Being on the faculty of the Institute of Functional Medicine is a rewarding part of my professional life. On Sunday, I returned from an intense weeklong meeting with other members of the faculty and leadership of the Institute for Functional Medicine.  I’m excited to report that we brought the Functional Medicine Health Matrix (for diagnosis and treatment) protocol to a new level. One of the things that is so exciting about this is that this proceeds from the same structural premise found in THE age-old Eastern approaches to health.  Thus, the Matrix is a marriage of the old and the new and has significant treatment implications. While the new Matrix will not be rolled out for a year to new practitioners, faculty physicians, such as myself, will be using the new Matrix immediately. We anticipate lowering health care costs and improving health outcomes to our patients using this new Matrix.
 
In addition to the faculty and leadership meeting, I attended a Functional Medicine Detoxification Education Module, which featured the latest data regarding chemical and environmental toxicity [we are all facing increased levels of toxicity], and various protocols to detoxify ourselves.

Let me start by acknowledging what is well known: Manic Depression or Bipolar disorder can be a devastating illness. Affecting at least 1% of the population, it can, untreated, result in suicide, ruined careers and devastated families. Bipolar disorder is often accompanied by alcohol and drug abuse and addiction, criminal and even violent behavior. I acknowledge this, because I do not want to make light of the burden this illness places on people’s lives, their families and communities.

On the other hand, the history of the world has been influenced very significantly by people with manic depression (see my website www.wholepsychiatry.com for details)-from actors and actresses (Patty Duke, Jim Carey and Robin Williams) to Politicians (Winston Churchill, Theodore Roosevelt) to astronauts (Buzz Aldren), media mogels (Ted Turner) and perhaps even well known religious figures.

It seems clear that for at least some people with Bipolar disorder, there is an increased sense of spirituality, creativity, and accomplishment. It may be that having bipolar disorder holds great potential, if one is able to master or effectively channel the energies, which are periodically available, to some higher task. This would of course presume the ability to abstain from harmful drugs and alcohol, to have good character, and at least some supportive relationships and community networks.

It might be helpful to consider a reconceptualization. Perhaps instead of it being a disorder, we can think of people with bipolarity as having access to unusual potency. This potency will find a way to be outstanding-either in a destructive way, or in a constructive way. If such a choice is presented to the person, perhaps it can open some doors.

I will be discussing this and other aspects of bipolar disorder on Wednesday, August 4th @ 12PM Eastern time in my free virtual teleconference.

In a previous blog, I talked about how many doctors and patients do not know the full story about their drugs or medical treatments because of a widespread problem involving unpublished or biased clinical trials. Here is an update on what is happening.

As I mentioned, frequently, medical journals or pharmaceutical companies that sponsor research will report only positive results, leaving out the non-findings or negative findings where a new drug or procedure may have proved more harmful than helpful.

“A new review of research about this problem points to hidden or misleading studies for all sorts of conditions, including depression, Alzheimer's disease, type 2 diabetes, menopausal symptoms and cancer”, said Beate Wieseler, deputy head of the Institute for Quality and Efficiency in Health Care (IQWiG) Drug Assessment Departmentresearchers at in Germany.

Much of that problem arises from financial conflicts of interest when pharmaceutical or medical device companies fund the studies, according to Wieseler and her colleagues.  They pointed to past research showing an association between industry sponsorship and positive outcomes or conclusions in studies.  The FDA currently does not disclose much of the information it receives from companies when deciding what drugs or devices to approve for market. Now Wieseler and her colleagues want a global system to register trials and make public all research results for drugs or other medical interventions.  They detailed their findings in the April issue of the journal Trials.

"It's been shown that reporting bias is associated with all sorts of funding – government funding, department funding, industry funding – but the worst source of bias is industry-funded," said Kay Dickersin, an epidemiologist at Johns Hopkins University in Baltimore.

The FDA's European counterpart, the European Medicines Agency, has also considered its own steps toward more disclosure. "The agencies understand that there's a need for more transparency," Wieseler said. "There is increasing understanding that the public should have access [to clinical trial data]."
But regulatory agencies still have not decided how to balance the need for public access against the desire by companies to keep commercial information or trade secrets confidential, Wieseler noted.

As a post script…

In the above we see the overlapping territory of medicine, government, and politics. I encourage people to be proactive in improving and protecting their health. Here is an opportunity to do so.

There are over 900 'new to nature' chemicals in our environments, in our blood, and many are even in the blood of unborn children. Now, following the heightened concern regarding bisphenol A (in clear plastics, such as baby bottles), the FDA is beginning to set its sights on Triclosan. Triclosan is an antibacterial preservative used in "76% of liquid soaps and 29% of bar soaps". Aside from soaps, triclosan is also used in toothpastes, cosmetics, shoes, socks, workout clothes, and many personal care products. Triclosan has been detected in the urine of 75% of Americans, 60% of US streams, and persists in the environment for at least 40 years.

"Animal studies have shown that triclosan alters hormone regulation" according to the FDA, and there is no benefit to using soaps containing this chemical. Despite the fact that the European Union will prohibit its use in products that come into contact with food beginning next year, the FDA states that it "does not have sufficient safety evidence to recommend changing consumer use of products that contain triclosan at this time." The last time I checked, we were part of the animal kingdom. It seems reasonable to conclude that there is a possibility that this chemical is part of the cause of the national epidemic of hormonal dysfunction (e.g, hypothyroidism). While the FDA is advising no change in regulation or consumer behavior until there is evidence that triclosan is harmful to humans, such studies could take years. Additionally, studies which can determine the synergistic effect of this chemical in combination with other new-to-nature concoctions will, in all likelihood, never be done.

Given the facts that a) animal studies show an effect of triclosan on thyroid function (reduction in thyroxine, testosterone and sperm counts in rats), b) triclosan is toxic to aquatic animals and plants and c) there is no benefit to using the product , I advise you to seek out products that are free of triclosan.

These products can be found at IKEA, the Body Shop, Whole Foods and Trader Joes (read the labels!).  Brands that do not use triclosan include Ivory, Tom's of Maine, Listerine Essential Care, Peelu, Weleda, Toxic Free Basics, Aveda, Clean Well, LUSH, Nature's Gate, Vermont Country, Paul's Organic, Dr Bronner's Magic Soaps, MiEssence, The Natural Dentist.

For more information, visit http://www.fda.gov/forconsumers/consumerupdates/ucm205999.htm

Yours in health,
Dr. Robert Hedaya

If you are reading this, you are probably a parent, a teacher, or perhaps even a teen yourself. In any case, you feel confounded by unpredictable and volatile behavior, emotions which seem to arise like tornados from out of the blue, and a parade of identities which seem to change as fast as a runway model’s wardrobe.  What causes all this chaos and confusion? In this article I will summarize some of the new research findings, which shed light on this most vibrant phase of life in the teen brain.

The structure of the brain

I often describe the overall structure of the brain as an ice-cream cone with two scoops. The cone itself is the most primitive part of the brain, called the brain stem. It controls basic functions such as alertness, breathing, blood pressure, and body temperature. Sitting on top of the cone sits the first scoop-the emotional brain (called the limbic system)- which is involved in hormonal control, memory, as well as automatic (and usually unconscious) emotional reactions. The second scoop is the conscious, thinking, planning, brain (called the cortex).

If we look deeper, or microscopically, into the brain, we see that there are millions of nerve cells, which, like streets and highways, are connected to each other. If you visualize a map of the United States showing all the highways as well as primary and secondary and even tertiary roads you can get a feel for a few things. First, not only are there many, many roads, but they seem to converge on certain points we call cities, towns, and neighborhoods. In the brain these points of convergence are called nuclei. One of the major nuclei in the brain is called the amygdala. This nucleus controls rage, fear, and sex. It also tells us (before we are consciously aware) whether a situation is safe, exciting, or dangerous, and our body reacts (again, before we are aware) immediately to this unconscious reflex. This assessment of the situation is based on early childhood experiences.

The Changing Teen Brain

During the teen years, under the influence of massive new hormonal messages, as well as current needs and experiences, the teenager’s brain is being reshaped, and reconstructed. Information highways are being speeded up (a process called myelination), and some old routes, closed down (this is called pruning); some are re-routed and reconnected to other destinations. And above all, old information highways are making lots of new connections to other highways, and other cites and towns (this is called sprouting).  It’s a massive construction project, unlike anything that occurs at any other time in life. In such as situation, things rarely flow smoothly, and surprise destinations thrive. This reconstruction explains why the personality and stability that was evident just a year or two before adolescence recedes, and suddenly new perspectives, and reactions abound.

One of the important things to remember is that what a teen does and is exposed to during this critical time in life, has a large influence on the teen’s future, because experience and current needs shape the pruning and sprouting process in the brain. So if a teen is playing lots of video games, this will shape the brain in such a way that they might become an excellent fighter pilot, but becoming an accountant or researcher will be less possible. Being the class clown will help make a good sales person later on, and running for class president will develop brain skills that are needed to run a business or take on a management position. Being exposed to drugs, computer sex, or violent movies, will also shape the brain and future of the adolescent, laying down the seeds of addiction and interpersonal conflict.

A Changing Brain Means A Changing Identity

Because of all the change that is occurring in the brain, as well as in their social and academic world, teens have a deep need to define themselves, to clarify who they are, and what they stand for. As they are losing their pre-adolescent identity, they are desperate for a new identity. This search can have constructive or destructive aspects to it. Often the new identity is supplied by their peer group, for better or for worse. Because the teen doesn’t know clearly what they want or what they can do, they like to try many different things. This helps them discover what works for them, what feels right, and who they are becoming. The parent-teacher role is to allow and encourage safe exploration.

The constructive approach to identity formation, which should be supported by parents and teachers, is to try new hobbies, take new classes, get involved in new organizations. Supervised exploration of new territory should be encouraged.  Teenagers need guidance not unrestricted freedom. They need novelty, but within bounds.

On the other hand, one common, easy, but non-productive way to define one’s identity, is to do or be the opposite of what the parents are, and to become involved in non-supervised activities. Mom and Dad like going to Shul, so I will sleep late on Shabbat. It is inevitable that there will be a clash and limits will be tested. I advise parents to make the limits reasonably narrow. It’s better for an adolescent to argue over whether they have to go to shul, than whether they can stay out with friends until one AM.

Undeveloped Brain Territory
One part of the teen brain that is undeveloped until the mid-twenties lies in that second scoop of the ice cream cone. This is called the pre-frontal cortex (PFC). This part of the brain, when fully developed, is in a constant dialogue with the emotional brain (the limbic brain). In the adult, the PFC and the limbic brain are in balance, each one inhibiting the other. So when an adult has an emotional reaction to being cut off by a speeding car, the PFC part of the brain says-“Hey, stop, and think about your desire to go speeding after that car. You might get a ticket, you might cause an accident, your insurance rates will go up”. For the teen, however, the PFC is undeveloped, and the emotional brain (including the amygdala mentioned above) rules the moment, until the PFC is developed in the mid-twenties. The teen thinks: “This is going to be exciting!”—if he thinks at all.   Auto insurance companies figured this one out long ago.

Sharing your PFC

One highly effective way for parents and teachers to help teens develop the PFC is to make sure they have some ‘skin in the game’, and to make them deal with the consequences of their actions.  This takes some thinking ahead (a PFC function) on the part of the adults, about the new freedoms and responsibilities that their teen will have. In the case of driving, for example, it is useful if the parents prepare the pre-adolescent with the idea that they will have to save up some money to pay for a car, insurance, gas etc.  If the teen ever gets a parking or speeding ticket, they need to know that they will pay for it. Letting the teen know this in advance, is in a sense, loaning the teen our frontal lobe functions.

Nutrition, Drugs, Alcohol and the Teen Brain

One of the most overlooked and problematic issues for teens is nutrition. The amygdala and other areas of the brain undergoing myelination (to make those connecting superhighways operate really fast) require healthy fats. That means fish oils. My grandfather from Aleppo some how knew that fish was brain food. Modern research has shown this to be true. High levels of these omega 3 fatty acids are associated with less depression and suicide, and many other health benefits too numerous to mention here.

Also, extremely important for the growing teen is making sure the brain gets enough zinc. Zinc makes the mood regulating chemical, serotonin, function properly. If there is too little zinc, often there is too much of the novelty-seeking chemical, dopamine, and even the overstimulating, anxiety-producing chemical, glutamate. Getting enough zinc is a challenge for teens because their growing bones take much of the body supply of zinc, leaving the brain in short supply. This shows up as irritability and moodiness, as well as zinc spots (white spots) on the nails. Giving the teenager a zinc supplement (enough till the nails clear) and a B50 complex can make a very significant difference in moodiness as well help clear up their skin. Add some fish oil capsules and you have some good support for the teen brain.

What doesn’t help the teen brain at all, are alcohol and drugs. For many reasons, including the fact that the teen brain is changing at such a rapid pace, new experiences that are pleasurable (e.g., music) very quickly become habits. Thus the teen will become addicted to substances much more easily than an adult will. Alcohol and drugs cause a Swiss cheese like change in the brain, so that some areas function normally, and others, like the holes in the cheese, under-function to a large degree. This change occurs throughout the brain, but the PFC is markedly affected, (where they are most undeveloped.)

Every Teen is Unique

Remember every teen is different and requires a different approach. If your teen is a responsible and diligent student, and has well adjusted peers, you might be more than willing to send them to college or on a teen tour. On the other hand, if they are showing more signs of impulsivity, which means an undeveloped PFC, they might not be ready to be on their own, with the unrestricted freedom. Strive to see what the best qualities of your teenager are—where their uniqueness lies—and help them find it. It’s the best you can do for the teen you love.

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!

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.

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.