The New York Times had a front page article on May 12th, 2010 entitled: "Doubt is Cast on Many Reports of Food Allergies".

The article reviewed a government report on the concept and prevalence of food allergies. From the NY times report (I have not read the article, as it is not available yet) there are some valid points (e.g., a food allergy must involve the immune system, certain food reactions are not true allergies, such as lactose intolerance). However my concern is twofold:

a) The NY Times summary of the article, and perhaps the publication itself, seem at this point to ignore IgG food allergies, (which are delayed) and only focused on IgE food allergies

b) The NY Times summary of the article, and perhaps the publication itself implies that many labs are of poor quality. I would agree that many labs are of poor quality, but lets be clear that this quality issue is an industry-wide problem and applies to standard laboratories such as Quest and LabCorp as well. As an example, two articles in the Journal of Clinical Endocrinology and Metabolism (about 6 years ago and 2 years ago) showed clearly that there was only one laboratory in the country doing accurate Vitamin D testing.

I know for a fact, because I routinely send in split samples to different labs, that there is at least one food allergy (IgG) lab that is reliable – ImmunoLabs. (I have no financial connection with them.) I also know that two food allergy labs, which I tested for reliability, were highly inaccurate and unable to explain their inaccuracy to me.

Delayed food allergy testing by a reliable laboratory is a very useful test when one is dealing with many chronic illnesses that have an inflammatory component. These diseases range from arthritis, osteoporosis, diabetes, cardiovascular disease, neuro-degenerative diseases, to psychosis, chronic fatigue, fibromyalgia, obsessive-compulsive disorder, and mood disorders. The list of disease states that have an inflammatory component is quite long.

I am concerned that the New York Times article, and perhaps the actual publication, (yet to be released) will inhibit people form addressing one of the major pathways for inflammation-the gut and diet. Estimates are that 60% of the immune tissue in the body surrounds the gut. We are constructed this way for a very good reason-each meal we eat represents a potential antigenic assault on the body.

Sincerely yours,
Robert Hedaya, M.D., D.F.A.P.A.

As I mentioned in part I of this blog, there is a strong association between insulin resistance, diabetes and mental health.

Caught and treated early, insulin resistance is reversible in >90% of patients, and there is a clear improvement in well-being associated with this reversal.  To get to the foundation of the problem, you must do a diagnostic work-up, to identify and deal with the layered factors which promote insulin resistance and diabetes. Factors to be assessed include:

a)     Cortisol-levels which are too high, (as might be the case in anxiety disorders, mood disorders, and psychotic disorders) cause insulin to be elevated, and increase appetite. Cortisol can be reduced easily enough by either supplements or medications, as well as psychotherapeutic methods (e.g., biofeedback, certain therapies, body work etc)

b)     Female and male hormones-low levels of testosterone result in lowered lean body mass (therefore lower metabolic rate), lower energy and vitality. High levels of estrogens (e.g. with potent birth control pills) can also cause weigh gain, albeit in a different pattern of distribution.

c)      Stress-many people over eat when tired, angry, frustrated, bored, lonely; Becoming mindful of your sense of hunger before eating, can, over time, reduce unconscious habitual stress eating. Identifying the situations which make you stressed and problem solving them when possible can help reduce stress eating. Keeping a daily log  (what you ate, when you ate it, and situations in which you over-ate) will definitely raise consciousness

d)     Lifestyle-getting adequate sleep (7-9 hours for most people), moderate exercise 4-5 times per week will reduce the tendency to eat highly processed foods in an out of control manner when you are tired.

e)     Inflammation and toxins: inflammation due to infection, or toxins in your environment can cause weight gain, as a hormone called Leptin can rise to unusual levels. Irvingia Gabonensis has been shown to help reverse leptin elevation and therefore help with appetite reduction and weight loss.

f)       Nutritional deficiencies (e.g., chromium, vanadium, thiamine) can lead to trouble handling carbohydrates in the body.

g)     Caloric restriction-the hardest part of the program is to reduce calories, but with the above measures, perhaps a support group (e.g. weight watchers, over-eaters anonymous, food addicts anonymous), you can do it.

Yours in Health,

Dr. Hedaya

Insulin resistance is a fully reversible condition in which the cells of the body become insensitive to the insulin signal, which itself is designed to take glucose (sugar) out of the blood and into the cells (for energy). If insulin resistance becomes severe enough, it progresses into type II diabetes. Diabetes is more difficult to reverse, and is associated with frequent urination, increased weight, increased thirst, and a host of other problems.

The connection between obesity, insulin resistance, diabetes and mental health problems is no longer questioned. There are number of reasons for the association, including the use of psychotropic medications which cause weight gain, and promote the metabolic syndrome; the social stigma associated with obesity and the lifestyle changes associated with diabetes; and inflammatory activation due to poor diet, high insulin and glucose levels, which in turn changes brain neurochemistry.

A recent study (McIntyre et al.  brain volume abnormalities and neurocognitive deficits in diabetes mellitus: points of pathophysiological commonality with mood disorders?: Adv. Ther. 2010 Feb;27(2):63-80. ) reviewed the literature on brain changes in type one and two diabetes, and concluded that the brain areas which are affected in mood disorders and DM diabetes mellitus, significantly overlap. The association is so compelling that one article in 2007 (Ann. Clin. Psychiatry; 2007 Oct-Dec;1994):257-64) was titled: “Should Depressive Syndromes Be Reclassified as “Metabolic Syndrome Type II”. The association with diabetes (and obesity and insulin resistance) extends beyond just mood disorders, to anxiety disorders, and major psychiatric syndromes such as bipolar disorder and schizophrenia.

I was thinking about the high rate of fractured families and the lack of community in the US, when I began to look at the issue from a different perspective. Fractured families may not be pathological from the planet’s point of view. The earth’s limited resources, or at least the way we are using them, cannot sustain the increasing numbers of human inhabitants. These days, it is clear that the tide has changed; we are not living in a time of easy expansion, which has been present for years. We are now at a point where resources are becoming scarce, air is polluted, water is polluted, and we are over-fishing the seas. It’s inevitable that human expansion has to slow down.

That means fewer children, and or more wars and famines. One way that comes about experientially is for our younger generations to have a harder time getting jobs, making enough money to support a marriage and a family; to find their way in the world. Consequently, they have fewer children, less affluence, a harder time establishing a career,  and may feel a sense of failure when they compare themselves or their achievements to those of their parents.

Without this global perspective, this situation can be experienced and misinterpreted as personal and familial failure. But it’s useful to realize that the tide has turned, and our young children are swimming upstream—more than the baby boomers were, and certainly they are swimming against a strong current, compared to the post-World War II generation.  A diminishing numbers of young people will establish large successful families; those who are able to do so will be in the minority.
Nature will have its way. Nature is fracturing the over-grown human social structure, with all the political and socio-economic changes associated with that. It is hard.

My hope in writing this is that people can recognize the rebalancing aspects of nature which are involved, rather than blaming themselves-- attributing the frustrations in achieving goals to be purely personal and familial failure, or  the result of psychological shortcomings.

Insomnia, an all too common problem, is usually attributed to stress, depression, anxiety, alcohol or caffeine use, poor sleep hygiene, restless legs syndrome, and sleep apnea. Hormonally, thyroid abnormalities, and unusually low levels of melatonin can cause insomnia as well. While all of these syndromes should be considered in evaluating insomnia, the role that PMS and female hormones (progesterone, estrogens) play in insomnia is rarely discussed.

Background

In healthy women sleep disturbances occur twice as often as they do in men. Insomnia is also often more common in the 1-2 weeks before menstruation begins (the luteal phase of the cycle), when compared with the first half of the menstrual cycle. The sleep regulating role of female hormones looms even larger in women with PMS (also known as PMDD, premenstrual dysphoric disorder), and women in the post-menopausal and postpartum phases of the reproductive cycle.

The most common finding in studies of healthy menstruating women is a reduction in dream sleep (REM sleep) in the luteal phase of the monthly cycle. REM sleep usually occurs at the time of the night when body temperature is lowest, but progesterone raises body temperature, thereby (presumably) reducing REM sleep. It is possible that variations in progesterone (which acts in some ways like valium acts, at the GABA-a receptor) and its metabolites may affect sleep quality directly, or via affects on body temperature. In sum, it seems that progesterone, the hormone that rises to very high levels (in the second half of the cycle) to prepare women for pregnancy, helps women fall asleep better, and stay asleep better (but dream less).

Melatonin, the ‘sleep hormone’, seems intimately involved with the female hormonal axis. Surprisingly, receptors for female hormones and melatonin both occur in the same areas of the brain, and melatonin is even found in human ovarian fluid! The relationship between melatonin, while very relevant, is clearly complex. In some studies progesterone and melatonin oppose each other, and in other studies they support each other’s actions. Estrogen, on the other hand seems to reduce melatonin action.

Women with PMS

In women with PMS, disturbances of sleep are very common in the second half of the menstrual cycle (as compared with the first half of the cycle), and dream sleep is reduced. Studies have documented that women with PMS have lower levels of progesterone toward the end of the cycle than their healthy counterparts, and I have seen this in my own practice. Lower levels of allopregnenolone (a breakdown product of progesterone which helps block anxiety) are also found in women with PMS, as well as lower GABA receptor activity levels. GABA is calming, and reduces anxiety.

Abnormal timing of melatonin secretion in PMS has also been documented and it is possible that this is related to reduced availability of serotonin during the second half of the menstrual cycle. Reduced serotonin could result in less melatonin production, and could be the result of increased inflammation in the body, since it is known that inflammation blocks serotonin production in the brain. Inflammatory mediators (TGF-beta-1 family) are involved in processes that control development of the ovarian follicle, the cradle of the egg.

This is pretty complex stuff, and we are far from understanding all or even most of the interactions, but clearly the data indicates that many body systems intersect between the reproductive and sleep cycles.

What can be done?

Despite the lack of clarity about mechanisms, insomnia associated with PMS is quite treatable, if a careful evaluation is done.

If you think you have PMS, carefully track your menstrual cycles and moods on a graph for three months. Get your female hormones measured several times during the first half and second half of your cycle, using blood samples or saliva samples, being sure to measure the pituitary hormones (FSH and LH) in your blood at least once in each half of the cycle.  Measure your melatonin in the second half of your cycle via saliva testing, and journal what you are eating during that time of your cycle. Also journal whether or not you notice more aches and pains during that period of time, as this indicates an inflammatory component, which lowers brain serotonin. This approach will help you be sure it is PMS and help shed light on what to do.

Some women with PMS benefit from light therapy with improved mood, perhaps via its effect on biological rhythms, improved timing of adrenal output, or melatonin release. Sleep deprivation (sleeping from 3-7 AM) seems to normalize circadian rhythms and REM sleep, as well as improve mood during the second half of the menstrual cycle, however this treatment was only studied for short, one-day periods of time. Selective serotonin re-uptake inhibitors (SSRI’s) are also effective in treating PMS.

Progesterone supplementation is very often useful if you have documented progesterone deficiencies, or estrogen excesses. Melatonin levels can be measured at night, and melatonin can be effective in alleviating the insomnia of PMS. Dietary changes may be indicated if aches and pains (which indicate an inflammatory process) are a significant symptom, since reduction in inflammation increases the brain’s ability to make serotonin and melatonin, and maintain a good mood, and low levels of anxiety.