiction. It's when we look at food addiction as a bad habit that needs to be changed by sheer force of will that we get into trouble - we fail inevitably and then the roller coaster of despair, anxiety, depression, mood swings and self-loathing begins.

The conventional medical world has been slow to see the connection between food addiction and obesity, or food addiction and anorexia and/or bulemia. The link is obvious to me, although the classic criteria of food addiction have not made it into the conventional bible of such problems: Our Diagnostic and Statistical Manual of Mental Disorders. However, if you look under "Bulemia," you'll find there is tremendous overlap with food addiction.

Kay Sheppard states that the path of food addiction is one of ups, downs and many side trips. I happened to own my food addiction relatively early in the process, mostly because I had the blessing to care for many women who were food addicts who recovered through an abstinent eating plan and 12-step. I had never seen people maintain a healthy weight as these women, and it intrigued me.

Kay talks about how young food addicts have more interest in food than their peers, who can often take it or leave it. She recommends a careful assessment of past behavior and attitudes as they relate to food to reveal addiction. Below is a list of symptoms taken directly from her book.

Stage I: Preoccupation with Food
Food addicts spend an "inordinate amount of time seeking, talking about, and involving" himself or herself with food. Movies = popcorn, Holidays = special food (e.g., my mom's yummy Yorkshire Pudding for Christmas, latkes for Hannukhah) ; "the food addict sees life in relationship to the next opportunity to eat."

Other facets of Stage I: Sneaking food and/or stealing food & money; discomfort in no-food situations; keeping secrets; concern about weight; self-loathing; and eating after others stop.

Stage II: Loss of Control and Attempts to Control
Kay describes this next phase as loss of control over the amount of food consumed and over behavior. Life becomes unmanageable. This leads to many attempted diets: Weight Watchers, Jenny Craig, Fat Flush, Nutrisystem, etc.

Other features? Self-deception; making excuses; lethargy, irritability and depression.

Stage III: Final Stages -- Efforts to Control Binging Fail Repeatedly.
This includes over-exercising, use of laxatives or diuretics, and cycles of failure may become more frequent.

Eventually there is a withdrawal phase of greater isolation and "numbing out" in food - with loss of interest in family, friends and other pursuits, work and family problems, emotional , physical, moral and mental deterioration, neglect of good nutrition, food is the main source of security, panic: obsession and compulsion take over, and then, in time, complete defeat.

Medical consequences of food addiction are legion: high blood pressure, pre-diabetes or diabetes (adrenal fatigue helps hasten this regardless of weight), high cholesterol and cardiovascular disease (our #1 killer in the US), and cancer. There are also lesser known conditions such as gallbladder disease, hepatic steatosis, lung impairment, hormonal imbalances (especially estrogen dominance and adrenal fatigue), obstetric complications, gout, joint dysfunction, etc.

The emotional and psychological effects may be even worse: bulemia, depression, anxiety, guilt, poor self-esteem, shame and self-contempt.

Fortunately, there is a solution. Kay's book is a great start along with joining a 12-step program such as Overeaters Anonymous or Food Addicts. If you are suffering and want to heal, call today or show up at a meeting.

F L O U R + S U G A R = E V I L

Some of us are as addicted to food as an alcoholic is to alcohol. Kay Sheppard wrote a great book about this, entitled Food Addiction: The Body Knows. I am especially interested in how addiction to flour and sugar leads to depression, anxiety, over-exercise, distorted body image, lethargy, irritability, PMS, weight obsession, and strained relationships, and by extension, how recovery can heal these conditions.

Here is her questionnaire for self-diagnosis:

1. Has anyone ever told you that you have a problem with food?

2. Do you think food is a problem for you?

3. Do you eat large amounts of high calorie food in a short period of time?

4. Do you eat to overcome shyness?

5. Do you eat when you are disappointed, tense or anxious?

6. Can you stop eating without struggle after one or two sweets?

7. Has your eating ever interfered with any part of your life?

8. Has being overweight ever affected any part of your life?

9. Do you weigh yourself once or more per day?

10. Do you eat more than you planned to eat?

11. Have you hidden food so that you would have it for yourself?

12. Have you felt angry when someone ate food you saved for yourself?

13. Do you worry that you can't control how much you eat?

14. Have you ever felt frantic about your size, shape or weight?

15. How many of these methods of weight loss have you tried in the past?

• self-induced vomiting
  
• laxatives
• diuretics
• fasting
• compulsive exercise
• amphetamines
• cocaine
• OTC diet pills
• sorbitol
• chewing and spitting food
• acupuncture, acupressure
• hypnosis
• urine shots
• special foods, drinks & supplements
• weight loss programs: how many? how often?

16. Have you ever felt so ashamed of the amount you eat that you hide your eating?

17. Have you ever been so upset about the way you eat that you wished you would die?

18. Do you overeat more than twice/week?

19. Do you invent plans in order to be alone to eat?

20. Do you seek out companions who eat the way you do?

Next time... stages of food addiction and how to recover, with the latest thinking from Dr. Mark Hyman, MD, and data on the role of dopamine in the food addict's brain.

Rhodiola for Mild-Moderate Depression

This is a recent article that shows benefit in treating mild-moderate depression. Rhodiola is used by many alternative providers for improved response to stress. SG

Swedish Rhodiola rosea Extract Effective in Treating Mild to Moderate Depression in New Clinical Trial
( Austin , TX , December 19, 2007).

This is the first double-blind, randomized, placebo-controlled study of Rhodiola rosea in patients diagnosed with depression. Patients given the Swedish-made Rhodiola rosea extract showed significant improvements in depression compared to those given placebo.

The trial, published in the Nordic Journal of Psychiatry, utilized a proprietary Rhodiola rosea root extract called SHR-5, a standardized extract used in the product Arctic Root® produced by the Swedish Herbal Institute in Gothenburg, Sweden.*

The 6-week trial was conducted on 89 subjects, aged 18 to 70, who were assessed with clinically significant depression according to two different standard measurements used in psychiatry: the Beck Depression Inventory (BDI, scores greater than or equal to 13) and the Hamilton Rating Scale for Depression (HAMD, scores greater than or equal to 21). Patients were randomly assigned to one of three groups. The first group received 2 tablets once daily (340 mg/day) of SHR-5, the second group received 2 tablets twice daily (680 mg/day) of SHR-5, and the third group was given 2 placebo tablets once daily. (Placebos were described as being identical in appearance to the treatment tablets and contained inactive ingredients with 170 mg of lactose.)

There were no statistically significant differences in the average HAMD and BDI scores among the subjects in the three groups before the herb extract or placebos were given. Following treatment, both groups given SHR-5 experienced statistically significant declines in mean total HAMD scores (from 24.52 to 15.97 in the lower-dose group and from 23.79 to 16.72 in the higher-dose group), as well as statistically significant declines in mean BDI scores (from 12.23 to 7.09 in the lower-dose group and from 10.38 to 4.75 in the higher-dose group). The subjects in the placebo group did not show statistically significant decreases in either the HAMD or BDI scores by the end of the trial.

The study’s authors also measured other effects of the treatment, called secondary efficacy variables. At both dosage levels of SHR-5, people in the HAMD subgroups experienced statistically significant improvements in insomnia, emotional instability, and levels of somatization (the conversion of anxiety into physical symptoms), while such measures did not significantly change in the placebo group. Also, the group given the higher dose of SHR-5 experienced a statistically significant improvement in regards to low self esteem, while the lower-dose group and the placebo group did not experience changes in low self esteem.

The authors concluded that SHR-5 demonstrates clear and significant anti-depressive activity in patients suffering from mild to moderate depression, evident from both overall depression levels as well as from specific symptom levels of depression. They further noted that no adverse effects could be detected in either of the groups given the Rhodiola rosea extract.

Alexander Panossian, PhD, research director of the Swedish Herbal Institute and a co-author of the study, noted that all synthetically-derived, conventional pharmaceutical antidepressant drugs have adverse effects. He added that St. John’s wort (Hypericum perforatum), a popular herbal antidepressant, has been associated with herb-drug interactions, particularly with the pharmaceutical blood-thinner warfarin.

“Because of this drug interaction problem, there is a big demand for new natural antidepressants,” stated Dr. Panossian (e-mail to C. Cavaliere, December 2, 2007). “We have found that our SHR-5 extract of Rhodiola has a significant anti-depressive effect in human and animal studies, with no effect on the pharmacological activity and concentration of warfarin in blood after their oral administration together with SHR-5. It is a very safe extract.”†

Richard P. Brown, MD, associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons, and a co-author of a comprehensive review of Rhodiola rosea2 and a book on the subject3 likewise commented on the need for new, safe anti-depression medications. “At least 50% of patients given prescription anti-depressants stop them within 3 months due to unpleasant side effects,” said Dr. Brown (e-mail to M. Blumenthal, November 19, 2007). He cited a recent National Institutes of Health-funded multi-center study in which only 30% of patients responded to citalopram, a standard antidepressant medication.4 “Many patients have partial responses and are left with residual symptoms,” he said.

Dr. Brown stated that this clinical trial on SHR-5 has shown promising results: “Two dose levels of Rhodiola rosea [SHR-5 extract] were found to significantly reduce symptoms of depression in patients with mild to moderate depression compared to placebo in this randomized clinical trial. In addition to mood elevation, evidence indicates that R. rosea has numerous other benefits, including enhancement of cognitive function, sexual function, and both mental and physical performance under stress. Additional studies are needed to explore and establish the potential applications of this herbal extract. In the meantime, phytomedicinal researchers and consumers can be encouraged by these findings.”

According to Dr. Panossian, the SHR-5 Rhodiola rosea extract is already widely used and trusted in some areas of the world. “Four hundred million daily doses have been sold in the last 20 years in Scandinavia , where Rhodiola (notably SHR-5) is used as an adaptogen in cases of decreased performance, such as fatigue and sensation of weakness.”

This study was funded by the Swedish Herbal Institute.

About the American Botanical Council

Established in 1988, the American Botanical Council (ABC) is the leading nonprofit, member-based international organization working to educate consumers, healthcare professionals, researchers, educators, industry, and the media on the safe and effective use of herbs and medicinal plants products. ABC is located on a 2.5 acre site in Austin , Texas , where it publishes HerbalGram, a peer-reviewed quarterly journal; HerbClip, a twice-monthly scientific literature review service; and HerbalEGram, a monthly electronic newsletter. ABC is also the publisher of The ABC Clinical Guide to Herbs, a continuing education and reference book, which contains extensive monographs on the safety and efficacy of 29 popular herbs, and the recent The Identification of Medicinal Plants: A Handbook of Morphology of Botanicals in Commerce, a guide to the macroscopic identification of botanical materials for industry quality control laboratories that ABC published in cooperation with the Missouri Botanical Garden. More information is available at http://www.herbalgram.org/. An extensive review of Rhodiola rosea, its traditional uses, and its scientifically-supported modern medicinal properties and uses was published in HerbalGram in 2002.

References

1.
Darbinyan V, Aslanyan G, Amroyan E, Gabrielyan E, Malstrom C, Panossian A. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord J Psychiatry. 2007; 61(5):343-348.
2.
Brown R, Gerbarg P, Ramazanov Z. Rhodiola rosea—a phytomedicinal overview. HerbalGram. 2002;56:40-52.
3.
Brown D, Gerbarg, P. The Rhodiola Revolution. Emmaus , PA : Rodale Press, 2004.
4.
Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163(1):28-40.

Female Brain & Stress

Check out this new study that shows the female brain reacts to stress differently then the male. Maybe this will help us understand the double rate in depression in women vs. men. The bottom line is that in women, the LIMBIC SYSTEM (our prehistoric part of our brains that is the controller of emotions) activates under stress. A longer-lasting response was seen in women. And what about our adrenals?

STUDY RESULTS--Penn researchers use brain imaging to demonstrate how men and women cope differently under stress

**Findings have implications for identifying gender differences in mood disorders

PHILADELPHIA – According to a study that appears in the current issue of SCAN (Social Cognitive and Affective Neuroscience), researchers at the University of Pennsylvania School of Medicine discuss how men and women differ in their neural responses to psychological stress.

“We found that different parts of the brain activate with different spatial and temporal profiles for men and women when they are faced with performance-related stress,” says J.J. Wang, PhD, Assistant Professor or Radiology and Neurology, and lead author of the study.

These findings suggest that stress responses may be fundamentally different in each gender, sometimes characterized as “fight-or-flight” in men and “tend-and-befriend” in women. Evolutionarily, males may have had to confront a stressor either by overcoming or fleeing it, while women may have instead responded by nurturing offspring and affiliating with social groups that maximize the survival of the species in times of adversity. The “fight-or-flight” response is associated with the main stress hormone system that produces cortisol in the human body – the hypothalamic-pituitary-adrenal (HPA) axis.

Thirty-two healthy subjects – 16 females and 16 males – received fMRI (functional Magnetic Resonance Imaging) scans before, during and after they underwent a challenging arithmetic task (serial subtraction of 13 from a 4 digit number), under pressure. To increase the level of stress, the researchers frequently prompted participants for a faster performance and asked them to restart the task if they responded incorrectly. As a low stress control condition, participants were asked to count backward without pressure.

The researchers measured heart rate, cortisol levels (a stress hormone), subjects’ perceived stress levels throughout the experiments, and regional cerebral blood flow (CBF), which provides a marker of regional brain function. In men, it was found that stress was associated with increased CBF in the right prefrontal cortex and CBF reduction in the left orbitofrontal cortex. In women, the limbic system – a part of the brain primarily involved in emotion – was activated when they were under stress. Both men and women’s brain activation lasted beyond the stress task, but the lasting response in the female brain was stronger. The neural response among the men was associated with higher levels of cortisol, whereas women did not have as much association between brain activation to stress and cortisol changes.

“Women have twice the rate of depression and anxiety disorders compared to men,” notes Dr. Wang. “Knowing that women respond to stress by increasing activity in brain regions involved with emotion, and that these changes last longer than in men, may help us begin to explain the gender differences in the incidence of mood disorders.”