Ginkgo

Ginkgo is a slow growing deciduous tree that grows up to 125-foot-tall and can survive for up to 1000 years. Ginkgo is the oldest surviving tree on Earth as the species dates back to the Jurassic era some 200 million years ago. It has changed remarkably little morphologically since then. It also happens to be one of the best researched medicinal plants with several high-profile publications. A study published in JAMA in 1997 concluded that treatment with ginkgo leaf extract of patients with dementia was safe and capable of improving or stabilizing cognitive performance and social functioning. Another well-controlled study published in 2006 confirmed this result as gingko was found comparable to donepezil in clinical efficacy for dementia treatment. However, a later JAMA study released in 2008 demonstrated ginkgo does not act to prevent dementia occurring in the first place. Ginkgo has also been found effective in the treatment of anxiety, although it is better known as a circulatory stimulant and nootropic (cognitive enhancer). Ginkgo, like the widely used anti-depressant and nervine tonic St. John’s wort, is an example of a medicinal plant success story.

Lemon balm

Lemon balm is another medicinal plant with an ancient history of use by the Romans, ancient Greeks, and Arabs for its medicinal properties. The 11^th century Arab physician, Avicenna, wrote, ‘Balm causeth the mind and heart to become merry’. In the middle ages, Europeans used the herb to reduce anxiety and it also became known as something of a cure-all. It is unclear how well founded their belief in lemon balm was as in modern times it is mainly known as an anxiolytic (reduces anxiety), nootropic, anti-depressant, and carminative (reduces excess gas). Double-blind placebo-controlled human studies have shown positive results for lemon balm extracts in the improvement of mood, reduction of anxiety, and improvement of cognitive abilities. These preliminary human trials suggest much of its more recent traditional use is justified.

Rhodiola

Rhodiola rosea may have been used as long ago as the Vikings to reduce fatigue and enhance the capacity to work. In an old Icelandic text from 1783, it is described as a herb to enhance the intellect and restore weak nerves. For many centuries Rhodiola was used by folk herbalists in Russia and Scandinavia as a whole-body tonic. There is strong scientific support for the reduction of fatigue with positive results in three well-controlled clinical trials. There is an additional study that found an improvement in mood in the treatment of mild to moderate depression.

Rhodiola is viewed as an adaptogen by modern herbalists, having the dual properties of relaxing and stimulating the nervous system to some degree. Adaptogens can be further grouped depending on how stimulating they are, Rhodiola is more on the stimulating side so should be taken in the morning to avoid insomnia. Ashwagandha, as described in the previous article, is a more calming adaptogen with a greater capacity to support sleep.

Alexander Panossian, the world’s foremost scientific authority on adaptogens, has published a recent review in 2017 describing the mechanism by which adaptogens are thought to work. Our current understanding is they prime the stress response system, namely the sympatho-adrenal or hypothalamic-pituitary-adrenal axes of the endocrine system, in a gentle manner that prepares the body for future stressors or adapting to chronic ones (e.g., major depression). It is thought that the modulation of stress hormones like cortisol and heat shock proteins like HSP70 is central to this mechanism.

A final cautionary note is that adaptogens should not replace good sleep and lifestyle habits. Although they are very mild relative to illegal alternatives, using them inappropriately as stimulants to replace poor sleep habits, in a similar manner to coffee, can eventually lead to burnout. It will be interesting to see how many additional traditional medicinal properties of the adaptogens will be confirmed by modern medical science.

References

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471. ISBN: 1605298891

Darbinyan, V., et al. “Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression.” Nordic journal of psychiatry 61.5 (2007): 343-348. DOI:10.1055/s-2007-986750

Darbinyan, V., et al. “Rhodiola rosea in stress induced fatigue—a double-blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty.” Phytomedicine 7.5 (2000): 365-371. DOI:10.1016/s0944-7113(00)80055-0

Dastmalchi, Keyvan, et al. “Chemical composition and in vitro antioxidative activity of a lemon balm (Melissa officinalis L.) extract.” LWT-Food Science and Technology 41.3 (2008): 391-400. DOI:10.1016/j.lwt.2007.03.007

DeKosky, Steven T., et al. “Ginkgo biloba for prevention of dementia: a randomized controlled trial.” Jama 300.19 (2008): 2253-2262. DOI:10.1001/jama.2008.683

Kennedy, David O., et al. “Anxiolytic effects of a combination of Melissa ofcinalis and Valeriana ofcinalis during laboratory induced stress.” Phytotherapy research 20.2 (2006): 96-102. DOI:10.1002/ptr.1787

Kennedy, David O., Wendy Little, and Andrew B. Scholey. “Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm).” Psychosomatic medicine 66.4 (2004): 607-613. DOI:10.1097/01.psy.0000132877.72833.71

Kuhn, Merrily A., and David Winston. Herbal therapy and supplements: a scientific and traditional approach. Lippincott Williams & Wilkins, 2000. ISBN:9781582554624

Le Bars, Pierre L., et al. “A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia.” Jama 278.16 (1997): 1327-1332. DOI:10.1001/jama.1997.03550160047037

Mazza M., et al. “Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer’s dementia in a randomized placebo?controlled double?blind study.” European Journal of Neurology 13.9 (2006): 981-985. DOI:10.1111/j.1468-1331.2006.01409.x

Panossian, A., G. Wikman, and J. Sarris. “Rosenroot (Rhodiola rosea): traditional use, chemical composition, pharmacology and clinical efficacy.” Phytomedicine 17.7 (2010): 481-493. DOI:10.1016/j.phymed.2010.02.002

Panossian, Alexander. “Understanding adaptogenic activity: specificity of the pharmacological action of adaptogens and other phytochemicals.” Annals of the New York Academy of Sciences (2017). DOI:10.1111/nyas.13399

Shevtsov, V. A., et al. “A randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work.” Phytomedicine 10.2 (2003): 95-105. DOI:10.1078/094471103321659780

Spasov, A. A., et al. “A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen.” Phytomedicine 7.2 (2000): 85-89. DOI:10.1016/s0944-7113(00)80078-1

Woelk, H., et al. “Ginkgo biloba special extract EGb 761 in generalized anxiety disorder and adjustment disorder with anxious mood: A randomized, double-blind, placebo-controlled trial.” Journal of psychiatric research 41.6 (2007): 472-480. DOI:10.1016/j.jpsychires.2006.05.004

Image via kerdkanno/Pixabay.

The reason for my head-scratching is that many of Dr. Chris’s diagnostic tests and therapies involve no technology at all, and are brain-dead simple. The bench scientist and geek in me (sensory physiology/chrono-neurobiology) instinctively rebels against a no-tech approach to anything, let alone medicine.

In an age of biotech marvels such as MRI, gene therapies, and targeted immunotherapies, my inner scientist is certain that no-tech approaches can’t be nearly as effective as modern medical science.

But the maddening fact is, my wife’s techniques do often work—so well in fact—that the bulk of her patients come to her because visits to other doctors who employ the latest drugs, tests, and procedures have failed to yield lasting results.

A cornerstone of Dr. Chris’s approach is a belief that patients’ bodies know more about what is ailing them and how to achieve lasting cures than do the patients’ conscious minds. So although she will start by asking questions of a patient’s mind, such as “What is going on in your life?” she quickly transitions to a dialogue with a patient’s body.

What’s the difference between talking to the mind and talking to the body?

Simple.

When she addresses a patient’s mind, Dr. Chris simply asks the patient a question, but when she addresses the patient’s body she will first coach the patient to “become” the body part that is suffering, such the lower back, then to respond in the first person as the lower back.

I once witnessed (with the patient’s permission) a dialogue between Dr. Chris and an ailing back that went like this:

Dr. Chris: Welcome to my office, Back, tell me how you feel.

Back: I am stiff all the time, with shooting pains. After the drive home from work, I get horrible spasms.

Dr. Chris. Thank you, Back. Do your spasms usually come after sitting for a long time?

Back: Yes!! I hate, hate, hate sitting.

Dr. Chris: Is there anything else you hate?

Back: I can’t stand my owner’s mother. When we go over for dinner she picks at him endlessly and I get really tense and tight. I want to stay away from that woman!!! I never want to see her again!!

Dr. Chris: Ok, now that I know what you hate, what do you like?

Back: Swimming! I love it when my owner does laps in the pool. I get warm and loose.

After observing such sessions and having been Dr. Chris’s patient myself (for stomach troubles), I have been shocked by how much patient’s bodies “know” what their minds don’t know, and how quickly a dialogue with the body can relieve symptoms.

For example, the patient in the Back-to-Dr.Chris dialogue professed ignorance about what was triggering his back spasms, only to immediately pinpoint specific triggers for his pain (such as sitting and a nagging mother) when he was queried as his back.

And that same patient, who walked into the office with a lower back so stiff that he couldn’t bend at the waist, loosened up almost immediately after the Back-to-Dr.Chris dialogue, as if venting of the true source of back pain (sitting too long and being with his mother too long) in and of itself was therapeutic.

Once I overcame my skepticism that such simple, direct techniques could actually work a lot of the time (although not always), I started asking myself:

How can neuroscience explain the success of Dr. Chris’s brand of mind-body medicine?

I confess that I didn’t have a good answer until recently when I stumbled upon two unrelated sets of research findings more or less at the same time.

The first body of research described implicit memory. It turns out that we are constantly learning things and storing them away in our unconscious without any conscious awareness that we are learning, or indeed, any overt knowledge of what we have learned.

Ken Paller and Joel Voss of Northwestern University, for example, have shown that unconscious learning occurs when test subjects passively observed kaleidoscope images while paying attention to something else. Moreover, those same subjects were able to make correct “intuitive” guesses based upon what they have learned, without having any conscious awareness that they had learned anything in the first place.

This finding, along with a host of similar results from other labs, implies that much of what we ascribe to gut feelings, hunches, or intuition are actually products of unconscious or implicit learning from past experiences. For example, Dr. Chris’s patient with lower back pain probably learned unconsciously that his back tightened up every time he went over to his mother’s house for dinner.

The second body of research that offered clues to the success of Dr. Chris’s methods, concerned the storage of long-term memories in the sensory cortex. These studies suggest that sensory experiences leave lasting memory traces in the very parts of the cerebral cortex that initially activate when the experiences originally occurred.

Putting the implicit learning and sensory memory research together (admittedly something of an intuitive leap) one could conclude that unconscious memories relating to sensations in a particular body part, might be stored in the region of the sensory cortex that activates when that body part experiences sensations.

Below is a brain map that shows the how areas of the body stimulate different areas of somatosensory cerebral cortex responsible that are responsible for processing touch, vibration, pain, and other sensations from different body parts. The somatosensory cortex occupies a gyrus (i.e., ridge) of the brain just behind the central sulcus (i.e, central fold/groove) called the post-central gyrus. Referring to this map, unconscious sensory memories from the back region (as designated by the blue arrow in the diagram below) would be stored near the top of the post-central gyrus, next to the hemispheric fissure that divides the left and right half of the brain.

So, what might be happening when Dr. Chris addresses a patient’s back (vs. the patient themselves) is that she is focusing the patient’s attention on somatosensory memories and associations stored in a particular region of the cerebral cortex and that the local activation in the somatosensory cortex occurs that when she does this helps release memories stored in the “back cortex” that would otherwise have remained unconscious.

True, I have no experimental data (such as fMRI brain scans showing somatosensory activation during Dr. Chris’s dialogues) to support this theory, so for the moment, it remains just a theory.

But at least the scientist in me is less baffled knowing that a plausible explanation for Dr. Chris’s successes in mind-body medicine is out there.

Based on lots of implicit learning accumulated watching Dr. Chris work, my gut intuition is that neuroscience has as much to learn from the success of her methods as she does from neuroscience.

Learn more about Dr. Chris’s methods and my neuro-scientific explanations of them in The listening cure: healing secrets of an unconventional doctor

References

Gandhi, S. (2001). Memory retrieval: Reactivating sensory cortex. Current Biology, 11(1), R32-R34. doi:10.1016/s0960-9822(00)00040-3

Gilbert, C. (2017). Listening Cure : Healing Secrets of an Unconventional Doctor. SelectBooks, Incorporated. ISBN:1590794370

Hasan, M., Hernández-González, S., Dogbevia, G., Treviño, M., Bertocchi, I., Gruart, A., & Delgado-García, J. (2013). Role of motor cortex NMDA receptors in learning-dependent synaptic plasticity of behaving mice. Nature Communications, 4. doi:10.1038/ncomms3258

Voss, J., & Paller, K. (2009). An electrophysiological signature of unconscious recognition memory. Nature Neuroscience, 12(3), 349-355. doi:10.1038/nn.2260

Image via Activedia/Pixabay.

What happens to your body when you ingest marijuana? THC (tetrahydrocannabinol) is the most active ingredient in marijuana. When you smoke this herb, it travels to your lungs before entering your bloodstream. Once in your blood, it travels to your brain and other organs (i.e., heart, tissues, etc.). FYI: Drinking or eating marijuana can delay the effects of THC. But, once it bonds with your brain’s neural receptors you become “high.”

THC can also affect the sections of your brain that control memory, thinking, concentration and focus, and coordination. When this occurs, it can trigger unpleasant side effects like distorted thinking, delayed learning, lethargy, increased appetite, low inhibitions, hallucinations, distorted perception, clumsiness, and memory loss. These side effects are normally temporary; however, they can still lead to dangerous consequences, especially if you drive while under the influence.

Is marijuana legal in the U.S.? Yes and no. The state legalization process (for medical marijuana) first began during the seventies. But, unfortunately, even though the process started 40-plus years ago, there has been very little progress on this front, in many states. Why not? Because each state is tasked with developing and enforcing its own laws, rules, and regulations.

Ironically, marijuana possession (in small amounts) has been legalized in other parts of the world (i.e., Czech Republic, Canada, and Israel), yet only 29 states (Oregon, Montana,  Alaska, Ohio, New Mexico, Arkansas, California, Illinois, New York, Colorado, Delaware, Washington, DC, Connecticut, Florida, Hawaii, Illinois, Maryland, Michigan, Vermont, Minnesota, Nevada, New Hampshire, New Jersey, Arizona, Maine, North Dakota, Pennsylvania, Massachusetts, Rhode Island, Washington, and West Virginia) have moved to decriminalize the herb for medicinal purposes.

It is important to point out that medical marijuana has not been thoroughly tested due to government regulations and production limitations. However, research suggests that it may ease nausea and vomiting during chemo treatments, alleviate chronic pain, boost appetite in those with HIV/AIDS, and relieve muscle spasms. In November 2016, Nevada, Massachusetts, California, and Maine also passed measures to legalize recreational marijuana.

Common Sexual Dysfunctions and the Effects of Marijuana

What are sexual dysfunctions? Sexual dysfunctions, also known as erectile dysfunction (ED), sexual disorders, premature ejaculation (PE), sexual malfunctions, and sexual arousal disorders, are issues that can occur during any stage of the sexual response cycle (i.e., anticipation, plateau, orgasm, and decline). This issue can prevent couples from experiencing sexual fulfillment during sexual intercourse.

What are the different types of sexual dysfunctions? They usually involve four categories: (1) desire disorders (a lack of sexual desire or a loss of interest in sex); (2) arousal disorders (an inability to become or stay aroused during sex or sexual activities; (3) orgasm disorders (unable to climax (orgasm) or a delay in climaxing); and (4) pain disorders (pain that occurs during sexual intercourse).

Should I use marijuana for my issue? Regarding marijuana and sexual dysfunction, THC can negatively affect penile function, possibly leading to premature ejaculation. How? Well, there are receptors in a man’s penile tissue that when confronted with THC, increases the risk of erection and orgasm issues. Why does this happen? Marijuana boosts dopamine levels in the body. Dopamine regulates moods and emotions. If you get accustomed to really high levels of dopamine, you may subsequently find that your natural level of this hormone may not be high enough to sexually stimulate you, thus, making it harder for you to maintain an erection.

Is it Even Safe?

Is it safe to use pot for sexual dysfunctions? Unfortunately, the answer is complicated. Study results have been both inadequate and variable. For instance, a recent La Trobe University study interviewed over 8000 Australian men and women, between 16–64 years old, to determine how marijuana usage could affect sexual function. Researchers focused on condom use, sexual partners, sexual dysfunctions, and sexual-transmitted diseases (STDs).

Results indicated that men, who use marijuana daily, are four times more likely to have orgasm problems and three times more likely to experience premature ejaculation, than men who do not use it or don’t use it regularly. In addition, researchers also found that daily male marijuana users are at-risk for delayed orgasms. So, why do men use it if it has serious side effects? Well, the researchers of the La Trobe University study believe that some men with premature ejaculation use marijuana because they believe that the herb will help them “last longer” – the reality is, however, that for many men, it actually worsens their conditions, causing them to ejaculate even faster. The common practice methods used to fix premature ejaculation don’t involve the use of marijuana.

Similarly, another study on sexual dysfunctions and marijuana found that marijuana usage is linked to lower testosterone levels, which is a contributor to erectile dysfunction. Like the previous study, the results also suggested that cannabis (marijuana) is associated with orgasm problems like premature ejaculation and an inability to achieve orgasm. Likewise, a 2010 study found that marijuana can affect sexual functions by disrupting the part of the nervous system that regulates erections, thereby, possibly leading to sexual dysfunctions like erectile dysfunction and premature ejaculation.

What are the Signs of Overuse?

To better understand the possible signs of overusing marijuana, it is important to answer the following questions. Have you gained or lost any weight, since using marijuana for sexual dysfunction? Do you need a higher amount of pot to get the same results, i.e., “last longer?” Are you spending exorbitant amounts of money on this herb hoping it will improve your sexual performance? Do you suffer from terrible withdrawal symptoms (i.e., cravings, insomnia, increased hunger, mood swings, irritability, depression, and/or anxiety) when you ease up on it or quit taking it all together? And lastly, is it creating a disturbance at work and/or issues in your relationship?

The truth is, most people believe that marijuana, in general, is harmless, but this is certainly not the case when it is being overused for sexual dysfunctions. Dr. Juan Paredes, a South Beach Clinic board-certified psychiatrist, specializing in male sexual dysfunctions, asserted that one of the major consequences of marijuana overuse, when treating sexual dysfunctions, is that it can lead to extremely weak orgasms, premature orgasms, or no orgasms at all.

In summary, marijuana usage and allowances have started to relax in some states and countries. And, legal restrictions and people’s perceptions of the herb have also eased over the last ten years. Because there is an increased acceptance of marijuana usage for a variety of reasons (i.e., from recreational to medicinal), it is important to learn the possible consequences of regularly ingesting it. Why? Well, because more and more studies are finding that there is a relationship between marijuana and male sexual dysfunctions. And, although smoking, eating, or even drinking marijuana may relieve some symptoms for some men, for others, it could end up being a disaster waiting to happen—in the bedroom.

References

Pro Con. (2017). 29 Legal medical marijuana states and DC. Retrieved from here.

Wu, B. (2017). Marijuana and erectile dysfunction: What is the connection? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/317104.php

Harclerode J. (1984). Endocrine effects of marijuana in the male: preclinical studies. National Institute on Drug Abuse Research Monograph Series, 44, 46-65. Access here.

Smith, A. M.A., Ferris, J. A., Simpson, J. M., Shelley, J., Pitts, M. K. and Richters, J. (2010). Cannabis use and sexual health. The Journal of Sexual Medicine, 7, 787–793. DOI: 10.1111/j.1743-6109.2009.01453.x

Localization and Function of Cannabinoid Receptors in the Corpus Cavernosum: Basis for Modulation of Nitric Oxide Synthase Nerve Activity

Image via GDJ/Pixabay.

St. John’s wort is a commonly known plant that is native to Europe and yields bright yellow flowers. Its name comes from flowering around St. John’s day on the 24th June. St. John’s wort has been used as long ago as the ancient Greeks, and the physician Dioscorides (40–90AD) used it in the treatment of sciatica. However, St. John’s wort has become known as less of a treatment for nerve pain and more so for depression, with multiple double-blind, placebo-controlled trials confirming its antidepressant properties. Authors typically compare St. John’s wort with mainstream anti-depressant drugs and find it has a preferable side effects profile. It is not without its downsides however, as excessive use has been linked to serotonin syndrome, sun sensitivity, and easy skin burning, and more generally with increased pharmaceutical drug metabolism by the liver. This means St. John’s wort may not be suitable for applications alongside other pharmaceutical drugs, and it is contraindicated with serotonin reuptake inhibitors.

American skullcap is a member of the mint family that is native to North America and grows wild in meadows and swamps. It was used by the Native Americans as a sedative and America’s 19^th century physicians, the Eclectics, widely used the herb for complaints involving an overactive nervous system such as insomnia, anxiety, and epilepsy. A human double-blind, placebo-controlled study supports skullcap’s application against anxiety, and a mood elevating effect has also been noted. Herbalist’s view both St. John’s wort and American skullcap as ‘nervine tonics’, meaning that they act upon the nervous system medicinally and are also considered to have a long-term renewing effect. While, this claim is yet to be verified by scientific studies, it certainly warrants further investigation.

Ashwagandha, the root of which is a popular home remedy in India, is a plant native to India that is mentioned in the traditional Ayurvedic medical text, the Charaka Samhita, approximately 2000 years ago. Here it is recommended as a tonic for emancipation, reproductive ability, and longevity. In Ayurveda, it is classified as a ‘rasayana herb’, a class of plant that are considered to restore and support long-term health and that overlaps to some degree with the Western definition of a ‘tonic herb’. Two double-blind, placebo-controlled human studies support ashwagandha’s role in the reduction of anxiety. It’s wide-ranging medicinal properties are supported by two additional well-controlled, human clinical studies on osteoarthritis and subclinical hypothyroidism. The emerging picture is that ashwagandha possesses a wide range of medicinal properties that will likely be better understood in the future. Ashwagandha has been well-tolerated across clinical trials, with a side effect profile similar to placebo.

References

Auddy B, Hazra J, Mitra A, Abedon B, and Ghosal S. A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: A double-blind, randomized, placebo-controlled study. J Am Nutraceutical Assoc. 2008;11:50–6. Access here.

Brock C, Whitehouse J, Tewfik I, and Towell T. (2014). American Skullcap (Scutellaria lateriflora): A Randomised, Double-Blind Placebo-Controlled Crossover Study of its Effects on Mood in Healthy Volunteers. Phytotherapy Research, 28(5), 692-698. DOI: 10.1002/ptr.5044

Castleman, Michael. “The new healing herbs.” Bantam Book, New York (2001): 465-471. ISBN: 1605298891

Chandrasekhar K, Kapoor J, and Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine 34.3 (2012): 255. DOI: 10.4103/0253-7176.106022

Dannawi M. Possible serotonin syndrome after combination of buspirone and St John’s Wort. Journal of Psychopharmacology 16.4 (2002): 401-401. DOI: 10.1177/026988110201600420

Hoffman, David. Holistic herbal. Element Books, 1988. ISBN: 1852300248

Laakmann G, Schüle C, Baghai T, and Kieser M. St. John’s wort in mild to moderate depression: the relevance of hyperforin for the clinical efficacy. Pharmacopsychiatry 31.S 1 (1998): 54-59. DOI: 10.1055/s-2007-979346

Markowitz JS, Donovan JL, DeVane CL, Taylor RM, Ruan Y, Wang JS, and Chavin KD. Effect of St John’s wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. Jama 290.11 (2003): 1500-1504. DOI: 10.1001/jama.290.11.1500

Ramakanth GS, Uday Kumar C, Kishan PV, and Usharani P. A randomized, double blind placebo controlled study of efficacy and tolerability of Withaina somnifera extracts in knee joint pain. Journal of Ayurveda and integrative medicine 7.3 (2016): 151-157. DOI: 10.1016/j.jaim.2016.05.003

Scudder, John. Specific Medication and Specific Medicines, 1870. ISBN:

Sharma AK, Basu I, and Singh S1. Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. The Journal of Alternative and Complementary Medicine (2017). DOI: 10.1089/acm.2017.0183

Szegedi A, Kohnen R, Dienel A, and Kieser M. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine. Bmj 330.7490 (2005): 503. DOI: 10.1136/bmj.38356.655266.82

Woelk, Helmut. Comparison of St John’s wort and imipramine for treating depression: randomised controlled trial. Bmj 321.7260 (2000): 536-539. PMCID: PMC27467

Wolfson P and Hoffmann DL. An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers. Alternative therapies in health and medicine 9.2 (2003): 74. PMID: 12652886

Image via kerdkanno/Pixabay.

Incidentally, the therapeutic value of marijuana stems from its ability to induce deep sleep, but only during the initial period of usage. This makes it the right time to find out how exactly marijuana affects sleep, and why some scientists and physicians are worried about the potentially harmful effects of marijuana over-use that these legalization moves might result in.

Marijuana and Sleep

Several research studies have unearthed the positive association between sleep and marijuana use. It is believed that marijuana usage in limited amounts can improve the quality of sleep.

There are five stages of sleep: four NREM (non-rapid eye movement) stages marked from 1 to 4 and a fifth stage called REM (rapid eye movement) sleep that is associated with dreaming. Stages 3 and 4 represent deep, slow-wave states of sleep, where the brain switches off almost completely and the heart rate and breathing decrease considerably. These states are restorative and refreshing. The four NREM and the REM stages occur in cycles throughout the period of sleep.

According to several studies, marijuana has been found to both induce sleep and increase the duration of Stage 4 sleep. These effects improve the overall quality of sleep in an individual.

Marijuana, Sleep, and Pain Management

Marijuana has long been used for therapeutic purposes. The sleep-inducing effect of marijuana is believed to not only help individuals suffering from sleeping disorders but also provide relief to patients affected by painful medical conditions. People suffering from multiple sclerosis, many forms of cancer, and rheumatoid arthritis experience excruciating bodily pain that not only affects their living standards but also the quality of their sleep. They have trouble falling asleep and also do not enjoy adequate hours of the deep sleep that facilitate the healing process.

According to one study, drugs containing cannabis (the plant from which marijuana is extracted) improved the quality of sleep in 40-50 percent of the subjects affected with one of the above-mentioned conditions. Additionally, this study noted that there was no decrease in the effect of the cannabis-containing drug even after four years of starting the therapy. There was also no need to increase the dosage of the drug. These findings come as a ray of hope to countless people who can now dream of enhancing the quality of their lives despite their medical conditions.

Marijuana and Dreams

Marijuana has been found to decrease the length of the REM cycle of sleep by increasing the duration of the slow-wave stages of sleep. The brain is active during the REM cycle, so a person dreams. On the other hand, the slow-wave stages are dreamless states. So when a person sleeps deeply, he dreams less.

Marijuana withdrawal has been associated with troubled sleep patterns and the occurrence of vivid dreams.

Marijuana, Sleep, and PTSD

The beneficial sleep-inducing effect of marijuana has not only interested scientists and physicians but also the common man. A recent study demonstrated an increase in the use of marijuana amongst people affected by post-traumatic stress disorder (PTSD). These people use marijuana as a means of coping with their psychological symptoms.

The classic symptoms of PTSD include frequent panic attacks in response to triggers that keep a person always on the edge and physically and mentally stressed out, disturbed sleep, and recurring nightmares. So it is not difficult to understand why PTSD sufferers would cling to marijuana, so they can sleep better and be spared the nightmares.

Marijuana Addiction: A Coping Behavior That is Hard to Shrug Off

The effects of marijuana on sleep and its therapeutic use to manage chronic pain and PTSD are some reasons that also lead to its abuse. Marijuana addiction is on the rise simply because it is a coping mechanism for many people. It is not just a substance that induces sleep; it is a drug that has given many people the chance to live a relatively pain-free life despite their medical conditions. Marijuana has also improved the quality of life of many people by helping them sleep better and be more productive and alert the next day.

So the politicians have a valid point when they pass legislation that legalize the use of marijuana for medicinal purposes. However, researchers sound a note of warning. Easy availability of marijuana would trigger an increase in the number of marijuana addiction cases.

Some other studies have found that heavy use of marijuana has been associated with disturbed sleep. Heavy users of marijuana often complain of lower quality of sleep, characterized by lesser time spent sleeping and lesser duration of deep sleep both when they are using the substance and when they abstain from the drug. They report struggling to fall asleep when they are not on marijuana. In fact, this is the reason why most recovering heavy marijuana addicts exhibit the most intense withdrawal symptoms and eventually relapse.

But there is good news – most of these troubling withdrawal symptoms eventually disappear after a person has been off marijuana for several weeks. This should encourage all those who are keen to break their marijuana addiction. Meanwhile, therapists and counselors should take note; the onus is on them to encourage their patients to keep going even when the withdrawal symptoms seem unbearable.

That marijuana has some medicinal benefits is no longer a moot point. What the stakeholders need to now mull over is how to control marijuana usage. Obviously, the more is not merrier here!

References

Bolla KI, Lesage SR, Gamaldo CE, Neubauer DN, Funderburk FR, Cadet JL, David PM, Verdejo-Garcia A, & Benbrook AR (2008). Sleep disturbance in heavy marijuana users. Sleep, 31 (6), 901-8 PMID: 18548836

Bonn-Miller MO, Babson KA, & Vandrey R (2014). Using cannabis to help you sleep: heightened frequency of medical cannabis use among those with PTSD. Drug and alcohol dependence, 136, 162-5 PMID: 24412475

Bonn-Miller, M., & Moos, R. (2009). Marijuana discontinuation, anxiety symptoms, and relapse to marijuana Addictive Behaviors, 34 (9), 782-785 DOI: 10.1016/j.addbeh.2009.04.009

Cohen-Zion, M., Drummond, S., Padula, C., Winward, J., Kanady, J., Medina, K., & Tapert, S. (2009). Sleep architecture in adolescent marijuana and alcohol users during acute and extended abstinence Addictive Behaviors, 34 (11), 976-979 DOI: 10.1016/j.addbeh.2009.05.011

Russo, E., Guy, G., & Robson, P. (2007). Cannabis, Pain, and Sleep: Lessons from Therapeutic Clinical Trials ofSativex®, a Cannabis-Based Medicine Chemistry & Biodiversity, 4 (8), 1729-1743 DOI: 10.1002/cbdv.200790150

Schierenbeck, T., Riemann, D., Berger, M., & Hornyak, M. (2008). Effect of illicit recreational drugs upon sleep: Cocaine, ecstasy and marijuana Sleep Medicine Reviews, 12 (5), 381-389 DOI: 10.1016/j.smrv.2007.12.004

Image via William Casey / Shutterstock.

In 1997, the National Institutes of Health (NIH) Consensus Development Program recognized acupuncture as a therapeutic intervention of complementary medicine. The World Health Organization (WHO) now recommends the use of acupuncture for treatment of numerous diseases and symptoms associated with cardiovascular, neurological, musculoskeletal, respiratory, gastrointestinal, gynecological and psychological disorders.

It is estimated that 3 million adults in the USA receive acupuncture treatments each year, with chronic pain being the most common reason for seeking this therapy. In fact, the efficacy of acupuncture in diverse painful conditions is now widely recognized, having earned the denomination “acupuncture analgesia”. An estimate of 50% to 85% of chronic pain patients seem to benefit from acupuncture.

Although acupuncture analgesia may have an important psychological component, increasing evidence has been demonstrating that the analgesic effect of acupuncture may indeed be due to a physiological action. The increasingly generalized use of acupuncture has stimulated research on the physiological and biochemical mechanisms underlying acupuncture analgesia. In the last decades, there has been a rapid development of our knowledge of the neurological processes induced by acupuncture. Although a consensual theory is still lacking, many hypotheses have been proposed for the mechanisms of acupuncture analgesia.

Acupuncture points seem to be special sites with denser sensory innervation and connective tissue, and a richer content of TRPV1 receptors, which are important players in pain mechanisms. The insertion of a needle into these points acts as a mechanical stimulus that activates the mechanoreceptors and sends afferent signals to the central nervous system, to areas involved in pain processing. Neurochemical processes of pain modulation are consequently activated, inducing acupuncture analgesia.

Both clinical and laboratory data indicate that the endogenous opioid system participates in acupuncture analgesia. In fact, a reduced need for opioid-like-medication in patients with chronic pain after acupuncture treatment has been reported. The noradrenergic system has also been associated with acupuncture analgesia in experimental studies, where a decreased level of noradrenaline in the brain was observed after acupuncture-induced analgesia. Studies in animal models of inflammatory and neuropathic pain have also found evidence for a role of serotonin and glutamate in acupuncture analgesia. Other pain mediators that have been suggested to be modulated by acupuncture include somatostatin, cannabinoids, and neurotrophic factors. However, clinical studies supporting these theories are still lacking.

Experimental models of pain have also indicated that acupuncture may have an anti-inflammatory action by having a modulatory effect on the release of pro-inflammatory mediators. These results have been supported by clinical findings showing a reduction in the production of pro-inflammatory molecules after acupuncture in patients with osteoarthritic pain and chronic pelvic pain syndrome.

Despite these recent advances in the understanding of the mechanisms of acupuncture analgesia, there is still a lot of ground to break. What seems to be clear is that, regardless of how that happens, acupuncture works. And there’s no harm in trying it.

References

Leung L (2012). Neurophysiological basis of acupuncture-induced analgesia–an updated review. Journal of acupuncture and meridian studies, 5 (6), 261-70 PMID: 23265077

Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K, & Acupuncture Trialists’ Collaboration (2012). Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine, 172 (19), 1444-53 PMID: 22965186

Vickers AJ, & Linde K (2014). Acupuncture for chronic pain. JAMA : the journal of the American Medical Association, 311 (9), 955-6 PMID: 24595780

Zhang R, Lao L, Ren K, & Berman BM (2014). Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 120 (2), 482-503 PMID: 24322588

Zhao ZQ (2008). Neural mechanism underlying acupuncture analgesia. Progress in neurobiology, 85 (4), 355-75 PMID: 18582529

Image via Andrey Popov / Shutterstock.

In general, complementary medicine refers to the use of unconventional medical therapies in conjunction with conventional medical treatment, while alternative medicine implies substitution for conventional medical therapies. More often, CAM is used in addition to conventional Western medicine.

While definitions of CAM vary, they frequently include, but are not limited to, massage, acupuncture, deep breathing, chiropractic adjustment, meditation, yoga, qi gong, vitamins and supplements, and guided imagery. In the Journal of Clinical Psychology, Crystal Park points out that “demographics associated with CAM use are fairly well established, but less is known about their psychological characteristics.” Other studies suggest that CAM use is associated with positive health behaviors and behavioral change. Consequently, the psychology of CAM users has implications as healthcare reform and other industry shifts move conventional providers towards integrated, outcome-focused care where they are expected to exert greater influence on patient behavior.

Increasing use of CAM in the United States

Out of pocket expenditures on CAM for the preceding 12 months, based on the CDC’s 2007 National Health Interview Survey, were almost $34 billion. Park reports that: “In the United States in 2007, the most commonly used CAM modalities were nonvitamin, nonmineral, natural products (17.7%), deep breathing exercises (12.7%), meditation (9.4%), chiropractic and osteopathic manipulation (8.6%), massage (8.3%), and yoga (6.1%).”

There was a precipitous drop in the government’s report of CAM use by Americans between 2002 and 2010. The 2002 National Health Interview Survey reported that 62 percent of Americans used CAM in the past 12 months. Due to the subsequent decision to reclassify prayer, which was previously included as a CAM modality and is no longer included in the definition, the number declined to 38.3 percent, still a substantial portion of the population. Prayer remains on the survey, but is no longer part of the CAM definition.

Contemporary research has attempted to quantify CAM use by the population, identify demographic predictors of use, and assess perceived CAM effectiveness related to specific conditions. The National Health Interview Survey collects substantial information on CAM use, perceived efficacy, as well as a multitude of conditions for which CAM is used. Other data sources specific to certain conditions, such as arthritis, have been used to examine both the efficacy of treatments and demographic characteristics of patients. Park suggests that increasing interest in CAM in the U.S. may be due to “greater awareness of the critical role that psychological distress plays in many medical conditions and health outcomes along with increased acceptance of the biopsychosocial model.”

Several studies suggest that women and middle-aged people are more inclined to use CAM. While women in general tend to seek healthcare more often than men, Park cites studies which find an “amplified” tendency for CAM use among women relative to overall use of health services.

While much research has focused on minorities and CAM use, the findings have been mixed. CAM use has been shown to increase with education and income, with more consistent results supporting the association with increased education. Explanations offered have included the idea that more educated patients are more capable of identifying and researching possible alternative treatments.

Studies have found an inverse relationship between health status and CAM use, which is consistent with other studies finding that increases in CAM use accompany multiple chronic conditions. Willison et al. found that chronically ill people use CAM two to five times as much as those who are not chronically ill. Interestingly, in the NHIS, only 30 percent of users of mind-body types of CAM used it for a specific condition; general wellness is a frequent aim of patients utilizing CAM.

Psychological traits of users

Parks reports that “psychological characteristics associated with higher mind-body CAM use include higher levels of openness, extraversion, social support, and goal persistence,” and that “considering one’s illness as having more severe consequences and beliefs that one has control over one’s health are related to greater use of mind-body CAM. Study participants who have used CAM have voiced motivations including wanting greater control over one’s health and dissatisfaction with conventional medicine. Greater awareness and practice of healthy behaviors has been associated with CAM use.

In a study of 243 British adults, Furnham sought to determine whether certain “big 5” personality traits, “modern health worries”, and attitudes towards science predicted attitudes and beliefs about CAM, wondering whether CAM was associated with neuroticism, skepticism towards science, or high levels of modern health worries. Furnham found that regular and occasional CAM users have higher modern health worries relative to non-users. Young males with a positive attitude toward science were the least likely to turn to CAM, and positive attitudes towards science were associated with skepticism towards CAM. The personality traits measured in the study were not predictive of CAM use.

Another aspect of the behavior of CAM users which has been the subject of research is whether or not they tell their conventional medical providers that they are using complementary or alternative therapies.

One study looked at potential adverse reactions between commonly used conventional treatments and CAM treatments. A study of urban, under-served minority patients with rheumatoid arthritis determined that 71.6 percent of research participants were using CAM, and that 59 percent shared this information with their provider. This same study found that women were more likely to disclose their use of CAM to their providers, while Hispanics were less likely to mention their CAM use.

Other research has found that many patients do not discuss their CAM treatments with their doctors. The National Center on Complementary and Alternative Medicine (NCCAM) and AARP identified common reasons that patients withhold this information: 42 percent said their provider never asks, and 30 percent said they didn’t know if they should raise the issue. As a result, the NCCAM started an educational campaign to promote discussions between providers and patients about CAM use: “Considering this and other campaigns addressing patient-provider relations it is of interest that an individual’s self-efficacy and their level of participation in health decision making are both potent.”

CAM use in other parts of the world

CAM is popular throughout the world. A study of South Koreans found that nearly 75 percent of those surveyed had used CAM in the last 12 months. A large Australian study found that 52 percent were current CAM patients and that 85 percent had used CAM treatments in their lifetime. The lifetime CAM use estimate from one UK survey was nearly half of those surveyed.

However, motivations differ among cultures. For instance, Koreans indicated that disease prevention and health promotion were the principal motive for CAM, with 45.8 percent seeking increased energy, 9.1% hoping to prevent disease, and 12.7 percent seeking anti-aging effects or beauty. Treatment of medical problems was the reported as the motive for only 20.3 percent of Korean survey participants, whereas in America people suffering from chronic conditions, particularly musculoskeletal problems, most often seek CAM.

Research gaps

Despite the quantity of research on the subject, there are relatively few definitive findings. This is due to the high degree of variability in CAM definitions, as well as variability in application. Park notes that “the specific definition of CAM used in any particular study strongly shapes the results of its prevalence statistics,” citing the earlier example of prayer. CAM treatments are also characterized by a great degree of heterogeneity. Many are self-administered, while others involve various practitioners.

Yoga and meditation methods vary considerably, for example. With so many CAM users using it for overall health rather than specific conditions, it is difficult to draw conclusions from the NHIS and other surveys. Efficacy measures often rely on subjective scales and self-reporting. Further convoluting the matter is the fact that so many CAM users have multiple, coinciding conditions for which they may be using CAM. Park also notes that CAM modalities “differ in historical precedent, cultural acceptability, cost, safety, extent to which they are systematic and rooted in traditional or new age approaches and purported mechanism of effect and the plausibility of that mechanism.”

Implications for health professions

CAM use has significant implications for various healthcare stakeholders. Since most CAM expenditures represent out of pocket costs to patients, insurers stand to gain where patients opt for non-covered services they deem more effective that prescriptions or conventional treatments which tend to be covered. Many conventional providers, such as primary care physicians, have integrated certain types of CAM into their business models, as a source of cash business and in response to patient demand.

As CAM gains traction as a socially acceptable means of treating chronic conditions, research efforts will continue to expand. Crystal Park duly noted that: “Knowledge about CAM modalities and their integration into clinical health psychology can be useful for researchers interested in taking a broader perspective on stress and coping processes, health maintenance and illness behaviors, and culture, and for practitioners seeking to incorporate CAM perspectives and techniques into their work. The increasingly expanding and officially recognized use of CAM warrants greater attention by conventional health care practitioners, decision makers, and researchers.”

References

National Health Interview Survey (2010). National Center for Health Statistics, Centers for Disease Control and Prevention.

Furnham A (2007). Are modern health worries, personality and attitudes to science associated with the use of complementary and alternative medicine? British journal of health psychology, 12 (Pt 2), 229-43 PMID: 17456283

Park C (2013). Mind-body CAM interventions: current status and considerations for integration into clinical health psychology. Journal of clinical psychology, 69 (1), 45-63 PMID: 22936306

Wallen GR, & Brooks AT (2012). To Tell or Not to Tell: Shared Decision Making, CAM Use and Disclosure Among Underserved Patients with Rheumatic Diseases. Integrative medicine insights, 7, 15-22 PMID: 23071389

Image via Andrey Popov / Shutterstock.

A number of studies have shown exercise to be beneficial in the treatment of depression or depressive symptoms. Further, exercise has remarkable positive, and few negative effects on other disorders. From a physical standpoint, exercise engagement may improve hippocampal volume, pre-frontal cortex blood flow, and increase brain mediators such as brain-derived neurotrophic factor (which may be a key marker of depression).

With several other diseases, there is a concern regarding the effectiveness of different types of exercises: resistance or aerobic. However, in the context of treating depression and its symptoms, research shows that little difference exists between them, making  the prescription far easier to physicians and the engagement almost limitless to patients.

Moreover, major depression is now well recognized as a risk factor for some of the most serious chronic diseases such as cardiovascular disease and diabetes, and similar in potency with traditional risk factors. Therefore, exercise prescription as a medical treatment would result not only in the improvement of depression, but also in preventing the occurrence of other diseases.

Vitally, data from several studies have shown exercise to be just as effective as medication in the treatment of depressive disorders. Furthermore, engaging in regular physical activity can reduce medication dependence. Even more importantly, other studies have demonstrated that exercise is more effective than medication in preventing relapse of the disease. It is also well established that additional benefits of exercise to individuals suffering from depression include reduced moodiness, better attitude, improved outlook, increased self-confidence, and enhanced mental well-being.

While the benefits of exercise as a depression treatment are undeniable, it may also have some barriers, for example intimidation, cost, or physical limitation. Therefore it is necessary to develop strategies for successful compliance by the patient, setting reasonable goals and preparing them for setbacks or obstacles.

Whether exercise is used as a first-line treatment or as a supplement to medication or psychotherapy, patients have virtually nothing to lose and much to gain from adopting an exercise approach in dealing with the symptoms of depression. Therefore, beyond the documented and aforementioned benefits of exercise on overall health, it is also time to more avidly begin considering exercise as a therapeutic strategy for patients suffering from depression.

References

Berlin AA, Kop WJ, & Deuster PA (2006). Depressive mood symptoms and fatigue after exercise withdrawal: the potential role of decreased fitness. Psychosomatic medicine, 68 (2), 224-30 PMID: 16554387

Blumenthal JA, Sherwood A, Babyak MA, Watkins LL, Smith PJ, Hoffman BM, O’Hayer CV, Mabe S, Johnson J, Doraiswamy PM, Jiang W, Schocken DD, & Hinderliter AL (2012). Exercise and pharmacological treatment of depressive symptoms in patients with coronary heart disease: results from the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) study. Journal of the American College of Cardiology, 60 (12), 1053-63 PMID: 22858387

Booth FW, & Laye MJ (2010). The future: genes, physical activity and health. Acta physiologica (Oxford, England), 199 (4), 549-56 PMID: 20345416

Pilu A, Sorba M, Hardoy MC, Floris AL, Mannu F, Seruis ML, Velluti C, Carpiniello B, Salvi M, & Carta MG (2007). Efficacy of physical activity in the adjunctive treatment of major depressive disorders: preliminary results. Clinical practice and epidemiology in mental health : CP & EMH, 3 PMID: 17620123

Rozanski, A. (2012). Exercise as Medical Treatment for Depression Journal of the American College of Cardiology, 60 (12), 1064-1066 DOI: 10.1016/j.jacc.2012.05.015

Rozanski A, Blumenthal JA, Davidson KW, Saab PG, & Kubzansky L (2005). The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. Journal of the American College of Cardiology, 45 (5), 637-51 PMID: 15734605

Image via Dmitry Berkut / Shutterstock.

Data indicate that there is significant biophysical and biochemical truth supporting this method, so much so that scientists continue to examine the relevant biochemical pathways active during laughter in an attempt to identify drug targets and develop novel drugs. When we laugh multiple areas of our brain including the frontal and occipital lobes become activated. On a biophysical level our blood pressure is lowered and our abdominal, diaphragm, respiratory, facial, leg, and back muscles are all actively engaged. Buchowski and colleagues at Vanderbilt University have determined that 10-15 minutes of laughter burns approximately 50 calories. This physical activity also results in an increase in movement of lymphatic fluids which facilitates the immune system in more effectively clearing cellular waste. Furthermore, it results in an increase in blood oxygen content and circulation which may help to inhibit the growth of parasites, bacteria, and cancer cells.

At the biochemical level, research has focused on examining the changes in hormone levels in response to laughter. Berk and colleagues at Loma Linda University School of Medicine report a reversal in serum levels of various hormones that play key roles in the stress hormone response cascade including cortisol, dopac, epinephrine, and growth hormone. Additional data from Stanford University indicate that humor activates the mesolimbic reward pathway in the brain, the same area of the brain that is implicated by cocaine and other addicting substances or rewarding activities.

While the data are broad and in some cases descriptive, the message is clear. The multifaceted and seemingly endless positive health effects of laughter make it, truly, the best medicine.  With that being said, I encourage everyone to redirect their attention to one of my favorite free medications: http://www.jokesgalore.com/. 

References

Buchowski MS, Majchrzak KM, Blomquist K, Chen KY, Byrne DW, & Bachorowski JA (2007). Energy expenditure of genuine laughter. International journal of obesity (2005), 31 (1), 131-7 PMID: 16652129

Berk LS, Tan SA, Fry WF, Napier BJ, Lee JW, Hubbard RW, Lewis JE, & Eby WC (1989). Neuroendocrine and stress hormone changes during mirthful laughter. The American journal of the medical sciences, 298 (6), 390-6 PMID: 2556917

Mobbs D, Greicius MD, Abdel-Azim E, Menon V, & Reiss AL (2003). Humor modulates the mesolimbic reward centers. Neuron, 40 (5), 1041-8 PMID: 14659102

Image via Diego Cervo / Shutterstock.

For the study, 51 heathy adults aged 25 to 55 years, with no prior meditation experience, underwent mindful attention training (MAT), cognitively-based compassion training (CBCT), or participated in a health discussion group. MAT teaches meditative techniques for enhancing awareness of a person’s internal and external environments; CBCT is a program based on Buddhist practices of compassion meditation. The health discussion group served as the control group.Each group participated in its respective intervention for 2 hours per week for 8 weeks. The MAT and CBCT groups were also asked to meditate daily for 20 minutes at home.  Before and after the study, the participants completed inventories of self-reported depression and anxiety. They also underwent functional magnetic resonance imaging scans while in a non-meditative state during which they were shown pictures of people and asked to identify the people as positive, negative, or neutral.

After the training, the MAT group showed a significant decrease in right amygdala activation – the area of the brain responsible for emotional response – in response to the positive photos. The CBCT group also showed a decreased response to the positive images and an increased response to the negative images, but the differences were not significant. The CBCT group did experience a significant decrease in depression scores, however. The control group showed no changes.

The authors of the study conclude that meditation training designed to enhance feelings of compassion led to a permanent increase in amygdala response to seeing other people suffer (i.e., the negative images.) The authors believe that the decreased depression scores also prove that meditation is beneficial to a person’s own well-being. Overall, the meditation induced training that was not task- or stimulus-specific, but, rather, process-specific. The authors hypothesize that the process-specific changes may lead to long-lasting changes in mental function.

Mediation is a process or activity designed to reduce irrelevant thoughts by enhancing internalized attention. Meditation has been shown to decrease stress, improve relaxation, enhance emotional stability, and increase concentration. Physical health is also improved by meditation, though the mechanisms by which meditation produces its effects are unclear. Still, meditation has led to significant clinical improvement in mental health disorders including anxiety, depression, affective disorders, and attention deficits. Meditation is being evaluated as an intervention for other mental illnesses.

The results of the current study are encouraging for meditation as a long-term intervention, but the results are far from conclusive. The sample size was small and most of the results were not statistically significant. Though, the findings do support a mind-over-matter approach to emotional processing and indicate that it might be possible to alter brain function with a little training. We could all use a little more compassion and a little less anxiety and depression these days. And, if a few minutes of meditation can get us there, then just say “Om.”

References

Chiesa, A., & Serretti, A. (2009). A systematic review of neurobiological and clinical features of mindfulness meditations Psychological Medicine, 40 (08), 1239-1252 DOI: 10.1017/S0033291709991747

Creswell JD, Irwin MR, Burklund LJ, Lieberman MD, Arevalo JM, Ma J, Breen EC, & Cole SW (2012). Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain, behavior, and immunity, 26 (7), 1095-101 PMID: 22820409

Desbordes G, Negi LT, Pace TW, Wallace BA, Raison CL, & Schwartz EL (2012). Effects of mindful-attention and compassion meditation training on amygdala response to emotional stimuli in an ordinary, non-meditative state. Frontiers in human neuroscience, 6 PMID: 23125828

Rubia K (2009). The neurobiology of Meditation and its clinical effectiveness in psychiatric disorders. Biological psychology, 82 (1), 1-11 PMID: 19393712

Sipe WE, & Eisendrath SJ (2012). Mindfulness-based cognitive therapy: theory and practice. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 57 (2), 63-9 PMID: 22340145

Image via suravid / Shutterstock.

Remove your opinion about that which appears to give you pain and you stand painless.
— Marcus Aurelius

Pain is inevitable. Suffering is optional.
— Dalai Lama

The insight of Marcus Aurelius and the Dalai Lama about the nature of pain alludes to the practical knowledge that physical pain can be managed effectively through proper training and mental discipline, neatly summarized by the popular phrase “mind over matter.”

In the West, the notion of “mind over matter” has been circulating for centuries (at least since Aurelius and previous Stoic philosophers), yet it has been relatively recently that a technique that puts this insight into practice became the subject of serious scientific examination, namely mindfulness meditation. Mindfulness meditation achieves this effect by cultivating a sense of equanimity through objective observation of the internal processes of the body. Over the past decade, the science of mindfulness meditation has revealed a wide range of cognitive and emotional benefits conferred on practitioners including enhanced attention, lower pain sensitivity, and reduced emotional reactivity. The evidence for these benefits has also been supported by brain imaging studies in long-term meditators showing that change occurs at the physiological level.

To date, the majority of mindfulness meditation studies have been conducted in individuals with long-term intensive meditation experience. In a study published earlier this year in the Journal of Neuroscience, researchers at Wake Forest University explored the impact of mindfulness meditation on pain after only a few days of meditation training.

A group of 15 healthy volunteers took part in four 20-minute sessions of mindfulness meditation instruction where they were trained to maintain awareness on their own breathing while acknowledging and letting go of distraction.

The study evaluated the effect of mindfulness meditation in two dimensions: 1) how the volunteers reported pain intensity and unpleasantness, and 2) how brain activation patterns changed as measured by functional MRI. To assess the volunteer’s pain response, a small thermal simulator heated to around 120°F was applied to the back of the leg.

Comparing responses to the heat before and after meditation training, volunteers reported a 40% reduction in pain intensity and a 57% reduction in unpleasantness associated with the heat stimulus. Brain imaging indicated increased activation in areas associated with awareness of the pain sensation and a reduced activation in areas associated with the emotional response to pain perception.

Interestingly, a decoupling of two brain areas, the dorsolateral prefrontal cortex and cingulate cortex, was observed. The prefrontal cortex is thought to control attention and other executive functions, whereas the cingulate cortex is associated with the emotional salience of a stimulus. The authors suggest that the beneficial effect of meditation may be due to a dissociation of the awareness of pain with the emotional evaluation of the pain attached to it. Accordingly, the meditators are aware of the pain sensation, but are not judging or focusing on the disturbing quality normally associated with the pain. Marcus Aurelius sums it up nicely,

If you are distressed by anything external, the pain is not due to the thing itself but to your own estimate of it; and this you have the power to revoke at any moment.

As a way to better understand the meditation experience, think about the mental focus a top endurance athlete exhibits in competition. The conviction to overcome excruciating muscle aches and pains enables world class cyclists to complete the Tour de France (a 2000 mile race over 21 days at altitude) and long distance runners to finish marathons in around 2 hours (averaging less than 5 min per mile). Of course, great endurance athletes are not necessarily meditators, but they are individuals who have cultivated mental discipline with years of training in which they have come to appreciate the essence of “mind over matter.”

This study hints at the fascinating implication that one need not pursue the path of a monk, adopt an extreme stoic philosophy or even engage in an intensive meditation retreat to experience substantial health benefits. It’s possible that intensive meditation may offer additional rewards, yet this study shows that even short-term meditation training yields a meaningful reduction in the suffering associated with common, everyday pain.

The National Institutes of Health (NIH) estimates that 70 million Americans suffer from chronic pain with an economic burden of at least $100 billion in the United States. The low cost and low risk of mindfulness meditation make it particularly attractive for chronic pain sufferers, though the value extends to anyone looking for a boost in concentration and a reduction in suffering. In a way, we all have become conditioned to react to the distractions in our environments like a dog conditioned to the sound of a bell. And so couldn’t we all use a bit of the calm, quiet mind lying dormant beneath the sound of the iPhone, the Blackberry, and Pavlov’s bell ringing in our ear?

References

May Day Fund. A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform. 2009.

Salomons TV, & Kucyi A (2011). Does Meditation Reduce Pain through a Unique Neural Mechanism? The Journal of neuroscience : the official journal of the Society for Neuroscience, 31 (36), 12705-7 PMID: 21900549

Zeidan F, Martucci KT, Kraft RA, Gordon NS, McHaffie JG, & Coghill RC (2011). Brain mechanisms supporting the modulation of pain by mindfulness meditation. The Journal of neuroscience : the official journal of the Society for Neuroscience, 31 (14), 5540-8 PMID: 21471390

Image via antoniomas / Shutterstock.

The new study examined a cross-section of approximately 1000 adults (about one-third were women) and examined their intake of chocolate. None of them had diabetes or coronary artery disease. More than 900 of the subjects were not using antidepressants. The participants completed a questionnaire to assess symptoms of depression, and they reported the number of chocolate servings they ate per week. Researchers compared the depression scale scores to chocolate consumption.

Overall, participants with scores indicating positive possible depression consumed significantly more chocolate than those not scoring positive (8.4 servings per month vs. 5.4 servings per month). Participants with higher depression scale scores, indicating probable major depression, consumed still more chocolate (11.8 servings per month).  There was no difference between men and women, and the results were not related to a general intake of fat, calories or carbohydrate intake, the authors stated. They were unable to determine if there was a causal connection between chocolate and depression, and, if so, in what direction.

Possibly, chocolate does have mood benefits and chocolate cravings are the body’s way of self-treating depression. Many studies have supported the idea that chocolate enhances mood; negative mood is often immediately improved after consuming chocolate, though the effect is generally short-lived. This immediate mood benefit likely contributes to the habit of eating to cope with stress. Chocolate consumption is also associated with increased guilt in many studies, primarily in so-called emotional eaters.

In addition to mood benefits, claims that chocolate improves cardiovascular health and has positive nutritive properties abound. The cardiovascular protective effects of chocolate are believed to come from the polyphenols that come from cocoa. Additionally, dark chocolate is believed to have positive effects on the action of insulin, as well as protect human skin from damage caused by UV rays.

Chocolate is a long way away from being considered a health food or prescribed as a treatment for chronic diseases. However, its sociocultural allure is unchanging. The new study, though, does inspire questions on emotion-regulated eating versus eating to regulate emotion. But, no matter the cause and effect of chocolate’s relationship with depression, consumption of the quintessential confection is not likely to change anytime soon.

References

Chang AS, Yeong BY, & Koh WP (2010). Symposium on Plant Polyphenols: Nutrition, Health and Innovations, June 2009. Nutrition reviews, 68 (4), 246-52 PMID: 20416020

Egan BM, Laken MA, Donovan JL, & Woolson RF (2010). Controversies in Hypertension: Does Dark Chocolate Have a Role in the Prevention and Management of Hypertension? Commentary on the Evidence. Hypertension PMID: 20404213

Macht M, & Dettmer D (2006). Everyday mood and emotions after eating a chocolate bar or an apple. Appetite, 46 (3), 332-6 PMID: 16546294

Macht M, & Mueller J (2007). Interactive effects of emotional and restrained eating on responses to chocolate and affect. The Journal of nervous and mental disease, 195 (12), 1024-6 PMID: 18091197

Macht M, & Mueller J (2007). Immediate effects of chocolate on experimentally induced mood states. Appetite, 49 (3), 667-74 PMID: 17597253

Macht M, Roth S, & Ellgring H (2002). Chocolate eating in healthy men during experimentally induced sadness and joy. Appetite, 39 (2), 147-58 PMID: 12354683

Rose N, Koperski S, & Golomb BA (2010). Mood food: chocolate and depressive symptoms in a cross-sectional analysis. Archives of internal medicine, 170 (8), 699-703 PMID: 20421555

Strandberg TE, Strandberg AY, Pitkälä K, Salomaa VV, Tilvis RS, & Miettinen TA (2008). Chocolate, well-being and health among elderly men. European journal of clinical nutrition, 62 (2), 247-53 PMID: 17327862

Williams S, Tamburic S, & Lally C (2009). Eating chocolate can significantly protect the skin from UV light. Journal of cosmetic dermatology, 8 (3), 169-73 PMID: 19735513

The study presents the results of the largest-scale clinical trial conducted with Ginkgo biloba, assessing more than 3000 adults aged 72 to 96 years. (The investigators have used the same population to investigate other aspects of Gingko treatment, with results published in several journals.) The current study focuses on the prevention of cognitive decline in older adults. The participants received a twice-daily dose of 120 mg of Ginkgo biloba or placebo. Over the 6-year follow-up period, the rate of decline of cognitive function, as assessed by standard cognitive and psychoneurological function exams, was calculated. Overall, there was no difference in the rate of cognitive decline between participants receiving Ginkgo biloba or placebo. These results did not change when modifying factors, such as age, sex, race, education, genetic variations, or baseline cognitive impairment, were considered.

This hardly seems like newsworthy information, given the plethora of studies that say the same thing. To date, there are no large-scale, definitive studies demonstrating that Ginkgo biloba has much of an effect on anything.  Most studies that do report benefits of Ginkgo biloba therapy are not comprehensive and obtained limited data regarding cognitive function. The results lend themselves to statistical misinterpretation and inappropriate extrapolation of the data.

Still, Ginkgo biloba sales are in the hundreds of millions of dollars worldwide every year. It is commonly used in European medicine to improve memory and treat neuronal disorders and improve brain metabolism. In the United States, it enjoys widespread use as a botanical dietary supplement. The current study should leave consumers asking, “Why?” Once again, Ginkgo biloba is verifiably ineffective for preventing a decline in cognitive function. Plus, as with many unregulated over-the-counter supplements, Ginkgo biloba places patients at increased risk for possible side effects and drug interactions.

Growing old gracefully and successfully is of paramount importance with an ever-older population. It is natural to strive for maintaining, and even enhancing, cognitive reserves. But, there is no evidence that proves Ginkgo biloba will help to achieve those goals. Clinicians and patients are better served by identifying and treating known conditions that may reduce brain capacity and cognitive function, including vascular risk factors, diabetes, and sleep disorders, and promote activities and lifestyles that build cognitive reserve.

… And we don’t want to have to tell you again!

References

Canis, M., Olzowy, B., Welz, C., Suckfüll, M., & Stelter, K. (2009). Simvastatin and Ginkgo biloba in the treatment of subacute tinnitus: a retrospective study of 94 patients American Journal of Otolaryngology DOI: 10.1016/j.amjoto.2009.09.004

Daffner KR. Promoting Successful Cognitive Aging: A Comprehensive Review. J Alzheimers Dis. Dec 14 2009.

Kaschel, R. (2009). Ginkgo biloba: specificity of neuropsychological improvement-a selective review in search of differential effects Human Psychopharmacology: Clinical and Experimental, 24 (5), 345-370 DOI: 10.1002/hup.1037

Leistner, E., & Drewke, C. (2010). Ginkgo biloba and Ginkgotoxin. Journal of Natural Products, 73 (1), 86-92 DOI: 10.1021/np9005019

Snitz, B., O’Meara, E., Carlson, M., Arnold, A., Ives, D., Rapp, S., Saxton, J., Lopez, O., Dunn, L., Sink, K., DeKosky, S., & , . (2009). Ginkgo biloba for Preventing Cognitive Decline in Older Adults: A Randomized Trial JAMA: The Journal of the American Medical Association, 302 (24), 2663-2670 DOI: 10.1001/jama.2009.1913

Medicines, including herbal medicines, make changes at a physiological level. Some of these changes are desirable and some are not. It would be irrational to imagine that any agent would have only positive benefits: if you believe an effect is real enough to do you good, you must also believe it could do you harm. The secret of good medicine is to balance the potential benefits of a drug with its known side effects.

There is a widespread perception that a herbal remedy is somehow more gentle or less ‘alien’ than a prescription drug. In fact, herbal medicines are generally no more than plant extracts containing an assortment chemicals whose actions are largely unknown. Is it really better to swallow a jumble of plant chemicals than a single, purified and identifiable one? With a prescription or over-the-counter drug, at least you know what you are getting; a herbal remedy, by contrast, can vary from one country to another, one manufacturer to another or even one bottle to another. In fact, analyses have revealed that the contents of many herbal products do not always match the ingredients listed on the labels, and some even contain dangerous poisons, including pesticides, lead or mercury. It is ironic that so many people who are so particular about what they consume are prepared to take tablets they so little about.

Despite the advances made in conventional medicines, many people live their lives in constant pain and discomfort, and are willing, or desperate, to give anything a try. It is these people more than most who must be protected from the false hopes and exaggerated claims that some herbal remedies offer.

Of course, many alternative health practitioners care deeply about their patients, and genuinely believe they can offer something that alternative medicine cannot. These practitioners stand to gain from regulation, through the increased credibility and patient reassurance that it brings. Indeed, the European Herbal and Traditional Medicine Practitioners Association (EHTPA) and National Institute of Medical Herbalists (NIMH) have both publicly welcomed government consultation. So, with support from practitioners and encouragement from the government, can it be long before alternative medicine comes under the umbrella with its better researched and more robust cousin, medicine?

Antioxidant

The active ingredient in turmeric is called curcumin. Antioxidant and free radical scavenging capacity of curcumin is on par with vitamin C and E, and several animal studies have demonstrated the ability to prevent oxidative damage to heart cells, blood vessels, kidney cells, liver cells, and lipid degradation. Rats pre-treated with curcumin fared better when strokes and heart attacks were induced.

Antibiotic

An oil produced from the turmeric plant has been studied as an antimicrobial, and was shown to be effective in killing E. coli, Pseudomonas aeruginosa, Staph aureus, and several Bacillus strains. Other culture studies have also suggested that turmeric may work as an antifungal and antiviral agent.

Wound Healing

Turmeric has long been considered a home remedy in India for surface wounds. Scientific research into the subject has surprisingly elucidated this practice. Wounds treated with curcumin had faster healing times, showed increased collagen synthesis, higher levels of transformation growth factor, and increased neovascularization. Studies looking at the ingestion of turmeric for treatment of gastric ulcers also showed preserved epithelial cells and decreased ulcer recovery times. Some have suggested that curcumin may be a helpful pre-treatment for patients who require exposure to radiation for treatment of cancers, to prevent skin damage.

Cancer Prevention

Curcumin has been shown to induce apoptosis of certain cancer cell lines in vitro including prostate and breast cancer. Animal models have demonstrated a protective effect of curcumin for a wide range of cancers including colorectal, stomach, skin, liver, oral, and breast. Pro-inflammatory cytokines such as tumor necrosis factor alpha and interleukin 1-beta have also been shown to become downregulated in the presence of curcumin.

Angiogenesis Regulation

The process of angiogenesis is responsible for the creation of new blood vessels. Under physiologic conditions, this process is necessary for growth, repair, and embryonic development. When left unchecked, angiogenesis can go awry causing conditions like diabetic retinopathy, rheumatoid arthritis, hemangiomas, and also may be responsible for the metastasis of tumors to distant sites. Curcumin seems to help regulate the process of angiogenesis, and prevent damage in animal models. This mechanism is not clearly understood yet, but further studies are currently underway.

As is the case with all dietary intake, moderation is the key. While no recommended daily allowance has been established for turmeric intake, the general consensus is that beneficial properties are conferred at doses ranging from 1-2 grams per day. Exceeding that range could lead to complications and side effects. Also, how curcumin interacts with exogenous substances like prescription medications is not clear, so caution is advised for higher intake. Regardless, the new found surge of popularity for Indian cuisine and culture has introduced Western civilization to turmeric, and the spice has certainly earned its public scrutiny as a possible superfood.

References

Mann, C., Neal, C., Garcea, G., Manson, M., Dennison, A., & Berry, D. (2009). Phytochemicals as potential chemopreventive and chemotherapeutic agents in hepatocarcinogenesis European Journal of Cancer Prevention, 18 (1), 13-25 DOI: 10.1097/CEJ.0b013e3282f0c090