Women have twice the frequency of depression as men, and are more vulnerable to many psychiatric disorders between puberty and menopause. Menopause and the post partum are time of high vulnerability for women. Women are more likely to be hospitalized or jailed in the days just before menstruation begins. Transdermal estrogen has been proven in three studies to have antidepressant effects (as opposed to oral estradiol). These facts, and others, beg for our attention to the role of female hormones in mental health. When one adds the concerns raised by the woman’s health initiative study of over 160,000 women on synthetic estrogens, one can easily be left in a state of confusion.
What to do?

First, write down a complete history of your mental health and hormonal events. This means looking at mental health symptoms just before and during puberty, in the days before your period, in response to pregnancy and birth control pills, after any female surgeries, and around menopause. What were your symptoms, did they get better or did some get worse? Include your family history of female (ovarian, uterine, breast) cancers, male cancers (prostate), and cardiovascular disease.

Next if you are still menstruating, track your symptoms and your cycle for three months. Some studies suggest that 50% of women who think they have PMS, do not. Whether that statistic is correct or not, you need to make an accurate correlation.

Finally, work with your doctor to check your FSH, LH, estradiol and progesterone in both the follicular (first 10-12 days) and luteal (days 18-24) parts of your cycle. If you can arrange for continuous salivary monitoring of estradiol and progesterone (less reliable) during that same cycle, you will get a very nice picture of what your hormones are doing in relation to your symptoms. In a simplistic way–estrogen tends to be activating, and progesterone is like the drug Valium—calming in small doses, sedating and depressing in large doses. If you want to be really comprehensive, you can test your genetics (CYP450 1B1 and COMT) and estrogen metabolism to determine whether you can improve your protection against female cancers by eating crucifers, or whether these veggies might increase your risk for making ‘bad’ estrogens.

In addition, look at other hormones (adrenal and thyroid) that influence the female hormone cycle to round out the picture.

All this and more will be discussed in my upcoming complimentary Lunch and Learn teleconference May 5th, at 12:00.

New research indicates that in cases of closed crush injury, runaway inflammation is not due to infection, as previously thought. Never able to find the source of the supposed infection, doctors and researchers were baffled until now. It turns out that when there is such an injury, the mitochondria, which are the energy powerhouses of the body, are released into the circulation. Since mitochondria are thought to be energy producing bacteria-like organisms it’s not surprising that the immune system would mount a response to these usually cell bound parts of us. Mitochondria are not usually present in the blood stream, and so they are recognized as foreign by the neutrophils that police our circulatory system against foreign invaders.

I find it interesting that the very essence of what allows us to have energy-these mitochondria-look and act like bacteria, and even have their own DNA. How is that for a cooperative relationship? We could not exist without them. We are more inter-dependant on those around us (and in us) than we like to think!

Most people (except those with liver and kidney disease) do not get enough protein (fish, meat, eggs) for breakfast and lunch. Try increasing your protein at breakfast and lunch for five days and see if you don’t notice a difference in your energy, reduced cravings at night, improved mood, and less of an afternoon slump within five days. I was so impressed by this effect that it was part of the motivation for my second book.

A recent study known as the Colorado Thyroid Disease Prevalence Study, found that 13 million Americans may have undiagnosed thyroid conditions, and suggested that more widespread thyroid testing is needed. Among their findings are the fact that 9.9 percent of the population had a thyroid abnormality that had gone unrecognized. An underactive thyroid -- hypothyroidism -- affects more women than men, and the risk increases with age for both men and women. Clearly, there is a need for more widespread thyroid stimulating hormone (TSH) testing and more aggressive treatment, especially for subclinical patients. Additionally, another study, called the NHANES study, showed that the reference ranges (for TSH) in most laboratories are too wide. Furthermore, relying on the TSH (being in the normal range) as the only way to define hypothyroidism may mean that still more millions are hypothyroid, but undiagnosed and overlooked.

A thorough workup of the thyroid axis should include an assessment of the adrenal axis as well. Of course a history (dry skin, hair loss, constipation, weight gain, brittle nails, irregular menses, muscle weakness, sensitivity to cold, recurrent upper respiratory tract infections, depression, low energy, hoarseness, elevated cholesterol), physical exam, body temperatures, and lab testing (TSH, free T4 , Free T3, reverse T3) are part of a complete evaluation.

Finally, another new study (of 17, 684 people) showed that when one is on thyroid hormone, an optimal dose is one that keeps the TSH very low, but not completely suppressed. This reduces risks of cardiovascular complications and fractures. These results are surprising, but the study was quite strong in design. (J. Clin Endocrinology Metab, Jan 2010, 951(1):185-193).

We will be hosting a workshop webinar on the effects of thyroid function and mental health on April 7th at 12:00 noon EST - 12:30pm. Registration is free, sign up today.

Yet despite these limitations, if I break my arm, or have an acute illness, I want a really good traditional doc. They do a pretty good job with acute illness. And if I have a chronic illness, I want a really good integrative medicine person.

My advice: On a day-to-day basis always be your own doctor-eat well, get enough sleep, exercise, meditate, have fun and build good relationships. When you need to see a health care practitioner you must work hard to be an active and full partner in the process. Learn as much as you can. Investigate, think, and trust your gut and common sense too. Be fully honest with your doctor. No one knows your life like you do. There are good doctors and other health care professionals out there. But you have to keep interviewing to find the one that is right for you.

In the long run, the entire socio-economic system needs to change, because lots of good people are blinded by it, many are hurt by it, and a few narcissistic and or sociopathic people in positions of power maintain it. I think I have some ideas—one practical, and one sweeping and far out. Stay tuned—in my next blog, where I hope to ‘flesh them out'.

The behavior patterns I have outlined above go far back in time. If you are interested, read "Mad in America". This 400-year history of the psychiatric establishment demonstrates the financial engine, masked as science, which has driven most developments in the field. Roughly fifty year cycles of new paradigms recur: invention, profit, and disillusion regularly re-cur almost like clockwork. 

I suspect we are now at the beginning of the next cycle in psychiatry with the loss of confidence in pharmaceuticals (‘a pill for every ill'). Trans-cranial magnetic stimulation, and deep brain stimulation may be the next wave. There is certainly enough profit in it. I expect to see more talk about these ‘promising new modalities' in the media. Interestingly, in the area of schizophrenia, it is humanistic treatment that has shown the best long term results-not drugs, not shock treatment, not psychoanalysis (nor spinning patients at high speeds, insulin shock, cold wraps, isolation rooms etc.). However, this information is not taught in medical school or psychiatric training, just as nutrition is by and large ignored.

I do not think that the alternative medicine field is going to be any better in this regard than the allopathic field. I have seen both alternative medicine and mainstream laboratories putting out inaccurate test results with impunity. I have heard far out, unsubstantiated claims from alternative practitioners. Conflicts of interest are just as prevalent in alternative medicine, only on a smaller scale.

So where is the problem? First of all chronic illnesses, which are the major focus of our health care system, usually do not occur in isolation. The woman who has heart disease generally has insulin resistance and osteoporosis too. Also, because of advances in the field of genetics, we now know that if you conduct a study on a disease—say heart attacks—and don't control for the relevant individual genetic differences, then you have a mixed population in which the intervention could work for a subgroup but not for the masses. 

The study can be very rigorous (double blind, randomized, placebo controlled) and demonstrate lack of benefit for the intervention, the evidence judged lacking. And that may be true for the group as a whole, i.e., on a population level. So if we look at the group as a herd, then public health interventions, and EBM are pretty useful. If we keep most of the herd alive, and only lose a few cows, that's pretty good. But we are not the herd, though we are part of it. We are individuals. 

EBM, under the mask of science takes population based data, and bowing to the power of money, political and economic pressure applies it to individuals. The mask of science serves the insurance companies very well.

I am waking to the fact that there is a long-term historical pattern of disinformation. Despite the periodic real advances in medicine over the centuries, facts demonstrate that the medical field dons the mask of science on a pretty regular basis.

Here is a brief outline of some additional evidence:

a) There are raging political-economic wars around Lyme disease, that have nothing to do with science. The Connecticut attorney General recently removed the mask of science from the IDSA (Infectious Disease Society of America), ordering this influential and prestigious group to reassess their guidelines for diagnosing and treating Lyme disease because they were selective in their consideration of the evidence, perhaps eliminated some with dissenting opinions from the committee, etc. Because of the IDSA's refusal to look at all the data and pursue the facts, many doctors are losing their licenses as medical boards and insurance companies target physicians who practice outside of the ‘standard of practice'. 

b) In the autism wars, via a Freedom of Information Act request, documents have been released clearly showing an attempt by the CDC to suppress data implicating mercury in the steep rise in autism in this country. Aren't they supposed to be on the people's side? Read the transcripts and you will see that some in the agency are clearly on the side of industry, not the consumer. Now, the CDC wears the mask of science, at least part-time.

c) Evidence based medicine (EBM) has been the buzz-word for doctors who have been trained in the last 15-20 years. It's an exciting, attractive concept: weigh the evidence in favor of a certain intervention in a certain disease by looking at all the highest quality studies, then rate the evidence in support of the intervention. 

Insurance companies love it, because it gives them a way to limit and control treatment.

On January 17th, 2008, the prestigious New England Journal of Medicine, published a landmark paper by Eric Turner and others:

"Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy".

This paper showed that among 74 FDA registered studies of antidepressants, 31% were not published. 37 studies showing positive results were published, while studies showing negative or questionable results were, with three exceptions, either not published (22 studies) or published in a way that (the authors conclude) erroneously conveyed a positive outcome. 

This means that if one were to read the literature, one would believe that 94% of the trials conducted were positive. In contrast to the published literature, the study authors, who reviewed all the FDA studies, found a 51% rate of positive trials. And finally, the ‘effect size' (useful for making clinical decisions, effect size is a measure of the strength of the relationship between two variables such as mood improvement and the use of a medication) reported from journal reports were often larger than the data on file with the FDA justified. The numbers were inflated.

Now, I am waking to the fact that there is a long-term historical pattern. Despite the periodic real advances in medicine over the centuries, facts demonstrate that this field dons the mask of science on a pretty regular basis. 

Here is a brief tour of the evidence:

a) In the 60's birth control pills were promoted as a hormonal way to eliminate unwanted pregnancies. The fact is that birth control pills are made of conjugated equine estrogen: these are not human hormones, they are horse hormones. Millions of women were given a foreign substance misrepresented as a hormone. Anyone who has knowledge of chemistry knows that if you move or change a single atom in a molecule its biological activity changes very dramatically. So while these substances are equine hormones, for humans these are xeno-hormones, or foreign hormones. It is nearly 50 years later that "medical scientists" decided to look in a serious way at the effect on women's health and were surprised by the damage being done. In this case gynecologists, backed by industry and politicians wore the mask of science.

b) For about 30 years, the HPA axis (hypothalamic-pituitary-adrenal axis) has been a focus of research in psychiatry, since it seems to be a core part of the way the body transduces psychosocial stress into depression. A steroid called dexamethasone has been given to people in an attempt to tease out the function and dysfunction of the HPA axis. Did I say steroid? Oops. Guess what. This steroid is actually synthetic. All of the studies on the HPA axis in depression have been done using a synthetic steroid. So, you must be wondering, what's the big deal? I was at a conference on ‘mood and corticosteroids' last June. A parade of scientists came across the stage, each one touting their issue, their study, their perspective. Finally, one researcher was presenting, and I could tell this guy was a ‘take-no-prisoners' seeker of truth. So I asked him: "Do you think it matters that all of the HPA axis studies are done using dexamethasone as their steroid, when it is foreign to the human body, when the human body makes hydrocortisone, not dexamethasone?" He pulled the mask of science and exposed the dark shadow underneath:‘When you look at which genes are turned off and which genes are turned on by the two compounds (hydrocortisone, the natural human corticosteroid vs dexamethasone), there is some overlap, but overall there is a wide difference in their metabolic and genetic effects.' Doesn't that matter if we are studying the natural function of the HPA axis? ‘It's a matter of convenience', he said. dexamethasone can be dosed once per day, rather than 3-4 times per day. Who said science should be easy?