Monday, October 14, 2019

Comments by djhnd

Showing 17 of 17 comments.

  • Although I’d have preferred that the title of this post be more broad: “fish oil and mental illness” I concur that omega 3 fats, preferably in the form of fish oil, have a strong effect on a wide array of psychiatric conditions.

    In my practice, I have seen the effect of fish oil be especially dramatic in bipolar disease, such that relatives of the patient could tell when she had skipped her dosage (the same day!)

    I recommend my patients take TWO grams of Omega-3s (that means you add up the amount of EPA and DHA listed on the label). In the U.S., the easily available Nature’s Bounty brand (ordinarily I wouldn’t list a brand, but this one is inexpensive and widely available, in U.S. Costco has it) has an enteric-coated fish oil in which 2 caps per day gets you to 1.8 grams per day, which is close enough.

    Daniel Heller N.D.
    Marin County, California

  • Hello

    I would like to know what other papers WERE accepted at the conference. If the overall tenor of the conference is to let the science speak for itself, maybe there were just too many papers submitted. However, I’d imagine that many of the papers being presented are drug-friendly, and support the interests of the exhibitors and supporters of the conference / profession/ society.

    Daniel Heller N.D.
    Marin County, California

  • Here’s a short exercise: how much funding does E Fuller Torrey get directly and indirectly from pharmaceutical companies with a vested interest in continuing and increasing Rxs of psych meds? And how much funding did R. Whitaker get from anti-psychopharm sources before and when he was researching and writing Anatomy of an Epidemic? Given that, whose motives are more credible?

    The Canadian programme is excellent – though interestingly no one has mentioned the Finnish program that merits a whole chapter in Anatomy of an Epidemic. They use short courses of low doses of psych meds, when needed, in addition to intensive support and psychotherapy with obligatory involvement of family.

    Of course, the Finnish don’t have rich-poor divide of U.S., and they believe in redistributive taxation in which everyone contributes financially to the common good of their fellow citizens.

    All in all, it is a sad state of affairs. Emphasis on sad, as in “heartbreaking.”

  • I don’t doubt that many people are making a living as middlemen in this process. But the real money that drives the current process is Big Pharma, I suspect. They have the most ot gain from this model, obviously. On the other hand, if Big Pharma disappeared tomorrow, a legion of Nurse Ratchetts would step in and find some other way to keep the system going.

  • I have noticed that MDs and those with a tendency to be favorably disposed to clinical pharmacology tend to assume that medications work, and tend not to look very far beyond immediate, short-term reactions to drugs – as is the case with this author. This perspective ignores, or glosses over, the long-term damage these drugs cause, and also ignores the tenuous evidence base for their effectiveness in the first place.

    Then I have noticed that people who have been harmed by the medications, or who are disposed to be suspicious/mistrustful of Pharma and perhaps of psychiatry or medicine in general, tend to assume that everyone has a negative reaction to medications, that they help no one and harm everyone.

    As in most things in this world, the truth, I believe, lies somewhere in the middle. MDs should examine the science behind the chemicals they prescribe, and discard everything they’ve been taught that could possibly have been influenced by the profit motive. Biased pseudoscience has left much of conventional medicine in a rotten state.

    People with an “anti-” perspective would be well-served by making “I” statements rather than sweeping generalizations. Drugs do help some people, and don’t harm everyone. Unfortunately, though, we don’t know who will be helped, who will be harmed, and why medications are active, or useless, in general or in any given case.

  • I can see both sides of this question. There is no doubt that people with depression and anxiety respond to SSRIs. There is also no doubt that SSRIs cause harm in some cases, and haven’t been PROVEN to be superior to placebo for anxiety.

    Unfortunately, science and medicine have not answered some fundamental questions, such as “why do SSRIs work in some people and not in others, and is it more than placebo? Since depression and anxiety are no longer though to be neurotransmitter issues, is there another mechanism whereby these medications could work? Is there some way, perhaps through genomic testing, to predict who will have adverse reactions, and who will benefit, from these medications.”

    It’s hard for everyone to have so many unanswered questions, and confusing. Unfortunately, Big Pharma and Medical Associations and M.D.s tend to be allergic to saying “We don’t know”, and it is an emotional and passionate issue.

    But we don’t know if what is happening is placebo or something else. We DO know that SSRIs are overprescribed, and they don’t work – if they work at all – in the way that people think they do.

  • “The authors compare benzos to TCA’s not really a fair comparison as TCA’s are not routinely used for depression or anxiety much today.”

    >> Your concern is addressed at the beginning of the discussion on page 359: “Our systematic review found a paucity of studies providing a controlled direct comparison of AD and BDZ in anxiety disorders. Most of the studies were concerned with TCA and only 3 with newer antidepressants. The superiority of AD over BDZ in terms of efficacy and tolerability was not supported by the available evidence.
    This joins a long list of findings that SSRIs don’t have much evidence to support their use, in any condition.

  • You certainly are raising a popular line of argumentation. For the reasons below, though, I would argue that it is a confused argument.

    “I tried to understand the logic of the people who say, “Massive supplements and chelation therapy can cure both autism and mental illness.” ”
    >>You are using an opaque shorthand by saying “people who say” – there are highly published researchers who have Ph.D.s in the biochemical relationships of nutrients and illness. To equate them with a Medical Doctor pushing chelation or a line of supplements to all comers is a disservice to the former, and to readers.
    You are similarly generalizing in saying that “they” claim a cure for both autism and mental illness. Who is this “they”? It’s fair to leave autism out of the discussion, since anyone making any claims about curing and treating that is much further outside the mainstream than those who point to published research on diet, nutrients, and mental illness.
    Also, and now I’m moving on to a pet peeve of mine – why do some opinionators expend so much oxygen on the relatively harmless hawkers of misinformation on harmless natural remedies, when the relatively murderous hawkers of bad-science-pharmaceuticals are given a pass. (Granted, there are plenty of people hammering them, too, but it is rare for someone to point out that both are trying to make their dime and dollar, but that Pharma leaves behind scorched earth while the effect of the subset of under- or mis-informed natural medicine folks pales in comparison?

    “I worked with one lady real hard to track down the science and kept running into dead ends where she couldn’t explain stuff. Anything she couldn’t explain, she said, “Well, that’s a conspiracy theory. The powers that be are hiding that data.””
    >> Ask a legitimate question of a legitimate source, and you may well get a better answer. For starters, anyone who claims a cure of anything, they are unlikely to be a legitimate source, so you’d be wasting your energy. Also – you only need to read the newspaper to know that, yes, Big Pharma and the FDA do indeed hide data, while people suffer and die as a result. That doesn’t mean that there is a cure for autism and mental illness – but to deny that billion dollar concerns obfuscate science is to deny reality.

    “1. How do you think chelation or detoxification works? What toxic thing is being removed and by what mechanism?”
    >> Chelation is one thing, and detoxification could be another (depending on what you or “they” mean.) But you could do an hour or so of research into DMSA, DMPS, or EDTA and get your answer. Chelation is basic biochemistry and works in humans, test tubes, soil.
    Unfortunately – and perhaps this is your point – the marketing of chelation and “detoxification” runs far ahead of the evidence. I believe readers of this blog will recognize this syndrome from their familiarity with SSRIs, benzodiazapense, anti-psychotics, and indeed the whole history of Big Pharma psych meds (at a minimum.)
    However, if you don’t believe there are any toxins in humans, then there is a whole field of literature that you may be unaware of. But, as a for instance, alpha-lipoic acid, n-acetyl cysteine, sulfurofanes, and other glutathione up-regulators all assist in glutathione reductase binding of xenobiotics which are then excreted primarily in stool (via bile.) Saunas and colonics are believed to have similar effects, and you can find the published data on this –what little there is on topics for which there is no billion dollar underwriter – with some digging.

    “2. How does the chelation or detoxification agent tell the difference between heavy metals like mercury or lead which are harmful are light metals like calcium and potassium and iron which are needed? How does it not strip those metals (which have the same electrical charge and are thus very similar chemically) all out of the body, too?”
    >> They don’t tell the difference, and they do chelate the good and the bad together, though the valence of the metal matters. Scientific practitioners supplement with minerals when they use chelation. However, chelation and detoxification for mental illness would be second or third tier treatments, in my opinion, compared to diet, supplements, and counseling / support.
    And – in my opinion – practitioners treating autism with natural medicine have an unfortunate tendency to be capitalizing on people’s desperation. While there are cases where diet and nutritional supplementation can help with function and behavior, there is little to no evidence that autism itself is reversible (though, like mental illness, it may often be misdiagnosed!)

    “3. Why do we say that emotional distress doesn’t have a chemical fix for pharma, but it’s OK to have a chemical fix for a naturopath? Like, why not look at life situations?”
    >> I’d be interested to know what you are referring to, but I can’t understand what you mean here.
    And – complicated topic – there are naturopaths and then there are naturopaths. I am a licensed naturopathic doctor (N.D.) who completed a 4 year medical program, passed rigorous medical board exams, and am licensed by the state of California to diagnose and treat disease. In my community, there are “naturopaths” with little to no formal training, but because of their money and political power, they were able to force the California legislature to let them practice and call themselves “naturopaths” when our law was passed. In popular perception, as your post demonstrates, the two camps are often lumped together. And, unfortunately, in my opinion, the profession and practice of natural medicine, whether it’s M.D.s, chiropractors, or N.D.s – much like conventional medicine and big pharma – proceed on the basis of insufficient evidence.

    “Now, I’m not denying that some people got sucked into the mental health system due to a vitamin deficit. But it’s a small percentage.”
    >> There is no data to support that “ small percentage.” In fact, no one actually knows, because it’s barely been studied, so this is speculation. A more likely speculation would be that “ a combination of psychosocial stressors, genetic susceptibility, improper diet and nutrition including food allergies and gluten intolerance, relative micronutrient deficiencies, use/abuse of recreational and pharmaceutical drugs, incorrect diagnosis, and brain-altering entertainment technologies account for the majority of mental illness”

    “Just start adding some protein and veggies to your meals and don’t get suckered into the megavitamin scams.”
    >> Good advice, though for people with actual mental illness, a little flip. Just adding protein and veggies won’t do much, and might be the wrong prescription. But if what you mean is “unbalanced blood sugar and undiagnosed reactive hypoglycemia account for an underappreciated but vast amount of mental-emotional morbidity”, I couldn’t agree with you more.

    “How to tell a scam: 1) they say the solution is simple or easy 2) eveyone gets the same solution 3) the solution is fast 4) the solution must be the correct brand name”
    >> I tell my patients “if it sounds too good to be true, it probably is.” This is a useful guide, but frequently wrong. For instance, your own (presumed) suggestion to balance blood sugar is simple, easy, and fast acting (a few days.) Furthermore, if you give me 100 people with anxiety, fatigue, depression, irritability, and I give them all a blood-sugar balancing diet, the response rate will be 25-33%. Another for instance: food allergy elimination. Give me those same 100 people, and I have them eliminate wheat and sugar from their diet, this simple, not necessarily easy one size fits all solution would have remarkably positive effects. The same would be true for adequate fish oil supplementation in bipolar people, though not so fast. Another example is magnesium supplementation in people who are deficient, something that is incredibly common (and nearly impossible to verify via labs.)
    In fact, I could easily design a one-size fits all diet and supplement and counseling program that wouldn’t be all that difficult, and I’d gladly put it up against a pharmaceutical approach (with a long term metric for the outcome, though some of the results of my approach would in fact be remarkably rapid.) Unfortunately, that just isn’t going to get funded.

  • Thank you for this post. As a licensed naturopathic doctor in the U.S. (California), I know how much good evidence there is for the approach you suggest – and, how much unsubstantiated fads carry the day with laypeople and the media, sadly and somewhat hopelessly confusing the issue, as Corinna’s reply above demonstrates. Unfortunately, you don’t have the time and space, and readers don’t have the time or bandwidth, to properly review the literature on this topic.
    I’d like to point out a couple of small – I’ll call them oversights – in your post. Keep up the good work!

    “One conclusion we could draw from this research is that if we would simply eat more raw foods”
    >> Raw foods are different from processed foods. Cooked kale is not raw, but it is certainly more nutrient dense than, say, raw celery or iceberg lettuce. Raw food is fad nowadays, with people making all kinds of outsized claims for it, compared to a “consensus” healthy diet.

    “perhaps more organically grown foods (to eliminate the exposure to herbicides and pesticides that can affect the nutrient status of the crop)”
    >>organic foods likely have greater mineral density due to agricultural practices that do not deplete topsoil. Magnesium supplementation has been suggested as a treatment for depression in multiple published papers (references upon request.)

    “increase our omega 3 intake by eating more fish”
    >>Mediterranean diet research shows that consumption of walnuts and flax also increase serum omega 3s, though probably not of docosohexanoic acid. Chia seeds likely have the same impact. And if you’re concerned about exposure to herbicides, pesticides, and heavy metals, the suggestion of eating more fish ought to conditional.

    “There was an excellent, high quality study in the UK published over 15 years ago showing that fresh vegetables and fruit have lower levels of nutrients than they did 50 years previously.”
    >>A likely pointer to top soil quality and depletion.

  • I am currently reading “Anatomy of an Epidemic” by Robert Whitaker, and I happen to be on the chapter on benzos. He makes two points: a) they started going out of fashion in the late 70s, when people began to realize how addictive and destructive they are and b) they haven’t ever really gone THAT far out of fashion. You’d think that the researcher whose book contributed the name of this blog/site/forum would be among the first to point out a collusion that favored SSRI and big pharma profits by shelving benzos. But he makes a very different point.

  • Hi Seth. My knowledge of this subject comes primarily from Irving Kirsch’s book “The Emperor’s New Drugs” which, as I’m sure you know, is an exhaustive analysis of SSRI’s FDA trials. Also, I’ve read the mainstream media articles on the topic in the Atlantic and NY Times. Kirsch doesn’t mention simultaneous administration of benzos. Do you have more exact references, or should I just do a search under the two (?) authors you mention?

    When I asked one MD psych about the “new truth” of SSRIs, she kind of shuffled and squirmed, then said “well, they’re still useful for anxiety, and all depressed people are anxious.”

    Daniel Heller N.D.