When It Comes To Depression, Serotonin Isn’t The Whole Story

Since the ’80s, the story of a chemical imbalance brought on by low serotonin has remained very popular.

“I don’t know of any story that has supplanted it,” says Alan Frazer, a researcher who studies how antidepressant medications work. He is also chairman of the pharmacology department at the University of Texas Health Science Center at San Antonio.

“It definitely continues to live — absolutely,” agrees his colleague Pedro Delgado, the chair of the psychiatry department at UT. “If you go to your community doctor, you’re likely to hear some version of that.”

But for many scientists who research depression, this explanation is no longer satisfying.

“Chemical imbalance is sort of last-century thinking. It’s much more complicated than that,” says Dr. Joseph Coyle, a professor of neuroscience at Harvard Medical School. “It’s really an outmoded way of thinking.”

Coyle, who is also the editor of the journal Archives of General Psychiatry, says that though serotonin plays a role in depression, low serotonin is likely not the cause of depression. Scientific thinking has clearly shifted, he says.

Still, the story of serotonin remains. Why does it continue to have such a powerful grip on the popular imagination?

Almost as soon as it was introduced in 1987, the antidepressant Prozac, which selectively targets the chemical serotonin, became a blockbuster. “Prozac just blew everything else out of the water,” Frazer says.

This had less to do with the efficacy of Prozac (it is not better at treating depression than tricyclics, the earlier generation of antidepressants) than with the fact that the drug had relatively few side effects.

The whole story here by Alix Speigel

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Diet, ADHD,and life style changes

Controlling ADHD, it’s not just what you eat, it’s also what you don’t eat.

In a recent story by NPR, For Kids With ADHD, Some Foods May Complement Treatment, they referred to a recent study published in the Journal of Pediatrics.

Eliminating junk food from a child’s diet is usually not enough to effectively treat attention deficit disorders.

You may remember the controversial studies linking food coloring and additives to hyperactivity in kids. Or you may know parents who have pinned their hopes on an elimination diet to improve their kids’ rowdy behavior.

“When [elimination] diets fail, parents can feel they’ve failed,” says Linda Brauer, coordinator of the Grand Rapids chapter of the advocacy group Children and Adults with Attention Deficit/Hyperactivity Disorder. She remembers feeling guilty when her son’s symptoms did not improve. But now she says the science is on her side.

A review paper published today in the journal Pediatrics evaluated the evidence from many studies on this topic. And it concludes that changing a child’s diet is usually not enough to effectively treat attention deficit hyperactivity disorder.

“Elimination diets may help,” whereas stimulant medications are generally very effective, writes J. Gordon Millichap, a neurologist at Children’s Memorial Hospital in Chicago who authored the paper.

Now, before all of the we-are-what-we-eat believers among us dismiss this, you should know that experts don’t deny the importance of diet. Far from it.

“[Diet's] main role in my clinical practice is as a complementary treatment,” Benjamin Prince, a psychiatrist at Massachusetts General Hospital tells us. That means kids with ADHD usually need medicine and good diets.

But what makes a good diet? Here are three tips for kids on the ADHD spectrum from the experts:

Eat a protein-rich breakfast. Kids with ADHD tend to burn lots of calories and can often be too overstimulated to sit down to eat. In addition, medication often suppresses their appetites. Put all of these factors together, and kids with ADHD are prone to feeling “hangry,” Prince says. (The term — a cross between angry and hungry — was coined by Prince’s friend.) The solution? Keep the calories coming. Complex carbohydrates, like whole grains, and foods rich in protein can help kids feel full longer. “So if you can have a glass of milk and a peanut butter sandwich, that’s going to help carry you through the day,” says Prince.
Cut back on sugary treats and processed foods. Australian researchers tracked patterns of eating among children with ADHD. They found that diets rich in sugary snacks, processed foods, red meat and high-fat dairy correlate with higher levels of ADHD. “Try to cut down on those foods,” recommends lead author Wendy Oddy of the University of Western Australia. And Millichap agrees. “We conclude that adherence to a ‘healthy’ diet (fish, vegetables, fruit, whole wheat and low-fat dairy) should be advised,” Millichap wrote to us.

Fish oil and omega-3 supplements. There has been a lot of interest and research on the value of omega-3s from fish oil — or long-chain, polyunsaturated fatty acids. “We think there’s some link between having low amounts of long-chain, polyunsaturated fatty acids and ADD,” says Prince. So he says adding healthy amounts of fish to the family diet — or taking fish oil supplements — are both fine. But he stresses that clinical trials on this subject have not been consistent. “The evidence is mixed” on whether omega-3s can help kids with ADHD, he says. But given the heart benefits for all of us (not just those with ADHD), Prince says, it can’t hurt.

Diabetes & Obesity

Massage School – a learning environment to help fight diabetes & obesity?

Steven R. Smith, M.D.: Sanford Burnham Medical research.

Obesity and diabetes are epidemic in Western societies and account for at least 1/10th of health care expenditures nationwide. The reasons for this are complex; however, it is clear that there is wide variation in individual susceptibility to our obesogenic environment. Our fundamental hypothesis is that the regulation of metabolism in peripheral tissues, specifically skeletal muscle, determines susceptibility to our rich environment and ultimately the common chronic diseases diabetes and cardiovascular disease. In the clinic, we aim to understand the control of fatty acid metabolism but also test novel therapeutic interventions to reduce body weight and treat diabetes. Our more ‘basic’ research focuses on the control of substrate switching between fat and carbohydrate with a particular emphasis on the regulation of fatty acid oxidation in skeletal muscle and the adipose tissue dysfunction that occurs in obesity.

Insulin resistance in skeletal muscle is a key feature of the pre-diabetic state and a precursor to type 2 diabetes and cardiovascular diseases. Our laboratory developed several techniques to study substrate switching in primary human muscle cells and we use these techniques to better understand how insulin resistance develops. We also use these tools to develop and test new strategies to activate fat oxidation as a means to improve insulin action and reduce body weight. Myoblasts grown in culture retain the metabolic characteristics of the donor. This provides us with a tool to explore the origins of the reduced capacity for fat oxidation; a key feature of patients with type 2 diabetes and their offspring. Current efforts are directed towards identifying epigenetic ‘marks’ that may account for these intrinsic differences in the capacity for fat oxidation. Using these same tools, new data from the lab suggests that insulin resistance is due in part to dysregulation of the breakdown of lipid within the muscle; we coined the term intramyocellular lipotoxicity to describe the insulin resistance that occurs due to an imbalance in these lipases. These data suggest that intramyocellular DAGs lead to insulin resistance in humans, and the dysregulation of the key lipolytic enzymes ATGL and HSL lie upstream of insulin resistance in skeletal muscle. Lastly, we are aggressively pursuing the regulation of the NAD+ producing enzyme NAMPT in skeletal muscle which lies upstream of the SIRTs as a potential therapeutic pathway in diabetes.

From the Journal of Clinical Investigation:

Rodent models of obesity induced by consuming high-fat diet (HFD) are characterized by inflammation both in peripheral tissues and in hypothalamic areas critical for energy homeostasis. Here we report that unlike inflammation in peripheral tissues, which develops as a consequence of obesity, hypothalamic inflammatory signaling was evident in both rats and mice within 1 to 3 days of HFD onset, prior to substantial weight gain. Furthermore, both reactive gliosis and markers suggestive of neuron injury were evident in the hypothalamic arcuate nucleus of rats and mice within the first week of HFD feeding. Although these responses temporarily subsided, suggesting that neuroprotective mechanisms may initially limit the damage, with continued HFD feeding, inflammation and gliosis returned permanently to the mediobasal hypothalamus. Consistent with these data in rodents, we found evidence of increased gliosis in the mediobasal hypothalamus of obese humans, as assessed by MRI. These findings collectively suggest that, in both humans and rodent models, obesity is associated with neuronal injury in a brain area crucial for body weight control.

For more, visit the Diabetes & Obesity Center of Excellence

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The Science of Healthy Living Continues to Expand!

High-Fat Foods Cause Brain Scarring

Keeping pounds off long-term is difficult for even the most successful dieter, and scientists may now be on the path to determining why.

A study published recently in The Journal of Clinical Investigation shows that high-fat foods cause damage to the hypothalamus – an area in the brain responsible for hunger, thirst and the body’s natural rhythms and cycles – in rodents.

“These are really important papers that begin to push the idea out that we’re not in control as much as we think we are,” says Dr. Steven R. Smith, co-director for the Sanford-Burnham Diabetes and Obesity Research Center, who wasn’t involved with the study.

However, Smith says researchers must first determine if the scarring happening in the rodent models will translate to the human condition. Not everything that scientists observe in rodents also applies to humans, of course, but it is a starting point.

“This is the tip of the spear. We’ve been talking a lot about diet and willpower and exercise and this sort of thing. This is radically different [thinking] – that diets can actually re-program the structure of the brain.”

The human body is designed to regulate how much fuel is stored as fat through a process called energy homeostasis, the study’s lead author Dr. Michael Schwartz says. For a normal-weight person, that’s good. But once a person becomes obese, his or her body seems to want to stay at that new weight permanently.

“That’s the biggest problem with obesity treatment,” says Schwartz, director of the Diabetes and Obesity Center of Excellence at the University of Washington. “Obese people can lose weight, but they have trouble keeping it off.”

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Why do nipples get hard when cold?

Science is so fascinating!

No one knows, but it’s probably for the same reason that cold gives you goose bumps. Low temperatures stimulate the tiny muscles attached to your hair follicles, which cause the hairs to stand on end. In other, hairier mammals, this process, known as the pilomotor reflex, can produce a layer of insulation. In humans, it seems to be vestigial. The areolae (the colored areas surrounding the nipples) also have smooth muscle cells that contract when stimulated, and cold weather can make the skin pucker inward while the nipples stick out. The squeezing of these muscles may also lead to increased protrusion of the Montgomery glands—the little bumps around the nipples that secrete fluid to facilitate breast-feeding. (Both men and women have Montgomery glands; under the right circumstances, men can even lactate. ) Few studies have been done on why the areolae, in particular, might be reactive to the cold.

The areola is one of the most sensitive areas of the body, and it can be stimulated in both men and women. In addition to their being sensitive to cold, nipples can also become made erect as a result of breast-feeding or sexual arousal. Both stimulate the release of the hormone oxytocin, which triggers the pilomotor reflex. In breast-feeding mothers, this can be prompted by tactile stimulation, or simply by the sight of a hungry baby. Men and women are equally susceptible to the pilomotor reflex during sexual activity, though the effect is less noticeable on smaller, male breasts.

For the rest of this article go to Slate.com

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The Argument of Assisted Suicide

Is There A Slippery Slope To Assisted Suicides?

Doesn’t look like it, according to the Royal Society of Canada, which released a report in december, showing that the euthanasia rate has remained steady in the Netherlands; in both 1990 and 2005, 1.7 percent of Dutch deaths were assisted:

An argument by Peter Singer:

The ethical basis of the panel’s argument is not so much the avoidance of unnecessary suffering in terminally ill patients, but rather the core value of individual autonomy or self-determination. “The manner of our dying,” the panel concludes, “reflects our sense of what is important just as much as do the other central decisions in our lives.” In a state that protects individual rights, therefore, deciding how to die ought to be recognized as such a right.

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Cancerous Skin Conditions

Cancerous Skin & Tissue Pathologies

Seborrheic Keratoses: Although Seborrheic Keratoses are often confused with warts, they are quite different. Seborrheic keratoses are non-cancerous growths of the outer layer of skin. There may be just one growth, or many, which occur in clusters. They are usually brown, but can vary in color from light tan to black. They vary in size from a fraction of an inch in diameter to larger than a half-dollar. A main feature of seborrheic keratoses is their waxy, “pasted-on” or “stuck-on” look. They sometimes look like a dab of warm brown candle wax that has dropped onto the skin.

Squamous Cell Carcinoma (SCC), the second most common skin cancer after basal cell carcinoma, afflicts more than 200,000 Americans each year. It arises from the epidermis and resembles the squamous cells that comprise most of the upper layers of skin. SCCs may occur on all areas of the body including the mucous membranes, but are most common in areas exposed to the sun.

Leukoplakia: These white patches or plaques on the tongue or inside of the mouth, arising in the mucous membranes, have the potential to develop into SCC. They are caused by sources of chronic irritation, including smoking or other tobacco use, and rough teeth or rough edges on dentures or fillings. Leukoplakia on the lips is mainly caused by sun damage.

Bowen’s Disease: This is generally considered to be a superficial SCC that has not yet spread. It appears as a persistent red-brown, scaly patch which may resemble psoriasis or eczema. If untreated, it may invade deeper structures.

Basal Cell Carcinoma (most common skin cancer): Basal cell carcinoma (BCC) is the most common form of skin cancer, affecting more than 800,000 Americans each year. In fact, it is the most common of all cancers. More than one out of every three new cancers are skin cancers, and the vast majority are BCCs. These cancers arise in the basal cells, which are at the bottom of the epidermis (outer skin layer).

Actinic Keratoses (AK): Actinic keratoses or solar keratoses are considered the earliest stage in in the development of skin cancer. They are small, scaly spots most commonly found on the face, ears, neck, lower arms, and back of the hands in fair-skinned individuals who have had significant sun exposure. Actinic keratoses can be treated by cryotherapy (freezing), topical chemotherapy (applying a cream or lotion), chemical peeling, dermabra- sion, laser surgery, curettage, photogynamic therapy (a chemical is applied to the skin prior to exposure to a light source), or other dermatologic surgical procedures.

Malignant Melanoma: Malignant melanoma is the most deadly of all skin cancers. Every year, an estimated 8,000 Americans will die from melanoma; it is projected that greater than 108,000 Americans will develop melanoma annually. Melanoma typically begins on the surface of the skin, where it develops when melanocytes (the cells that give skin, hair, and eyes color) are damaged, which causes these cells to grow uncontrollably.

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Skin Pathologies

Skin & Tissue Pathologies

Acne is an inflammation of sebaceous glands characterized by soreness, itching, and
pimples over the face, back, and shoulders.

Contact dermatitis is an irritation to the skin characterized by itching, burning, stinging, rash, or hot and swollen areas (poison ivy, detergent reactions, etc.).

Hives are histamine reactions characterized by large raised welts and intolerable itching. Heat rash takes place when sweat ducts have been clogged and can usually be prevented by avoiding tight clothes or clothes that don’t breathe.

Impetigo is a superficial skin infection caused by staph or strep bacteria characterized by itching and pain in affected areas, often accompanied by crusted pustules or pimples. It usually occurs around the mouth, nose, and hands.

Warts are a viral infection of the skin characterized by solitary or clustered protrusions or nodes of flesh most often found on hands, feet, or genitals. They can be spread by contact but are usually only very mildly contagious, if at all.

Boils are bacterial infections of plugged hair follicles characterized by a swollen and painful area on the skin like an overgrown pimple.

Ringworm (Tinea Corporis) is a fungal infection characterized by itching and small, scaly, ringed patches.

Jock rot (Tinea Cruris) is a fungal infection characterized by severe itching and moistness in the genital area.

Athletes foot (Tinea Pedis) is a fungal infection of the feet and hands characterized by itching, burning, cracks in the skin, scaling, and tiny blisters.

Monilia infections, or “yeast” infections, occur when a normally present yeast fungus (Monilia) gets out of balance with other local flora. It is characterized by severe itching around the vagina, anus, body folds, or crotch area.

Scabies is an itching caused by a mite called Sarcoptes scabiei, which lives in burrows it makes under the skin. It is usually acquired though physical contact with other affected people.

Lice are tiny bugs that may be seen at the bases of hair shafts and cause intense itching. There are three varieties: head lice, body lice, and pubic lice. They are transmitted by physical contact.

Conjunctivitis is a highly contagious infection of the mucus membrane of the eyelid. It may be bacterial or viral and is characterized by itching, tearing, and discharge from the eye. It is self-limiting and may last anywhere from ten to fourteen days.

Sty, a staph infection of the small glands of the eyelid, often at the eye-lash follicle.

Psoriasis is a chronic skin disease characterized by distinct, reddish, scaly, round skin elevations.

Decubitus Ulcers or bedsores are ulcerations caused by a constant deficiency of blood to tissues over a bony projection.

Herpes Simplex is a contagious viral infection on the nerve endings, characterized by small blisters on the mouth, lips, genital areas, or eyes. Affected areas may itch or be painful.

Staphylococcus (staph) is a group of bacteria that can cause a number of diseases as a result of infection of various tissues of the body. Staph can often live quietly on the skin, waiting for a lesion in which to grow.

MRSA (Methicillin Resistant Staphylococcus Aureus) is a staph bacteria. MRSA is a highly drug resistant variety of the basic staphylococcus aureus infection.

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Skin Color

What Makes Skin Color?

The epidermis is the outermost layer of the skin, which acts as the body’s major barrier against an inhospitable environment. The epidermis is avascular, (without blood) and composed for four cell types:

Keratinocytes, Melanocytes, Langerhan cells, and Merkel cell.

Keratinocytes accounts for 95%, while melanocytes make up less than 2%. The epidermis can be further subdivided into the following strata: corneum, lucidum (palms and bottoms of feet), granulosum, spinosum, & basale.

Cells are formed through mitosis at the basale layer. Every 27 days, these cells migrate towards the surface, die and harden (keratinized).

This keratinized layer of skin is responsible for keeping water in the body and keeping other harmful chemicals and pathogens out, making skin a natural barrier to infection.

Melanocytes produce a protein called melanin. In humans, melanin is the primary determinant of skin color and is also found in hair and eyes. Melanin is found in the plant, animal, and protozoa kingdoms, where it predominantly acts as a pigment. The most common form of biological melanin in the epidermis is eumelanin, a brown-black polymer.

Another common form of melanin is pheomelanin, a red-brown polymer largely respon- sible for red hair and freckles.
All humans have the same number of melanocytes, but some produce more eumelanin and pheomelanin than others.

People with dark skin and hair produce more eumelanin, whereas blondes produce very little eumelanin or pheomelanin.

Redheads produce mostly pheomelanin.

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Happy Graduation Flagstaff Fall 2011

ASIS is proud to announce the completion of another successful program!

Good luck to you all!

ASIS in Flagstaff will begin another training on February 16.

Come join us as we explore a multi-faceted perspective of health and education.

The aspiration that guides ASIS is to create a safe, supportive, and evocative learning environment, while celebrating the diversity, uniqueness, and beauty of each individual being’s body, mind, and soul.

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