Overactive bladders

This posting is not really about twitchy aging bladders that can't hold their own against a simple cup of coffee without whining uncomfortably for attention, but rather about the effect those frequent signals to head for the head have on our already addled brains.

Here's how the bladder connects with brain. That 'gotta' go now' message is sent to Barrington's nucleus, the brain center in charge of bladder contraction and urination. But no simple reflex here; rather than just send back a simple command to let 'er rip or hold on a moment dear, Barrington's nucleus feels compelled to tell the locus ceruleus all about it. This is the area in our noggin in charge of arousal and attention. I guess it makes sense because someone's got get up, find the loo, and transport the bladder there to do its business.

So researchers in Pennsylvania asked a group of rats to participate in an experiment wherein their bladder outlets were surgically narrowed to mimic an obstructed or overactive bladder(1). While Barrington's nucleus showed decreasing activity in the obstructed rodents compared to a control group (which may explain why people with OAB leak without knowing it until it's too late), the obstructed group demonstrated a hyperactive locus ceruleus.

Because the locus ceruleus is connected to the cerebral cortex, an area in charge of thinking, mood, and memory, the Philadelphia investigators conjectured that this hyped up bladder thing ultimately could affect behavior in an adverse sort of way. Indeed, the poor blocked-up rats brain activity consistent with chronic hyperarousal as seen in persons feeling anxious or stressed. And when the rats with obstructed bladders slept, their brain activity showed theta waves associated with restless sleep.

Researchers concluded: "Overactive bladder as a result of partial obstruction is particularly prevalent in the elderly, a population that is also vulnerable to neurobehavioral deficits and sleep disturbances. The present findings suggest that this visceral dysfunction may contribute to neurobehavioral and sleep deficits in this population."

Of course, surgically obstructed male rats are one thing, and aging women with overactive bladders quite another, but OAB may be just another brick in the deteriorating wall of our aging brains.
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(1)Rickenbacher, E. et al. Impact of overactive bladder on the brain: Central sequelae of a visceral pathology. Proc Natl Acad Sci U S A. 2008 Jul 21. [Epub ahead of print]

Diastolic dysfunction

The diagnosis of diastolic heart failure, unfortunately, is often missed by unwary physicians.
---heartdisease.about.com/od/livingwithheartfailure/a/diastolic_HF.htm

Before I say more than a few words about diastolic dysfunction, I want to note that I am mostly not unwary. Who'd want to go to an unwary physician anyway? I will admit, however, that I was a little unwary regarding the consequences of diastolic dysfunction, but I am no longer so. Here's the scoop.

If diastolic dysfunction is a new one to you, I'm here to tell you it was not part of my original medical education. When I learned about heart function gone awry, it was all about a delivery deficiency. In other words, a failing heart is unable to squeeze out sufficient blood with each beat. As a result, tissues receive less oxygenated blood, the lungs receive less blood to oxygenate, blood backs up as it waits for its turn to pass through the stressed-out heart, and the lungs, liver, and legs fill with fluid. All this is now known as systolic heart failure or a failure of the heart to adequately eject blood during contraction aka systole. What a messy fluid build-up and lack of blood flow results from systolic heart failure after heart attacks, viral infections, rhythm disturbances, or alcohol toxicity among other things.

So several years ago, I started seeing 'diastolic dysfunction' showing up on echocardiogram results. "What on earth," I asked my friends the cardiologists, what were they seeing on ultrasound examinations of the heart that qualified as an abnormality of the relaxation phase of the heartbeat.

Whereas systolic dysfunction is a delivery problem as noted above, I learned that diastolic dysfunction is an acceptance problem. Once blood is squeezed out during systole, the heart relaxes to accept a new load of blood in preparation for its next beat. The heart muscle slackens, the mitral valve opens, and blood rushes in to the big chamber known as the ventricle. Just to get that extra kick, the top chamber known as the atria squeezes a bit more in just before the ventricle begins to contract once again. If the ventricle is stiff, however, from years of working out against high blood pressure, diastole does not go so well. The ventricle is unable to accept as much blood.

Early on in diastolic troubles, that last atrial squeeze gets the heart volume up to normal. The patient motors on oblivious to the chaos brewing in his/her overworked heart (Naw, Doc, I don't check my blood pressure. I feel fine.) Then stiff becomes stiffer in a ventricular sense, and the heart no longer fills with enough blood to meet the demands of exercise. Fluid begins to back up in the lungs when the patient tries to mow the lawn or go for a walk. The volume overload in the lungs creates pulmonary hypertension which further accelerates the diastolically failing heart thing.

What brought this all to my mind? One of my patients, younger than me, came in with swollen legs. She's a skinny lady, so her edematous ankles were particularly alarming. She has an unfortunate history of hypertension, high cholesterol, smoking, and an inability to exercise for years due to a back injury. Her echocardiogram showed that her heart was pumping okay but she had serious diastolic dysfunction and severe pulmonary hypertension. As if this was not sufficient trouble, her chest x-ray shows one side of her diaphragm is paralyzed, so we are currently looking for a possible lung cancer high in her lungs squashing her phrenic nerve.

So that is why I: 1) ask my patients not to smoke, and 2) press them to keep after their pressure.

Family and fiber: Colorectal cancer risk

I'm always recommending a screening colonoscopy to my patients 'of age,' after all, I had one, therefore, so can they. Here's the top two excuses (after 'I'm a chicken' and 'I'm embarrassed') that people give me for not undergoing this important screening test, and here's what I have to say to them:

1) No one in my family has colon cancer. While having a first degree relative (parent or sibling) with a history of colorectal cancer (CRC) increases risk 2-fold, 80% of persons who get CRC have no such family history.

2) I eat a high fiber diet. Boston doctors undertook a prospective study of nearly 89,000 women ages 34-59 in 1980.(1) They found no association between dietary fiber intake and the risk of CRC during 16 years of follow-up.

One might raise the question, as did Dr. Neil Raven(2), as to what really constitutes a high fiber diet. He responded to the above study in a letter to the editor wondering if the flaw in the study's design might not be that Boston women who say they eat high fiber aren't really as fiber-filled as they think. He cited information from Dr. Denis Burkitt, a physician who spent time in West Africa studying lifestyle and disease. Per Dr. Raven:

Burkitt began his lecture with a slide showing a stool of a typical Western, "civilized" person, a sausage-shaped thing, familiar to most of us, in a toilet bowl. His next slide was of a stool of a typical rural West African, which looked like a flat cow pie. Burkitt postulated that the West African's stool moved more quickly through the colon, giving carcinogens contained on its surface less time to be in contact with the mucosa — thus less time to induce carcinogenesis.

During the question-and-answer period, many questions from the audience concerned how one determined whether or not a diet was high in fiber in the sense Burkitt meant. Burkitt shook his head at all the salads, cereals, and breads offered as sources of fiber. He showed a slide of the staple cereal eaten by West Africans, which looked, in its wooden bowl, not too different from the stool that came out the other end. The only thing the study by Fuchs et al. proves is what anyone who heard Burkitt's lecture already knew: the American public has been sold a sugar-coated misconception.
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(1)Fuchs, CS et al. Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women. NEJM Volume 340:169-176 January 21, 1999 Number 3.

(2)Raven, ND. Dietary Fiber and Colorectal Cancer. NEJM Volume 340:1924-1926 June 17, 1999 Number 24.

"The middle of my foot hurts"

My old arch is falling down (click on image; watch it throb!)

"Have you ever heard of Liz Franks?" the octagnenarian asked me, waving her foot in the air.

"Yeah," I said slowly, "I've heard of it [her?!?]. My voice screamed 'haven't a clue,' but my patient proceeded with her story.

"The middle of my foot hurts sometimes when I walk. The PA at my podiatrist's office says it's a Lisfranc injury and it has something to do with a separation in the bones of the feet. He told me that's why my foot hurts and the top of it swells."

Ah, yes, Lisfranc's as in Lisfranc's fractures. And now I had the entire Lisfranc's file open in my brain and the sum total of its contents revealed in those three words.

I looked it up later on the Internet, and learned that Doc Lisfranc was a field surgeon in Napolean's army, and the joints named after him are in the midfoot where the long bones or metatarsals below the first and second toes meet the various bones under the ankle. Wang, whoever he is, has seriously injured his and won't be playing for the Yankees for awhile. On average, Lisfranc's injuries occur abruptly and dramatically in athletes or in those who've fallen from great heights or been injured in car accidents. Lisfranc joints can be subtly sprained in athletic endeavors.

In no case, per my search, do Lisfranc dislocations or fractures occur in little old ladies who now and again get pain whilst walking. Pain in the midfoot of the aged is either midfoot impingement syndrome or degenerative arthritis of the middle of the foot including, perhaps, the Lisfranc joints.

The midfoot is the highest point of the arch. As we age--and by we, I definitely include me--the arch sags or just plain goes to ground causing the bone ends to crash into each other in a painful, unsupported sort of way. As a result, with each weight-bearing step the bone ends grind together. This daily grind, over time, wears down the joints causing degenerative or osteo- arthritis.

While merely impinging on one another's space, this bone on bone action causes episodic pain with weight-bearing activities. Once arthritic, the pain is more consistent, and the entire top of the foot can be painful and swollen. As with all archless conditions, standing in bare feet aggravates the pain; I advise all my flatfoots--including myself--to immediately slip their aging feet into arch-supported clogs or sandals on rising in the morning. Good Feet has a lightweight orthotic perfect for wearing with open-toed shoes.

And, as you may know, I am also a great fan of YogaToes, the plastic toe separators, which pull the toes and their metatarsal bones out of each other's face and space.

Enduring love or just never letting go?

When it is our time to grieve, we must live each day as it comes,
dealing with both the mundane routine of living and our inner struggle.
Grieving and living through the entire experience of bereavement will
change us, and if we do it well, the change will be for the better. We
know we are becoming whole when we can look to the future with some
readiness to engage once more.
--Carolyn Jaffe "All Kinds of Love: Experiencing Hospice"

Grief, of course, has been a part of my life and thoughts this past year, both during the final months of my mother's life and the time since she died in late March. I have been surprised at the ease with which I've made this transition since her death, realizing though that she and I had ample time to say good-bye and knowing that she was ready to exit when she did. Interesting research from UCLA(1) suggests that those who experience what is termed 'complicated grief'--defined as feelings of loss that are so overwhelming that the person is debilitated and unable to resume normal life--have characteristic patterns of brain function underlying this show-stopping state of mind.

Psychologists there studied a group of women who'd experienced the loss of a mother or sister in the previous five years. The subjects were classified as either complicated or noncomplicated grievers. Using functional MRI imaging (fMRI), a technique that can identify which parts of the brain are actively at work, the researchers found that all the women lit up their pain centers when they viewed either pictures of their loved ones or words related to loss. Neutral words or pictures of strangers did not elicit this response.

They were surprised, however, to discover that those women suffering from ongoing complicated grief also activated the nucleus accumbens area of the brain. This region is the neurological command center for experiences of pleasure and reward. While it is unclear why this occurred, lead researcher Dr. Mary-Frances O'Connor theorized that intense attachment in complicated grief activates reward centers in ways similar to that experienced by contact with the loved one before death occurred. Those with fMRIs lit up in reward centers all reported 'yearning' but there was no correlation with the time that had passed since the death.
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O'Connor, MF, Craving love? Enduring grief activates brain's reward center. Neuroimage 2008 May 10. [Epub ahead of print]

Just ashed my Mom...

and she knew that this was a great final resting place. She started life in Leadville, Colorado, and arrived back there on June 21, 2008, her 88th birthday!

Aromatase inhibitors and body aches

Many breast cancers behave enough like normal breast tissue that they are stimulated to grow in the presence of estrogen. While premenopausal women produce most of their circulating estrogen in their ovaries, the postmenopausal set converts androgens (male hormones) from their adrenal glands into estrogen via the aromatase enzyme.

For that reason, the risk of recurrence of estrogen receptor positive breast cancers can be reduced by either blocking cellular estrogen receptors with tamoxifen or preventing the production of estrogen with aromatase inhibitors. In fact, use of drugs such as exemestane (Aromasin) or letrozole (Femara) over 5 years has been shown to improve disease-free survival compared with 5 years of tamoxifen therapy.

Unfortunately, some women do not tolerate therapy with aromatase inhibitors due to joint pain. This discomfort may be due to the effects of lack of estrogen on tissues of the musculoskeletal system similar to the body aches experienced by some women as they enter menopause. Here's an excerpt from a March, 2008 issue of JAMA as one woman describes her experience with Aromasin:

As planned, I switched to taking exemestane [from tamoxifen]. But while taking it, I was feeling like I was a hundred years old. When I got up in the morning and opened my hands, all my joints would be sore and my arms hurt. All of my joints felt creaky. I started thinking, why should I stay on the exemestane for another 2 1/2 years? Why am I doing this to myself? So I called my doctor and asked him to switch me back to tamoxifen.

Of frogs, princes, shoes, and feet

One of my favorite books whilst growing up was an illustrated version of Grimms' Fairy Tales. Contrary to popular belief, the princess in the tale of The Frog Prince was so sickened by the attentions of the slimy frog that she "...picked [him] up with her finger and thumb, carried him upstairs, and put him in a corner." When he came creeping up requesting a spot beside her in bed, "she felt beside herself with rage and, picking him up, she threw him with all her strength against the wall, crying 'Now will you be quiet, you horrid frog?'"

So what's this got to do with horrid feet? I've been vainly attempting to replace my broken down not-so-New-Balance exercise shoes. Alas, New Balance no longer makes that model, so I must've tried on a dozen pairs of other NB styles at DSW's Denver store. Thank heavens the help pays you no mind there, because I was close to heaving a shoe or a salespunk, which one mattered not, at the wall. I left with sturdy Easy Spirit slip-ons, but no go-fast shoes.

Today, I scored by stepping out of the NB box into Balance shoes (that's Balance with a backwards B that looks like d that rhymes with c that stands for made-in-China comfort). Danced my heart out at Jazzercise an hour later with no pain at all.

The moral of my story is don't settle for sore feet. Try rolfing, neurokinetics, orthotics, Yoga Toes, orthopedists, and kiss as many shoes as you need to so that your feet can carry your heart, brain, bones, and muscles intact to the finish line.

Lipotoxicity

It starts with ectopic lipid deposition. Don't you just hate that--looking for fat in all the wrong places...and finding it? But we're not talking thighs, waists, and back ends here, but rather heart, muscles, liver, and pancreas.

Researchers theorize that our overconsumption of lipid-rich foods results in oversecretion of insulin. As a result, our livers produce too much sterol response element binding protein 1c (you might know it as SREBP-1c) which results in that organ gearing up to take those extra calories and turn them into fat molecules called triglycerides. Great gobs of these calorie-dense triglycerides then float through the bloodstream on their way to some storage depot where they will sit waiting for the coming famine that never comes. It's merely annoying to wear the extra fat in rolls about your waist, but it's downright toxic to stow them in your heart, muscles, liver, and pancreas.

Ectopic fat, i.e. triglycerides stored in all the wrong places, results in a world of metabolic trouble with a capital T that rhymes with D that stands for diabetes. Once in muscle cells, the fatty acids cause the muscle tissue (our biggest bodily consumer of sugar) to resist the actions of insulin, thus preventing the uptake of sugar out of the bloodstream and into these cells.

Fat stowed in pancreatic cells further amplifies this metabolic mess by killing off the very cells that make insulin. When the human body goes one Big Mac over the line, therefore, we not only eat fat but our liver makes more fat, our muscles become insulin resistant, and our pancreas are rendered less able to make more insulin.

Too much fat in, too much fat made, too much fat stowed in the wrong places. The lipotoxic effects of overeating, the lipocentric theory of diabetes. Two lessons: 1) Don't ignore the high triglyceride levels on lab panels--they're a huge red flag that you're on the way to diabetes, and 2) Don't discount the enormous value of any weight loss, even a little, with respect to preventing and treating diabetes.

Young@Heart

Want to smile and feel good about growing older? This movie is about remarkable old people in a singing group. Remarkable not because they've aged without physical ailments but rather because they've aged with spirit and humor despite their infirmities. The documentary follows them through the initial rehearsals to their sold-out performance with interim stops for a show at a local prison, and several trips to hospitals.

I need to find a singing voice and a fifty-something musical director in 20 or so years so I too can be young@heart.

Sleep apnea and memory problems

You snooze, you lose. Neurons, that is, in charge of memory function, lost when you go apneic (quit breathing) while sleeping. Check out the details at Menopause moments.

Highways, blood vessels, and indoor air

A lot of research suggests that particles from outdoor air affect vascular function, especially at high doses. We wanted to see whether the concentration of airborne particles in a regular, normal home would be sufficient to cause similar effects, so we removed them, and indeed we found they had [adverse] effects.
---Dr. Steffen Loft, University of Aarhus, Denmark

The air here in central Denver hangs heavy in the winter and is downright visible in the summer. If ever I deluded myself in thinking that staying indoors protected me and mine from the crap in our air, Dr. Loft has proven otherwise.

Loft and company studied a delegation of Danes living near heavily trafficked roads(1). These old folks, ages 60 to 75, spent four consecutive days in their homes-- two breathing high-efficiency particle-air (HEPA) filtered air and two without. The filter removed 60% of the resident schmutz in their air and improved their flow-mediated dilation (FMD or FMV) by more than 8%. FMD is an indirect measure of the healthy function of blood vessels.

Is 8% a significant boost to vascular function? Again, per Dr. Loft: "...I believe people with overt, severe cardiovascular disease have a reduction in microvascular function in the region of 30% to 40%. I think this improvement is something like what you might expect from a well-working drug."
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(1)Brauner EV, et al. Indoor particles affect vascular function in the aged. An air filtration-based intervention study. Am J Respir Crit Care Med 2008. 177:419-425.

Yoga Toes vs. a Trip to the Orthopedist

They both cost me roughly the same--about $45. The former got me two clear plastic toe separators with a lifetime guarantee against breakage. The latter got me 5 minutes of his time, plus assurances that 1) my flatfeet were the source of my pain (I knew that) and 2) my posterior tendon was not hopelessly and permanently stretched (I didn't know that, but hoped it was true).

Here's my conclusion after one month of Yoga Toe workouts (stick your toes into the Yoga Toes, lie down, watch TV). Spend your money on them and skip the copay for the overpriced specialist. Compare and contrast:

December, 2007, I walk 5 blocks to an antique/thrift store on Colfax Avenue. My feet hurt so much that I wonder if I'll be able to make it home. No cell phone along on my retail adventure, so no choice but to hobble home.

May, 2008, I visit the Black Hills of South Dakota and scramble up a steep slope for 25 minutes to take in the breathtaking view (and try as I might, I can't make the guys there on Mt. Rushmore come through). I skid down (on feet not back end) and walk briskly back down the path to the car. No pain at all.

Lovaza

"And I'll need a script for Lovaza..."

Dang, one of those humbling moments. What on earth is Lovaza? Should I just ask or should I excuse myself for a moment on the pretext that I need a new prescription pad, then look it up quickly in the PDR? Well, by hook or by book, I found out what it was.

Lovaza is Omacor. Omacor, by any name, is a high potency omega-3 fatty acid supplement, but that particular name was entirely too similar to Amicar, a drug used to prevent or treat serious bleeding in hemophiliacs. Not that anyone would have trouble reading my writing, but if they should, that's a heckuva mistake to make.

I always ask my patients about the supplements they take during their annual exams. As a result, I know that most everyone is on to the fish oil fad instead of the previously top popular vites C & E. Research suggests that use of these oils can prevent sudden cardiac death(1), decrease risk of Alzheimer's disease(2), improve the mood(3), and lower triglycerides.

So why pay for fancy prescription strength Lovaza when you could do a 3 for 1 deal at Puritan.com(current sale price)? The two products have similar EPA and DHA content--one capsule of either the OTC or rx variety has roughly 1,000 mg of these worthy fatty acids which is the recommended dose for persons already diagnosed with coronary artery disease. Patients with elevated triglycerides (blood fats) should consider a daily dose of 4,000 mg.
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(1)Is it death or tuna casserole deficiency?
(2)Be the right sort of fat head
(3)Fishing for a good mood

Cough CPR

If you're like me, you've received multiple copies of the e-mail that sings the praises of coughing your way out of cardiac arrest. The method remains controversial and has earned itself a place on "urban legend" web-sites. A Polish cardiologist, however, continues to investigate the method and would like to pull it out of the mythic category into everyday practice.

Sudden cardiac death caused by rhythm abnormalities of the heart which cut off circulation to the heart and brain takes out 300,000 Americans each year. Dr. Tadeusz Petelenz notes that patients have a 20-30 second prodromal period prior to pitching marked by dizziness, shortness of breath, nausea, sweating, and weakness. If properly trained, a quick thinking cardiac patient can launch into cough CPR, maintaining consciousness long enough to call for help.

Animal studies support the physiology behind this maneuver. Forceful rhythmic coughing causes an upswing in pressure through the chest cavity. With each cough, blood is squeezed out of the lungs, back through the heart, and into blood vessels serving important organs such as the brain. With each deep inspiration between coughs, blood zips back through the right heart chamber and into the lungs and the coronary circulation.

Over 100 of Dr. Petelenz's at-risk patients were taught cough CPR and successfully hacked their way out of nearly 300 prodromal events. They required medical assistance through 73 events during which they were unable to cough up their blood pressure. Doubtful colleagues at the Annual Congress of the European Society of Cardiology objected that there was no coughless control group, but who would want to be assigned to that bunch of deadbeats now that Dr. P. has fair evidence that it works? If I were a patient at high risk for sudden cardiac death, I'd rather cough than wait to see if this prodrome was the big one.

Carotid bruits

We're always looking for an easy-to-use, 'crystal ball' of a test that will predict cardiovascular risk. Since we can't actually visualize the blood vessel walls, we use 'surrogate markers' that are more or less associated with unwanted future outcomes like stroke and heart attack.

The carotid arteries are well-placed for easy access as they head upwards through the neck on either side of trachea. Not only does atherosclerotic narrowing in these essential vessels increase risk for embolic stroke (where little bits of clot and cholesterol guck break off from the walls and block the blood supply to parts of the brain), the health of these vessels is a good predictor of overall vascular health.

Thickening of the carotid walls known as intimal-medial thickness or IMT is a known risk factor for heart attack and stroke. Although this can be measured without actually needling these big old arteries, and thank heavens for that, carotid ultrasound technology is not readily available in the average PCP's office. Advancing age, LDL-cholesterol levels, and diastolic blood pressure(1) are good current predictors of IMT thickening(2). These measurements can be used then as surrogate markers raising suspicion that a person rating high in all three areas might well have carotid artery disease.

The latest issue of The Lancet confirms that another test easily performed on aging persons during their annual physical provides additional cardiovascular risk assessment. Around the age of 50 or so, I begin to feel for normal pulsation in the carotid arteries (but not both at once as bilateral pressure on these vessels can induce fainting!) as well as listen with my stethoscope for the unwanted, rhythmic whish of a carotid bruit that occurs as the heart contracts and sends a surge of blood through narrowed old carotids.

Doctors from Walter Reed Medical Center analyzed data from thousands of carotid arteries and their attached humans with respect to risk of heart attack with or without death in follow-up. Those whose carotids hummed at outset were twice as likely to have a heart attack in the 2-7 years that followed, and had nearly thrice the risk of cardiovascular death.

So ask your doc to check up your neck at your next physical.
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(1)Diastolic pressure is the lower reading on blood pressure measurement which measures the amount of pressure in your blood vessels as your heart relaxes in preparation for the next beat. The upper or systolic number is the pressure generated as the heart contracts. Diastolic hypertension is also a known risk factor for abnormal thickening of the heart wall.
(2)Davis, PH, et al. Carotid Intimal-Medial Thickness Is Related to Cardiovascular Risk Factors Measured From Childhood Through Middle Age. Circulation. 2001;104:2815-2819.
(3)Pickett, CA, et al. Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. The Lancet. 2008; 371:1587-1594.

Methylfolate and depression

...or how to B undepressed.

Folate is a B vitamin that occurs naturally in green leafy vegetables. It plays a host of important roles in the human body, and is so essential to the proper construction of the nervous system of a developing human that the FDA mandated in 1996 that its synthetic form--folic acid--be added to breads, flours, and other grain foods.

The trouble with folic acid supplementation or even naturally occurring dihydrofolate from food sources is that the body must convert them into the active form which is L-methylfolate (known as MTHF--yes, I thought of that word too the first time I read it). Some people are better MTHF producers than others. For purposes of our discussion, we will focus on the effects of MTHF deficiency and the fully developed brain.

The brain is tightly guarded by the 'blood-brain barrier.' Certain molecules can't pass through the blood vessel walls into brain tissue, and folate is one of them. MTHF, on the other hand, slips right in, and a right good thing it does because it is an important co-factor in producing the three most important neurotransmitters involved in mood regulation. If you're low on MTHF, studies suggest that you may subsequently run low on dopamine, norepinephrine, and serotonin. We're talking transmitters with a capital T that rhymes with D that stands for depression.

A host of research shows that supplementing methylfolate--thus skipping the necessary internal steps to activate folic acid--improves depression under a host of circumstances. This being an older person's health blog, let me illustrate with one study which supplied sad, old people with MTHF.

Researchers coaxed 20 elderly people who were not only Italian but also depressed to take 50 mg daily of MTHF rather than antidepressants. Four said the Italian equivalent of 'what's the use' and quit. The remaining subjects showed significant improvement in their depressive symptoms.

But you don't have to be old to enjoy the potential mood elevation of MTHF. A product called Deplin is now available by prescription and specifically indicated for use in patients having a less than stellar response to antidepressants. Theoretically, it might also be useful for persons with mild mood disorders not on other medications.

The basic science literature supporting the theory that MTHF improves brain function is large, but clinical research, except for the random Italian or so, is sketchy. Thus Deplin has been designated a 'medical food' which apparently does not have the stringent proof requirements of prescription drugs. Nevertheless, no adverse effects of MTHF supplementation have occurred, and a downloadable coupon at deplin.com makes this an affordable gamble of a therapy.

Menopause moments

Milk in the cupboard, cornflakes in the 'frig. Women of 'a certain age' find these moments infinitely amusing...and definitely scary. Are we overwhelmed, inattentive, out of estrogen, or slipping down the road to dementia?

I invite you to check out my newish blog Menopause Moments. Share a momentary brain lapse that made you laugh, then read the latest research about what constitutes a menopause moment (aka senior moment), and what you can do to assure that yours will never become a permanent state of mind.

Unipedal standing

Less scholarly, perhaps, to just call it standing on one foot. Unipedal or onefooted, these Japanese orthopedists wondered if a daily balancing act might make old people less prone to pitch to earth and break their hips(1).

During their six month study, they divvied a pack of old folks at high risk of falling into two groups. The test subjects stood on one foot, then the other, one minute per side for three sessions each day. The other group just stood their ground in the usual manner.

Dr. Sakamoto previously calculated the load-bearing effects of stork-like posturing on the femoral head(2) or that part of the hip bone connected to the pelvic bone. This area is susceptible to loss of bone density and fracture when an old person goes to ground. He concluded that unipedal standing placed a load equivalent to 2.75 times the body weight on the involved femoral head, and one minute of time spent doing so was the equivalent of 53 minutes of walking with respect to benefits to bone density.

Let's see, one minute per side x 3 sessions per day equals six minutes of balancing acts vs. 318 minutes of walking. Well, how would you rather spend your discretionary time?

Alas, either six months is not long enough to determine the benefits of unipedal standing on old Japanese fogies, or you can't fool Mother Nature. At the end, there was a sort of significant decrease in falls in the test group compared to controls, and only one hip fracture in both groups.

I don't know whether I'm going to do this or not. Maybe if I could wear my Yoga Toes while balancing and thus do all my weird self-trials at once.
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(1)Sakamoto, K et al. Effects of unipedal standing balance exercise on the prevention of falls and hip fracture among clinically defined high-risk elderly individuals: a randomized controlled trial. J Orthop Sci. 2006 Oct;11(5):467-72.
(2)Sakamoto, K. Effects of unipedal standing balance exercise on the prevention of falls and hip fracture. Clin Calcium. 2006 Dec;16(12):2027-32.

Thanks to Jacob Schor, ND and his always excellent newsletter for calling my attention to these articles. You can subscribe at denvernaturopathic.com.

Stowed St. Francis in snow

Mom's St. Francis statue in his new home in Colorado Springs. Looks right at home, doesn't he? That snow is right here, right now, in not-so-sunny Colorado.

Photo courtesy of Tobi.