About Me

Welcome to my blog! I am a medical doctor currently in the role of a health entrepreneur and a health coach/consultant. My blogs are focused on using a holistic approach towards healthcare. I believe patients are not just diseases but humans as a whole. Therefore, conventional treatments should be combined with alternative/natural therapies. My blogs focus on providing guidance to fix the cause of conditions and not just reduce the symptoms.

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Top Medical Uses of Cannabis: A Multi-directional Approach

  December 09, 2020    

 


Cannabis and Sleep: 

Various research studies on cannabis and sleep disorders have established that cannabidiol (CBD) may possess therapeutic potential for treating insomnia. Additionally, delta-9-tetrahydrocannabinol (THC) may be associated with decreased sleep latency but can cause impairment in sleep quality over long periods of time. In terms of obstructive sleep apnea (OSA), studies have suggested that synthetic or exogenous cannabinoids, such as nabilone and dronabinol, may exert temporary benefits by modulating serotonin levels in the brain that cease OSA by enhancing inspiration. CBD may hold a potential for the treatment of excessive daytime sleepiness and REM sleep behaviour disorders by reducing REM sleep duration, while nabilone may aid in reducing nightmares caused in PTSD and lead to an improved sleep in patients with chronic pain. Similarly, THC reduces the amount of time spent in REM sleep, which reduces vivid dreaming associated with PTSD. The theory behind these statements is that the lesser time spent dreaming, the more restorative, restful and deep sleep is possible. However, a word of caution is that REM sleep is very important for the proper cognitive and immune functioning, and cannabinoids that reduce this stage of sleep can impair memory and weaken immunity. 

Cannabis and Stress and Anxiety: 

 The endocannabinoid system (ECS) is integrally expressed in the central nervous system (CNS) and is responsible for processing the feelings of anxiety, stress and fear. Recent research has highlighted possible mechanisms underlying these central roles of the ECS. The ECS acts as a regulatory buffer system that, after processing anxiety and fearful memories, decides an appropriate reaction to stressful events via generating emotional responses. The endocannabinoids, or the endogenous cannabinoids present in our bodies naturally, establish a complex network between stressful events and the associated rewards network by interconnecting the ECS, dopamine system and the hypothalamo-pituitary-adrenocortical axis of the brain, that together work to create a balance between well-being and distress. Similar to the positive effects of social networking and exercising, cannabis causes a state of relaxation and contentment, thanks to the increased concentration of cannabinoids in the system that activate oxytocin and dopamine, the “feel good” neurochemicals. In contract, withdrawal from cannabis produces the opposite effects by lowering the ECS time, enhancing the release of stress hormones and reducing dopamine levels. 

Cannabis and Cancer: 

 Patients undergoing treatment for various cancers who took the aid of cannabis have reported several associated benefits such as suppressed nausea and vomiting, increased appetite, reduced pain and decreased levels of anxiety and stress. Clinical studies do indicate that cannabis alone does not reduce these adverse effects any better than the other pharmacological medications available, however, it has a clear advantage of treating these side effects simultaneously - a trait that traditional cancer medications lack. Additionally, medications derived from certain chemicals in cannabis can also be used as adjuvant therapy with the standard medications to enhance the beneficial effects or as treatment options for those refractory cases for whom traditional medications have failed. THC in the form of dronabinol has been applied for more than a decade for treating nausea, vomiting and stimulating appetite in cancer and has been used for several years for AIDS patients as well. Other cannabinoids, or any combinations of cannabinoids, may prove to be more beneficial than THC alone. In any case, such novel pharmaceutical discoveries hold a promise to benefit people living with AIDS and debilitating forms of cancer. Currently, commercially available cannabinoids, such as dronabinol and nabilone, are approved for the treatment of cancer-related adverse effects. 

Cannabis and Autoimmune Disorders: 

Some preclinical investigations have been performed to assess the role of few cannabinoids in autoimmune diseases. CBD, in particular, has been found to be immunomodulatory, rather than immune-suppressive. The possible mechanism proposed is that CBD actually slows down the production of T-cells (a kind of immune cell), which suppresses the memory of the immune system. By such method, CBD helps cut down the likelihood of future autoimmune attacks. Additionally, CBD has been shown to upregulate the expression of genes that are involved in reducing oxidative stress, which in turn help reduce cell damage incurred by autoimmune diseases. THC is another exogenous cannabinoid that is immunosuppressive but only at high doses. In lower doses, it functions as an analgesic and anti-inflammatory. THC may help downregulate the T- cell functions, thereby decreasing the harmful and robust effects of immune cells. According to growing preclinical evidence, cannabinoids may aid in keeping the immune system in a healthy balance, protecting against cell damage caused by autoimmune attacks, reduce production of T-cells, and prevent the triggering of the immune system with little to no side effects. 

Cannabis and Seizures: 

Both THC and CBD are exogenous cannabinoids that bind to receptors in the brain and are effective in reducing pain linked with conditions like multiple sclerosis, HIV and AIDS. By attaching to such receptors, these cannabinoids prevent the signal transmission of pain. Although the exact mechanism of how CBD controls epileptic seizures is not fully understood, it appears to work on other signalling systems in the brain that control pain as well as possess neuroprotective and anti-inflammatory properties. The use of cannabinoids for the treatment of seizures is has a lot of scope and it poses an opportunity for the researchers to confirm its safety, efficacy, strength and route/method of administration. Similar to conventional anti-seizure medications, cannabis affects cognitive function (especially in children), which might cause patients to miss their doses, resulting in the return of seizures. 

 

References: 

1. Bolla, K. I., Lesage, S. R., Gamaldo, C. E., Neubauer, D. N., Funderburk, F. R., Cadet, J. L., David, P. M., Verdejo-Garcia, A., & Benbrook, A. R. (2008). Sleep disturbance in heavy marijuana users. Sleep, 31(6), 901–908. https://doi.org/10.1093/sleep/31.6.901 
2. Kesner, A. J., & Lovinger, D. M. (2020). Cannabinoids, Endocannabinoids and Sleep. Frontiers in molecular neuroscience, 13, 125. https://doi.org/10.3389/fnmol.2020.00125 
3. Botsford, S. L., Yang, S., George, T. P. (2019). Cannabis and cannabinoids in mood and anxiety disorders: Impact on illness onset and course, and assessment of therapeutic potential. Am J Addict, 29(1), 9-26. https://doi.org/10.1111/ajad.12963 
4. Mack A, Joy J. Marijuana as Medicine? The Science Beyond the Controversy. Washington (DC): National Academies Press (US); 2000. 6, MARIJUANA AND CANCER. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224387/ 
5. Katz D, Katz I, Porat-Katz BS, Shoenfeld Y. Medical cannabis: Another piece in the mosaic of autoimmunity? Clin Pharmacol Ther. 2017 Feb;101(2):230-238. doi: 10.1002/cpt.568. Epub 2016 Dec 20. PMID: 27859024. 
6. Perucca E. (2017). Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?. Journal of epilepsy research, 7(2), 61–76. https://doi.org/10.14581/jer.17012

  

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Cannabis: Its Functions and Interactions| How Does it Affect Your Body?

  December 08, 2020    

 


What is the difference between Marijuana and Hemp? 

Both Marijuana and Hemp belong to the Cannabis Sativa (L.) herbaceous plant. The terms used are based on the content of delta-9-tetrahydrocannabinol (THC) content found in each. Marijuana contains more than 0.3mg/gm of THC in the dry weight of the plant, where Hemp has less than 0.3mg/gm of THC content. While Marijuana is a schedule 1 drug, that is it has no significant medicinal value and is highly addictive, Hemp has been legalized in the states that have approved USDA programs. 

Our Endocannabinoid System: 

The endocannabinoid system (ECS) is an integral system that plays an important role in the development of the central nervous system (CNS) via a process called synaptic plasticity, whereby neurons change their interconnections based on the response to inner and environmental aspects. The ECS contains three parts: the endogenous cannabinoids, the cannabinoid receptors and the various proteins that function as enzymes for the synthesis and breakdown of these molecules. Two best studied endogenous cannabinoids are called 2-arachidonoyl glycerol (2-AG) and arachidonoyl ethanolamide (anandamide). Exogenous cannabinoids, such as THC, exert their biological effects by interacting with the cannabinoid receptors present in the CNS. Because of the common use of cannabis socially and the role of endocannabinoids in multiple biological processes, a lot of research has been done on the ECS. It regulates both physiological and cognitive processes and maintains overall health and homeostasis. The ECS is responsible for fertility, pregnancy, prenatal and postnatal development, mood, memory, appetite, sensation of pain and inflammation. Endocannabinoids play major roles in immunomodulation; they also possess anti-cancer and anti-inflammatory effects. Phytocannabinoids are cannabinoids extracted from the cannabis plant and agricultural hemp, called cannabidiol (CBD). 

Functions of THC vs. CBD: 

The exogenous cannabinoids, THC and CBD, that are extracted from the cannabis flower are originally in the form of weak acids. They undergo a chemical process called decarboxylation to finally become a more potent version of themselves. Possible medical roles of THC include neuroprotection, anti-convulsion, muscle relaxation. Whereas, CBD primarily functions as antioxidant, anti-neoplastic (anti-cancer), anti-anxiety, anti-acne. 

Drug-Drug Interactions: 

Drug interactions occur pharmacokinetically, that is by affecting the metabolism of drugs by altering their enzymes, such as the cytochrome P450 (CYP450). CYP450 is manipulated by interacting components through either induction or inhibition. Induction of CYP450, which may take a longer period of time (several days), causes reduced levels of drugs in blood as their metabolism is increased, which further reduces their effects on the body. On the other hand, the CYP450 inhibition takes little time and leads to an increase in drug concentration in the blood via slowed metabolism, which exaggerates the drug effects, resulting in adverse effects and related toxicities. All phytocannabinoids inhibit CYP40 enzymes, CBD being the strong inhibitor. 
  • Warfarin and cannabis: Cases have been reported where the International Normalized Ratio (INR) was found to be increased in patients who were previously taking warfarin due to certain heart conditions and were co-administered with cannabis. The strongest risk factor is increased bleeding/hemorrhage and therefore, patients must be warned against it. 
  • Clobazam and cannabis: Several studies have established the use of Clobazam and CBD adjuvently for the treatment of refractory epilepsy in children as they both inhibit the CYP450 enzymes. It has been found that when CBD is co-administered in such cases, the blood levels of Clobazam are increased many fold, which reduces the occurrence of epilepsy by almost 50%. 
  • Rifampicin, Ketoconazole, Omeprazole and cannabis: Ketoconazole and Omeprazole (CYP450 inhibitors) were shown to increase while Rifampicin (a CYP450 inducer) was shown to reduce THC and CBD concentrations. 
 
References:
1. Alsherbiny, M. A., & Li, C. G. (2018). Medicinal Cannabis-Potential Drug Interactions. Medicines (Basel, Switzerland), 6(1), 3. https://doi.org/10.3390/medicines6010003
2. Namdar, D., Anis, O., Poulin, P., & Koltai, H. (2020). Chronological Review and Rational and Future Prospects of Cannabis-Based Drug Development. Molecules (Basel, Switzerland), 25(20), 4821. https://doi.org/10.3390/molecules25204821 
3. Cox, E. J., Maharao, N., Patilea-Vrana, G., Unadkat, J. D., Rettie, A. E., McCune, J. S., & Paine, M. F. (2019). A marijuana-drug interaction primer: Precipitants, pharmacology, and pharmacokinetics. Pharmacology & therapeutics, 201, 25–38. https://doi.org/10.1016/j.pharmthera.2019.05.001 
4. Lu, H. C., & Mackie, K. (2016). An Introduction to the Endogenous Cannabinoid System. Biological psychiatry, 79(7), 516–525. https://doi.org/10.1016/j.biopsych.2015.07.028

  

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Inflammation: Definition, Diseases and Treatment

  November 06, 2020    


Inflammation is always thought of as a harmful effect that our body endures. However, as we will see below, inflammatory response is very essential for our survival. It means our immunity is robust and that our body is capable of fighting unwelcomed invaders.

Objectives of this article:

  • What is an inflammation?

  • Good vs. bad inflammation

  • What is an acute inflammation?

  • What is a chronic inflammation?

  • What is an autoimmune disease?

  • How can inflammation be treated or managed?

 

What is an inflammation?

Inflammation is our body's natural defense mechanism against invaders. These invaders can be germs (viruses, bacteria, fungi etc.) or any other object that our body recognizes as foreign. There are also instances when our body reacts to our own tissues, considering it foreign somehow, which is referred to as an autoimmune disease. Inflammation is triggered by our immune system , leading to five distinct signs: redness, heat, swelling pain and loss of function of the affected body part.

Good vs. Bad Inflammation:

Inflammation is generally thought to be always harmful. But that is a misconception. In fact, inflammation triggered by immune cells are vital for our survival. This type of "good inflammation" is referred to as acute inflammation. The other kind, "bad inflammation", generates harmful effects on our body that lasts for a longer term and is referred to as chronic inflammation. 
 

What is an Acute Inflammation?

Acute inflammation is the immediate short-term process (within minutes to hours) by which our immunity fights off foreign material or begins the healing procedure of tissue injury. It subsides within few days. The immune cells in this case release certain proteins and chemicals that generate the previously mentioned five signs of inflammation. Common examples: catching a cold or flu, burns/cuts/scrapes etc.

What is a Chronic Inflammation?

Chronic inflammation is the slow long-term process that lasts for months to years, depending on the level of injury and the body's ability to repair to damage. Factors that lead to the development of chronic inflammation include recurrence of acute inflammation, body's inability to clear germs for a long time, high oxidative stress causing tissue injury and autoimmune disorders. Signs and symptoms of chronic inflammation include fatigue/low energy, body pain, depression and/or anxiety, weight gain or weight loss, recurrent infections due to weak immunity caused by stress, gastrointestinal (GI) complaints like diarrhea, constipation, acid reflux. Some common chronic inflammatory conditions are obesity, diabetes, stroke, arthritis and other joint diseases, allergies etc. 

What is an Autoimmune Disease?

In an autoimmune condition, the immune system is overactivated and instead of normally fighting off the invaders, the body begins to attack its own tissues considering it foreign in response to an unknown trigger that facilitates the building of antibodies against these tissues. Common signs and symptoms associated with autoimmune diseases are fatigue/low energy, skin problems, joint pain and swelling, swollen glands, fever, GI discomfort. Some examples of autoimmune conditions include rheumatoid arthritis, systemic lupus arythematosus (SLE), Multiple Sclerosis (MS), Inflammatory Bowel Disease (IBD), Psoriasis etc.

How Can Inflammation be Treated or Managed?

  • Reduced intake of saturated and trans fats: processed and packaged foods that are high in saturated and trans fats induce inflammation, while healthy fats like olive oil and omega-3 fatty acids (in nuts and seeds, fish oil) reduce inflammation.
  • Consumption of low glycemic-index foods: these food items are digested more slowly (high in fiber) by the body that curb hunger and do not wreak havoc in insulin levels, thus minimizing the risk of obesity, diabetes, stroke and heart disease. 
  • Inclusion of fruits and vegetables: Broccoli, kale, kiwis, citrus fruits are some examples of antioxidant-rich foods that fight inflammation by reducing oxidative stress and related injury.
  • Essential micronutrients: Vitamin D, Vitamin E, Zinc, Selenium, Magnesium are strong antioxidants that have high anti-inflammatory properties.
  • Physical exercise: moderate workout of 150 minutes per weeks is associated with increasing relaxation and reducing stress and related proteins, chemicals and hormones in the body that induce inflammation.
  • Conventional medications: Metformin (Type 2 Diabetes), Glucocorticoids (chronic inflammation/autoimmune disease), non-steroidal anti-inflammatory drugs or NSAIDs (acute inflammation).

 References:
1. The Good, The Bad, The Ugly of Inflammation
2. What are Common Symptoms of Autoimmune Disease - John Hopkins
3. Pahwa, Roma, et al. “Chronic Inflammation.” SpringerReference, 10 Aug. 2020, doi:10.1007/springerreference_31974.

  

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Whipple's Disease: Symptoms, Diagnosis, Treatment | Dealing With Weight Loss and Chronic Diarrhea?

  October 28, 2020    

 

Whipple's disease is commonly thought of as a digestive issue exclusively, which is not the case. Additionally, it is so rare that it is often misdiagnosed as other more common digestive conditions. 

Objectives of this article:

  •  What is Whipple's Disease?

  •  What are the Symptoms of Whipple's Disease?

  •  How is Whipple's Disease Diagnosed?

  •  How is Whipple's Disease Treated?

  •  Other Conditions Similar to Whipple's Disease


What is Whipple's Disease?

Whipple's disease (WD) is a rare but a chronic bacterial infection caused by a bacterium called Tropheryma whipplei. It interferes with the breakdown, digestion and absorption of food and vital nutrients that pass through the gut. 
While the bacterium predominantly affects the digestive system, it is not the only site of attack. Whipple's disease has debilitating effects on other organs such as the joints, heart, lungs, brain, eyes and skin, and therefore, produces specific symptoms accordingly. 

What are the Symptoms of Whipple's Disease?

  • Joint pain: not all joint pains are arthritis! WD is easily misdiagnosed as other forms of chronic inflammatory arthritis. The medications that the patients are mistreated with results in even a more severe, life-threatening form of WD.
  • Heart: the bacterium can invade the pericardium (outer covering of the heart), myocardium (the heart muscle) as well as the valves that the blood pumps through. This results in specific murmurs, particularly aortic and mitral valve insufficiency that has been noted in 25% of the cases, roughly. 
  • Lungs: WD can invade the pleurae (outer covering) of the lungs as well as the lung tissue, which produces symptoms that can be misdiagnosed as lung cancer such as chronic cough, weight loss, difficulty breathing, pleural effusion (build-up of excess fluid between the coverings of the lungs).  
  • Brain: Although very rare, WD can exclusively affect the CNS, without causing any gastrointestinal (GI) disturbances. Often without generating significant symptoms, CNS involvement results in worse outcomes with long-term effects such as cognitive impairment and dementia, so immediate tests and treatments are mandatory. 
  • Eyes: Involvement of the eyes in WD generally occurs with GI and CNS symptoms and causes inflammation, swelling, and hemorrhage, which can lead to blurred vision or loss of vision.
  • Skin: Skin manifestations primarily result from nutritional deficiencies due to malabsorption caused by WD. Hyperpigmentation results from Vitamin B3, B12 deficiency or low cortisol. Petechiae or purpura (red spots on skin) may appear due to Vitamin C or K deficiency. Also, swelling may result from increased protein loss from the GI tract.
  • GI and associated common symptoms: severe diarrhea leading to anemia, nutrient deficiencies, abdominal pain/discomfort, low-grade fever, headache, cough, weight loss and muscle waste.

 How is Whipple's Disease Diagnosed?

Endoscopic examination of the small intestines with a tissue biopsy is the initial step in diagnosis. Endoscopy characteristically reveals swollen, red tissue with whitish appearance. Close study of the tissue under a microscope confirms the diagnosis. Other organ tissues may also be sampled relevant to the presenting signs and symptoms.  Specific test names that you may across are Polymerase Chain Reaction, or PCR (tells about the amount of bacteria present), Periodic-Acid Schiff, or PAS (stains bacteria pink for better visualization), electronic microscopy (high resolution reveals the presence of bacteria).

How is Whipple's Disease Treated?

WD was potentially fatal before the administration of antibiotics. However, at current times, it is efficiently treatable with a good prognosis. General guidelines include the following treatment regimen: IV ceftriazone or IV Penicillin for 2-4 weeks followed by trimethoprim-sulfamethoxazole for an additional year. When treated effectively, the symptoms generally resolve within 2-3 months.

Other Conditions That Mimic Whipple's Disease:

  • Celiac Disease
  • Crohn's Disease
  • Irritable Bowel Syndrome (IBS)
  • Lactose Intolerance
  • Grain Allergy 

WD may be rare but it does exist and is very commonly misdiagnosed as other very different conditions but ones that produce similar symptoms. Immunocompromised middle-aged men in locations that lack proper sanitation and fresh water are at increased risk of contracting this illness. Fortunately, better diagnostic tests and the use of antibiotics can effectively treat this potentially chronic and fatal condition.


References:
 

 Puéchal X. Whipple disease and arthritis. Curr Opin Rheumatol. 2001;13(1):74.

Bai JC, Mazure RM, Vazquez H, et al. Whipple’s disease. Clin Gastroenterol Hepatol. 2004;2(10):849-860.

Ratnaike RN. Whipple’s disease. Postgrad Med J. 2000;76(902):760-766.

Scheld WM. Whipple disease of the central nervous system. J Infect Dis. 2003;188(6):797-800.

Savaryn B, Decker M, Ye C, Bacani J, Houston S. An atypical case of Whipple’s disease presenting as fever of unknown origin: A brief review. Off J Assoc Med Microbiol Infect Dis Can. 2019;4(4):241-247.

Dolmans RAV, Boel CHE, Lacle MM, Kusters JG. Clinical Manifestations, Treatment, and Diagnosis of Tropheryma whipplei Infections. Clin Microbiol Rev. 2017;30(2):529-555.

  

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Blueberries Nutrition and Health Benefits

  October 04, 2020    

 

Photo by Joanna Kosinska on Unsplash

Blueberries are a very popular part of North American diet. One simple reason is because it tastes good. But are you aware of its nutritional facts and what the latest research indicate about this "super fruit"? 

In this article:

  • Blueberries benefits in brain health, diabetes and cardiovascular health

  • Latest trends in snacking

  • Blueberries nutrition facts

  • Ways to incorporate blueberries into daily diet


Blueberries Benefits in Brain Health:

  • Krikorian et al. 2020: Older subjects who were showing signs of memory impairment were enrolled in a study for 16 weeks where they consumed one serving of blueberries daily (1 cup). At the end of 16 weeks, significant improvement was noted in visual and spatial memory with increased memory processing speed. 
  • Miller et al. 2017: 13 healthy men and 24 healthy women between the ages of 60 and 75 were randomly selected to either receive daily supplementation of blueberries or a placebo for next 3 months. The group that received blueberry supplementation showed significant decline in making errors in their verbal memory. 

 

Blueberries Benefits in Diabetes:

  • Stull et al. 2010: The experimental group that received daily supplementation of blueberries for 6 weeks displayed significant improvement in insulin sensitivity.
  • Stote et al. 2020: Consumption of blueberries for 8 weeks resulted in significant reduction in type 2 diabetes risk factors and improvement in HbA1c levels in overweight men.

 

Blueberries Benefits in Cardiovascular Health:

  • Johnson et al. 2015: Blueberries consumption for 8 weeks lead to a 5-6% decrease in high blood pressure in post-menopausal women.
  • Curtis et al. 2019: One cup of blueberries intake daily for 6 weeks resulted in significant improvements in heart health measures in men and women with metabolic syndrome.

 

Latest Trends in Snacking:

According to a survey conducted by Information Resources Inc. & US Department of HHS, almost half of Americans consume 3+ snacks per day and one-third consume 4+ snacks per day, out of which 65-75% Americans want snack items that curb hunger, boost energy and provide nutrition. Snacking with nuts and fruits can help boost nutrition and provide additional health benefits as they increase the overall diet quality and provide essential nutrients to children.

 

Blueberries Nutrition and Benefits: Powerful Snacking Option

A handful of blueberries is roughly equal to a cup or one serving, which is equivalent to 80 calories. Four major nutrients that are packed in blueberries include: fiber (increases fullness, aids in digestion and regulates healthy cholesterol levels; 3.6g per serving), vitamin C (a strong antioxidant that improves immunity, stabilizes free radicals and prevents cellular damage, helps in collagen synthesis to support healing, increases iron absorption; 16% of daily requirement per serving), vitamin K (regulates blood clotting and metabolism; ~25% of daily requirement per serving), Manganese (aids in bone development and converts digested food into usable energy; ~25% of daily requirement per serving).

 

How to Incorporate Blueberries in Your Diet:

  • Blueberries provide complex carbohydrates in form of high dietary fiber. They are best paired with forms of proteins such as nuts, seeds, cheese, hummus, yogurt and eggs.
  • The sweetness of blueberries can be paired with savory items including various herbs, lemon, cheese, olives etc.
  • Bowls (with proteins, greens, fats and carbs) and smoothies (with greens and fruits)
  • Bento boxes: kids-friendly, well-balanced, varied nutrients in one meal.
Blueberries are one of those super fruits that are not only extremely satisfying to our taste but are equally nutritious as well. They can be easily incorporated into our diets in form of sustainable snack items. And, thanks to the versatility in their taste, they can deliciously be paired with savory items, and high-protein foods for a more nutritional balance.

 

 References:

1.Prior RL, Cao G, Martin A, et al. Antioxidant capacity as influenced by total phenolic and anthocyanin content, maturity, and variety of Vaccinium species. J Agric Food Chem. 1998;46(7):2686-2693.
 2.Joseph JA,Shukitt-Hale B, Denisova NA,et al. Reversals of age-related declines in neuronal signal transduction, cognitive, and motor behavioral deficits with blueberry, spinach, or strawberry dietary supplementation. J Neurosci. 1999;19(18):8114-8121. 
3.Krikorian R, Kalt W, McDonald JE, Shidler MD, Summer SS, Stein AL. Cognitive performance inrelation to urinary anthocyanins and their flavonoid-based products following blueberry supplementation in older adults at risk for dementia.J Funct Foods. 2020;64:103667. 
4.Miller MG, Hamilton DA, Joseph JA, Shukitt-Hale B. Dietary blueberry improves cognition among older adults in a randomized, double-blind, placebo-controlled trial.EurJ Nutr. 2017;57(3):1169-1180. 
5.Stull AJ, Cash KC, Johnson WD, Champagne CM, Cefalu WT.Bioactivesin blueberries improve insulinsensitivity in obese, insulin-resistantmen and women.JNutr.2010;140(10):1764-1768. 
6.Stote KS, Wilson MM, Hallenbeck D, et al. Effect of blueberry consumption on cardiometabolic health parameters in men with type 2 diabetes: an 8-week, double-blind, randomized, placebo-controlled trial. CurrDev Nutr. 2020;4(4):nzaa030.
 7.Johnson SA, Figueroa A, Navaei N, et al. Daily blueberry consumption improves blood pressure and arterial stiffness inpostmenopausal women with pre-and stage 1-hypertension:arandomized, double-blind, placebo-controlled clinical trial.JAcadNutrDiet. 2015;115(3):369-377. 
8.Curtis PJ,van der Velpen V, Berends L,et al. Blueberries improve biomarkers of cardiometabolic function in participants with metabolic syndrome —results from a 6-month, double-blind, randomized controlled trial.Am J Clin Nutr. 2019;109(6):1535-1545. 
9.IRI.How America eats:the state of the snacking industry. https://www.iriworldwide.com/IRI/media/Library/webinar/IRI-How-America-Eats_2019-State-of-Snack-Industry.pdf. Published April 9, 2019. 
10.US Department of Health and Human Services;US Department of Agriculture. 2015–2020Dietary Guidelines for Americans,8th Edition.https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/. Published January 7, 2016. 
11.Loth KA, Tate A, Trofholz A, Fisher JO, Neumark-Sztainer D, Berge JM.The contribution of snacking to overall diet Intake among an ethnically and racially diverse population of boys and girls. J Acad Nutr Diet. 2020;120(2):270-279. 
12.Barnes TL, French SA, Harnack LJ, Mitchell NR, Wolfson J. Snacking behaviors, diet quality, and body mass index in a community sample of working adults. J Acad Nutr Diet. 2015;115(7):1117-1123. 
13.U.S. Highbush Blueberry Council. 2019 U.S. Highbush BlueberryCouncil segmentation study. 
14.Moghaddam E, Vogt JA, Wolever TMS. The effects of fat and protein on glycemic responses in nondiabetic humans vary with waist circumference, fasting plasma insulin, and dietary fiber intake. J Nutr. 2006;136(10):2506-2511. 
15.Flavor pairings. U.S. Highbush Blueberry Council website. https://www.blueberrycouncil.org/blueberry-cooking-tips/flavor-pairings/.

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Meaning of Anxiety: A Holistic Approach

  August 09, 2020    

"Our anxiety does not come from thinking about the future, but from wanting to control it." - Kahlil Gibran

What does ANXIETY mean? From my personal experience and with those that I have met, I have learned, and accepted, that stress and anxiety is as integral to our existence as bread and butter. It is WRONG to perceive anxious people as neurotic or weak, as NONE OF US is immune from it. It is also imperative for me to point out that stress and anxiety are NOT always harmful. In fact, these feelings are very crucial for our survival. They prepare us to face the uncertainties and enhance our performance in difficult tasks. So, when does this "normal" become a "disorder"? Let's find out. 

 

Objectives of this article:

  •  What anxiety disorder means

  •  How to recognize anxiety disorders

  •  Evidence-based anxiety treatment options

 

What does anxiety mean? How do you differentiate between everyday anxiety and an anxiety disorder?

An everyday anxiety and an anxiety disorder typically vary only in their frequency and severity of symptoms that is measured by the extent to which one's life is affected. A simple question that will make it clearer: Are you able to fulfill your daily responsibilities without much difficulty? If the answer is no, it is a disorder. Anxiety is a mental state of mind where our brain perceives something as a threat. That threat then transforms into physical symptoms such as sweating, fast and shallow breathing, headaches, chest pain, dizziness, shakiness, nausea. Our sympathetic nervous system takes control and stress hormone levels rise. We naturally engage in safety-seeking, comforting behaviors; we avoid circumstances that trigger stress and anxiety, which feeds on itself and reinforces the perception of threat. Over extended periods of time, this perception leads to severe physical symptoms like chronic fatigue, loss of concentration, insomnia. (Read: What is the Relationship Between Sleep, Stress and Nutrition?)


What are some of the challenges of diagnosing anxiety disorder?

In the very first meeting with the doctor, the patient's chief complaint is the physical symptoms they are experiencing, including tiredness, headaches, abdominal issues. The initial step, therefore, is to run a thorough physical examination. While it is established that anxiety causes physical symptoms, the vice versa if often very common as well where certain medical conditions lead to the development of anxiety, like lung disease, heart disease, diabetes, obesity. The other culprit is the medications that generate anxiety-like feelings. Some popular examples are steroids, decongestants, asthma and thyroid medications, and those used for the treatment of Parkinson's disease. Finally, it is important to rule out the existence of substance abuse that can cause anxiety, like alcohol and other drugs like cocaine and LSD. The next step involves checking the mental status of the patient. Why is the patient feeling unwell? Here it is important to address their lifestyle habits such as sleep, diet, exercise, personal events. While all of the factors mentioned above present as a challenge in diagnosing anxiety, the one factor that has a huge impact is the social stigma associated with being stressed and anxious. Patients find it difficult to admit to their doctors that they are struggling with anxiety; they don't want to seem vulnerable and neurotic; they feel they will not be heard seriously - their feelings will be outright dismissed. Therefore, it is extremely important for doctors to not jump to conclusions very early - they should first empathize and connect with their patients. 


Just how disabling are anxiety disorders?

Anxiety disorders are extremely underestimated in their impact on a person's daily life. And to make the matters worse, there is a huge burden of the associated social stigma. According to research, social anxiety disorder feels worse than having a high blood pressure or diabetes. Generalized anxiety disorder feels worse than the above mentioned and asthma or any sort of heart condition. The worst is the obsessive-compulsive disorder, fairing poorer than all of the above conditions, including kidney disease. Can you imagine now how disabling anxiety is? 


Is there a relationship between anxiety and depression?

Anxiety can present with symptoms that overlap with depression. Those diagnosed with an anxiety disorder will very commonly experience at least one episode of depression. Therefore, it is important for the healthcare professional to assess the presence of both. If the patient is successfully treated with antidepressants and are taken off the medications, there is an increased risk for the anxiety component to bounce back and become worse. Therefore, discontinuing treatment should be assessed with caution.


When is it recommended to meet a psychiatrist?

Psychiatric evaluation is warranted when the patient fails to respond to the interventions of the general practitioner (GP). Usually, the normal response time is between 6-8 weeks. Some factors that can complicate patient response is the co-presence of other conditions like personality disorders, bipolar disorders or substance use. 


How can it be explained to the patient that they are dealing with an anxiety disorder?

First and foremost, show empathy. It takes 2-3 consults with the doctor before a patient is willing to accept that they are indeed dealing with anxiety. When the doctor has had meaningful conversations with the patient, and the patient has come to terms with the diagnosis, then is the correct time to provide medications and written materials for the patient to familiarize themselves with the condition. It is vital to develop a mutual understanding with the patient before the doctor refers them for a psychiatric evaluation or the chances are that those patients will never return to continue treatment. 


What are some other suggestions for the patients to handle their anxiety?

While awaiting a formal diagnosis, patients are encouraged to adapt lifestyle modifications such as eating a healthy diet, exercising, minimizing alcohol intake, keeping track of caffeine intake, practicing mindfulness with meditation and breathing exercises. They can also use external health resources to learn more about their condition, which can be further discussed with their psychologist/psychiatrist.


Why is Cognitive Behavioral Therapy (CBT) most commonly recommended and what does it include?

CBT is backed by the greatest amount of research, clinical trials and meta-analyses that have concluded that it is most superior to other models in terms of its success rate. Typical CBT includes understanding the patient as a whole by asking what triggered the anxious feelings and what strategies they are implementing to cope with these feelings, and then formulating a treatment plan that is specifically tailored to their lifestyle and goals. Does the patient understand what they are going through? How do they solve their day-to-day life problems? CBT involves reshaping the patient's reasoning and thought processes to face their fears and challenge the thinking patterns. Behavioral techniques are also implemented in the treatment where the patient is gradually and increasingly exposed to their fears over time till the associated anxiety is reduced. 


When are medications necessary and which ones are recommended?

General practice guidelines state that medications are opted for when patients are severely distressed and/or not responding to other interventions. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most widely recommended first-line treatment globally. The second-line class of medications is the Serotonin- Norepinephrine Reuptake Inhibitors (SNRIs). The initial treatment begins with SSRI monotherapy for 1-2 weeks, typically starting with half the dose of what is prescribed for depression, accounting for the fact that anxious and stressful patients are hypersensitive. For the next 4-6 weeks, medication response is monitored. If the response is positive, the same treatment continues for 6-12 months. If the response is negative, either the medication dose is adjusted or an alternate medication is started. Other classes of medications, such as beta blockers, benzodiazepines and antipsychotics, should NOT be used as first-line treatments due to their side effects (*Note: Medications are given in combination with CBT*).


What to look for if the patient is not responding to treatment:

Discuss with the patients about their lifestyle habits or any related factors that might be playing a role. Are they compliant with their medications? The medication dose can also be reviewed and adjusted. Are there any unhealthy/stressful situations at home or work? Patients can be encouraged to meet with their psychologist/psychiatrist more frequently to maintain the treatment momentum. Lastly, check in on any other medical conditions that the patient may be mismanaging and inducing anxiety as a result.

 

Some strategies to maintain mental health:

  • Regular exercise

  • Balanced, healthy diet

  • No smoking

  • Maintenance of a good sleep hygiene

  • Socialization  

 

Anxiety can be debilitating and distressing and bringing it to the attention of a healthcare professional should never be dismissed due to social stigmas. Why should you ever be in control of your thought processes? Anxiety disorders have a high recovery rate and they CAN be managed successfully. I encourage you to consult with your doctor if you feel your lifestyle is severely compromised due to certain fears or thoughts. If you are looking for more related resources that can help you combat anxiety, please leave your comment below and connect with me. 

Read: What is the Relationship Between Sleep, Stress and Nutrition?




References:

1. Andrews et al, British Journal of Psychiatry (1998); 173: 123-131.

2. RANZCP clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder 2018.

3. Craske, uptodate.com, Psychotherapy for generalised anxiety disorder 2018.

4. Australian Medicines Handbook 2018.

5. Maudsley prescribing guidelines in psychiatry, 13thedition, 2018.

  

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