Issues of the Mind Articles #2

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Issues of the Mind

Pregnancy Depression Fueled by Social Conflict
In the July 2007 issue of the journal, Obstetrics and Gynecology (2007, 110: 134-140), Dr. Claire Westdahl of Emory University's School of Medicine reports that low social support and high social conflict contribute to prenatal depression in pregnant women. Dr. Westdahl and colleagues conducted a prospective study involving structured interviews of 1,047 low-income, minority pregnant women from early pregnancy to one year after giving birth and report that the subjects reported high levels of social support and moderate levels of social conflict with 33% reporting depressive symptoms with social conflict being the stronger predictor. Dr. Westdahl partly concludes by writing, "…we have learned from this research that social conflict predicts prenatal depression more than lack of social support and that social support doesn't protect pregnant women from prenatal depression."

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Cinnamon Extract and Type 2 Diabetes
In the May 2007 issue of the journal, Pharmacotherapy (2007, 27: 595-599), Dr. David Pham from the Kings County Hospital in Brooklyn, New York, along with his colleagues at other centers from around the country, conducted a meta-analysis and report that two prospective randomized, double-blind, placebo-controlled studies involving a total of 164 Type-2 diabetic patients showed moderate improvements in lowering blood glucose levels with the administering of cinnamon supplements which was over-all well tolerated (although one trial in one of the studies showed no difference between cinnamon and placebo). Dr. Pham and his colleagues partly conclude by writing, "These data suggest that cinnamon has a possible modest effect in lowering plasma glucose levels in patients with poorly controlled type 2 diabetes. However, clinicians are strongly urged to refrain from recommending cinnamon supplementation in place of the proven standard of care, which includes lifestyle modifications, oral antidiabetic agents, and insulin therapy."

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First Drug Treatment for Fibromyalgia Approved by FDA
On June 22, 2007, the United States Food and Drug Administration approved the drug Lyrica (pregabalin) [already used for seizures, shingles-related rash and diabetic neuropathy] in doses of 300 to 450 milligrams per day, for use in the treatment of fibromyalgia. This is the first drug approved for this condition and it has been shown to reduce pain and improved daily functioning in fibromyalgia patients. The approval was based on two randomized double-blind studies involving 1,800 fibromyalgia patients. Side effects include: dizziness, sleepiness, weight gain, dry mouth, hand/feet swelling, and problems with concentrations. Dr. Steven Galson of the FDA in a statement said, "Today's new approval marks an important advance, and provides a reason for optimism for the many patients who will receive pain relief" with this drug." The drug's maker, Pfizer, released a statement quoting Dr. Don Golenberg, co-chair of the American Pain Society's fibromyalgia guideline panel as saying, "Having a medication approved for use in fibromyalgia, along with research advances, will go a long way to improving our understanding and treatment of this common disorder."

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Families Often Find Hospice Is Too Late To Help
In the June 21, 2007 on-line version of the Journal of Pain and Symptom Management, Dr. Joan Teno and colleagues from Brown University in Providence, Rhode Island found that after surveying 106,514 bereaved family members of hospice patients served by 631 hospice programs, 11 percent said their family member/relative received hospice referrals, and care, too late as well as reporting that their family members received inadequate pain control while continuing to have difficulty breathing and emotionally coping with end of life issues. Among the 11 percent who thought that the physician referral to hospice was too late, 19 percent cited lack of emotional support, and 41 percent cited being uninformed as to what to expect, as the most common unmet family needs. Dr. Teno partly concludes by writing, "Ultimately," she said, "we need to educate the public about the benefits of early hospice referral so they can get the full benefit of hospice services and not just an intense intervention in the last days of life."

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The Healing Heart-A Review of Psychological Treatments for Cardiac Patients
In a recent edition of the European Heart Journal (20078; 28 (24): 2972-2984), Dr. Wolfgang Linden and colleagues from the University of British Columbia Department of Psychology report that in a review of 43 randomized trials of the effectiveness of psychological treatment for cardiac patients, they found that treatment beginning at least two months after a cardiac event showed greater mortality benefits then treatments right after the event and that decreased death rates occurred even though patients still reported experiencing negative affect. Dr. Linden partially concludes by writing, "Mortality benefits due to PT (psychological treatment) were achieved despite small concomitant changes in negative affect. PT of cardiac patients reduces mortality and event recurrence…The timing for the initiation of PT may be a critical mediating variable for mortality outcomes."

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Folic Acid and Women of Childbearing Age
In the March 14th, 2008 issue of Morbidity and Mortality Weekly Report (MMWR. 2008; 57(1):5-8), Dr. J.R. Petrini of the March of Dimes Foundation reports that despite the 1992 U.S. Public Health Service recommendation that women of childbearing age should consume a minimum of 400 ug of folic acid daily to reduce the risk in pregnancy of neural tube defects, anencephaly or spina bifida, that 18-24 year old women--who make up 61% of all child-bearing aged women--were the least knowledgeable regarding folic acid consumption and had the lowest reported daily use of the supplement. Dr. Petrini partially concludes by writing, "...Because women in this age group account for nearly one third of all births in the United States, promotion of folic acid consumption should be targeted to this population."

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The Hard Sell of Preventative Medicine
In the January 2008 issue of the journal, Family Practice Medicine (Fam Pract Manag., 2008;15(1):22-24), Dr.Linwood Watson, a family practice physician in North Carolina writes that due to many physicians shying away from emphasizing prevention with their patients (e.g., inquiring about a flu shot, pap smear, or tetanus shot), he recommends using the following strategies to "sell" the patient on the benefits of preventive medicine. For example, stressing the extra benefit of a diabetic patient getting their preventative flu shot in light of their elevated sugar levels or problematic cardiac functioning which could make fighting off an infection difficult. Dr. Watson also suggests that the physician know their patient and tailor making a pitch for prevention to the patient's family, age or cultural demographic needs. "Knowing your product," and being "passionate" about preventative medicine, followed by honing "your delivery," are the remaining steps that Dr. Watson recommends for getting the patients to adopt and implement preventative medical interventions whether that be flu shots, pap smears, diet, or healthy eating. Dr. Watson partially concludes by writing, "Try these strategies for yourself, and you may wind up selling your patients on preventive measures that could significantly improve their health and well-being."

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Pregnancy Nutritional Counseling for Vegetarian Moms
In the March 2008 issue of the Journal of Midwifery and Women's Health (J Midwifery Womens Health. 2008;53(1):37-44), Debra Penney, Certified Nurse Midwife at the University of Utah writes that vegetarian diets are frequently made up of plant based foods in addition to variations that may include eggs, grains, legumes, seeds, fruits and nuts. About 2.5% of adults in the U.S. follow a vegetarian diet and about one percent are vegan (no animal sources of food). Ms. Penney reports that demographically, vegetarians typically live in large cities, in costal areas and are female. Although the public frequently misunderstand the nutritional soundness of a vegetarian diet, Penney states that the American Dietetic Association, as well as the American College of Obstetricians and Gynecologists, state that a balanced vegetarian and vegan diet is adequate to maintain health for all stages of life including pregnancy and lactation. Penney points out that few studies exist that look at vegetarian nutrition and pregnancy outcomes. Therefore, for pregnant or lactating vegetarian mothers, Penney recommends that health professionals take a three to seven day diet history and particularly assess for vitamin B-12 (newly absorbed B-12 may cross the placenta vs. maternal tissue sources of stored B-12 which don't), vitamin D, calcium, iron, essential fatty acids, and protein—all of which are essential during pregnancy and lactation in order to meet energy demands. Specifically, low maternal serum levels of B-12 during the first trimester is an independent risk factor for neural tube defects as well as macrocytic anemia.

Vitamin D deficiency during pregnancy has been associated with neonatal hypocalcemia and issues with tooth enamel. To ensure adequate calcium intake during pregnancy, Penney writes that it is recommended that pregnant women who are vegetarians should consume 1200 to 1500 mg/day of calcium from such food choices as bok choi, broccoli, kale, okra, turnip greens and soy products.

Iron is also important and studies cited by Penney show that iron deficient related low hemoglobin in the first trimester is associated with preterm birth and fetal growth restriction.

Finally, essential fatty acids and sufficient protein intake are important as well especially for cell membrane and nervous system functioning. Penney writes that sources of essential fatty acids include flaxseed, walnuts, soybeans and mungo beans. Protein sources include tofu, nuts, legumes and eggs.

Penney partially concludes by writing, "…Pregnant and lactating vegetarians require acceptance for their choices, education, and resources to address their nutritional needs. Vegetarians may feel defensive and misunderstood because of their food choices. Establishing a trusting, nonjudgmental attitude toward the health practices and beliefs of the client will facilitate effective counseling. The use of food lists and menus for vegetarians may be helpful resources for the health care provider when discussing diet selections with the client…"

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Greater Risk of Heart Problems For Women with Poor Sleep
In the March 11th, 2008 article entitled "Poor Sleep More Dangerous for Women," posted by the online publication Science Daily based upon research conducted by Dr. Edward Suarez at Duke University found in the on-line journal, Brain, Behavior and Immunity, results of a sleep study showed that poor sleep in general is associated with greater psychological distress and elevated risk for heart disease and type 2 diabetes. However, in the Duke study it was discovered that these risk associations were found to be stronger for women than for men. Suarez and his colleagues studied 210 healthy middle-aged men and women without histories of sleep disorders and found that for women, poor sleep is strongly associated with high levels of emotional distress and greater feelings of hostility, anger and depression with concomitant higher levels of C-reactive protein, interleukin-6 and insulin—all associated with inflammation-related risks of heart disease and diabetes. Sleep onset insomnia symptoms were more associated with this elevated profile than sleep maintenance insomnia. Suarez partially concludes by writing, "Good sleep is related to good health. More research needs to be done to define gender-linked responses to poor sleep, including the role that sex hormones play over a lifetime and how sleep needs and responses change from childhood to maturity.

Dr. Larry Lachman is a Licensed Clinical Psychologist based in La Jolla, California, who is the co-author of a book on coping with cancer entitled, "Parallel Journeys." Dr. Lachman is a Psychology Instructor at Chapman University and Argosy University in San Diego. Dr. Lachman can be reached through his website located at: www.DrLarryLachman.com