MEDICINE IS MUSIC

Chronic Pain and Your Emotions: Is There A Connection?

Dr. Eric Viegas, ND

www.medicineismusic.ca

@medicineismusic

chronic pain emotions

You’re in pain. You decide to go to your doctor to address it, but you feel like the physical approach used is lacking something specific to how you feel.

 

Pain is a very interesting sensation; it is highly individualized and subjective. The perception of pain can be limited or worsened by stress.

 

When our bodies encounter physical trauma, a damage to nerve fibres can result in physical pain. If you are suffering from depression, your mental health can worsen the physical pain. Social factors like isolation and loneliness can further complicate the picture of your pain.

 

So as you can see, your emotions and how you deal with them can affect how you experience your pain.

 

Fibromyalgia (FM) and Irritable Bowel Syndrome (IBS) are both conditions where people experience a high degree of pain and discomfort without obvious clinical or laboratory evidence to indicate damage to the affected areas. Also, FM and IBS may occur at the same time, further complicating treatment.

 

A recent theory called central sensitivity syndrome (CSS) attempts to explain the persistent pain felt from these conditions. CSS notes a hyper-excitement of the central nervous system (brain and spinal cord) rather than a direct issue with the affected areas. CSS may explain the emotional component of pain and the need for it to be addressed in chronic persistent pain syndromes (1).

 

Now let’s talk about feelings of fear and anxiety, common forms of stress response.

 

Fear is experienced when we encounter a threat, and it motivates defensive behaviours like running away to escape.

 

Anxiety is usually the anticipation of a threat and results in hyper-alertness and defensive responses.

 

Acutely, fear has the ability to decrease pain, while anxiety may increase it. Eventually, repeated experiences with fear may lead to anticipatory anxiety and persistent pain.

 

Positive emotions, on the other hand, are associated with pain relief. Dopamine is a neurotransmitter involved in the brain’s reward center and is triggered by stimulants like food, water, sex, and drugs. Dopamine makes us feel good by reducing anxiety and fear. As a result, addiction to substances that boost dopamine is often seen in people with chronic pain.

 

Interestingly, pleasant music may also trigger the dopamine reward center and suppress pain (2).

 

Pain is complex, and what works for one person’s pain may not work for you.

 

It is important to be able to identify and label your emotions if you deal with chronic pain, because a difficulty in experiencing, expressing, and describing emotional responses has been shown to be elevated in conditions like low back pain, fibromyalgia, and TMJ disorder. This emotional difficulty, called alexithymia, is often elevated in people with high levels of chronic pain (3).

 

So how can you move forward and address your emotional well being? A good way to start is to draw a picture of how you are feeling if labelling your emotions through spoken word or journalling is difficult.

 

Certain MDs, NDs, psychotherapists, counsellors, and other professional therapists use mindfulness based therapies to further help you work through emotional traumas that might be affecting your pain.

 

Expression of your emotions is helpful if done in a healthy way; perhaps writing, painting, yoga, exercise, singing or dancing may allow for a healthy expression of your emotions.

 

Local community support groups may also be helpful if addiction is a main factor numbing you from your emotions.

 

References:

 

  1. Arendt-Nielsen L, Nie H, Laursen MB, Madeleine P, Simonsen OH, Graven-Nielsen T. Sensitization in patients with painful knee osteoarthritis. Pain 2010; 149: 573-581.
  2. Fields HL. Understanding how opioids contribute to reward and analgesia. Regional Anesthesia and Pain Medicine 2007; 32: 242-246.
  3. Lumley MA, Neely LC, Burger AJ. The assessment of alexithymia in medical settings: Implications for understanding and treating health problems. Journal of Personality Assessment 2007; 89: 230-246.

Physical Activity Beneficial for Cancer Patients

Dr. Eric Viegas

www.medicineismusic.ca

@medicineismusic

exercise cancer

People who are physically active before and after a cancer diagnosis are 40% more likely to survive when compared to their sedentary (little to no exercise) counterparts.

 

A recent study from April 2018 found that exercise holds benefit for all types of cancer. The researchers looked at pre- and post diagnosis physical activity in over 5000 cancer patients who received their diagnoses between 2003-2016. There were more women than men in the study, and the average age was around 60 years old.

 

According to the authors of the study, the greatest increase in survival was observed in people who exercised 3 to 4 days per week both before and after diagnosis. Interestingly, people who chose to exercise everyday did not fare much better, a boon to the weekend warriors among us!

 

Interestingly, people who were sedentary 10 years prior to their diagnosis but who decided to become more active after their diagnosis had a 25% increased chance of survival when compared to people who remained inactive after diagnosis.

 

As the authors stated, “The message is that it’s never too late to start exercising”.

 

Exercise can help people improve strength, heart and lung function, and overall quality of life.

 

So what is stopping you from exercising? It’s probably a complex answer, and that’s okay. Exercise should be fun, and something that you can fit into your schedule without adding a high burden of stress. Even something simple like daily walks and stretching can be beneficial for the most sedentary among us.

 

If injuries are preventing you from meeting your exercise goals, perhaps it’s time for a tune up with your chiropractor or osteopath. If the issue is due to your mood, perhaps it’s time to find ways to address your mental health through diet, lifestyle, and therapy.

 

Our bodies were made to move, so ensuring that you are taking care of your body’s needs will go a long way to improve your energy levels, stress resilience, and exercise capacity!

 

References:

 

Physical Activity Significantly Boosts Survival in Cancer Patients – Medscape – Apr 23, 2018.

Herbal Medicine for Anxiety and Depression: New Evidence

Dr. Eric Viegas, ND

March 2018

depression anxiety herbal medicine naturopath ottawa

 

Depression is estimated to affect 5.4% of Canadians aged 15+ (1).  1 in 8 adults will meet the criteria for a mood disorder in their lifetime (1). Women have higher rates of depression than men.

 

Anxiety can also be present with a diagnosis of depression, further impacting a person’s quality of life.

 

People living with depression experience a lack of pleasure in activities that once brought them joy, sleep issues, fatigue, guilt and feelings of worthlessness, memory and concentration issues, and thoughts of suicide.

 

Depression and anxiety also contribute to a high burden of stress in people with cancer.

 

In a survey of 3370 cancer survivors, 20% identified with moderate to severe levels of depression, and 40% were living with moderate to severe anxiety lasting 6 years after diagnosis (2).

 

Due to the large number of adverse effects, and interactions with chemotherapeutics, conventional antidepressant and anti-anxiety medications are not favourable for cancer people (3). It’s no surprise then that this population seems to favour herbal remedies for anxiety and depression.

 

A recent systematic review summarized the evidence from 100 single herb clinical trials for depression and anxiety from 1996-2016 (4).

 

Here are the top herbal remedies for anxiety and depression as identified by this study:

 

Lavender

A fragrant and relaxing plant to grow in your garden, lavender is also used in perfumes and aromatherapy products. Lavender extracts, taken orally, show a stronger anti-anxiety effect than placebo and are comparable in effect to prescription drugs (eg. paroxetine, lorazepam) in human trials. Lavender also has fewer adverse effects than these drugs.

lavender anxiety depression naturopath ottawa

A tea made from lavender buds may improve the effect of citalopram; a commonly prescribed antidepressant medication.

 

Passionflower

Used by Native Americans as a remedy to improve sleep and anxiety, passionflower tea may improve sleep quality. When used with clonidine, passionflower extract was also shown to improve mental-emotional well-being for people undergoing opioid withdrawal.

passionflower depression anxiety sleep naturopath ottawa

Compared to the anti-anxiety medications oxazepam and sertraline, passionflower extract was not more effective in reducing severity of symptoms, but it had much fewer adverse effects.

 

Saffron

A commonly used spice in South Asia and the Middle East.

saffron depression anxiety premenstrual naturopath ottawa

Saffron was found to be most beneficial for people that identified with mild to moderate anxiety. Some studies also showed that saffron was superior to standard antidepressant drugs (fluoxetine and imipramine).

 

Women who have a flare-up of anxiety and/or depression premenstrually also benefited from saffron extract.

Black Cohosh

Commonly found in most herbal preparations for menopausal symptoms, black cohosh may have a positive effect on hot flashes.

black cohosh depression anxiety hormones naturopath ottawa

One study using a patented extract called Remifemin® was shown to be as effective as low dose topical estrogen in reducing hot flashes, anxiety, and depression without the adverse effects of hormone therapy.

Chamomile

Popular in sleep teas, chamomile is an effective anti-anxiety herb for people dealing with mild to moderate anxiety.

chamomile anxiety depression naturopath ottawa

Chamomile was also shown to be effective in the long-term (the study looked at 38 weeks of treatment) but had no effect on relapse rates.

 

Chaste Tree

Another herbal remedy for hormonal issues, chaste tree/vitex is often taken for premenstrual and fertility issues.

chaste tree vitex anxiety depression fertility naturopath ottawa

Chaste tree, when compared to the antidepressant fluoxetine, was shown to be more effective in reducing physical symptoms associated with depression in postmenopausal women.

 

Always check with your doctor before starting any nutritional supplement, herb, or medication.

 

Follow the links for additional information on anxiety, insomnia, and fatigue.

 

References

 

  1. Pearson, Caryn, Teresa Janz and Jennifer Ali. 2013. “Mental and substance use disorders in Canada” Health at a Glance. September. Statistics Canada Catalogue no. 82-624-X.
  2. Inhestern, L., Beierlein, V., Bultmann, J. C., Moller, B., Romer, G., Koch, U., & Bergelt, C. (2017). Anxiety and depression in working‐age cancer survivors: A register‐based study. BMC Cancer, 17(1), 347.
  3. Fajemiroye, J. O., da Silva, D. M., de Oliveira, D. R., & Costa, E. A. (2016). Treatment of anxiety and depression: Medicinal plants in retrospect. Fundamental & Clinical Pharmacology, 30(3), 198–215.
  4. Yeung, K., et al. Herbal medicine for depression and anxiety: a systematic review with assessment of potential psycho-oncologic relevance (2018). Phytotherapy Research, 1-27.

Mindset and Holistic Health

Mindset and Holistic Health: What’s serving you, and what isn’t?

Dr. Eric Viegas, ND

 

mindset dr. eric viegas naturopath ottawa

I often have people with chronic illnesses approach me for treatment. Sometimes, they do quite well with just minor lifestyle and nutritional changes. These treatments can be thought of as addressing an underlying, physical, cause.

 

However, I have also treated cases that require healing of a deeper underlying cause.

 

Our minds and bodies are very closely connected to one another, and their influence on each other should not be overlooked.

 

There are numerous clinical studies emphasizing the importance of diet, exercise, and stress management when it comes to a healthy mood balance, but what about the other way around?

 

What about your mindset? What do you focus on in your attitudes, beliefs, and behaviours?

 

Can the connection between your physical health and your mindset (that is, your emotional health) be the underlying cause of your distress?

 

A good example of this is insomnia.

insomnia mindset dr. eric viegas naturopath ottawa

Chronic insomnia is a common problem for many Canadians. Since supplements are easy to get over the counter, I find most people self-prescribe remedies to help themselves sleep. In some cases, the self-prescription may work, but it will not deal directly with the underlying cause of insomnia if you don’t do the work of asking “why?”.

 

When you are trying to fall asleep how do you feel? Anxious? Frustrated? Scared?

 

Your individual emotional response to your insomnia is an important factor in assessing and treating it.

 

Taking a melatonin supplement recommended by a supplement store employee for insomnia may initially help you, but it does not address your underlying emotional health and mindset.

 

What makes you feel anxious? How long have you felt this way? Has the feeling changed with time? In what other areas of your life do you find yourself feeling that way? I often ask questions of this nature to understand a person as a whole being; what makes them who they are and how do they react to their stress on the physical, mental-emotional, and spiritual planes?

 

Asking non-directional questions, either with the help of a health professional or on your own, will help you to reframe your perceptions. When we take a step back from our habitual behaviours, attitudes, and beliefs we have the opportunity to foster a deeper understanding of why it is we do what we do.

 

Ultimately, the question of  “do these beliefs/emotions/thoughts serve you?” will arise, and it is not an easy question to answer.

 

Perhaps your anxiety is helpful when it comes to meeting deadlines at work. But, if you cannot recover from a stressful day with a healthy sleep because your anxiety is keeping you awake, then your mindset is not serving you as a whole person.

 

I am not a fan of New Year’s resolutions. In 2018, instead of making a New Year’s resolution, think about your emotional health. Ask yourself “what makes me feel this way?” and explore the inner workings of your mindset.

 

Bolster Your Immune System for The Holiday Season

Q&A: How Will My Immune System Survive The Holidays?

 

With winter and family holidays fast approaching, I am constantly asked about what can be done to bolster the immune system and reduce stress. Here are some easy tips to get you through the rest of the year.

 

Q: I’m travelling a lot over the holidays, what can I do to boost my immune system?

 

A: A recent study used elderberry to prevent the onset of influenza during air travel. The study looked at 600-900 mg of elderberry extract containing 90-135mg of anthocyanins. Study participants took 2 capsules per day for 10 days before air travel. Two to four days before departure, the dosage was increased to 3 capsules per day, until 4 days after arrival at their destination (1).

immune system dr. eric viegas

Anthocyanins belong to the flavonoid group of phytochemicals; commonly found in teas, wine, fruits, vegetables, nuts, olive oil, and cocoa. They add vibrant color to these foods, along with a potent antioxidant capacity. Recent research into the human effects of anthocyanins has revealed their ability to strengthen blood vessels, balance the immune system, and combat inflammation (2,3).

 

Of the 312 participants taking the elderberry extract, 29 developed a cold. The group taking the placebo treatment had greater symptom severity and over twice the duration of illness compared to the elderberry group.

 

For more information on how you can best avoid the cold and flu this year, click here

Q: I’ve heard sugar can compromise my immune system. What lifestyle behaviours can help me with my sweet tooth?

 

A: Sugar is a contributing factor when dealing with illness over the holidays. Try structuring your meals with a low carbohydrate content, and increase your consumption of proteins from meat and vegetable sources. Some good vegan sources of protein include pumpkin seeds, lentils, black beans, almonds, and tempeh.

healty immune system dr. eric viegas

Munching on high protein snacks will help to keep your blood sugar stable, increase feelings of fullness, and make it less likely for you to grab extra holiday treats.

 

Q:What about stress and my immune system? My family drives me crazy over the holidays, and I know I’m going to get sick because of the added stress…

 

A: Stress is an inevitable part of everyone’s lives. Unfortunately, you can’t pick your family, but you can build your resilience to the added stress that comes with holiday get togethers.

 

Daily yoga is an excellent way to tone your nervous system and help you keep a cool head when dealing with added stress.

healthy immune system dr. eric viegas

A recent systematic review of 11 studies found that yoga enhanced the production of the body’s own antioxidants vitamin C and glutathione in healthy, diabetic, prediabetic, hypertensive, and renal disease patients. As a result, there was a significant reduction of oxidative stress after a session of yoga (4).

 

The great thing about yoga is that you don’t need to go to a class to reap the health benefits. A quick search of youtube will get thousands of results for many different types of yoga; one for every person’s unique needs.

 

Have a safe and happy holiday!

 

References:

 

  1. Tiralongo E, Wee SS, Lea RA. Elderberry supplementation reduces cold duration and symptoms in air-travelers: a randomized, double-blind placebo-controlled clinical trial. Nutrients. 2016;8(4):182.
  2. Lila, Mary Ann. “Anthocyanins and Human Health: An In Vitro Investigative Approach.” Journal of Biomedicine and Biotechnology 2004.5 (2004): 306–313. PMC. Web. 2 Nov. 2017.
  3. Youdim K, Martin A, Joseph J. Incorporation of the elderberry anthocyanins by endothelial cells increases protection against oxidative stress. Free Radic Biol Med. 2000;29(1):51–60.
  4. Pal, R. & Gupta, N. (2017). Yogic practices on oxidative stress and of antioxidant level: a systematic review of randomized controlled trials. Journal of Complementary and Integrative Medicine, 0(0), pp. -. Retrieved 2 Nov. 2017, from doi:10.1515/jcim-2017-0079.

Eczema FAQs & How Naturopathic Medicine can help

eczema dr eric viegas

Dr. Eric Viegas, ND

 

Why do I have Eczema?

  • Partly due to genetics, immune dysregulation causing allergic inflammation, and environmental factors.
  • If you have a family history of eczema you are more likely to develop it. Environmental factors like bacterial (staphylococcus aureus) colonization of damaged skin, and chronic phthalate exposure (found in textiles, food products, and plastics) contribute to inflammation and immune dysregulation.
  • There is some evidence that the presence of helicobacter pylori, a bacteria commonly known for causing stomach ulcers, can also contribute to immune dysregulation and inflammation of the skin barrier.
  • Food triggers are also an important contributor to eczema. Increased intestinal permeability contributes to allergen sensitization, so chances are good that your digestive system needs some help. A naturopathic doctor can work with you to establish which foods may be contributing to your eczema.
  • If you have endocrine problems like thyroid disease it is best to take your medication and be well managed, as worsening hypothyroidism may also worsen the severity of your eczema.

 

What is the best treatment for Eczema?

  • A combination of dietary management, skin care, and stress management will help to control the chronic symptoms of eczema and address the underlying causes.

 

Can diet affect Eczema?

  • Eggs, wheat, dairy, soy, peanuts, tomatoes, and artificial colours & preservatives have been implicated as triggers in a large percentage of eczema cases. Elimination of these offending foods has been shown to restore normal intestinal function and reduce the progression of new food allergies. Avoidance of these foods may be continued for up to one year to achieve the best results.
  • There is also a growing body of evidence to support histamine intolerance in the development and severity of eczema. In histamine intolerance, ingestion of histamine-rich foods (think red wine, aged cheeses, cured meats) overwhelms your gut’s ability to breakdown this inflammatory molecule. Overtime, more systemic signs of histamine intolerance (rashes, heart palpitations, irritable bowel syndrome, and allergies) develop.
  • Eating more fatty fish (eg. salmon, herring) in pregnancy, lactation, infancy and childhood has shown protective effects against eczema in epidemiologic studies.

 

What lifestyle behaviours can help with my eczema?

  • First, stop scratching. Scratching will break the skin barrier and allow for bacterial colonization.
  • In terms of keeping clean, baths are more beneficial than showers as long as you remember to “soak and smear”; bathe, pat yourself dry, and then apply a very generous amount of moisturizer to the skin. For added benefit, soak oatmeal in a clean cloth bag in your bath to soothe your skin.
  • People suffering from the itchiness of eczema tend to have more anxiety, and feel more stressed out. Finding an outlet for your stress and keeping your anxiety at a manageable level will help to benefit your outlook and the severity of your eczema. A naturopathic doctor has many tools to address high stress and anxiety.

 

What are natural topical remedies for Eczema?

  • Seabuckthorn oil, castor oil, olive oil, coconut oil, calendula oil, chickweed cream, and moisturizers containing beeswax can all help to moisturize the skin and maintain its barrier. It is also important to use a mild pH-neutral soap free of any perfumes or fragrances to avoid any unwanted skin irritation.

 

What Supplements are good for Eczema?

  • Daily fish oil supplementation and use of the probiotic strains lactobacillus acidophilus and bifidobacterium bifidum are two supplements with good evidence for use in eczema.
  • However, you should always consult your doctor before starting any new medication or supplement. A naturopathic doctor will take a thorough health history to determine any other health concerns that should be addressed along with your skin health and come up with a comprehensive treatment plan. It is not uncommon for people with eczema to also experience digestive issues, allergic rhinitis (seasonal allergies), and asthma.

 

References:

 

Kido M., Tanaka J., Aoki N., et al: Helicobacter pylori promotes the production of thymic stromal lymphopoietin by gastric epithelial cells and induces dendritic cell-mediated inflammatory Th2 responses. Infect Immun 2010 Jan; 78: pp. 108-114

 

Elias P.M., and Schmuth M.: Abnormal skin barrier in the etiopathogenesis of atopic dermatitis. Curr Opin Allergy Clin Immunol 2009 Oct; 9: pp. 437-446

 

de Maat-Bleeker F., and Bruijnzeel-Koomen C.: Food allergy in adults with atopic dermatitis. Monogr Allergy 1996; 32: pp. 157-163

 

Agata H., Kondo N., Fukutomi O., et al: Effect of elimination on food-specific IgE antibodies and lymphocyte proliferative responses to food antigens in atopic dermatitis patients exhibiting sensitivity to food allergens. J Allergy Clin Immunol 1993; 91: pp. 668-679

 

Kremmyda L.S., Vlachava M., Noakes P.S., et al: Atopy risk in infants and children in relation to early exposure to fish, oily fish, or long-chain omega-3 fatty acids: a systematic review. Clin Rev Allergy Immunol 2011 Aug; 41: pp. 36-66

 

Barnes B.: Thyroid therapy in dermatology. Cutis 1971; 8: pp. 581-583

 

Maintz, L., et al. “Evidence for a reduced histamine degradation capacity in a subgroup of patients with atopic eczema.” The Journal of Allergy and Clinical Immunology. Vol. 117, No. 5 (2006): 1106–1112.

 

Worm, M., et al. “Exogenous histamine aggravates eczema in a subgroup of patients with atopic dermatitis.” Acta Dermato-Venereologica. Vol. 89, No. 1 (2009): 52–56.

 

Anxiety Disorders: What Are Your Options?

Anxiety Dr. Eric Viegas Naturopathic Medicine Ottawa

Anxiety Disorders: What Are Your Options?

 

Dr. Eric Viegas, ND

 

Anxiety disorders affect 1 in 4 Canadians at some point in their lives, making anxiety the most common mental illness in Canada. Psychotherapy and benzodiazepine medication are the conventional treatment options for anxiety. However, benzodiazepine drugs carry a high rate of addiction potential, can make people feel sedated, and carry a long list of side effects. So what can be done about anxiety if you want to pursue other treatment options?

 

First and foremost, it’s important to identify the source(s) and trigger(s) of your anxiety. What makes it better or worse? Is it a social setting that triggers a panic attack? A big test that you’re studying for that’s causing general anxiety? The importance of understanding your anxiety, rather than avoiding it, carries with it a significant mental and physical benefit. Our brains have the ability to tell the difference between suppressing our emotions versus addressing and labelling them. It is okay to feel anxious. Learning from our anxieties offers the opportunity for better self-understanding. When we understand why we react with anxiety, we learn from our thoughts, behaviours, and actions. Identify and label how you are feeling and you’ll find that your mood won’t have as much of an impact on your daily function. Proper sleep, a healthy diet, good social support, and a lifestyle that includes plenty of physical activity all factor into your wellbeing when dealing with anxiety.

 

A diet deficient in certain amino acids, vitamins, and/or minerals can have a negative impact on your mental-emotional wellbeing. Certain amino acids, vitamins, and minerals can help to calm an overactive mind through calming your nervous system, and correcting vitamin and mineral deficiencies that might worsen anxiety. In fact, even low iron can contribute to anxiety. An adequate intake of protein from both animal and vegetable sources can help with amino acid intake, and improved blood sugar control. Stable blood sugar levels can be achieved through the consumption of healthy fats like olive oil, coconut oil, avocados, nuts, and seeds. Fibre from fruits and vegetables can stabilize blood sugar, and add vitamins and minerals to your diet. It is important to avoid packaged foods that contain high amounts of simple sugars when trying to control your blood sugar.

 

Lavender is an excellent anti-anxiety herb, acting on your nervous system to calm your body and mind. In trials involving adults with anxiety, lavender was found to be as beneficial as benzodiazepine medication in alleviating feelings of restlessness, and improving sleep. You can even stuff lavender buds in your pillowcases to help with restlessness during the night. Green tea also helps with feelings of anxiety thanks to theanine. It’s an amino acid that can help reduce feelings of stress, promote relaxation, and help with attention. Green tea and lavender are just a couple of the many alternative treatments for anxiety.

 

Other factors that can contribute to anxiety include (but are not limited to): thyroid disease, heart disease, liver disease, kidney disease, digestive diseases, substance abuse, allergies, depression, and other mental illnesses. It’s important to speak with your doctor to determine the underlying factors influencing your individual anxiety, and discuss what treatment alternatives are right for you.

ADHD: Drugs, Diet, and Naturopathic Medicine

ADHD ADD Dr. Eric Viegas Naturopathic Medicine Ottawa

ADHD: Drugs, Diet, and Naturopathic Medicine

 

Dr. Eric Viegas, ND

 

I recently watched a standup comedy special starring Norm MacDonald. He was commenting on his childhood, and how all he wanted to do while sitting in a classroom was to go outside and play with a big tree branch. He then wondered about hyperactive kids today and their feelings about being stuck in a classroom with the addition of authority figures yelling, “Now we’re going to drug you.” While this commentary is an oversimplification of the plight of modern kids, it does raise the question of whether or not medications are the only option when dealing with attention deficit hyperactivity disorder (ADHD).

 

It is estimated that 5% of all Canadian children ages 3 to 9 fit the criteria for a diagnosis of ADHD (1). Boys are more commonly affected. Inattention, hyperactivity and impulsivity, in both the classroom and at home, are the main symptoms of ADHD. The recent changes to the DSM-V now include details to help doctors identify ADHD in adults, and changes the previous age cutoff in children from 7 to 12 years old (2). It is important to not jump to a hasty diagnosis of ADHD, as there are many other disorders that mimic it.

 

Children who are on the autism spectrum often suffer from ADHD. Oppositional Defiant Disorder (ODD) is often mistaken for ADHD. In ODD, children display angry and irritable mood, argumentative or defiant behaviour, or vindictiveness for at least 6 months. Children and adults with ODD will direct their anger towards at least one person who is not a sibling, and will have significant problems at work, in the classroom, or at home (3). While children with ODD are more likely to also have a learning disability, the important issue here is to receive a thorough workup and diagnosis from a trained psychologist. An accurate diagnosis will ensure that appropriate treatment is provided for you or your child.

 

The American Academy of Pediatrics recommends that preschool children with ADHD receive behavioural therapy as a first line treatment. In school children with ADHD, stimulant medications like methylphenidate (aka Ritalin) and atomoxetine are considered first line treatment (4). Common side effects of these medications include reduced appetite and weight loss, problems sleeping, and stunted growth. Long-term use of methylphenidate can also lead to depletion of zinc in children with ADHD (5). When supplemented with zinc + methylphenidate, children with ADHD in a 2004 study improved in teacher and parent rating scales compared to children taking placebo + methylphenidate (6).

 

In a 2016 retrospective study of around 4200 children in the Netherlands, researchers found that children with ADHD were more likely to be medicated for asthma, seasonal allergies, and eczema. Furthermore, ADHD was deemed to be more common in children whose parents were taking medications for asthma and seasonal allergies (7). In 2015, a systematic review of hypoallergenic diets for children with ADHD found a small but significant improvement in symptom severity (8). Another 2015 study showed that supplementing fish oil into children’s diets for 16 weeks brought down both inflammatory markers and ADHD symptom severity (9).

 

The reality of ADHD is that some people require medication to control their symptoms. A variety of naturopathic interventions can target the side effects of commonly prescribed ADHD medications, ADHD symptoms, and comorbid conditions like allergies and digestive concerns. Speak with your Naturopathic Doctor to find out which interventions are best suited for you or your child.

 

References:

 

  1. Brault MC, Lacourse E. Prevalence of prescribed ADHD medications and diagnosis among Canadian preschoolers and school-aged children: 1994-2007. Cdn J Psychiatry 2012; 57:93-101.
  2. http://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F90-/F90.9. Accessed June 17, 2017.
  3. http://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F91-/F91.3. Accessed June 17, 2017.
  4. ADHD: Clinical practice guideline for the diagnosis, evaluation and treatment of ADHD in children and adolescents. American Academy of Pediatrics 2011.
  5. Viktorinova A, et al. Changed plasma levels of zinc and copper to zinc ratio and their possible associations with parent-and-teacher-rated symptoms in children with ADHD. Biol Trace Elem Res. 2016; 169(1):1-7.
  6. Akhonzadeh S., et al. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial. BMC Psychiatry 2004; 4: 1-6.
  7. Van der Schans J, et al. Association between medication prescription for atopic diseases and attention-deficit/hyperactivity disorder. Ann Allergy Asthma Immunol 2016.
  8. Heilskov Rytter MJ et al. Diet in the treatment of ADHD in children: a systematic review of the literature. Nord J Psychiatry 2015;69(1): 1-18.
  9. Bos DJ, et al. Reduced symptoms of inattention after dietary omega-3 fatty acid supplementation in boys with and without ADHD. Neuropsychopharm 2015; 40(10): 2298-2306.

 

NAC: A Helpful Nutrient for Smoking Cessation, COPD, PCOS, Addiction, and Obsessive Rituals

N-acetylcysteine Addiction Dr. Eric Viegas Naturopathic Medicine Ottawa

 

N-Acetylcysteine: A Helpful Nutrient for Smoking Cessation, COPD, PCOS, Addiction, and Obsessive Rituals

 

Dr. Eric Viegas, ND

 

Cysteine is a sulfurous amino acid found in garlic, broccoli, brussel sprouts, oats, lentils, eggs and meat. Interestingly, sheep require cysteine in order to produce larger quantities of wool. Just like sheep, humans need dietary sources of cysteine because we can’t make it on our own. Cysteine can combine with glycine and glutamate to form glutathione (GSH); one of your body’s key antioxidants. GSH is synthesized in the lungs, and by its main reservoir, in the liver.1 Damage from free radicals, peroxides, and heavy metals is severely limited by adequate levels of GSH.

 

If these benefits sound appealing, and you’re about to reach for that bottle of reduced GSH, don’t bother. Oral GSH use does not raise the levels of GSH in your bloodstream.2 Instead, SAMe, Vitamin D3, and NAC are nutrients that have been shown to increase levels of GSH in the human body.3,4 This article will focus on NAC’s long use as a safe adjunct to treatments, and as a therapy on its own.

 

NAC, or N-acetylcysteine, is a dietary supplement that was originally created to combat liver toxicity from tylenol/acetaminophen overdose; the most common cause of poisoning worldwide.5 Currently, there is a growing body of evidence favouring the use of NAC as an adjunctive therapy for various addictions, mental illnesses, hormonal & metabolic problems, and cancer-related conditions.6,7

 

In 2002, 37 women with polycystic ovarian syndrome (PCOS) and insulin resistance were treated for 6 weeks with 1800-3000 mg/day of NAC. Researchers noted that women treated with NAC had increased insulin sensitivity compared to controls 8 ; their bodily tissues more readily responded to insulin and pulled sugars out of their bloodstream. In addition, NAC induced a significant reduction in testosterone levels. High levels of testosterone are implicated in the worsening of PCOS symptoms.  

 

NAC restores glutamate concentrations which then stimulates group II mGluR receptors. Glutamate transmission is inhibited and reduces the perceived reward of nicotine.9 In a 2011 3.5 day-long double-blind pilot study, smokers were given 3600 mg/day of NAC or placebo.The group smoked an average of 17.5 cigarettes per day, but they refrained from smoking during the study. When participants were given a cigarette after the trial concluded, those that received NAC reported less satisfaction from smoking that cigarette than individuals in the placebo group.9 Moreover, the NAC group reported less withdrawal symptoms than the placebo group.9 It is important to consider that no addiction therapy is truly successful in the long-term without the help of counselling. Cigarette cravings were not reduced in the NAC group compared to placebo.

 

Chronic obstructive pulmonary disease (COPD) is a common complication from a history of tobacco use. COPD patients given 600-1800 mg/day of NAC for 2 months had improved red blood cell function, and decreased peroxide levels by up to 54%.1 Mucus hypersecretion in the lungs by elastase activity, and severity of cough also decreased. NAC is also a strong mucolytic, meaning it can break down the chemical bonds in mucus, and allow it to be excreted more easily. The mucolytic activity of NAC makes it a promising nutrient in other respiratory concerns like cystic fibrosis, asthma, sinusitis, and seasonal allergies. To cap things off, NAC can protect DNA in the respiratory and digestive tracts from damage; DNA damage is one of the first steps in carcinogenesis.7

 

NAC has also demonstrated promising outcomes in cocaine addiction, and bipolar disorder when combined with counselling and medication.6 After 8 weeks of 1800 mg/day of NAC, 16 of 29 pathological gamblers experienced significant reductions in gambling behaviour.6  Since Obsessive Compulsive Disorder (OCD) shares similarities with addiction in terms of brain region activity, NAC may benefit obsessive rituals. Only one case report exists of NAC use in OCD. The patient initially only partially responded to antidepressant medication. With the addition of 3000 mg/day of NAC for 13 weeks, the patient showed improvements in control of compulsive washing and obsessional triggers.6  Trichotillomania (TTM), a grooming disorder where patients obsessively remove body hair, may also benefit from NAC supplementation. 45 women and 5 men with TTM were given 1200 mg/day of NAC, or placebo, for 6 weeks. In the second 6 week period, the dosage was increased to 2400 mg/day of NAC. The participants also received psychotherapy and were medicated. At week 9, and until the end of the study, symptoms of TTM decreased in the NAC group compared to placebo.6

 

NAC is a nutrient with a long history of safety and efficacy. For more information on the benefits of NAC, and to find out if it is right for you, consult your Naturopathic Doctor.

 

References:

  1. Dekhuijzen PNR. Antioxidant properties of n-acetylcysteine: their relevance in relation to chronic obstructive pulmonary disease. Eur Respir J 2004; 23: 629-636.
  2. Allen J, Bradley RD. Effects of oral glutathione supplementation on systemic oxidative stress biomarkers in human volunteers. J Altern Complement Med 2011; 17(9): 827-833.
  3. Garcion E, et al. New clues about vitamin D functions in the nervous system. Trends in Endocrinology and Metabolism 2002; 13(3): 100-105.
  4. Lieber CS. S-adenosyl-L-methionine: its role in the treatment of liver disorders. The Amer J Clin Nutr 2002; 76(5): 1183-1187.
  5. Gunnell D, et al. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide & Life Threatening Behaviour 2000; 30(4): 313-326.
  6. Dean O, et al. N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action. J Psychiatry Neurosci 2011; 36(2): 78-86.
  7. De Flora S, et al. Mechanisms of n-acetylcysteine in the prevention of dna damage and cancer, with special reference to smoking-related end-points. Carcinogenesis 2001; 22(7): 999-1013.
  8. Fulghesu AM, et al. N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fertility and Sterility 2002; 77(6): 1128-1135.
  9. Lianne S, et al. Efficacy of n-acetylcysteine in the treatment of nicotine dependence: a double-blind placebo-controlled pilot study. Eur Addict Res 2011; 17: 211-216.