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THE MAGNESIUM SOLUTION

Magnesium deficiency is an extremely prevalent condition. In fact, it is estimated that more than half of the US population does not meet required intake levels of magnesium.

It can present with anxiety, insomnia, muscle cramps, muscle weakness, and fatigue. It can also lead to diabetes and irregular heart rate.

There are a number of pitfalls when it comes to the diagnosis of magnesium deficiency. Let’s say, you read the symptoms above and they seem to fit. So you go to your doctor and ask them to check magnesium levels. The results come back, the doctor calls you and tells you to relax – your magnesium level was within normal limits.

Should you forget about it? Absolutely not. It’s very likely that your doctor is not familiar with the difference between hypomagnesemia (low serum levels of magnesium) vs magnesium deficiency. The latter may occur despite normal blood levels if your cells have a difficult time absorbing and using this vital element.

A better test would be a micronutrient analysis performed on your leukocyte white blood cells. If you doctor doesn’t know about it, you can get it from “order it yourself” labs but keep in mind that some of the more progressive insurance do now cover this costly test, at least partially.

Now, let’s say the micronutrient analysis confirms that your cells are low on magnesium. Ok, that explains the fatigue, muscle cramps, your nervousness and insomnia. Great news. You start taking over the counter magnesium supplements and look forward to quick improvement. Several weeks or months go by and you’re not any better. What should you make out of that? Maybe it wasn’t the real reason after all?

Don’t be too quick to jump to conclusions. Take a look at the supplement bottle that you bought. If you haven’t done a lot of research about it, you might have ended up with magnesium oxide, the most commonly used form of magnesium supplement and the most useless one. The bioavailability of magnesium oxide is very low, which means that your body will get very little out of these pills. Toss these bottle in the trash and get yourself the right kind of supplement: magnesium aspartate, chloride, lactate, citrate or glycinate. I personally found lactate to be the easiest to on the stomach but I have to admit that I haven’t tried all of them. It may take a little digging around to find but most health food or supplement stores should have at least one brand with it.

Magnesium supplementation with magnesium lactate was a big part of my own fatigue solution. I still notice how on the days when I forget to take it, my fatigue and muscle cramps tend to come back. I should also note that I had severe preeclampsia during my pregnancy, the treatment for which is intravenous magnesium. It makes me wonder if I was already deficient in magnesium back then.

: Natural remedies, Vitamins

You’re one step closer to your old self!

Remember the times when you used to party like a rock star, pull of allnighters studying for exams, and run around all day doing three hundred things at once? Well, those times have passed. Now you stumble through your day, and everything takes effort and by 9pm you can’t imagine departing from your couch. Where did all that energy go? You might be telling yourself that it’s a normal process of aging but how do you know that there is no other explanation?

The purpose of this site is to educate the readers about various causes of fatigue. The doctors are not very helpful when it comes to this diagnosis. There are so many possible causes and explanations, it’s like looking for a needle in haystack. And who wants to do that, especially with the modern-day five minute visit. The more you know, the more likely you are to get proper evaluation and treatment.

So when it comes to fatigue, you must be your own advocate. Do not give up on the joy of life without trying. I am a physician and it still took me almost two years to figure out what was making me so damn tired. But eventually I got my life back and I hope that with the help of this website you will too.

: MEDICAL FACTS

GLUTEN ATTACK:CELIAC DISEASE

You have probably heard of it. You may remember the old rule about not giving babies wheat until they are at least six months old. You have seen the isles in grocery stores stocked with varieties of gluten free foods. But what exactly is gluten intolerance, a condition more commonly referred to in the medical world as celiac disease?

Celiac disease, also known as gluten-sensitive enteropathy or celiac sprue is a multisystem disorder that affects 1% of American population. Gluten is a protein in wheat, rye and barley. In susceptible individuals, their immune systems mistakes gluten antigen for a pathogen and initiates an inflammatory response, which damages intestinal wall mucosa. This in turn leads to the poor intestinal absorption of food and vitamin and nutrient deficiencies.

Celiac disease can present itself within many other organs, causing a specific rash called (dermatitis herpetiformis) on elbows and buttocks, or affecting nerve endings, blood cells or reproductive organs. The prevalence of celiac disease in the US has been on the rise in the last few decades but it may also have to do with physicians becoming more aware of the disease and learning to identify it earlier.

However, most of the time celiac disease still goes unrecognized for many years and some people go through their lives without ever receiving the correct diagnosis (it can often be mistaken for Irritable Bowel Syndrome). It is more often found in people who have other autoimmune disorders, such as Type I diabetes or thyroid disease.

Most common presenting symptoms are gastrointestinal problems (diarrhea, heartburn, weight loss, and a lot of gas). However, it can also present with fatigue, miscarriages, rashes, joint pain, depression, headaches and a myriad of other problems. This “great mimicker” feature is what makes it so tricky to recognize celiac disease. The initial screening test is serum anti-tTG IgA antibody. If it is positive, then the diagnosis should be confirmed by small bowel biopsy done through endoscopy.

The only existing treatment is religious adherence to gluten free diet, which is very cumbersome and difficult to achieve, because most of the foods in our diet are rich in gluten. Not only dietary but also even some other non-edible items, such as lipstick of some medications may contain gluten. It requires significant amount of knowledge, planning and discipline. Patients are recommended to take supplements of fat-soluble vitamins (D, E, A and K), B12, B6 folic acid and iron. Long-term complications include intestinal cancer and liver disease. The longer a person goes undiagnosed and untreated, the greater the risk for long-term complications.

Tips for staying gluten-free while dining out, from the Gluten Intolerance Group:
www.gluten.net/downloads/print/Diningflat.pdf

Image: Suat Eman / FreeDigitalPhotos.net

: Health conditions, MEDICAL FACTS

NARCOLEPSY

For a long time when I heard the word “narcolepsy” I imagined an unfortunate person who would fall unconscious in the middle of the sentence and wake up the next day – an image based on River Phoenix character from the early 90s movie “My Private Idaho”. There was surprisingly little education on the subject of sleep disorder in medical school but fortunately I have opted to do a three- week elective at a sleep center during my residency.

There I learned that narcoleptics were all around me, albeit not extreme as the classic case (in fact the character from the movie above was suffering from cataplexy- a condition that in very rare cases is associated with narcolepsy).
Narcolepsy in its more usual and subtle form is suspected when a person is suffering from excessive sleepiness despite adequate amount of sleep and the diagnosis is made by performing a sleep study (polysomnogram) that is done during the night and then MSLT (multiple sleep latency test) which measures tendency to fall asleep during the day. The whole thing amounts to a rather involved and cumbersome test, the patients get a couple dozen electrodes glued to their heads and get to hang out in a hotel-like sleep suite for almost 24 hours.

You too have probably seen quite a few people affected by narcolepsy –it may be the girl in your college class who used to sleep through most of the lectures, the guy at your work who tends to nod off during most of the conferences, the uncle who falls asleep on the couch watching a football game, a friend who is always complaining of being tired and not being able to get a refreshing sleep… It never occured neither to any of these people nor to anyone around them that their brains simply doesn’t function normally when it comes to sleep. Narcolepsy is one of the most under-diagnosed medical conditions, partially because the sleep deprivation-an alternative explanation to symptoms is so common that people accept their symptoms as part of life, partially because the diagnosis is so cumbersome to make and partially because of the lack of awareness about this condition both among physicians and patients.

The medical director of the Sleep Center where I did my rotation during the residency years ago told me that he diagnosed his own daughter with narcolepsy when she was 17. Her sleep study was markedly positive for sleep onset within minutes with expedited transition to REM sleep – a hallmark of narcolepsy. She was placed on a stimulant medication and just a few months later she went from a C+ student to having almost all straight A’s in high school. Her short term memory, poor concentration and mood swings have all resolved.

The modern science of genetics attributes narcolepsy to a mutant gene that codes for a specific neutrotransmitter region. The disruption of proper function leads to abnormal regulation of sleep cycle sequences and often intrusion of REM sleep into wakefulness. People with narcolepsy also are prone to sleep paralysis, they are uncomfortably aware of not being able to move or see when they are asleep. They can also experience hallucinations when they either fall asleep or waking up. While helpful at hinting toward epilepsy, neither one of these symptoms is required to be present in order for diagnosis of epilepsy to be established, and they also can occur on occasion in perfectly healthy individuals.

For many years, the traditional medication for treatment of narcolepsy were amphetamine derived drugs, such as Ritalin. Lately, however there has been a surge of new drugs on the market, that are more specifically directed at the sleep wake cycle regulation (Provigil, Nuvigil) and are less prone to abuse. Also there is a medication called GHB (the substance with a tainted past of a popular date rape drug in the 80s). It is sold under the brand name Xyrem. This medication induced deep stages of sleep, which are deficient in narcoleptics, and has been extremely effective in controlling the symptoms. The downside is that it is very tightly regulated and quite expensive.

: Health conditions, MEDICAL FACTS
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DOPAMINE: THE MOLECULE OF HAPPINESS

Recently my friend Amy had a very bad experience a minor emergency room. She came in hoping to get a relief for a horrible migraine that made her suffer all day longthat did not respond to any measure or medication she tried at home.

Unfortunately, the ER physician, had a jaded view that any young person asking for a pain medicine is a drug addict until proven otherwise. Therefore, instead of the morphine she has always received for her migraines in the past, he decided to prescribe her a cocktail of non-narcotic medications, with the main ingredient being compazine –an old school anti-psychotic medication which is still used to treat nausea and believed by some doctors to help break the migraines.

“It burnt really bad as it entered my vein” Amy told me. “Then within minutes I knew something was horribly wrong with my body. A few minutes later my headache was almost gone but a horrible feeling came over me. It was so awful that I would have take my migraine over it any minute if I could. I felt such despair and dislike for living that I wanted to end my life right there and then…It only lasted about half an hour but it could have easily been the worst thirty minutes of my life…”

As it turns out Amy was very sensitive to the effects of compazine, which is a dopamine antagonist. Dopamine is the molecule that acts in the brain to promote the feeling of pleasure and makes us look forward to enjoying things and activities. Once most of dopamine receptors in her brain were blocked, Amy entered a state of intense dysphoria- she could not feel a single positive feeling. In other words, while normally an optimistic and cheerful person, she had temporarily suffered the maximum possible degree of unhappiness.

Dopamine is the neurotransmitter that is pivotal to motivation, creativity and sexual desire. Drugs like cocaine and amphetamines act in the opposite way. They cause a burst of dopamine to be released which leads to euphoria – an exaggerated feeling of happiness which is very addictive to humans because it makes all other experience dwarfed in comparison.

People with Parkinson’s disease also suffer from a lack of dopamine but it is limited to a very specialized part of the brain where it is responsible not for the mood but for the movement. Low levels of dopamine levels has also been linked to ADHD and social anxiety disorder.

On the other end of the spectrum, there can be too much of a good stuff too. Schizophrenia and paranoid behavior are believed to be caused by excess of dopamine in certain parts of the brain.

Anti-Parkinsonian medications such as Sinemet, Requip, Mirapex and others raise levels of dopamine in the brain. You would think that giving these drugs to people who already have normal levels will also cause euphoria but it is not the case. The change in dopamine level caused by this medications is much more gradual and the brain has time to adjust. Nevertheless, these medication have a potential to create a whole slew on unpredictable side effects related to dopamine. The Mirapex is implicated in turning previously very responsible and monogamous people into sex addicts and obsessive-compulsive gamblers. The main character in the movie “Awakening” played by Robert DeNiro who wakes up from severe Parkinsonian coma in the end goes crazy from paranoia and grandiosity caused by incorrect dosing of levodopa, which was still an experimental drug at that time.

An Ayurvedic herb called Mucuna pruriens that contains a small amount of levodopa. The amount is likely too small to cross the blood brain barrier in a quantity large enough to impact any changes but there are some people who claim that their mood and concentration get better when they take it. Some, on other hand only report jittery feeling akin drinking five cups of coffee and others feel nothing at all.

The wide spread belief that eating brown spots on bananas raises dopamine levels is incorrect. While eating overly ripe bananas is probably not going to harm you, it won’t make you happy either.

 

For more information about the role neurotransmitters play in our mood go to my blogs:

http://www.chronicfatiguediagnosis.com/?p=312 “The History of Depression”

http://www.chronicfatiguediagnosis.com/?p=319 “The Future of Depresssion”

 

 

Image: Salvatore Vuono / FreeDigitalPhotos.net

: A FEW OF MY THOUGHTS, Other
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THE TALE OF HYPOGLYCEMIA

Many people go through the glucose-insulin yo-yo throughout most of their days, which leaves them feeling very fatigued.

I often find myself to be a victim of this vicious circle. The problem lies in the unbalanced nutrition. The old 40/30/30 rule still holds true- the best way to eat is to consume roughly equal portions of carbs, protein and fat throughout the day. Most of us are not well versed enough in nutrition and do not have sufficient enough control over our meals to achieve that. We tend to consume too many carbohydrates and simple sugars. Some lucky people have very adoptable pancreas and liver that can handle it well, but for the rest of us this results in postprandial over-secretion of insulin. The carbohydrates and sugars are quickly digested but the insulin remains floating in our blood for another 4 or 5 hours, causing mild hypoglycemia and fatigue. You may not even detect the low blood sugar with conventional glucometer, but this is because your body is working hard to keep it normal – a process that involves mobilization of glycogen and conversion of fatty acids which use up your energy stores. In addition, the insulin excess also triggers a whole wide range of unnecessary biochemical reactions in your body that may contribute to your fatigue. In other words, the delicate chemistry of your body is off balance.

These blood sugar highs and lows can be avoided, when one consumes five or six small balanced meals throughout the day. This will insure more even levels of blood glucose and prevent “bottoming out” in between meals. Think of a typical breakfast choices we make- a bowl of frosted cornflakes. A croissant with coffee. These are 100% carbohydrate melas that are guaranteed to send you sugars and insulin on a wild spin and leave you feeling starved by mid-morning. On other hand a bowl of oatmeal with a generous serving of nuts and a yogurt, or a toast with ricotta cheese would last you much longer in terms of energy reserve and hunger suppression.

I have recently subscribed to a gourmet dietary service in order to test the above hypothesis on myself. It is rather pricy but it comes with five freshly prepared and nutritionally balanced meals per month that are delivered to your door every evening. I get three carefully planned meals and two snacks. I must admit that the difference in my wellbeing has been quite striking. Not only my blood glucose seems to be more steady, but I also consume a lot more vegetables and fruit that I probably would not eat otherwise. My energy level has improved remarkably as soon as I began this new diet. The service is too expensive to stay on it long term but hopefully this experience will inspire me to adhere to better eating habits on my own and will condition my brain to healthier food choices in the future.

<p><a href=”http://www.freedigitalphotos.net/images/view_photog.php?photogid=151″>Image: Suat Eman / FreeDigitalPhotos.net</a></p>

: A FEW OF MY THOUGHTS, Lifestyle
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THE FUTURE OF DEPRESSION: Part 2

The modern medical science still has yet to figure out all of the organic causes of depression. Interestingly, the brain receptors that traditional drug makers have persistently disregarded so far, have become the golden mine for the illicit drug industry.

It is a known fact that some people are completely indifferent to pain pills, while others become addicted after taking only a few Vicodin after a dental surgery. The answer to these varying degree of susceptibility may be hiding in the emerging theory of Endorophine System Deficiency. Opioids are substances that stimulate the same receptors as endorphins that are produced in our body naturally. Some people are born with lower than normal levels of these endorphins than others and spend their lives feeling for the most part unhappy and miserable deep inside. Until one day, when they discover opioid narcotics and begin to self medicate their depression. Unfortunately, their initial bliss is short lived. The majority of narcotic pain meds are not suitable for long term use as tolerance and dependence develops very quickly, requiring higher and higher doses to achieve the desired effect. The way these drugs were designed and the euphoria they tend to induce makes them very prone to abuse.

While drugs of abuse may provide user with short term fix for their depression they are not suited to provide a long term solution to the problem. In fact, quite the opposite- the depression is likely to worsen during the periods of abstinence.On other hand, there is some emerging data that a weak non-narcotic opioid agonist tramadol (a drug frequently used to treat moderate pain) and a partial opioid suboxone (which is currently used for treatment of opioid dependence) may be useful for treatment of depression that did not respond to conventional medications. However, these medications are not officially approved and it is very unlikely that any but a few very daring physicians would use them for depression treatment at this point.

Another system that definitely plays role in our mood is endocannabinoid system. A few years ago, Sanofi-Aventis released an anti-obesity drug called Rimonabant on the European market. The drug worked by blocking the cannabinoid receptors of the brain, -the effect exactly opposite to the one exerted by marijuana which stimulates them. The idea was quite ingenious and based on the logical conclusion that since cannabis are known to stimulate appetite in most people, the drug with the opposite action on the same receptors will lead to reduced appetite and weight loss. The theory proved it be correct: Rimonabant worked but its time under the sun was cut short as it was withdrawn from the market just a few years later. The reason it was pulled off was due to the reports of the serious side effects, namely severe depression and suicide in people who took it. This confirms the crucial role of endocannabinoid receptors in our mood. In the several US states where marijuana has been legalized, some physicians already began to recommend it to their patients with generalized anxiety or major depressive disorder as an alternative to prescription medication. There is also anecdotal evidence, that Marinol,the synthetic cannabinoid mainly prescribed to cancer and AIDS patients to stimulate appetite, tends to alleviate depression in some users. However, because of the controversy that it associated with medical marijuana, there are ongoing research attempts to produce synthetic drugs that are not cannabinoids per se but can still act on the cannabinoid receptors and exert similar effects on the mood without making one feel “high”.

Image: Boaz Yiftach / FreeDigitalPhotos.net

: MEDICAL FACTS
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THE HISTORY OF DEPRESSION: Part 1

The modern theory about neurotransmitter origin of depression is relatively new and is likely destined for significant revision in the next 10-20 years.

The idea that there is a chemical imbalance behind depressive mood began to emerge in the middle of the twentieth century. Immediately drug companies began a desperate search for the “happy pill”. The first generation of anti-depressants, mainly tricyclics and drugs such as trazodone and nefazodone, had limited success marketing success due to the fact that such high doses were required to achieve even marginal benefit that the side effects were intolerable to most people. Then in the mid seventies- hallelujah- came the famous SSRIs (Selective Serotonin Reuptake Inhibitors). The chemical mystery of depression appeared to be solved, and it all came down to low levels of the brain neurotransmitter called serotonin, or at least that was the belief imposed on the population by the robust marketing campaign that enabled Prozac to become one of the most successful prescription drugs in history. Unfortunately, soon it became clear that while some people clearly did benefit from SSRIs, at least just as many who still remained depressed. (The interesting ploy in the SSRI story is that patients are told to give it six weeks before the medication will take its effect – and many may experience natural improvement in their depression by that time anyway. Also, it is unclear how many people simply benefit from the placebo effect that medication gives them, rather than due to the pharmacological effect.)

The pharmaceutical scientists began to scratch their heads and wonder if perhaps they have overlooked something. Maybe serotonin was not the only substance that affected our mood. Soon, we were presented with new and more advanced preparations – Effexor (venlafaxine) which affected not only serotonin but norepinephrine as well, and Wellbutrin (burpopion) which also helped to raise dopamine levels. Other brand name antidepressantas began to flood the market-Lexapro, Cymbalta, Savella, Pristiq- just to name a few in the most recent years… And once again,there were some people who found miraculous cure in those drugs, while others noticed nothing but the side effects.

There are some savvy medical offices out there that advertise themselves as “providing the most advanced treatment in the history of depression.” Supposedly, they test the patient blood for different levels of neurotransmitters and choose the one that is most appropriate for them based on the results of the tests. The patients need to foot a hefty bill that is not covered up by their insurance. The only problem with this seemingly logical approach is that there is no correlation between levels of neurotransmitters in the blood with those that are found in the brain. And it is only those molecules that are present in the brain that really matter. It may be actually possible to measure the level of brain neurotransmitters but it could only be achieved by testing cerebrospinal fluid, not blood, and I am not aware of this being done anywhere outside of research labs.

The science of depression is just beginning to emerge. I am optimistic that somwhere down the road the diagnosis will be much more straightforward, with either a genetic screen or an advanced brain imaging scan, the work of guessing where the problem lies will be virtually eliminated. And even if the serotonin theory eventually becomes disproved, it will never be discounted. The main achievement of Prozac’s ad campaign was that it lifted the veil of stigma and changed public opinion from viewing depression as a weakness or a personal choice to the one of the legitimate disease. And to each depressed person who took it, even if merely as a placebo, it gave something far beyond a high serotonin dose. It gave them Hope.

 

 

Image: Boaz Yiftach / FreeDigitalPhotos.net

: MEDICAL FACTS
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The VIRILE HORMONE

Testosterone is a magnificent hormone. It is the hormone of energy, desire, and ambition. (Of course it has a dark side to it as well, being responsible when present in excessive quantities for aggression and promiscuity). Both men and women depend on testosterone for their bodies to function well, however men require it in the amounts that are hundred-fold higher than women. I have already touched on testosterone deficiency in women in the post about birth control, and  now I would like to focus on testosterone deficiency in men. On one hand testosterone is often abused by young  athletes and bodybuilders who push their testosterone from normal to supra- normal levels to improve muscle mass and performance. This is unhealthy for the body and can cause serious medical problems. On other hand, there are plenty of men out there who have low testosterone but may never even find out about it. Decreased testosterone in men (medically known as hypogonadism) is more prevalent than most people think. Over the last few decades, testing older men for testosterone deficiency has become more widespread. (more…)

: Hormones, MEDICAL FACTS
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DHEA CONTROVERSY

Despite being in its infantile stage of development, the science of anti-aging has proved to be a great commercial success. You probably have heard about wealthy people, including many celebrities, who are pouring their money into various anti-aging programs. The three most often used medicines in these anti-aging regimens are testosterone, growth hormone and DHEA (dihydroepiandrosterone). I plan to write about all of these eventually but today I will focus on the latter because it is the one that is most easily available.
These days DHEA can be found virtually in any US pharmacy or health store. In Europe, on other hand, it is classified as a dangerous drug and available only by prescription. (At the same time birth control pills, which are also hormones are available over the counter in Europe, while in the US a woman often must be subjected to an unnecessary Pap smear in order to obtain them). (more…)

: MEDICAL FACTS
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