Fats, Inflammation and Depression
We have talked before about the associations between inflammation and psychiatric illnesses.
There is yet more evidence in the shape of a study just published in the journal Psychosomatic Medicine. by Janice K. Kiecolt-Glaser and her colleagues from Ohio State University College of Medicine in Columbus.
The study involved 43 older adults with a mean age of 66.67 years, and the results suggests that the imbalance of omega-6 and omega-3 fatty acids in the typical American diet could be associated with the sharp increase in heart disease and depression seen over the past century. The more omega-6 fatty acids people had in their blood compared with omega-3 fatty acid levels, the higher their levels of the inflammatory mediators tumor necrosis factor-alpha and interleukin-6, and the greater the chance that they would suffer from depression. These are the same inflammatory mediators associated with insulin resistance, type 2 diabetes and coronary artery disease, all of which are more common in depression. And depression is more common in diabetes, arthritis and coronary artery disease than expected.
Our hunter-gatherer ancestors consumed two or three times as much omega-6 as omega-3, but today the average Western diet contains 15- to 17-times more omega-6 than omega-3. There were 6 individuals in the study who had been diagnosed with major depression, and they had nearly 18 times as much omega-6 as omega-3 in their blood, compared with about 13 times as much for subjects who didn’t meet the criteria for major depression.
Depressed patients also had higher levels of tumor necrosis factor alpha, interleukin-6, and other inflammatory compounds. And as levels of depressive symptoms rose, so did the omega 6 and omega 3 ratio. So it seems as if the effects of diet and depression enhance each other. People who had few depressive symptoms and/or were on a well-balanced diet had low levels of inflammation in their blood. But when they became more depressed and their diets became worse – which is very common when people are depressed – then the inflammatory mediators in the blood surged.
Omega-3 fatty acids are found in foods such as fish, flax seed oil and walnuts, while omega-6 fatty acids are found in refined vegetable oils used to make everything from margarine to baked goods and snack foods. The amount of omega-6 fatty acids in the Western diet increased sharply once refined vegetable oils became part of the average diet in the early 20th century.
Depression alone is known to increase inflammation, the researchers note in their report, while a number of studies have found omega-3 supplements prevent depression.
So this more evidence for the value of eating fatty fish like salmon, mackerel or sardines two or three times a week, but be sure to avoid fish that may contain a lot of mercury. If you add more fruits and vegetables to your diet, you will also reduce your levels of omega-6 fatty acids.
I have just finished analyzing all the new literature on using fish oils for the prevention and treatment of psychological and psychiatric problems, and I am going to post my findings in the next couple of days.
Arthritis and Sex
Today being Valentine’s Day (you did remember didn’t you?), Arthritis Care in the United Kingdom has taken the opportunity to publicize its free booklet on sex, relationships, intimacy and arthritis, downloadable from its website (pdf).
Integrated Medicine is all about empowering and caring for the whole person, so I was very pleased to see this document. I spent some very happy times helping people with various types of arthritis, and I was astonished how infrequently anyone had ever asked them about the ways in which the illness impacted normal daily activities and had ever given them any advice on ways to work around problems.
Let me quote form the Arthritis Care news release:
"One of the reasons we produced the guide is to address issues people felt awkward discussing. It may be embarrassing to talk to your consultant rheumatologist, nurse or GP about emotional and sexual things, or matters of self-image and self-esteem – and they may be embarrassed to be asked. So where do you turn?’ said Kate Llewelyn head of publications at Arthritis Care, who was diagnosed with rheumatoid arthritis at the age of thirteen.
The booklet provides a valuable insight for healthcare professionals and for the partners and families of people with arthritis, highlighting issues of concern to them, and suggesting practical and achievable solutions.
For people with arthritis, or other disabilities, difficulty can start before any relationship, pre-dating any date.
‘Managing pain and other symptoms is exhausting, and it stops many people getting out and socializing. As a result, arthritis can be isolating, keeping you from making friends or seeing family, let alone dating and finding a partner. And maybe you are not very mobile, so can’t dance, or play sport, or can’t drink because of your medications. What’s more, although anti-discrimination law means venues must now offer better access for disabled people, you still may find it harder to do things people without arthritis take for granted’, said Kate Llewelyn.
Once a relationship has been formed, the challenges continue; the couple must work out ways of ensuring their personal and sexual relationship is sustained and developed, overcoming and working round the incurable and debilitating condition.
The report discusses a number of very practical matters: how pain and also medication can interfere with sex drive and some can cause weight gain. Many forms of arthritis are also associated with anemia and/or chronic fatigue.
It also discusses some of the psychological factors that can interfere with the sex lives of arthritis sufferers. For example, men may feel emasculated if they cannot perform their ‘traditional’ roles like playing sport or carrying heavy objects. Women may feel unfeminine if they put on weight with steroids, cannot do the housework or lift their children as a result of having arthritis. Others, with limited joint movement, or severe pain may be put off sex altogether, or find some of the traditional sex positions too uncomfortable.
‘The book has got diagrams of lovemaking positions which people of differing physical abilities and limited movement have found useful. If you’ve got problems with your spine, or hips, or knees, it makes sense to experiment with positions that place least weight or strain on the rogue joints. Of course, after joint surgery or replacement, you may be advised to take a temporary break from sex, but, relationships are more than sex, and, with this guide, abstinence may make the heart grow fonder’, said Kate Llewelyn.
Sex is rarely discussed with people strugglig with chronic illness, often because health care providers get embarassed about it.
It is essential for that to change, and I want to say a big thank you to Arthitis Care for having the courage to do this.
Curing Chronic Pain: Its All Done with Mirrors
There is a fascinating new approach to treating chronic pain.
The story goes back two years, to the publication of important research from a team at the Royal National Hospital for Rheumatic Diseases, in Bath in England. They wrote a paper in which they tried to link joint pain in neurological conditions. They wanted to see how the pain of rheumatoid arthritis, fibromyalgia and complex regional pain syndrome might relate to phantom limb pain (PLP) experienced by many amputees.
They suggested that in each condition there is reorganization in the sensory regions of the cerebral cortex. And it is this reorganization that generates pain and an altered body image. It seems to be just the same in rheumatology patients as has previously been hypothesized for amputees with PLP; that is a motor/sensory conflict. The body and the sense don’t match and it hurts. Their initial research indicated that something incredibly simple: using a mirror could help people correct of this conflict. They were able to show that a mismatch between motor output and sensory input creates sensory disturbances, including pain, in rheumatology patients and also in healthy volunteers.
In a second paper the investigators were able to show that doing a movement while looking at a distorting mirror could quickly induce uncomfortable symptoms in fit healthy people.
For over two decades, David Blake – the senior author of this research – has championed the idea that there is an important neurological component in inflammatory arthritis. It all started with a simple observation that has puzzled generations of clinicians: why is it that joint involvement in inflammatory arthritis is so often symmetrical? It isn’t surprising if both hips get arthritis: they will likely both have been subjected to a lot of wear and tear. But why should arthritis involve the second joint of the index finger in both hands? It has always looked as if this might imply some neurological contribution.
The idea is that although pain may have originated in inflamed joints, it is maintained and exacerbated by the nervous system. This fits with a fact that has been known to acupuncturists for centuries and has been replicated in pain clinics around the world. If you can interrupt what we call the pain cycle – constant chronic pain that feeds on itself and gets progressively worse – then you may often see pain relief for weeks or months, or sometimes even indefinitely. It is quite common for chronic pain to have had a clear physical precipitant, but to be maintained by key regions in the brain.
This new research strongly supports these observations, implies that the successful treatment of chronic rheumatological pain may involve a neurological approach, and offers a brand new therapeutic option.
“The speaker is only a mirror. Where you can see yourself. When you recognize yourself clearly, you can put aside the mirror.”–Jiddu Krishnamurti (Indian Spiritual Teacher, 1895-1986)
“Perception is but a mirror, not a fact. What I look on is my state of mind reflected outward.”–A Course in Miracles
Turmeric and Arthritis
I recently reported about some research from SIngapore that indicated that the spice turmeric might help with cognition.
Today there is a study form the University of Arizona in the journal Arthritis and Rheumatism suggesting that the spice may also be helpful in experimental rheumatoid arthritis. In line with most other studies of herbal supplements it is interesting that the maximal effect was obtained by using the natural form of turmeric, that contains three major "curcuminoids," the likely active ingredients. If one of the three is missing, the effect is a lot less.
The extracts appears to work by preventing the activation of a protein that controls when genes are switched on or off in the joint. Once the protein known as NF-KB is activated, it binds to genes and increases the production of inflammatory proteins, which in turn attack the joints.
This is not a surprise: In traditional Indian Ayurvedic medicine turmeric has been used for centuries as a treatment for inflammatory disorders including arthritis. Based on that, dietary supplements containing turmeric rhizome and turmeric extracts have been sold for years. However, there’s been little direct evidence that they are helpful.
We are going to need more research before we can sy whether turmeric supplements can be recommended for medicinal pruposes, and eating more spices is unlikely to work.
These findings are opening up a new approach to treating not just rheumatoid arthritis, but perhaps also other inflammatory diseases such as inflammatory bowel disease, asthma and multiple sclerosis. Interestingly the turmeric extract also has another effect: it deactivates a biochemical pathway that leads to the resorption of bone. So it may help with osteoporosis.
Rheumatoid Arthritis: A Neurological Disease?
For more than a century, there’s has been a puzzle in rheumatology. Why is it that so many people with inflammatory arthritis get symmetrical involvement of their joints? It is very common for people to get exactly the same joints involved in both hands or in both feet.
Sometimes joints get affected by arthritis because they have already been subjected to a lot of wear and tear: that’s thought to be one of the reasons why gout most often affects the big toe. But the symmetrical pattern of arthritis is far more difficult to understand. There has been speculation for at least 30 years that this symmetry indicates neurological involvement in the disease, and there was a stimulating paper on the topic seventeen years ago, and it has been known for some time that artificially induced arthritis in one joint produces inflammatory changes in the same joint on the other side of the body.
Now investigators from the University of California at San Diego School of Medicine have published an important discovery. Rheumatoid arthritis drugs work better, at least in arthritic rats, when delivered into the central nervous system. Rheumatoid arthritis (RA) is a disease in which there is chronic inflammation, leading to joint pain and destruction. Pain and inflammation in the joints are constantly monitored by the central nervous system, and we have known for many years that the nervous system can regulate inflammation and immune responses. It was demonstrated in the 1960s that damage to certain regions in the hypothalamus of the brain could impair the work of the immune system. The scientists from San Diego focused on a protein called p38, which is involved in a number of cellular processes critical to the development of RA. Several substances that block the action of p38 are effective in animal models of arthritis and are currently being tested in clinical trials in patients with RA.
Pain and inflammation activate p38 in the brain and spinal cord, and blocking it by introducing medicines directly into the central nervous system reduces inflammation in joints.
This is important research, because it opens up new possibilities for treating an illness that can often be very difficult to treat. It may also help explain another observation. Some patients with rheumatoid arthritis who are treated with acupuncture get a reduction in joint symptoms and sometimes even repair of some of the damage to the cartilage in their joints. Experienced acupuncturists see this in about a third of patients whom they treat, so it was a surprise to see a review claiming that acupuncture did not help RA. If we see a disconnect between clinical observation and a research study, there are two options: either clinicians are deluding themselves or there’s something wrong with the research method. Interestingly, there’s recently been a great deal of discussion about the kind of research methodology that produced this negative result, prompted by a very interesting and challenging paper.
My conclusion? Acupuncture may indeed be a valuable adjunctive treatment for RA. But whether it will work on its own remains less certain.
And the best approach of all is to address the physical, psychological, social, subtle and spiritual dimensions of a person with RA. In other words, the new form of Integrated Medicine that I describe in Healing, Meaning and Purpose.
Chronic Widespread Pain, Fibromyalgia and Anti-inflammatory Proteins
Chronic widespread pain is a common and distressing medical condition that can be difficult to treat and is usually associated with fatigue, poor sleep and depression. One major subgroup is fibromyalgia. A connection between fibromyalgia and cytokines – small proteins that act as messengers between cells – has been suspected for some time, since some cancer patients treated with the cytokine interleukin -2 develop fibromyalgia-like symptoms. A new study from Wurzburg in Germany, published in the August 2006 issue of Arthritis and Rheumatism examined cytokine profiles in patients with chronic widespread pain and found that they had significantly lower levels of the anti-inflammatory cytokines IL-4 and IL-10.
This is an important finding: Previous research has shown that IL-10, administered as a protein or via gene transfer, reduces sensitivity to pain. Similarly, IL-4 has been shown to dull the pain response. There is also another piece to this: genetic variations in different cytokine genes are associated with distinct diseases, such as the association between IL-4 gene variations and asthma, Crohn’s disease, and chronic polyarthritis.
Although low levels of anti-inflammatory cytokines could be a consequence of chronic widespread pain and its treatment, it is much more likely that these proteins actually play a role in the causation of chronic widespread pain.
This new research raises all kinds of possibilities for the physical treatment of a particularly horrible set of illnesses.
Temporomandibular Joint Dysfunction
The temporomandibular joint (TMJ) is the hinge joint that connects your mandible or lower jaw to the temporal bone at the side of the skull.
The joint can be affected by many disease processes including osteoarthritis, rheumatoid arthritis, the arthritis associated with psoriasis and infectious arthritis. There’s a whole ragbag of other illnesses and injuries that can affect the joint. But it is more commonly affected by muscular tension, problems with the bite, or tooth grinding (bruxism). I’ve been interested in TMJ problems ever since my days working in the Princess Margaret Migraine Clinic in London, where I saw a great many people with chronic headaches due to problems at the joint. A dental colleague helped many of them. Once I had been trained in acupuncture, I found that this is one condition in which I’ve always had good rates of success, both in humans and in horses.
So I was pleased to see an audit of 60 patients with TMJ dysfunction was compiled from the practices of 15 dental practitioners in the United Kingdom who were applying to become members of the thriving British Dental Acupuncture Society. Simple acupuncture was used at local points around the joint, on the neck, and on a point on the hand that is linked up with the joint, and tends to relax muscles and improve blood flow. This was a simple study, and in hindsight, it could have been improved. But the conclusions were encouraging: 85% of patients benefited, and the intensity of the pain was reduced by an average of 75%. This is remarkable since the patients were only receiving acupuncture and not any of the “extras” that I normally recommend as a matter of course.
Technorati tags: Temporomandibular joint Arthritis Acupuncture Migraine
A New Way of Looking at – and Treating – Inflammation
Diseases of both large and small blood vessels are two of the biggest problem facing people with diabetes. Not only is it a huge clinical challenge, but also nature sometimes does our experiments for us. The high rates of coronary and peripheral vascular disease in diabetes can be seen as a kind of experiment of nature: a recognizable set of chemical abnormalities that might shed light on vascular diseases in general. It was those twin factors: a huge clinical problem, and an experiment of nature, that lead me to pick the topic of my research doctorate.
When I was working on my research doctorate in the mid 1980s, I came across a lot of old research that seemed to show links between inflammatory and autoimmune conditions like systemic lupus erythematosus and rheumatic fever, and the eventual development of coronary artery disease. There was also a lot of old and largely forgotten research about the link between some viral infections and the development of coronary artery disease and acute coronary artery occlusions, because some infections can make blood more “sticky.” Inflammation evolved as one of the body’s defence mechanisms.
So I made the proposal – revolutionary at the time – that diabetes, coronary artery disease and a range of other illnesses might be inflammatory rather than degenerative. I soon found inflammatory markers in people with diabetes, that helped predict when someone was running into trouble with their eyes, kidneys or heart. Even with stacks of data, I had to spend a lot of time defending that position, because it also implied that some illnesses thought to be irreversible might not be.
With the passage of time, it has tuned out that I was probably correct. Chronic inflammation, wherever it starts, mat have long-term effects on the body and on the mind. Chronic inflammation increases the risk of diseases of many blood vessels, as well as causing anemia, organic depression and cognitive impairment. Here is a partial list of common conditions in which inflammation is a prominent factor:
1. Rheumatoid arthritis
2. Systemic lupus erythematosus
3. Fibromyalgia
4. Chronic infections
5. Insulin resistance or metabolic syndrome
6. Arteriosclerosis
7. Diabetes mellitus
8. Hypertension
9. Asthma
10. Inflammatory bowel disease
11. Psoriasis
12. Migraine
13. Peripheral neuropathy
14. Alzheimer’s disease
15. Autism
16. Gingivitis
17. Cystitis
The reason for raising the issue is not to say “told you so!”
It is instead that we need to think about inflammation a little differently. There is a mountain of information about the physical aspects of inflammation. We can stop at the simple description of inflammation as a condition in which part of the body becomes reddened, swollen, hot, and usually painful, or we can look below the surface: we can examine inflammation not only as a physical problem, but also as a psychological, social, subtle and spiritual problem. Why bother? Because the deeper approach allows us to understand and to treat and transcend inflammation as never before.
I am going to write some more about specific ways to address inflammation and what it means in future articles. I would also like to direct you to the book Healing, Meaning and Purpose, in which I talk about specific approaches in more detail.
But I would like to start with this.
In Ayurvedic and homeopathic medicine, inflammation is a sign of an imbalance in the vital forces of the body, and the traditional Chinese system agrees: here inflammation is usually a manifestation of an excess of Yang Qi, or a deficiency of Yin Qi. Most of our lives are seriously out of balance: Yang Qi is like a rampaging lion that has been stimulated by:
Acidic foods;
Environmental toxins;
Unwanted sexual stimulation:
Noise;
Discordant music:
Constant demands from others:
Toxic relationships;
Years spent in front of television sets and limitless multi-tasking.
It should be no surprise to learn that all of these inflammatory conditions are increasing rapidly throughout the Western world. Not because we are getting better at identifying them, or we are living longer, but genuinely increasing.
It is wrong to put all the blame on poor diets or inadequate exercise. The problem is more subtle and is a reflection of distorted Information being fed to our bodies, minds, relationships, subtle systems and spiritual relationships.
The great news is that this simple conceptual shift gives us a whole load of new tools for handling these problems, and for using them as catalysts to growth.
In the next few weeks, I am going to drill down and give you some specific guidance that ties into the material in Healing, Meaning and Purpose and the next two that are on the launch pad.
Fasten your seat belt!
Technorati tags: Inflammation Aging Alzheimer’s disease Arteriosclerosis Neuropathy Autism Arthritis Systemic lupus erythrmatosus Fibromyalgia Inflammatory bowel disease Gingivitis
