Psychiatric Illnesses and Fibromyalgia
There’s an interesting and important article in last month’s issue of the Journal of Clinical Psychiatry, by a group of investigators from the University of Cincinnati.
They have shed important new light on fibromyalgia. We’ve recently learned how it is linked to disturbances of the serotonin transporter, as well as anti-inflammatory proteins, and that is may respond best to the kind of comprehensive multi-leveled approaches that we use in Integrated Medicine.
The new research compared people with fibromyalgia with people with rheumatoid arthritis, and it found that fibromyalgia, but not rheumatoid, may be associated with a range of psychiatric illnesses:
- Major depressive disorder
- Bipolar disorder
- Comorbid anxiety disorders including panic disorder, social phobia, posttraumatic stress disorder and obsessive-compulsive disorder
- Eating disorders and
- Substance abuse
What was particularly important in this study was that the psychiatric problems usually preceded the onset of fibromyalgia. So it wasn’t that people were developing psychological problems because they were in chronic pain.
It’s beginning to look as if fibromyalgia is part of a larger group of disorders that all share common etiologies or causes. Family studies have indicated that fibromyalgia and mood disorders share some of the same – perhaps genetic – determinants.
The study also confirms what we have said before: fibromyalgia is not only associated with some psychiatric problems, but also with other medical disorders, several of which may also co-exist with the same psychiatric problems. They include:
- Chronic fatigue syndrome
- Irritable bowel syndrome
- Interstitial cystitis
- Multiple chemical sensitivities and
- Migraine
Not only does this research highlight the need to check people with fibromyalgia to see if they might also be struggling with a psychiatric problem, but it is helping us home in on some of the mechanisms linking these apparently separate problems.
This particular study was done mainly in white women, and the investigators knew who had fibromyalgia, so there’s more work to be done.
But if you or a loved one is struggling with fibromyalgia, it is good news to know that we are making rapid progress in unraveling this horrible illness.
Global Warming
My interest in global warming is three-fold: the first is scientific: is this all just a political bandwagon, driven by a misunderstanding of normal climatic cycles? Secondly, if it is a real phenomenon, then we have a responsibility to future generations: a part of what we refer to as a central philosophical plank: “Legacy.” Third is the impact of global warming on patterns of illness, in particular infectious and environmental pathogens, and how we can build resistance and resilience to them.
Some of the more recent evidence had a good airing on the Scientific American website.
My own view is that global is now clearly proven: I have just seen too much evidence, from walking the balmy streets of Stockholm in dead of winter when the temperatures should have been tens of degrees lower to an analysis of changing patterns not just of temperature, but of disease. The warming is a consequence of a lack of balance and harmony: too much Yang activity overwhelming the Yin necessary to stabilize the world. Or, in the language of spiral dynamics, too many people and social structures being stuck at the levels of the Red and Orange Memes.
The only thing that I find a little irksome is the number of people who lecture us about global warming while continuing to engage in all kinds of activities that contribute to the problem. Your humble reporter first became interested in installing solar panels while still living in England. Not practical in a country where once the sun rarely shone very much, and where the panels used to be prohibitively expensive.
We plan to install some next year, while continuing drastically to conserve other resources. And to try and anticipate the impact of global climate change on illness.
Chronic Fatigue, RNase Deficiency and Spiritual Development
I was very sorry to hear that Ken Wilber, whose work I admire enormously, has recently been very unwell. While weakened by an underlying chronic illness, he took a nasty fall that has left him pretty badly bruised, and with some possible neurological problems. Fortunately he is already somewhat better.
According to Ken, his underlying illness is a form of chronic fatigue syndrome called or caused by RNase-L Enzyme Dysfunction. People with the problem develop a number of bizarre symptoms apart from fatigue, including muscle weakness, fevers and immune dysfunction. The RNase enzyme is normally activated when a cell has to deal with viruses, some toxins and some bacteria. There is a good introduction here.
There is a growing literature on the subject: investigators from Brussels have recently shown a link between exercise performance and immune dysfunction in some of these patients. It may be that elevated RNase-L enzyme activity may provide us with a biological marker for some cases of chronic fatigue syndrome. Despite this research, I still have many colleagues who continue to say that chronic fatigue syndrome and a probably related condition, Chronic Fatigue and Immune Dysfunction Syndrome, are purely psychological problems.
I am quite sure that they are wrong.
Not least because there are very few illnesses that can be reduced to just psychological or just physical causes. These artificial distinctions do little to help people suffering with genuine problems. (You may be interested to have a look at a brief piece that I wrote about this artificial distinction.)
I do know that the most difficult problems that I have ever faced in clinical practice have been the chronic fatigue syndromes and a possibly related problem: interstitial cystitis. The only things that have helped have been approaches employing the five dimensional approach: physical, psychological, social, subtle and spiritual.
And now I’m going to go out on a limb and do something that normally I do not. I will normally not make even the broadest comments about someone’s diagnosis and treatment unless I’ve seen them myself: there are few things worse than people trying to diagnose at long range and when they only have half the information. But when I see symptoms like these: fatigue and fever, physical weakness and sometimes profound psychological effects, I have to ask whether the biochemical markers are actually telling us something different: that some people with these problems may actually have what used to be known as “diseases of discipleship.” An old-fashioned term used to describe some of the physical challenges and changes that may accompany spiritual evolution. If I am correct, I would predict that Ken – and many other sufferers – should also have profound disturbances of their normal circadian rhythms, some predictable but subtle endocrine disturbances, and otherwise inexplicable sensations roughly corresponding to the channels identified in Chinese and Ayurvedic medicine.
One of the most startling recent discoveries in medicine has been that some of the time-honored laws of healing are changing, because we are ourselves changing very rapidly. In Healing, Meaning and Purpose, I spent a long time talking about some of the reasons for coming to that understanding, and how to use it to improve our health and well-being. I fully expect to spend the remainder of my career showing people how these new laws and principles can help us all, as well as ensuring that appropriate research continues to help us develop these new understandings about health and wellness.
So I’m going to suggest that Ken’s problems might never have happened if he hadn’t been on such a deep spiritual quest, and if he hadn’t been turning up a lot of answers that matter.
Get well Ken!
Technorati tags: Ken Wilber Chronic fatigue syndrome RNase deficiency Chronic Fatigue and Immune Dysfunction Syndrome Interstitial cystitis Spiritual development Circadian rhythm Integrated medicine Integrative medicine Laws of Healing
Surviving Airplanes
I’m an extremely frequent flier: in an average year I fly the equivalent of ten to twelve times around the world, or all the way to the moon and part of the way back. So I’ve had to learn all the tricks for surviving countless hours in the air.
Some of them you will know already: keep hydrated, avoid alcohol, move and stretch whenever you can. I’ll soon be posting my jet-lag strategies.
But I wanted to let you know about a product that I’ve been using for years: it’s now called Yarrow Environmental Solution. I’ve certainly found that it’s been very helpful in reducing some of the exhaustion that is a common part of long haul air travel.
There is a piece of unpublished research that seems to confirm that the remedy is having a measurable effect. I wish that I had the time to do a more extensive study to see whether my observations have a scientific basis.
Current scientific models can’t explain how the flower essence could possibly work. Yet my observations and those of many students and patients are that it can be very helpful indeed. Not just to frequent fliers, but also for people who spend a lot of time in front of computer screens or under artificial light.
If you are exposed to any of these things, and find yourself constantly drained and exhausted, you may find this essence very helpful, as part of a package of Integrated Medical care.
Regular readers know that I’m most insistent on full disclosure. So I can reveal that I have absolutely no relationship with the manufacturer, other than buying bottle of their essences.
Technorati tags: Yarrow Environmental Solution Flower Essence Society Biofield Subtle energyIntegrated medicine Integrative medicine Environmental illness
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
Health Risks of X-Rays
There have been alarmist and often sensationalist stories about the health effects of ionizing radiation since it was first discovered. Wilhelm Conrad Röntgen won the Nobel prize in Physics in 1901 for his discovery of X-rays, and it was quickly discovered that over-exposure to X-rays was dangerous. Marie Curie – the Polish-born French scientist who won two Nobel prizes in 1903 and 1911 – died of leukemia. It has often been suspected that it was related to her long-term exposure to radiation.
As a child growing up in England, many shoe shops had primitive X-ray devices called fluoroscopes to allow kids and their parents to look at their little toes inside their shoes. Despite knowledge of the health effects of X-rays I reported in an article published fifteen years ago, that while working at a hospital in Nanjing, China, I was shocked that the ancient X-ray equipment had no shielding at all.
There is no doubt that X-rays and their more sophisticated progeny, like CT scans, have revolutionized medicine, and saved countless lives. So how do we weight the risks and benefits of diagnostic X-rays? The last thing that we want to do is to discourage people from having the medical help that they need.
Help has arrived in a new report Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2 from the National Academy of Science, published in September 2005. I think that this report should be considered the definitive and authoritative resource on the subject of radiation risk.
Dr. Richard C. Semelka has produced an outstandingly helpful summary of the report and its key recommendations.
1. The report says that medical X-rays can cause cancer, and that there is no safe lower limit. The risk is very low, and, as one might imagine, is higher in children. It is also important to be aware that cancers are not uncommon and almost always have multiple causes, so claiming a causal link between a diagnostic X-ray examination and the subsequent development of a tumor is very difficult. The main tumors said to be associated with X-rays are leukemia, thyroid and breast. The time between exposure and tumor development can be very long.
2. Therefore any use of X-rays, particularly CT scanning should be done judiciously. One of the problems in the United States is that many professionals have been forced to practice defensive medicine. They could be held legally liable if they do not do a test.
3. Professionals already use the lowest possible dose of radiation.
4. Professionals are already discussing whether there are any possibilities of substituting other types of diagnostic imaging.
Now I’m going to tell you a story. Some time ago I had a health problem that may well have been a result of exposure to radiation as a child. The health problem is now long gone, but it sensitized me to the issue. So what would I do now if a physician recommended that I have an X-ray or a CT scan? I would discuss the options:
How important is the test?
What would be the downside of not having it?
Is there any other way of getting the same answer without using X-rays?
If the answer to that one is “no, “ then what’s the lowest dose of radiation that we can use?
And how can we shield the bits of me that don’t need a dose of X-rays?
Then, even with my medical history, I personally would almost certainly go ahead and have the test. But every person would be well advised to have that discussion with their health care provider.
Many professionals read my articles, and for you, it would be worth considering getting the report, and going through Dr. Semelka’s thoughtful article.
I think it’s excellent that scientists have produced this report and that thoughtful radiologists around the world are working on the best ways of safe guarding the welfare of the public. I am going to continue to report the emerging scientific literature on this important topic.
Technorati tags: X-rays radiation carcinogenesis
Sick Building Syndrome
Sick building syndrome (SBS) was first recognized in 1982, and is a combination of symptoms associated with an individual’s place of work – most often an office building -though there have also been instances of SBS in residential buildings. A 1984 World Health Organization report into the syndrome suggested up to 30% of new and remodeled buildings around the world might be linked to symptoms of SBS.
Many symptoms have been associated with SBS, including:
- Headache
- Dry or itchy skin
- Chronic fatigue
- Irritation of the eyes nose or throat, sometimes with a dry coughs
- Dizziness
- Nausea
- Difficulties in memory and concentration
- Extreme sensitivity to smells or bright lights
For SBS to exist, these symptoms must disappear soon after the occupants go outside.
There have been many explanations for these symptoms, primarily related to environmental pollutants. But I have something to add to that list. Some time ago I spent a happy year working at the Charing Cross Hospital in London during which I made an odd observation. On days that I worked in the laboratory on the tenth floor, I would be exhausted by the middle of the day, while on days when I worked in the outpatient clinic in the basement, I could easily get through a 5 hour clinic without difficulty. I mentioned it to a neurophysiologist friend who told me something very interesting: it had been discovered that on days when the wind blew at 5-10 miles an hour, the building began to vibrate like a giant tuning fork, and that the vibration was at its worst between the tenth floor and the top of the hospital. The vibration was imperceptible to most people, but I clearly had the misfortune to be sensitive to it. Yet without this experience, I might never have known of the potential adverse effects of vibration of the human body.
I have been consulted by a number of corporations and government organizations that have had trouble with people getting sick in certain buildings. Until now we have thought that it was all environmental, and that it could be anything from vibration to poor ventilation, chemicals, molds and many things in between. So I was very surprised to see a report published in the journal Occupational and Environmental Medicine from a first rate research group at University College London.
The British Inland Revenue Service demolished an entire 19-storey building in Bootle, Merseyside, after almost half of the employees had developed illnesses compatible with SBS. In a study published two and a half years ago, it was claimed that adding ultraviolet light to ventilation systems to kill microbes could vanquish the symptoms of SBS. But this new research suggests that the cure may actually be better management.
The new study included 4,052 civil service workers between the ages of 42 and 62 who were enrolled in a larger general health study. The men and women in the study worked at 44 different office buildings around London. The workers completed surveys designed to assess their general health and whether they had symptoms linked to SBS. They were also asked questions about the physical properties of the offices that they worked in and the stresses associated with their jobs.
As in earlier studies, women tended to have more symptoms associated with SBS than did men. Younger workers also had more of the symptoms than older workers. Almost one in five women and one in seven men reported five or more symptoms associated with sick building syndrome.
Now here was the surprise: the authors found little association between physical work environment and the symptoms. But there was a strong association between the symptoms and feelings of having high job demands and little support in the workplace. They also found that the more control people have over their workstation, the fewer symptoms were reported.
Though the findings fail to support "sick buildings" as a common cause of worker illness, the study should not be interpreted as meaning that the physical quality of the workplace is unimportant. It is most likely that we are dealing with a combination of physical and work related factors.
As I was reading the report and reviewing the rather vague but often quite severe symptoms, I was reminded of some recent work that I have been doing on burnout: I’ve just published an article about it. My interpretation of this study is that many cases of SBS are likely a form of burnout that is partially modulated by physical factors in the environment.
Technorati tags: sick building syndrome, workplace, occupational medicine, burnout, Stress
Climate Change and Your Health
When I hear the continuing arguments about climate change, I often fancy that I can in the far distance hear Nero playing his lyre while Rome burns. In March the BBC reported faster than expected warming of the Antarctic over the last 30 years. This report was based on a paper in the journal Science by a team from the British Antarctic Survey.
Gradual climate change is drawing particular attention in Europe, where the climate is exquisitely dependent on the Gulf Stream. In some places records have been kept for centuries, and there seem to have been genuine changes in a short space of time. A few years ago I was in Stockholm in the week before Christmas, and it was so warm that I was able to walk around in my shirtsleeves. That made it the warmest December in almost 800 years. People notice things like that, and governments and populations are eager to do something before the Arctic is reduced to a puddle.
Even if we are just seeing a natural climatic cycle, the consequences could be disastrous. Leaving aside the obvious matter of a rise in sea level, there is also the impact of global climate change on health. Earlier this year the BBC reported a speech by Professor Paul Hunter from the University of East Anglia in Norwich, to the Society of Applied Microbiology at the Royal Society in London. He pointed out that global warming, with hotter summers and more frequent and heavy rainfall and storms, would create the right conditions for an increase in food poisoning and other gastrointestinal upsets caused by microorganisms.
Global warming could also create conditions favorable for a return of malaria to the United Kingdom. Professor Hunter has published papers on this important topic before. He is no alarmist, and his work underscores the way in which our environment and we are closely interlinked, and even small climatic changes may have major effects on illness.
We could discuss this topic in a great deal of detail. Suffice to say that it is more important than ever for all of us to get into the habit of washing our hands, ensuring the cleanliness of food, and even more so of the water that we use, and that we do all that we can to build our resilience.
There is also another matter of equal importance, and that is the dwindling supply of fresh water around the world. The number of us is growing fast and our water use is growing even faster. A third of the world’s population now lives in water-stressed countries, and it is expected that this will rise to two-thirds by the year 2025. The cruelty of the situation is that there is altogether more than enough water available for everyone’s basic needs. The water is in the wrong places and much of it is unusable.
The United Nations recommends that people need a minimum of 50 liters of water a day for drinking, washing, cooking and sanitation. Global water consumption rose six-fold between 1900 and 1995 – more than double the rate of population growth – and goes on growing as farming, industry and domestic demand all increase.
As important as quantity is quality – with pollution increasing in some areas, the amount of useable water declines. Each year, more than five million people die from waterborne diseases, which is 10 times the number killed in wars around the globe. Most of the victims are children.
Seventy percent of the water used worldwide is used for agriculture. Much more will be needed if we are to feed the world’s growing population, which is predicted to rise from about six billion today to 8.9 billion by 2050. And consumption will further increase as more people expect Western-style lifestyles and diets. Here is a useful statistic: one kilogram of grain-fed beef needs at least 15 cubic meter of water, while a kilo of cereals needs only up to three cubic meters. Many futurists are already predicting that water will become as much of a strategic issue as oil is today, with wars being fought over the water supply.
As of today, we should all start thinking about ways in which we can reduce our own water consumption and make provision to collect and purify water ourselves.
“Everybody talks about the weather but nobody does anything about it.” — Charles Dudley Warner (American Author, 1829-1900)
Technorati tags: global warming, water, Environment, Climate Change, pollution
Sun Bed Addiction
One of the most pernicious claims of some purveyors of medical misinformation is that there is no connection between exposure to sunlight and skin cancer.
I just saw that repeated by someone on an infomercial promoting his latest book. The person speaking was a marketer with, I understand, no scientific or medical training. The fact is that exposure to ultraviolet light has been shown to damage DNA in cells grown in culture in the laboratory, and the pattern of damage is exactly what we predict would cause cells to become malignant.
There are protocols for transforming normal cells into malignant ones using ultraviolet light alone. We also know from epidemiological studies that exposure to sunlight is linked to the development of skin cancer. The best predictors are both the number of hours exposed, and the number of times that the skin has been burned. Despite this information, there was a 300 percent increase in the number of indoor tanners in the United States between 1986 and 1996.
So why do people continue to use sun beds? Apart from vanity, there is now increasing evidence of another factor. Earlier this year investigators from the University of Minnesota published a study suggesting that the over-use of indoor tanning by adolescents could be addictive. The age at initiation of usage, the frequency of use and the relationship between use and difficulty in quitting indoor tanning are consistent with other potentially addictive behaviors taken up during adolescence.
Now a team from Wake Forest University in North Carolina has published a small study in which they showed that in four of eight frequent tanners, giving them the opioid antagonist naltrexone caused them to experience symptoms very much like those that we associate with drug withdrawal. I recently came across a case of a young person who was tanning obsessively, at least once a day. It turned out that she also had a substance abuse problem. Though this study is small and preliminary, it certainly seems to fit with clinical observations.
We already knew that ultraviolet light can elevate mood: it has been known for many years that in people with bipolar disorder, they are more likely to become manic as the days become longer and they are exposed to more sunlight. There is also some evidence that ultraviolet light may elevate testosterone levels, which is one of many possible reasons why some people report increased libido while vacationing at the beach. (I feel sure, gentle reader, that you can come up with a long list of other reasons for that observation…)
Technorati tags: utltraviolet light, sun bed, mood
