From the NY Times today comes a report on a high protein, very low carbohydrate diet to treat epilepsy.   Your diet matters to the health of your brain.  Recently I mentioned an elimination diet that was highly effective in treating ADD children.  Could it be our diets are making our brains sick?  It is at least part of the puzzle.  Enjoy the article by Aliyah Baruchin. 

A formerly controversial high-fat diet has proved highly effective in reducing seizures in children whose epilepsy does not respond to medication, British researchers are reporting.

As the first randomized trial of the diet, the new study lends legitimacy to a treatment that has been used since the 1920s but has until recently been dismissed by many doctors as a marginal alternative therapy.

“This is the first time that we’ve really got Class 1 evidence that this diet works for treatment of epilepsy,” said Dr. J. Helen Cross, professor of pediatric neurology at University College London and Great Ormond Street Hospital. She is a principal investigator on the study, which will appear in the June issue of The Lancet Neurology.

Though its exact mechanism is uncertain, the diet appears to work by throwing the body into ketosis, forcing it to burn fat rather than sugar for energy. Breakfast on the diet might consist of bacon, eggs with cheese, and a cup of heavy cream diluted with water; some children drink oil to obtain the fats that they need. Every gram of food is weighed, and carbohydrates are almost entirely restricted. Breaking the diet with so much as a few cookies can cause seizures to flare up.

For the British trial, the researchers enrolled 145 children ages 2 to 16 who had never tried the diet, who were having at least seven seizures a week and who had failed to respond to at least two anticonvulsant drugs.

One group began the ketogenic diet immediately. The control group waited three months before starting it. In the first group, 38 percent of the children had seizure rates reduced by half, compared with 6 percent in the control group. Five children in the diet group had reductions exceeding 90 percent.

Perceptions of the diet have changed sharply in the last decade. In 1993, a Hollywood producer, Jim Abrahams, took his 1-year-old son, Charlie, to Dr. John M. Freeman at the Pediatric Epilepsy Center at Johns Hopkins, which was one of the few centers championing the diet. Within three days of starting the diet, Charlie’s incapacitating seizures, which had resisted multiple medications and surgery, stopped entirely.

With his wife, Nancy, Mr. Abrahams founded the Charlie Foundation to Help Cure Pediatric Epilepsy to promote education about the diet. He produced an instructional video for parents and a made-for-television movie, “First Do No Harm,” starring Meryl Streep as a mother who seeks out the diet for her child.

As a result of the Johns Hopkins work, research on the diet blossomed and it became a standard treatment at hospitals and epilepsy centers in the United States and abroad.

Dr. Shlomo Shinnar, director of the Comprehensive Epilepsy Management Center at the Montefiore Medical Center in the Bronx, called the new study “an important trial that lays to rest the issue of ‘Does it really work or not?’ ”

Although the diet has to be medically supervised, Dr. Shinnar said, it is a mistake to believe that it requires extensive hospital resources and a staff’s constant attention. “Here they don’t have this,” he said of the British trial. “This study makes it clear that this actually can be made to work in a community setting.”

This study was just published in the Journal of Attention Disorders.  It shows that 47% of patients over time had positive results, especially for inattentive ADD.  Quite stunning for a natural supplement. Enjoy. 

 Omega-3/Omega-6 Fatty Acids for Attention Deficit Hyperactivity Disorder: A Randomized Placebo-Controlled Trial in Children and Adolescents by M. Johnsson and colleagues.

Objective: The aim of the study was to assess omega 3/6 fatty acids (eye q) in attention deficit hyperactivity disorder (ADHD).

Method: The study included a randomized, 3-month, omega 3/6 placebo-controlled, one-way crossover trial with 75 children and adolescents (8-18 years), followed by 3 months with omega 3/6 for all. Investigator-rated ADHD Rating Scale-IV and Clinical Global Impression (CGI) scale were outcome measures.

Results: A majority did not respond to omega 3/6 treatment. However, a subgroup of 26% responded with more than 25% reduction of ADHD symptoms and a drop of CGI scores to the near-normal range. After 6 months, 47% of all showed such improvement. Responders tended to have ADHD inattentive subtype and comorbid neurodevelopmental disorders.

Conclusion: A subgroup of children and adolescents with ADHD, characterized by inattention and associated neurodevelopmental disorders, treated with omega 3/6 fatty acids for 6 months responded with meaningful reduction of ADHD symptoms. (J. of Att. Dis. 2008).

Many people have written to ask about the elimination diet:  It consisted of rice, turkey, lamb, vegetables, fruits, margarine, vegetable oil, tea, pear juice and water.  I know it does sound like much, but doing this diet for 9 weeks is worth a try for people with ADHD to see if it is of benefit.  Then slowly you can add back other foods to see which ones may be trouble.

In a landmark study from Holland researchers found that putting children on elimination diets significantly improved ADD symptoms.  The abstract is below.

Eur Child Adolesc Psychiatry. 2008 Apr 21 A randomised controlled trial into the effects of food on ADHD.Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Pereira RR, Buitelaar JK.ADHD Research Centre, Liviuslaan 49, 5624 JE, Eindhoven, The Netherlands 

The aim of this study is to assess the efficacy of a restricted elimination diet in reducing symptoms in an unselected group of children with Attention deficit/hyperactivity disorder (ADHD). Dietary studies have already shown evidence of efficacy in selected subgroups.

Twenty-seven children (mean age 6.2) who all met the DSM-IV criteria for ADHD, were assigned randomly to either an intervention group (15/27) or a waiting-list control group (12/27). Primary endpoint was the clinical response, i.e. a decrease in the symptom scores by 50% or more, at week 9 based on parent and teacher ratings on the abbreviated ten-item Conners Scale and the ADHD-DSM-IV Rating Scale.

The intention-to-treat analysis showed that the number of clinical responders in the intervention group was significantly larger than that in the control group [parent ratings 11/15 (73%) versus 0/12 (0%); teacher ratings, 7/10 (70%) versus 0/7 (0%)]. The Number of ADHD criteria on the ADHD Rating Scale showed an effect size of 2.1 (cohen’s d) and a scale reduction of 69.4%. Comorbid symptoms of oppositional defiant disorder also showed a significantly greater decrease in the intervention group than it did in the control group (cohens’s d 1.1, scale reduction 45.3%).

A strictly supervised elimination diet may be a valuable instrument in testing young children with ADHD on whether dietary factors may contribute to the manifestation of the disorder and may have a beneficial effect on the children’s behaviour.

Sleep terrors, also called night terrors, are a very disturbing problem in children and adults.  They are characterized by extreme terror and a temporary inability to regain full consciousness.  The person may wake abruptly from sleep and be accompanied by gasping, moaning or screaming.  It is very difficult to fully awaken the person. 

Here is a fasinating study showing 5HTP as a potentially effective treatment.

Eur J Pediatr. 2004 Jul;163(7):402-7. Epub 2004 May 14. L -5-Hydroxytryptophan treatment of sleep terrors in children.  Bruni O, Ferri R, Miano S, Verrillo E.  Centre for Paediatric Sleep Disorders, Department of Developmental Neurology and Psychiatry, University of Rome “La Sapienza”, Via dei Sabelli 108, 00185 Rome, Italy.

To test the hypothesis that the administration of L -5-hydroxytryptophan (L -5-HTP) might exert beneficial effects on sleep terrors, we carried out an open pharmacological trial in a group of children with sleep terrors compared to a group of children with the same disorder but without L -5-HTP treatment. Participants in the trial were 45 children (34 males and 11 females; age range 3.2-10.6 years), referred to the Sleep Centre of the Department of Developmental Neurology and Psychiatry of the University of Rome “La Sapienza”, affected by sleep terrors. All subjects underwent: (1) complete medical and sleep history; (2) complete neurological examination and EEG recording whilst awake and sleeping, (3) a structured sleep diary for 2 months, (4) after 1 month, all subjects were examined again from the clinical and EEG points of view and (5) after 6 months, a structured interview in order to evaluate the clinical outcome. After the first visit, L -5-HTP was administered (2 mg/kg per day) at bedtime to 31 randomly selected patients for a single period of 20 consecutive days. After 1 month of treatment, 29/31 (93.5%) of patients showed a positive response. In the comparison group without drug therapy, after 1 month, the episodes disappeared only in four children (28.6%) while ten children (71.4%) showed the persistence of episodes with the same frequency as before. After 6 months, 26/31 (83.9%) of children treated with L -5HTP were sleep terror-free, while in five children (16.1%) sleep terror episodes persisted. Of the children in the comparison group, ten (71.4%) continued to show sleep terrors at 6-month follow-up. CONCLUSION: to our knowledge, this is the first study demonstrating the efficacy of a new drug treatment for sleep terrors. These results confirm our initial hypothesis and represent evidence that treatment with L -5-hydroxytryptophan is able to modulate the arousal level in children and to induce a long-term improvement of sleep terrors.

Can some anxiety be good?  Of course! Anxiety is what prevents you from driving 125 miles per hour down the freeway in the rain.  Anxiety prevents you from giving someone you just met in the bar your home phone number.  Remember the movie Fatal Attraction? 

I think I have been a fairly anxious person most of my life.  When I was little I had an older brother who pounded me on a regular basis, which may have set up a sense in my brain that something bad is about to happen.  I used to bite my finger nails and often carried a lot of tension in my shoulders.  But anxiety is not all bad. 

After medical school I went back into the Army as an officer so I could do my psychiatry training at Walter Reed in Washington, DC.  But first I had to go to several weeks of officer training school at Fort Sam Houston in Texas.  One day we were doing a ropes course.  We had to traverse a ravine, hand over hand using a rope anchored to each end.  It was about fifty feet across and 30 feet above a dry rock bed.  The physical part didn’t bother me.  But they tied us to the rope with a Swiss seat, a rope around our waist and through our legs.  When we got out into the middle of the ravine we were instructed to let go and let the Swiss seat hold us up.  For some reason I did not trust it.  When I got out into the middle of the ravine I did not want to let go.  I felt like a scared little bunny rabbit.  I knew my friends would be laughing at me and it caused quite an internal crisis.  But that day the scared bunny rabbit won. I didn’t let go and scurried to the other side.  With my friends razzing me I climbed up on the other side of the ravine only to turn around and see my best friend at the course let go of the rope.  They had mistied his Swiss seat and I watched him fall 30 feet to the rocks below, where he broke his neck and punctured his lungs.  From that moment on I have been grateful for my anxiety.  It often helps prevent bad things from happening. 

Clearly some anxiety is good, but what can you do when it gets out of control.  As in ADD, depression and bipolar disorder, there are different types of anxiety disorders, so knowing which type you have is essential to getting the best treatment.  Certain medications and supplements can be very helpful. With anxiety disorders I tend to use supplements first because I do not like what I have seen on scans.  Some of the anti-anxiety medications, like Xanax, work like alcohol on the brain.  Supplements such as 5-HTP, GABA, kava kava and green tea have been found to be helpful.  Plus, I really like hypnosis, guided imagery and meditation to calm anxiety and teaching people how to rid themselves of the anxious ANTs that provide the seeds of anxiety disorders.

ABC in Washington, DC did a story on our work.  Forgotten head trauma can ruin your life.  Check out this video.  Also, I usually think tennis is a relatively safe sport, but not for some people who lack impulse and anger control. I bet his scan before the injury was not among the healthiest.

http://www.wjla.com/news/stories/0408/508342.html

http://sportsillustrated.cnn.com/2008/tennis/04/02/bc.ten.bloodiedyouzhny.ap/index.html?cnn=yes

Also, due to the success of the PBS special, Change Your Brain, Change Your Life hit the New York Times bestseller list for the second straight week.

Daniel 

Dear Friends:

I am just finishing the first round of 13 cities in just over 2 weeks for our new PBS special.  It has been an amazing experience and I hope you have had a chance to see it.  The response across the nation has been overwhelmingly positive and it is currently one of PBS’ top rated shows.  My book, Change Your Brain Change Your Life has been in the top ten at Amazon.com for most of the tour and I am already scheduled to visit more cities during the June Pledge Drive.  For those who have not seen the show it is now available on DVD at the store.

During the live shows we have asked for callers to ask questions. Some of the most popular questions have been about ADD, bipolar disorder and the impact of marijuana on the brain (especially in Oregon :)).  The question that surprised me the most was about the impact of general anesthesia on memory. I have been asked this question in every city.  I noticed 10 years ago that some patients lose memory after general anesthesia and the docs usually do not tell you it is a potential side effect.  I have seen it firsthand along with the damage on scans.  Being on a brain healthy program is important at all times, but especially before and after undergoing anesthesia. 

To your brain health,

Daniel

I appreciate everyone’s prayers and encouragement as I continue on my PBS tour.  The program is one of the top shows for PBS this season, which means people are interested in brain health.  I am traveling to 8 cities over the next week or so, including Hartford, CT (tonight), Pittsburgh, Tampa Bay, Long Island, NY, Miami, Raleigh, Phonex and Detroit.

Also, in the morning (Tues AM) I will be on Good Morning America talking about the brain and poor judgment with the current scandal in New York.

I was emailed today a wonderful interview about fish oil, substance abusers and anger reduction.  I include it here for your information. It is great reading and a very forward thinking study.

Substance Abuse, Anger and Omega-3 Fatty Acids

Laure Buydens-Branchey, M.D.

Research Service (151/BK)

VA New York Harbor Healthcare System - Brooklyn Campus

800 Poly Place, Brooklyn, NY, 11209, USA

“Long-chain N-3 Polyunsaturated Fatty Acids

Decrease Feelings of Anger in Substance Abusers,”

Psychiatry Res, 2008 Jan 15;157(1-3):95-104 45708 (2/2008)

Kirk Hamilton: Can you please share with us your educational background and current position?

Laure Buydens-Branchey: I have an MD degree and was trained as a psychiatrist at the Payne Whitney

Clinic, The New York Hospital (now the Weil Cornell Medical College) in New York, NY. I am presently a psychiatrist assigned to the Research Service at the New York Harbor Healthcare System – Brooklyn Campus in Brooklyn, NY.

KH: What got you interested in studying the role of omega-3 fatty acids and the feelings of anger insubstance abusers?

LBB: There were some data indicating that fatty acids supplementation decreased hostility but these data were scant. We were interested in studying omega-3 effects in substance abusers because there are strong associations between high-frequency and high-severity aggressive behaviors and substance use disorders on one hand and because we had observed that the diets of substance abusers are deficient in many nutrients, including omega-3s.

KH: When you say omega-3 fatty acids are you talking about eicosapentaenoic acid (EPA) and

docosahexaenoic acid (DHA)? What is the physiology of omega-3 fatty acids that might improve aggressive tendencies in substance abusers?

LBB: There are two omega-3 fatty acids that have been shown to play a role in the pathophysiology of a wide range of psychiatric disorders. They are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), usedeither singly or in combination. The effects of these fatty acids are diverse and complex and their respectiveroles in specific behavioral problems have not yet been completely elucidated. DHA is an important componentof the membranes of neurons (brain cells) and could affect the function of neurotransmitters, includingserotonin that has been implicated in violence. EPA, on the other hand, is not concentrated in neuronalmembranes but may affect the function of neurotransmitter systems via neuroimmunological and vascular effects. It could for instance increase the blood flow in the brain.

KH: Where did you come up with a dose of 3 gm/d of omega-3 fatty acids? What was the breakdown of EPA and DHA in mg per capsule? Were they given in a single dose or divided dose? With meals or away from meals?

LBB: No consensus has been reached yet about the ideal dose of omega-3 polyunsaturated fatty acids (PUFAs) that should be used to promote psychiatric health. Based on a review of major epidemiological studies conducted in the US, the daily intake of EPA and DHA recommended by the International Society for the Study of Fatty Acids and Lipids (ISSFAL) for cardiovascular health is 500 mg. More recently Hibbeln et al (2006) have proposed that the daily allowance of long-chain (LC) omega-3 PUFAs that would protect the US population against both cardiovascular and major psychiatric diseases should be as high as 3.5 grams per day for a 2000 Kcal diet. Several studies had shown that a daily dose of 3 grams of omega-3 PUFAs was effective in alleviating a variety of psychiatric symptoms and was almost entirely devoid of side effects. No consensus has been reached about the relative proportions of EPA and DHA that should be used. Available evidence seems to indicate that EPA either alone or in combination with DHA is more effective than DHA alone. For these reasons, participants in our study taking the active substance were given capsules containing 450 mg of EPA, 100 mg of DHA and 50 mg of other omega-3 LC PUFAs and were told to take 5 capsules daily. They were not instructed to take the capsules with meals but were told that they could take them in divided doses.

KH: Were fatty acids levels done on these patients before, during or after the study? If so did the levels correlate with supplementation or symptoms?

LBB: Fatty acids profiles were obtained before and after the 3-month supplementation period used in our study. Our data show a strong correlation between changes in plasma levels of omega-3 PUFAs and psychological changes. More important increases in plasma levels were associated with more pronounced decreases in anger. These data have not been published yet.

KH: Can you tell us about your study and the basic results?

LBB: In a randomized, double-blind, placebo-controlled study involving 24 subjects with substance use disorders, supplementation with omega-3 PUFAs was found to decrease feelings of anger. The subjects were randomized to one of two groups for 3 months: (1) PUFA group (n=13) receiving 3 g of omega-3 PUFAs (EPA + DHA) daily; (2) placebo group (n=11) receiving placebo daily. Subjects in the PUFA group showed a progressive decline in anger scores (assessed with a scale), with no decline observed in the placebo group. Following the end of the supplementation, 6 subjects from the PUFA group and 8 subjects from the placebo group were followed for 3 additional months. Anger scores remained significantly decreased among the PUFA group subjects. Though preliminary, these data indicate that n-3 PUFA supplementation could be beneficial in the treatment of some patients with hostile tendencies.

KH: Were there any side effects with the therapy? How was the patient compliance?

LBB: Side effects were almost non existent. Two patients reported having loose stools.

KH: Do substance abusers have an increased need for omega-3 fatty acids?

LBB: Yes, they do. Although we cannot generalize our findings to all abusers of substances, the different groups of patients we studied ate approximately one third of the long chain polyunsaturated fatty acids (which include EPA and DHA) of the daily amounts recommended by ISSFAL.

KH: How do you determine who is a candidate for omega-3 fatty acid therapy?

LBB: We cannot say for sure who the best candidates for omega-3 therapy might be. It would stand to reason that individuals whose omega-3 intake is suboptimal and who present psychological or psychiatric problems might benefit from supplementation. This would necessitate the recording of a dietary history or, better a determination of omega-3 blood levels but this determination is not part of routine laboratory tests.

KH: Do you think that omega-3 fatty acids could be used for aggressive behavior in individuals other than those with substance abuse issues?

LBB: The answer to this question is yes. In one study, DHA supplementation prevented an increase in aggression at times of stress in Japanese students. In another study, EPA was found more effective than a placebo in diminishing aggression in women with untreated borderline personality disorder and in yet another study, prisoners treated with a cocktail of supplements that included omega-3’s had fewer disciplinary incidents.

I hope you have been able to see the new PBS special.  It is doing very well and has helped raise a lot of money for PBS in just its first week of airing.  I am thrilled, because it helps get our message out to the general public and raises money for PBS, one of my favorite venues for lifelong learning.

Now comes a large study from England that basically says antidepressants are no better than sugar pills.  How does the study below have any validity.  I have been a psychiatrist for a long time, now more than 25 years.  I know antidepressants work when prescribed properly.  But I also know that I can help people heal with natural supplements, exercise and psychotherapuetic interventions. 

Most doctors prescribe antidepressants as if depression was a single or simple disorder.  Our brain imaging research says it is at least 7 different disorders and giving everyone the same treatment invites failure and often making people worse. We need to tailor the treatment to indivual brains, not vague diagnostic categories.  Enjoy the article.

LONDON (AFP) — Best-selling anti-depressants like Prozac and Seroxat are barely more effective than placebos in treating most people with depression, a study led by a British university said Tuesday.

The research, which analysed 47 clinical trials, breaks new ground by incorporating data not previously released by drug companies which researchers obtained under US freedom of information laws.

Its findings prompted some academics and mental health campaigners to question whether people with mild and moderate depression should be prescribed drugs like Prozac, which has been taken by 40 million people worldwide.

“The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great,” said Professor Irving Kirsch of Hull University, in northern England, who led the team.

“This means that depressed people can improve without chemical treatments.

“Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients unless alternative treatments have failed to provide a benefit.”

The study, published in the journal PLoS (Public Library of Science) Medicine, looked at Prozac, Seroxat, Effexor and Serzone and found the drugs were only better than a placebo for some people with severe depression.

Kirsch’s team said it was one of the most thorough probes into the impact of new generation anti-depressants or selective serotonin reuptake inhibitors (SSRIs).

But drug companies strongly questioned the findings.

A spokesman for Eli Lilly, which makes Prozac, said that “extensive scientific and medical experience” had shown it is “an effective anti-depressant.”

And GlaxoSmithKline, which makes Seroxat, said the study had not acknowledged the “very positive benefits” of the drugs.

“Their conclusions are at odds with what has been seen in actual clinical practice,” a spokesman said.

“It is widely recognised by experts in the field that studies in depression are challenging and very difficult to conduct.”

One leading academic who has studied why drug companies only publish some of their data on new drugs said in the wake of the findings they should be obliged to provide full details.

Doctor Tim Kendall, deputy director of Britain’s Royal College of Psychiatrists research unit, said the study was “fantastically important.”

“I think it’s too dangerous to allow drug companies — where profit is a key factor — to be able to withhold data which shows that a drug is ineffective or harmful,” he said.

Alison Cobb, of British mental health charity Mind, hailed the findings as “a serious challenge to the predominance of drugs in treating depression.”

“Anti-depressants do help many people but by no means all and some people experience severe side-effects with them,” she said.

“Nine out of 10 GPs (general practitioners) say they’ve been forced to dish out drugs because they don’t have proper access to ‘talking treatments’ such as cognitive behavioural therapy, which are recommended as the first-line treatment for mild to moderate depression.”

Another mental health charity, Sane, warned the findings “could remove what has been seen as a vital choice for thousands,” adding people should not stop taking their drugs immediately.

As the study was published, the British government published details of a 170-million-pound (225-million-euro, 335-million dollar) programme to improve access to counselling and therapy for people with depression.

Officials say this should see 900,000 more people receiving such treatments over the next three years.