Migraine and Bipolar Disorder
Back when the world was new, I cut my teeth in migraine research, and migraine and other headaches were the topic of my first book. So I’ve always kept an eye out for new developments.
There’s an interesting case report from India, about a nineteen year old who developed mild mania as part of the aura or warning of his attacks. This sort of case is interesting for what it might be able to teach us about each illness. It is also good for us to know that bipolar disorder is highly co-morbid: it is associated with many other illnesses apart from migraine:
1. Anxiety disorders
2. Substance abuse disorders
3. Attention deficit disorders
4. Personality disorders
5. Impulse control disorders
6. Eating disorders
7. Insulin resistance
8. Obesity
9. Diabetes mellitus
10. Cardiovascular diseases
11. Pain disorders
This is why diligent clinicians are always on the lookout for bipolar disorder: if it is missed and remains untreated, it can cause havoc: suicide attempts, damaged relationships, substance abuse and general misery.
Migraine is one of the vascular headaches that is occasionally associated with an array of other vascular problems, like Raynaud’s phenomenon, ischemic heart disease and stroke. But the aura is something else altogether. For many years it was thought that the migrainous aura was a result of a reduction in blood flow to regions of the cerebral cortex. Almost 25 years ago that was shown to be inaccurate. It is due to a release of witches’ brew of excitatory and inhibitory amino acids in the cortex. It is highly likely that the release of excitatory amino acids is the explanation for the manic symptoms.
Migrainous mania is evidently rare, but apart from visual disturbances, I’ve seen all sorts of strange auras: sudden food cravings; intense sweating; extreme irritability and many other things besides.
The treatment of migraine still revolves around avoidance or modulation of triggers, pain relief and prophylaxis. The big change in recent years has been the increasing amount of experience and small amount of evidence indicating the value of non-pharmacological approaches like spinal manipulation, temporomandibular joint adjustment, acupuncture, the tapping therapies and homeopathy.
To an integrated practitioner, the key is to understand the problem as more than just headache: we can guide a person to see the problem in its broader context, as a challenge designed to find a path toward inner wellness. We also see it as a process that has meaning and purpose and is a Divinely inspired invitation to grow spiritually and as an individual.
That may sound a lot for a headache, but it is the best possible way to triumph over the problem!
“The cure of the part should not be attempted without treatment of the whole.”
–Plato (Athenian Philosopher, 428-348 B.C.E.)
Technorati tags: Migraine Bipolar disorder Insulin resistance Attention deficit disorder AnxietyIntegrated medicine
How Many Angels Can Dance on the Head of a Needle? Moving Beyond the Metabolic Syndrome
I have written a great deal both on this blog and in scholarly articles, about insulin resistance and the insulin resistance and metabolic syndromes.
You will have noticed that I’ve always used the term insulin resistance syndrome.
This is not a matter of semantics. For years now I’ve been worried about the splitting that’s been going on in the field: we currently have six sets of definitions of the metabolic syndrome. And apart from the fun of going to all those conferences in exotic parts of the world, you have to ask what’s been achieved by these ever more divisive attempts to “define” the medical consequences of insulin resistance.
The American Diabetes Association has begun to promote the concept of “cardiometabolic risk.” The Association has established a national Cardiometabolic Risk Initiative (CMRI) to stress the association between diabetes, heart disease and stroke. The idea of introducing this umbrella term is to help people better understand and manage all diabetes and cardiovascular risk factors, and to side-step some of the controversy surrounding the definition of insulin resistance or metabolic syndrome and which cluster of variables are in and out.
A new Cardiometabolic Risk (CMR) Calculator to help us evaluate an individual’s risk of diabetes or vascular disease should be available by the end of the year.
The formula already includes factors such as:
1. Body mass index
2. Waist circumference ratio
3. Fasting plasma glucose
4. HDL-cholesterol
5. LDL-cholesterol
6. Triglycerides
7. Apolipoprotein B
8. Blood pressure
9. C-reactive protein
10. Age
11. Sex
12. Race/ethnic origin
13. Family history
14. Tobacco use
Part of the reason for this new initiative is the discovery that pre-diabetes, or impaired fasting glucose, where plasma glucose levels are 100-125 mg/dl, is associated with a high prevalence of cardiovascular disease risk factors such as obesity, hypertension and dyslipidemias.
The person who first proposed the insulin resistance syndrome, a.k.a. syndrome X, a.k.a. metabolic syndrome, is Gerald Reaven who first recognized the syndrome in a landmark paper in 1988. He recently gave a lecture entitled; “Insulin Resistance Versus Metabolic Syndrome: Different Names, Different Concepts, Different Goals.” I am in complete agreement with his basic proposition, which is that insulin resistance explains the clustering of all of the components that make up the metabolic syndrome. So Gerry’s position is that there’s no point in trying to make a diagnosis of metabolic syndrome: everything is due to insulin resistance.
So instead of wasting time and resources in trying to diagnose metabolic syndrome, it is much better to understand the pathophysiology: what is going on at the molecular level, how these processes produce risk factors, and whether we can predict others. We should identify and treat each of the underlying processes and the complications of insulin resistance. If we are going to have a syndrome, it should be called insulin resistance syndrome.
And let’s stop these academic debates and get on with the job at hand: there is a 600% variation in peoples’ ability to have insulin transport glucose into cells. More than half the US population is destined to develop at least some degree of insulin resistance, so we need to look for better ways to identify people who have it, and to apply the principles of integrated medicine to keeping them healthy.
Technorati tags: Insulin resistance Insulin resistance syndrome Metabolic syndrome Cardiovascular disease Hypertension Inflammation Hyperlipidemia Weight gain Integrated medicine
Acupuncture for Obesity
I was recently astonished to realize that it is now 25 years since I began my training in acupuncture.
It is an extraordinary system of prevention and treatment, yet one of my biggest disappointments has been the lack of effect in smoking and obesity. I have plenty of friends and collegues who have had great results, but I just have not. In fact I find that the "tapping therapies" seem to be a lot more helpful.
So I was interested to see a note about a report from Germany, that claimed modest success in treating the weight gain that can accompany treatment with some prescription medications. It will be interesting to see if anyone else is able to replicate the study. If they do, I shall report it immediately.
In the meantime, we have enjoyed considerable success with an integrated weight management strategy that addresses the physical, psychological, social, subtle and spiritual aspects of the issue. If you try only to diet and/or exercise, the long term results are usually disappointing.
Address everything at once in a very carefully coordinated manner, and the results can be spectacular. Remember the adage: Combinations are Key.
I outline our strategy in the last chapter and CD of Healing, Meaning and Purpose. Later this year we shall be publishing the entire program, and inviting researchers to examine our approach objectively.
Technorati tags: Obesity Weight management Acupuncture Integrated medicine The Atlanta Approach
Homeopathy as a Part of a Comprehensive Treatment Plan
I have been using homeopathic remedies for over 25 years, and I have often found them to be extremely helpful.
I part company from many of my friends who are classical homeopaths who insist that using any form of conventional medicine "suppresses" illnesses, rather than curing them, and so should all be avoided like the plague.
As we started rolling out the new integrated model of healthcare, which integrated conventional medicine, lifestyle changes and homoeopathy, many people objected violently on the grounds that ANY use of other, non-homeopathic treatments would prevent the homeopathic remedies from working.
This has come up recently with several common problems: using homeopathic "vaccinations" in place of the real thing; using homeopathic remedies for influenza, to the exclusion of conventional treatments. And now we hear of people being advised to use homeopathy for malaria prohylaxis. This worries me: I have seen people die of malaria, and it isn’t pretty. Homeopathy may be a useful adjunctive treatment and it may also help with any side effects of conventional treatment.
Please don’t play Russian Roulette with your health.
I thought that it would be a good idea to reproduce the following brief article:
Alternative malaria treatment may not work from PhysOrg.com
British health authorities are urging tourists not to rely on alternative treatment such as homeopathy to fight malaria.
[…]
Technorati tags: Homeopathy Integrated medicine Malaria
Convergence
One of the many things differentiating complementary and alternative medicine from the more conventional type, is that complementary practitioners are not much interested in a pathological diagnosis, and instead focus far more on the whole person. There are more than 500 types of complementary and alternative medicine, and virtually all work on the principle that they want to stimulate the body to heal itself.
It is not so well-known that in recent years some of the most cutting edge academic research in medicine has been breaking down artificial organs-based barriers, and focusing instead on the whole person, and look at research in a more holistic way. So a cardiologist and liver expert may be working together on the same problem.
Someone was asking me why this blog has so many categories? The reasons is that artificial barriers between illnesses, health, wellness, consciousness and spirituality are breaking down, and this blog reflects that. I was asked, “So are you interested in self-help or health and wellness?” the answer to that one is “Yes.” All of these are inextricably linked.
A second conceptual change, that is not much known outside of research centers, is that much of the current thrust in pharmacology is based on modulating the body’s responses, rather than simply blocking diseases processes.
Despite this apparent convergence, there are still some enormous differences in approach:
1. The medical research enterprise remains profoundly reductionist, and so it tends to ignore some key aspects of what it is to be human: we are a great deal more than sets of biochemical reactions.
2. Dismissing the social and psychological aspects of health and illness remains an Achilles’ heel of most academic research. When I was working in academia, a distinguished colleague came over form the England to give a lecture. An expert in brain imaging, he spoke a lot about consciousness and free will. As one of my American friends said afterward: he sound just like you in our research meetings!
3. Complementary, alterative and now integrated medicine remains firmly focused on relationships as a key to healing. Not just the relationship of a client and their family, but the relationship between client and therapist. And there is a third arm to this. When, in the mind-1980s, we first started putting together the principles of this new Information Medicine known as Integrated Medicine in the United Kingdom or Integrative or Integral Medicine in the United States, a key component of it was the insistence that the therapeutic encounter would require the therapist to do more than just show up and do something technical. But that the therapist would also be aware of the impact of the encounter on them, and the importance for the therapist to be involved in growth work themselves. There was a time when psychotherapists would remain in therapy throughout their careers. That may not now be feasible. But it is entirely feasible for a therapist to take a bit of time each day to calm themselves; to reflect on what is going on inside them and in the subtle currents of the interactions between them, the person who has come to them for help and guidance, and all the other people involved in the situation. This is the way in which medicine is going to develop in the future.
The extraordinary advances of biomedical research can be an incredible boon to humanity, but they need to be leavened by an understanding of the context within which they are developing.
“A physicist who rejects the testimony of saints and mystics is no better than a tone-deaf man deriding the power of music.”
–Sir Sarvepalli Radhakrishnan (Indian Philosopher and, from 1962-67 President of India, 1888-1975)
Technorati tags: Alternative medicine Complementary medicine Integrated medicine
Understanding Attention Deficit Disorder as a Long-term Challenge
Regular readers will know that I am a huge advocate of natural and non-invasive methods of treatment whenever possible. But sometimes we reach an impasse, and the only option is to use pharmacological or other types of conventional intervention. But even then, it is a mistake to assume that physical treatment alone will be sufficient to help the individual and their family: it is only sensible also to address the psychological, social, subtle and spiritual dimensions of the person. And we must never lose sight of the positives: some people who have health challenges are transformed for the better, and some “illnesses” may carry gifts with them. I’ve talked about the creativity of people with bipolar disorder and schizotypy and the empathy and innovation that may accompany attention deficit disorder.
There is often a fine balance between the positives and negatives of an illness and the types of help that may be of greatest value.
I have just been involved in a common discussion at this time of year: a young person has quite bad attention deficit disorder (ADD). Since she started pharmacological treatment not only has she risen from being a failing student to getting all As and Bs, but the quality of her life has improved dramatically. Unfortunately, she has been told that she only needs to take her treatment when she feels that it is necessary to complete her schoolwork. Many healthcare providers continue to believe that ADD and ADHD are just academic problems. There is a very good new review article that discusses this misperception in some detail. Prescription patterns show that the majority of school-age children are only being treated from Monday to Friday, and from 7AM to 3PM. Why does this matter?
There is excellent and extensive research about the consequences of non-treatment, and most of it has nothing at all to do with school. If people with ADD and particularly with ADHD are left untreated, they are more likely to:
1. Develop substance abuse
2. Be involved in a serious accident
3. Engage in illegal activities
4. Contract a sexually transmitted disease
5. Have an unplanned pregnancy
6. Become separated or divorced
The article makes a point that we have often discussed with families: these consequences of non-treatment are events that primarily occur outside the school environment. So withholding medicine just when it is needed the most may be a risky business.
We are now seeing increasing evidence that successful pharmacological treatment reduces these consequences of untreated ADD/ADHD to the rates found in the general population. Simply using appropriate medications can protect people from adverse consequences of these problems both now and in the future.
I think that we should look at ADD in the same way that we look at an illness like diabetes. In diabetes, the high blood glucose and elevated lipids are not themselves the problem. They may cause symptoms, but the real danger lies in the long-term physical consequences of high glucose and lipids. It is these that can be so devastating to the person with the illness, causing the so-called complications of diabetes, such as retinopathy, kidney and heart disease.
Similarly ADD/ADHD may cause symptoms – such as problems in school – but it is the long-term consequences that can cause such problems. Children and adolescents, and for that matter some adults with both illnesses don’t realize that these are the main reasons for treatment.
There is a common myth that adults know that they need to take their medication, and so they do. Hands up anyone who has only taken half of a course of antibiotics!!
There is very striking study of adults with ADHD who were asked to do a simulated driving test while on and off their medicines. The people in the study rated their driving performance just the same whether they were on or off their medicines. Despite the fact that when they were off their treatment they were an astounding five “standard deviations” worse in terms of driving safety and responsibility! For people not used to looking at statistics this may not seem like much, but the difference is astonishing. You would not want to share the road with an untreated person with ADD.
We know that within the first three months of treatment 50% of children and adults will have stopped their ADD/ADHD treatment and most studies agree that by 18 months, the figure is around 80%.
We need to get the message out that:
- ADD and ADHD can create some nasty long-term problems if not adequately treated.
- For a host of reasons, most people will stop their treatment, so plan for it, and don’t just wait for it to happen.
- Adequate treatment consists of a lot more than giving medication and hoping for the best.
- People need psychoeducation.
- They need to learn coping strategies.
- The family needs to know how to help and how to deal with the problems that someone with ADD/ADHD may be causing them.
- And people need to know how and when to use medications and how to integrate them with non-pharmacological strategies.
Technorati tags: Attention deficit disorder Attention deficit hyperactivity disorder Substance abuse Treatment
Healia.com
Carol Kirshner, web mistress extraordinaire, has just alerted me to a great resource for anyone looking for information on health, wellness and healing, called Healia.com.
Carol’s review is excellent, and now that I’ve tried out the website, I really do share her enthusiasm.
One of the reasons for creating my own blog is that the internet is full of medical misinformation. I have just been writing an article that I am going to post tomorrow. My initial reactions to some of the statements that I found on line would not have been fit for you gentle reader. Suffice to say that there were comments on some websites that betrayed a complete ignorance about the workings of the human body and recommendations that can best be described as bovine excreta.
Healia.com seems to be very different. I have been putting it through its paces, and I’ve so far not found a single problem or contentious area, despite throwing a lot of unusually tough questions at it. I fully anticipate that it’s going to become one of my major research tools, and for matters pertaining to health, it seems to be better than any other search engine that I’ve found.
Technorati tags: Internet search engine Health Healing Wellness
A Mini Experiment
Well we consumed the first of the squash, cooked with onions and walnuts: delicious! And I’ve been a real bore telling everyone about my horticultural adventures.
But there’s another small piece to all this. It’s almost ten years since I became a Reiki Master. The person who performed the final initiation worked in the business world and told me that all the plants in her office leaned toward her desk, rather than the sunlight. Since then I’ve known a number of Reiki practitioners who have told me that they have used it to help the growth of plants.
So I thought that I would try it on the new vegetable garden. But being a good scientist, I just used it on half of the vegetable garden. Look at the picture, and see if you can guess which half of the vegetable plot got the treatment.
You can certainly see that one half has a luxurious growth of corn, beans and squash, and the other half a great deal less.
I’m not going to read too much into this little experiment. Although the whole plot has received identical care, and the pH of the soil is same from one end to the other, there could still be some other factors influencing the growth of half the plants. But it has made me think about doing a more formal experiment. And for now I’m going to do a typical crossover study: I’m going to go out and use reiki on the half of the garden with the less impressive growth and see if we can get some catch-up growth.
Technorati tags: Reiki Plant growth Experimental method
Human Evolution
For more than a century, the received wisdom has been that humans finished their physical evolution between one hundred thousand and fifty thousand years ago, and that there have been only minor changes in cognitive abilities over most of that time.
I have always found those assertions to be fundamentally flawed. Our bodies have changed beyond all recognition in the last few hundred years, as I’ve pointed out in my last book and CD series Healing Meaning and Purpose. Even more than that we have changed and are changing mentally. If we were to go back in time ten thousand or even one thousand years, we would find that people were cognitively, emotionally and morally quite different from modern humans. Not simply because of technology and the explosion of knowledge about the external universe, but because there is a dynamic relationship between our development as a species and our creations, with each feeding off the other.
It is only recently that a number of theoreticians, philosophers and psychologists have begun to look at the ways in which we are continuing to develop and what it means for all of us.
The German psychiatrist and philosopher Karl Jaspers first pointed out the great moral leap forward in what he called the Axial Period, between about 700-200B.C.E., during which the foundations of many of the world’s great religions first appeared, probably in response to the prevailing violence and unpleasantness of the time. More recently the Polish-born Swiss philosopher Jean Gebser started developing intriguing models of the transformations of human consciousness. In the United States, the psychologist Clare Graves developed a revolutionary concept of developing levels of development of the personality, that has evolved into Spiral Dynamics. (You may be interested to look at a review that I have just written about an excellent CD program detailing the latest developments in this field.)
And then there is Ken Wilber whose work in this field is remarkable, and whose creation of the Integral Institute promises great things. To these luminaries I now add Dudley Lynch a writer whose work I have only recently discovered.
Dudley recently wrote a very sensitive blog item about the efforts of a person with a mental illness trying to keep himself integrated in a sea of psychic chaos. He was kind enough to publish my brief response, which needs a little more detail.
The reasons for raising these points about continuing human development are these:
1.The manifest physical changes in people over the last few hundred years have enormous – and largely neglected – implications for clinical medicine.
2. It is likely not just peoples’ physical bodies that have changed, but also their subtle systems. I pointed out in my last book and CD series that the chakra system has developed to its current point only within the last few thousand years. This continuing development is also one of the reasons why some therapies that once only worked occasionally are now becoming more stable and predictable, and why some new forms of therapy – like the tapping therapies – are now being discovered.
3. It is because of these profound changes that new forms of therapy are now being developed. Not just using a supplement here, or a breathing exercise there, but precise combinations that help guide the healing of every aspect of an individual and his or her relationships and spiritual connections.
4. Some people who appear to have psychotic illnesses are moving into new developmental stages without having passed through the necessary intermediate stages. I have just read a first person account of an English journalist who could easily have been diagnosed with a manic illness, but was almost certainly undergoing a spiritual emergence.
5. Major emotional, cognitive, moral, conscious and spiritual shifts can be profoundly frightening to many people, and are doubtless one of the reasons for the profound feelings of social dislocation and violent reactions that we are observing throughout the world.
6. It is no surprise that new spiritual pathways are now emerging. Many will doubtless be very helpful to many of the thirty million Americans who count themselves as spiritual seekers, but have not yet found what they are looking for.
7. Taken together, these new understanding about the longitudinal development of people, relationships and whole societies are already having extraordinary effects on our ability to guide them all in more healthy and integrated pathways.
Technorati tags: Human evolution Axial period Ken Wilber Karl Jaspers Alternative medicine Complementary Medicine Integrated Medicine Chakras Subtle energy
