How N acetyl cysteine prevents hair pulling is not fully understood but is believed to act in the brain and reduces activity of a neurotransmitter, called glutamate. It is believed that glutamate mat play a role in the compulsion to pull hair. When levels of glutamate are reduced, the drive to pull hair also disappears.
There have been previous anecdotal reports and case series which have also reported that N acetyl cysteine may reduce the urge to use illicit drugs like cocaine.
The dose of N acetyl cysteine used in the study varied from 1.2- 4 grams per day. Even though hair-pulling episodes declined, most individuals did not see a marked improvement in their quality of life.
So what about the individual who has Trichotillomania?
One should understand that this is only one study that shows benefits of N acetyl cysteine for hair pulling. The supplement is easily available without a prescription from any health food store and is relatively safe to ingest. The cost of N acetyl cysteine is also substantially lower than all presently prescribed drugs for the disorder. Therefore, if you have a habit of puling your hair and would like to stop it, N acetyl cysteine may not be a bad idea. Of course, if it does not work within 2-3 months, then the above study was hogwash.
Archives of general psychiatry, 2009-07-18
Thursday, July 23, 2009
Finally a treatment for hair pulling? Part 1
Hair pulling is a relatively common disorder in the general population. This agonizing disorder is more common in females and is often associated with an obsessive compulsive personality. Current estimates indicate that at least 2 million adult Americans over the age of 20 have this disorder. There are countless more individuals who have not been diagnosed or are too shy to visit a physician. Despite being aware about this disorder for decades, the treatment for hair pulling or Trichotillomania has not been very satisfactory. Over the years, countless treatments have come and gone. Today, pharmacological drug therapy and behavior alterations are the mainstay of treatment but have limited success.
Recently a paper published in the Archives of General Psychiatry offers new hope for patients who suffer from Trichotillomania. In a small trial involving 50 individuals, it was observed that those who took the health supplement, N acetyl cysteine, had marked improvement of symptoms after only 12 weeks. N acetyl cysteine used in the study was obtained in a pill form from health food stores like GNC and Vitamin Shoppe.
If these studies do hold up, then this may herald a potentially new treatment for this disturbing disorder.
Why people pull hair remains a puzzle and there are countless theories. The bottom line is that chronic hair pulling is a diversion from a stressful situation, which eventually turns into addictive psychological relief. The majority of individuals not only pull hair from the scalp but also from other parts of the body. At least 20 percent of individuals even eat their hair and a very few minority pull other people’s hair. While hair-pulling sounds painful, most trichotillomanics claim that it provides a calming feeling and relief from the acute anxiety.
Recently a paper published in the Archives of General Psychiatry offers new hope for patients who suffer from Trichotillomania. In a small trial involving 50 individuals, it was observed that those who took the health supplement, N acetyl cysteine, had marked improvement of symptoms after only 12 weeks. N acetyl cysteine used in the study was obtained in a pill form from health food stores like GNC and Vitamin Shoppe.
If these studies do hold up, then this may herald a potentially new treatment for this disturbing disorder.
Why people pull hair remains a puzzle and there are countless theories. The bottom line is that chronic hair pulling is a diversion from a stressful situation, which eventually turns into addictive psychological relief. The majority of individuals not only pull hair from the scalp but also from other parts of the body. At least 20 percent of individuals even eat their hair and a very few minority pull other people’s hair. While hair-pulling sounds painful, most trichotillomanics claim that it provides a calming feeling and relief from the acute anxiety.
Sunday, July 19, 2009
Can the Mediterranean diet prevent Alzheimer’s dementia? Part 1
Over the years, there has been a great interest in ways to delay or prevent Alzheimer’s dementia. Besides use of drugs, some researchers feel that perhaps a change in diet may help prevent the decline in cognitive impairment that occurs in old age. It is widely believed that a healthy diet may help prevent development of mild cognitive impairment (MCI) and delay onset of Alzheimer’s disease (AD).
Current estimates indicate that about 10% to 15% of individuals with MCI convert to AD each year.
One of the diets thought to have some benefit in delaying mild cognitive impairment is the Mediterranean diet. Previous clinical research revealed that conformity to a Mediterranean diet was linked to a reduced risk for AD, but its effect on developing MCI was unknown.
The recent study from Washington Heights Inwood Columbia Aging Project (WHICAP) looked at the benefits of adherence to a Mediterranean diet and development of mild cognitive impairment over several years.
To explore whether cognitively normal individuals whose food intake was more representative of a Mediterranean diet were less likely to develop MCI, the researchers examined data from 1393 cognitively normal individuals and 484 individuals with MCI who were participants in the WHICAP multiethnic community study in New York. The majority of individuals studied were in the 7/8th decade of life. Study participants were given a score of 0 to 9 based on their faithfulness to a Mediterranean diet, where 9 indicated greatest adherence to this diet.
Strong adherence to a Mediterranean diet was characterized by a high intake of fish, fruit, vegetables, legumes, cereals, and unsaturated fat; a low intake of dairy products and meat; and a moderate intake of alcohol/wine.
Current estimates indicate that about 10% to 15% of individuals with MCI convert to AD each year.
One of the diets thought to have some benefit in delaying mild cognitive impairment is the Mediterranean diet. Previous clinical research revealed that conformity to a Mediterranean diet was linked to a reduced risk for AD, but its effect on developing MCI was unknown.
The recent study from Washington Heights Inwood Columbia Aging Project (WHICAP) looked at the benefits of adherence to a Mediterranean diet and development of mild cognitive impairment over several years.
To explore whether cognitively normal individuals whose food intake was more representative of a Mediterranean diet were less likely to develop MCI, the researchers examined data from 1393 cognitively normal individuals and 484 individuals with MCI who were participants in the WHICAP multiethnic community study in New York. The majority of individuals studied were in the 7/8th decade of life. Study participants were given a score of 0 to 9 based on their faithfulness to a Mediterranean diet, where 9 indicated greatest adherence to this diet.
Strong adherence to a Mediterranean diet was characterized by a high intake of fish, fruit, vegetables, legumes, cereals, and unsaturated fat; a low intake of dairy products and meat; and a moderate intake of alcohol/wine.
Sunday, July 12, 2009
Melatonin and jet lag?
One of the hassles about long distance air travel is jet lag. Jet lag occurs when the body’s internal rhythms no longer work in synchrony. The day and night cycle become disturbed and the individual often requires several days to get back into his/her normal rhythm. There is evidence that melatonin, a hormone released from the pineal gland, is important when it comes to regulating many body rhythms and the sleep-wake cycle. For decades, melatonin has been sold in health stores as an aid for sleep and help recovery from jet lag.
Millions of pills of melatonin are bought by consumers to treat jet lag, but is melatonin effective?
Cochrane reviews recently looked at 10 randomized clinical trials in which melatonin were used by airline personnel, military employees and other regular airline passengers. Melatonin was compared to a sugar pill. The outcome measures looked at subjective well being daytime tiredness, onset, quality of sleep, psychological functioning, duration of return to normal, or indicators of circadian rhythms.
The studies found that melatonin was quite effective when taken close to the target bedtime at the destination, decreased jet lag from flights crossing 5 or more time zones. Daily doses of melatonin between 0.5 and 5mg were both equally effective, except that people started to fall asleep a lot faster when using the higher dose. Doses above 5mg appeared to be no more effective than the lower doses of melatonin.
A slow release preparation of 2 mg melatonin also worked well at inducing sleep. Some studies indicated that this formulation may be of more benefit when greater than 4-5 time zones are crossed.
The studies revealed that timing of the melatonin dose was important. If the melatonin was taken at the wrong time or very early in the day, it was likely to cause sleepiness and delay adaptation to local time. The incidence of other side effects was low. A number of case reports have also suggested that individuals with epilepsy and patients taking warfarin (blood thinner) might come to harm from melatonin.
Conclusion
Melatonin is quite effective in preventing or reducing jet lag, and for short-term use appears to be safe. It may be a choice for jet lag treatment for travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys. Despite these positive reports, there are a lot of anecdotal reports that melatonin often fails to work. The reason(s) for these discrepancies are not well understood, but more likely than not, are probably related to fake or counterfeit products.
http://www.cochrane.org/reviews/en/ab001520.html
Millions of pills of melatonin are bought by consumers to treat jet lag, but is melatonin effective?
Cochrane reviews recently looked at 10 randomized clinical trials in which melatonin were used by airline personnel, military employees and other regular airline passengers. Melatonin was compared to a sugar pill. The outcome measures looked at subjective well being daytime tiredness, onset, quality of sleep, psychological functioning, duration of return to normal, or indicators of circadian rhythms.
The studies found that melatonin was quite effective when taken close to the target bedtime at the destination, decreased jet lag from flights crossing 5 or more time zones. Daily doses of melatonin between 0.5 and 5mg were both equally effective, except that people started to fall asleep a lot faster when using the higher dose. Doses above 5mg appeared to be no more effective than the lower doses of melatonin.
A slow release preparation of 2 mg melatonin also worked well at inducing sleep. Some studies indicated that this formulation may be of more benefit when greater than 4-5 time zones are crossed.
The studies revealed that timing of the melatonin dose was important. If the melatonin was taken at the wrong time or very early in the day, it was likely to cause sleepiness and delay adaptation to local time. The incidence of other side effects was low. A number of case reports have also suggested that individuals with epilepsy and patients taking warfarin (blood thinner) might come to harm from melatonin.
Conclusion
Melatonin is quite effective in preventing or reducing jet lag, and for short-term use appears to be safe. It may be a choice for jet lag treatment for travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys. Despite these positive reports, there are a lot of anecdotal reports that melatonin often fails to work. The reason(s) for these discrepancies are not well understood, but more likely than not, are probably related to fake or counterfeit products.
http://www.cochrane.org/reviews/en/ab001520.html
Monday, July 6, 2009
Can testosterone supplements help relieve schizophrenia?
Schizophrenia is a common malady in our society. Estimates indicate that close to 1% of people in North America suffer from schizophrenia. The disorder affects all races, cultures, and both genders. The disorder is associated with inability to determine what is real. These individuals may develop false beliefs, hallucinations, distorted perceptions and have emotional withdrawal. Over time, most schizophrenics develop apathy.
Over the years, the major treatment for schizophrenia has been based on use of drugs. Each and every pharmaceutical anti psychotic drug available today has its pros and cons; there is no ideal drug and many of these drugs also have profound side effects. In the last two decades, there has been a push by some health workers to recommend sex hormones, estrogen and testosterone, for the treatment of schizophrenia. So far, there is not a single study that has shown a correlation between low levels of testosterone and schizophrenia, and in fact, many individuals with low levels of testosterone never develop schizophrenia. Nevertheless, like all things in medicine, there are always some unorthodox health care workers who view things differently and put into practice unsubstantiated theories.
Over the decades, many individuals with schizophrenia have been treated with dehydroepiandrosterone (DHEA) as an adjunctive therapy to standard anti psychotic drugs.
The question remains, is testosterone helpful for schizophrenia?
Literature analysis of three small studies compared anti psychotic drugs to DHEA and a sugar pill.
What about the results?
There was no evidence that supplementing testosterone benefitted schizophrenics. Even though the number of patients studied was small, there was no benefit seen. Testosterone did not help improve any of the symptoms of schizophrenia. The only positive thing to come out of the study was that short-term use of testosterone was not found to be associated with any harmful side effects.
Therefore, for the moment, schizophrenia is still treated with conventional pharmaceutical drugs and use of sex hormones remains experimental. Individuals who want to use testosterone or any other supplement for schizophrenia should first consult with their psychiatrist. All individuals should be aware that long-term use of testosterone is associated with many side effects including masculinization; a number of side effects are irreversible even when the hormone is stopped
http://www.cochrane.org/reviews/en/ab006197.html
Over the years, the major treatment for schizophrenia has been based on use of drugs. Each and every pharmaceutical anti psychotic drug available today has its pros and cons; there is no ideal drug and many of these drugs also have profound side effects. In the last two decades, there has been a push by some health workers to recommend sex hormones, estrogen and testosterone, for the treatment of schizophrenia. So far, there is not a single study that has shown a correlation between low levels of testosterone and schizophrenia, and in fact, many individuals with low levels of testosterone never develop schizophrenia. Nevertheless, like all things in medicine, there are always some unorthodox health care workers who view things differently and put into practice unsubstantiated theories.
Over the decades, many individuals with schizophrenia have been treated with dehydroepiandrosterone (DHEA) as an adjunctive therapy to standard anti psychotic drugs.
The question remains, is testosterone helpful for schizophrenia?
Literature analysis of three small studies compared anti psychotic drugs to DHEA and a sugar pill.
What about the results?
There was no evidence that supplementing testosterone benefitted schizophrenics. Even though the number of patients studied was small, there was no benefit seen. Testosterone did not help improve any of the symptoms of schizophrenia. The only positive thing to come out of the study was that short-term use of testosterone was not found to be associated with any harmful side effects.
Therefore, for the moment, schizophrenia is still treated with conventional pharmaceutical drugs and use of sex hormones remains experimental. Individuals who want to use testosterone or any other supplement for schizophrenia should first consult with their psychiatrist. All individuals should be aware that long-term use of testosterone is associated with many side effects including masculinization; a number of side effects are irreversible even when the hormone is stopped
http://www.cochrane.org/reviews/en/ab006197.html
Saturday, June 27, 2009
Should I take Kava extract for my anxiety?
Generalized anxiety is a common medical ailment in North American society. This medical disorder can present with a range of symptoms. In severe cases, anxiety can be disabling and affect one’s life style. For decades, the only treatment available for generalized anxiety has been pharmaceutical drugs. There are many drugs which have been used to treat anxiety, and while effective, drugs also possess adverse side effects. For this reason, many patients have been turning to alternative health care for managing their anxiety.
One of the products frequently consumed by individuals with anxiety is kava. Kava is easily available in most health food stores and estimates indicate that sell of this herbal extract brings in hundred of millions of dollars. The question remains, "is Kava effective for treating anxiety?"
Cochrane reviews recently published the results of twelve trials that looked at kava versus placebo in the management of anxiety. The study looked at the oral preparation of kava extract. Out of the 12 studies, results of 7 studies were compared and assessed using stringent clinical criteria.
Compared with a sugar pill, kava extract was more effective for symptomatic relief of anxiety. Even though the number of patients assessed was small, the results did show a mild to moderate improvement in patients treated with kava. Further, kava was also found to be safe and relatively free of side effects when treatment was conducted anywhere from 1-24 weeks.
So what does mean for the consumer who has anxiety?
For once at least, some herb appears to be effective in treating a medical ailment. Kava has been shown to be safe for short-term usage and it does relieve anxiety. What is not known so far is whether kava works in all people with anxiety. Kava is a lot cheaper than all currently available pharmaceutical medications. For the individual with anxiety, one should perhaps try out kava for at least 4-6 weeks to determine if it works. If kava makes no difference after a 2-month period, it is not going to work at all. Before doubling up on the dose, perhaps one should discuss this situation with a health care professional. In the end when all else fails, one has no choice but to revert back to the pharmaceutical drugs.
http://www.cochrane.org/reviews/en/ab003383.html
One of the products frequently consumed by individuals with anxiety is kava. Kava is easily available in most health food stores and estimates indicate that sell of this herbal extract brings in hundred of millions of dollars. The question remains, "is Kava effective for treating anxiety?"
Cochrane reviews recently published the results of twelve trials that looked at kava versus placebo in the management of anxiety. The study looked at the oral preparation of kava extract. Out of the 12 studies, results of 7 studies were compared and assessed using stringent clinical criteria.
Compared with a sugar pill, kava extract was more effective for symptomatic relief of anxiety. Even though the number of patients assessed was small, the results did show a mild to moderate improvement in patients treated with kava. Further, kava was also found to be safe and relatively free of side effects when treatment was conducted anywhere from 1-24 weeks.
So what does mean for the consumer who has anxiety?
For once at least, some herb appears to be effective in treating a medical ailment. Kava has been shown to be safe for short-term usage and it does relieve anxiety. What is not known so far is whether kava works in all people with anxiety. Kava is a lot cheaper than all currently available pharmaceutical medications. For the individual with anxiety, one should perhaps try out kava for at least 4-6 weeks to determine if it works. If kava makes no difference after a 2-month period, it is not going to work at all. Before doubling up on the dose, perhaps one should discuss this situation with a health care professional. In the end when all else fails, one has no choice but to revert back to the pharmaceutical drugs.
http://www.cochrane.org/reviews/en/ab003383.html
Saturday, June 20, 2009
Is Valerian effective for anxiety?
Anxiety disorders are quite common in our society. Anxiety can vary in intensity and can severely affect one’s lifestyle. There are many medications available to treat anxiety but none is ideal and all of them have side effects. For this reason, many individuals with anxiety have now been turning to alternative health care for treatment of anxiety. One of the natural substances high highly recommended by the herbalist for anxiety is valerian.
Valerian is a herb sold as a dietary supplement in health food stores. It is a common ingredient in natural products recommended for sleep, tension, and stress relief. As far as clinical evidence about its sedating ability is concerned, most of the data are inconclusive and not supportive. Nevertheless, the herb is found to be safe when ingested for a short time, but there are no long-term data.
As far as anxiety is concerned, the effectiveness of Valerian is a puzzle. To date, all reports about valerian for treatment of anxiety are anecdotal and most are made by the vendors of this product. Individuals who take valerian seem to indicate that it does not work all the time. Other individuals have tried out different brand names of the same herb and found no difference in the anxiety symptoms.
As far as clinical evidence is concerned, there is very little data. However, recently Cochrane reviews looked at one randomized study involving 36 patients with generalized anxiety. This 4-week study compared valerian to diazepam and a placebo. The patient population was homogenous and various scales were used to measure anxiety symptoms. At the end of 4 weeks, valerian was no different from the sugar pill when it came to relief of anxiety symptoms. Diazepam was more effective than valerian when it came to symptom relief for anxiety. The only good news about valerian was that no patients reported side effects.
So what about the consumer with anxiety?
This was only one small study but again, despite all the hype about valerian, it did nothing for relief of symptoms of anxiety. Even though benzodiazepines have side effects and are addictive, these drugs still remain effective for anxiety. The other negative about benzodiazepines is that they are expensive and often interact adversely with other drugs. For the individual with anxiety, the choice of how to treat anxiety is difficult. Should one take a herb which is useless and moderately expensive or take a drug which is very expensive, has side effects but works?
The answer- neither. Try Buspirone. This non-addictive drug does not impair mechanical performance such as driving. Response to Buspirone occurs approximately in two weeks, as compared to the more rapid onset associated with benzodiazepines. The only negative- individuals who have previously taken benzodiazepines for the treatment of anxiety generally do not respond well to Buspirone.
http://www.cochrane.org/reviews/en/ab004515.html
Valerian is a herb sold as a dietary supplement in health food stores. It is a common ingredient in natural products recommended for sleep, tension, and stress relief. As far as clinical evidence about its sedating ability is concerned, most of the data are inconclusive and not supportive. Nevertheless, the herb is found to be safe when ingested for a short time, but there are no long-term data.
As far as anxiety is concerned, the effectiveness of Valerian is a puzzle. To date, all reports about valerian for treatment of anxiety are anecdotal and most are made by the vendors of this product. Individuals who take valerian seem to indicate that it does not work all the time. Other individuals have tried out different brand names of the same herb and found no difference in the anxiety symptoms.
As far as clinical evidence is concerned, there is very little data. However, recently Cochrane reviews looked at one randomized study involving 36 patients with generalized anxiety. This 4-week study compared valerian to diazepam and a placebo. The patient population was homogenous and various scales were used to measure anxiety symptoms. At the end of 4 weeks, valerian was no different from the sugar pill when it came to relief of anxiety symptoms. Diazepam was more effective than valerian when it came to symptom relief for anxiety. The only good news about valerian was that no patients reported side effects.
So what about the consumer with anxiety?
This was only one small study but again, despite all the hype about valerian, it did nothing for relief of symptoms of anxiety. Even though benzodiazepines have side effects and are addictive, these drugs still remain effective for anxiety. The other negative about benzodiazepines is that they are expensive and often interact adversely with other drugs. For the individual with anxiety, the choice of how to treat anxiety is difficult. Should one take a herb which is useless and moderately expensive or take a drug which is very expensive, has side effects but works?
The answer- neither. Try Buspirone. This non-addictive drug does not impair mechanical performance such as driving. Response to Buspirone occurs approximately in two weeks, as compared to the more rapid onset associated with benzodiazepines. The only negative- individuals who have previously taken benzodiazepines for the treatment of anxiety generally do not respond well to Buspirone.
http://www.cochrane.org/reviews/en/ab004515.html
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