Writing and Health: Part Deux

Last weeks post about writing was pretty popular, so I decided to do another post about it and some of its benefits. If you missed last weeks’ post you can click on it here:

https://pharmacybrute.wordpress.com/2015/01/21/writing-your-way-to-health/

writeThis won’t be a comprehensive overview of everything beneficial from writing. It is a fascinating thing and I do agree that writing and command of language is a skill that can only benefit everyone that is involved; writing or reading.

In many of the studies that I’ve looked at, the writing performed has been centered around self-expression and dealing with emotions and experiences rather than mundane and the everyday. I find this interesting, as mentioned in the previous post, as it focuses our brains on things that affect us very deeply, rather than external “things” that really matter very little.

One study found that blood pressure was reduced as an effect of expressive writing. [1] Another study assessed blood pressure only right after the writing, and found that it was elevated and mood was more negative. [2] This might be explained by people either reliving events, or just having stress associated with thinking about them. The interesting part is that during follow-up, people reported fewer health center visits. This might be a result of expressing the emotions and getting them out of the system, so to speak, rather than having to deal with them in a clinic setting.

In a study of women, it was found that those with chronic pelvic pain who wrote about the stressful consequences of their pain reported lower pain intensity ratings than women who only wrote about positive events. [3]

PTSD (post traumatic stress disorder) is a problem among many people, especially members of the military. During a writing period of just 2 weeks, sufferers of PTSD were asked to write about the trauma or a trivial topic. In both groups “everyone reported less severe PTSD symptoms, impact, and dissociation, and fewer health visits, but about the same suicidal ideation and depression” [4] The trauma group got worse right after writing but were better at the 6 week follow-up. The trivial group was better after and continued to be so at the follow-up.

Another study looking at “traumatic events” found that writing also helped with depression and avoidance behavior. No benefit was found in a “waiting list” group who received no instructions, and who effectively didn’t participate in the trial. [5] It is possible that people with traumatic events in their past simply need to write to receive benefit, with content not so important.

In one interesting study of prison inmates, 3 groups; traumatic writing, trivial writing, and no writing, were assessed pre and post writing assignments. No differences were found between groups with the exception of the traumatic writing and sex offenders. They were found to have decreased infirmary visits than others. [6]

I again reiterate what I said in my last post: WRITE! Write and express thoughts and feelings in a journal. Write a short story too while you’re at it. Look at a writing exercise as just that, an exercise. If that is too much stress, because it sounds like a chore, then write for fun. Exercise is always more productive when you’re having fun doing it, so is writing.

So start a writing club. Try your hand at poetry. Maybe divulge your feelings and emotions concerning things that have happened in the past. Share it with the world or keep it to yourself, but write and enjoy the benefits of learning to command your language.

CIAO

1.Davidson, K., Schwartz, A. R., Sheffield, D., et al (2002) Expressive writing and blood pressure. In The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-being (eds S. J. Lepore & J. M. Smyth), pp. 17–30. Washington, DC: American Psychological Association.

2.Pennebaker, J. W. & Beall, S. K. (1986) Confronting a traumatic event. Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274–281.

3.Norman, Sally A., et al. “For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain.” Psychosomatic Medicine 66.2 (2004): 174-183

4.Deters, Pamela B., and Lillian M. Range. “Does writing reduce posttraumatic stress disorder symptoms?.” Violence and victims 18.5 (2003): 569-580.

5.Schoutrop, Mirjam JA, et al. “Structured writing and processing major stressful events: A controlled trial.” Psychotherapy and psychosomatics 71.3 (2002): 151-157.

6.Richards, Jane M., et al. “Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates.” Journal of Abnormal Psychology 109.1 (2000): 156.

Writing Your Way to Health

Unleash your mind power with a good ol fashion pen and paper

Unleash your mind power with good ol fashion pen and paper

Writing is something that all of us have done from time to time. Maybe it hasn’t been a novel or a movie script, but even a grocery list counts as writing. Keeping a journal also counts. I’ve heard over the years that writing can be therapeutic in different ways and wanted to discuss just a few of these things today, especially since drugs aren’t always the answer and finding other avenues of treatment for the mind is useful, especially when it’s free.

In a study of college students, researchers looked at how writing would affect depressive symptoms in those students. College, after all, can be a trying time for many a student. The students were instructed to write on their “deepest thoughts and feelings on current and past emotional upheavals” (intervention) or “time management conditions” (control). [1] It was set for three consecutive 20 minute sessions, plus a booster session 5 weeks later. Depressive symptoms were measured just before the first of three session, just before the 5 week booster and 6 months later.

Students in the “feelings” group did report lower depression scores than those in the control group. The 5 week booster seemed to have no effect. It would be interesting to see if this study was repeated, but with more writing sessions instead of 4, and on a more consistent basis.

In a study with cancer patients, subjects were asked to write about their feelings and thoughts of the cancer, or neutral topics, on four different occasions. Patients writing about their feelings exhibited better physical functioning scores and seemed to improve the cancer related symptoms. [2]

In another intervention in marriages, couples who were experiencing discord and disagreements were assigned to a control or writing group. The writing group was asked 3 specific questions and they were given time to write about them. The writing wasn’t started until a year into the study. The couples who wrote had their downward spiral level off, while the couples who didn’t write, continued in decline. [3] It’s not to say that writing fixed all the problems in the relationship, but it did make an environment from which they could come together and not continue to grow apart.

Writing about it may also be an important step. And I mean actually taking out a pen or pencil and paper and writing, rather than just typing on a keyboard. In a study looking at brain scans and writing, good writers showed more activation in areas of “cognition, language, and executive functions, consistent with predictions, and also in working memory, motor planning, and timing”. [4] This may be beneficial when helping a person really use their brain in coping or figuring out emotional problems.

In another look at typing vs longhand, it was found that people who write notes tend to assimilate information and process it to write it down, whereas typers just assimilate and type the facts. In other words, writing notes longhand while learning allow people to understand concepts better than if they were to type. Actual facts are maintained about the same in both groups. [5]

I think this is some good advice in general; to write regularly and to try to write instead of type. I’ve noticed in my own writing, my style changes when I’m brainstorming or just rambling vs when I’m being direct or making a point. When I write a prescription for example, my writing is neat, organized, and very legible. When I’m taking notes in a class or a meeting, it is more sloppy and all over the place, and not just because I’m trying to be quick.

Does this mean anything? I think it is reflective of different parts of my brain being utilized when writing, I think that’s obvious. It probably goes deeper than that, but I’m no neuro-expert. What I am convinced of is that writing can be beneficial for all sorts of things, but you have to do it to get the benefit. It also appears that focusing on your thoughts and feelings, in other words, what is actually being processed by you, is far more important than just writing about what you did or what you’re going to do, say in a schedule.

Maybe this writing doesn’t have to be everyday, but regularly, whatever that is, would probably be best. Maybe that’s a journal once a week or month. Maybe writing is part of work and your sick of writing already. Sometimes a break from the things we do is part of health as well, or at least changing what we write about.

Writing blog posts regularly can sometimes be a bit boring, so I’m writing a novel on the side for fun. It has reinvigorated my love for writing and now the blog doesn’t seem like a chore as sometimes it can.

Being intentional about writing can be useful too. In the studies listed above, postive outcomes were seen when subjects were answering specific questions about what problems they were facing. So write specifically. If you don’t want to, then at least try writing.

So if any of you want to try a different approach to depression, pain, cancer, crazy children, or anything else, I give you this challenge; write about it.

I’d love to hear any experiences anyone has had with this in the comments.

CIAO

 

1.Gortner, Eva-Maria, Stephanie S. Rude, and James W. Pennebaker. “Benefits of expressive writing in lowering rumination and depressive symptoms.” Behavior therapy 37.3 (2006): 292-303.

2.Milbury, Kathrin, et al. “Randomized controlled trial of expressive writing for patients with renal cell carcinoma.” Journal of Clinical Oncology 32.7 (2014): 663-670.

3.Finkel, Eli J., et al. “A brief intervention to promote conflict reappraisal preserves marital quality over time.” Psychological science (2013): 0956797612474938.

4.Berninger, Virginia W., et al. “fMRI activation related to nature of ideas generated and differences between good and poor writers during idea generation.” BJEP Monograph Series II, Number 6-Teaching and Learning Writing. Vol. 77. No. 93. British Psychological Society, 2009. 77-93.

5.Mueller, Pam A., and Daniel M. Oppenheimer. “The Pen Is Mightier Than the Keyboard Advantages of Longhand Over Laptop Note Taking.” Psychological science (2014): 0956797614524581.

 

Does Magnesium Help Sleep?

In last week’s post we discussed some of the possible benefit of giving up electronic screens before bed to avoid blue light. Some people may even wear yellow/orange visors to filter out the blue light.

Today I want to talk about something I’ve mentioned before, and something that many people lack; magnesium.

Magnesium is a metal that is required in the body for over 300 different reactions. It is found in many different foods in various quantities and sold in you local drug stores, supermarkets and everywhere else. The substance has been used for numerous ailments, and rightly so, since it has a wide variety of uses in the body.

So does it help in sleep?

In your brain there is a neurotransmitter called GABA  which is responsible for some of the calming actions in the brain. If the brain had an “on” and “off” switch, GABA could be likened to the off. That is a very basic view of it and there is more involved to it, but for the purposes of this talk lets keep it simple. If you’re interested in some heavier reading, or if you want to read it to put you to sleep, you can go here:

http://emedicine.medscape.com/article/1188226-overview#aw2aab6b3

In the evening, in the hypothalamus, GABA is used, as well as another transmitter called galanin, to calm the brain down. It does so by inhibiting the arousal areas of the brain. It’s kind of like when you had a friend spending the night at your house and you’d get a bit loud, then your dad came and banged on the door or wall telling you to pipe down. GABA kind of does the same thing.

Here’s the thing; GABA is potentiated by magnesium [1].

People who have chronically low levels of magnesium may have problems falling asleep and staying asleep. I can’t speak to the number of people who come into the pharmacy for things like zolpidem for sleep, but I’d love to see what their magnesium levels are and if something like a supplemental magnesium would help. I do know we over prescribe sleep agents.

From a personal note, I have had better sleep with magnesium and know people to whom I’ve recommended it get better sleep as well. I know this is anecdotal, but it is strong enough evidence for me to recommend it.

In a small trial in Italy, researchers looked at supplemental magnesium with zinc and melatonin in patients living in long-term care facilities. They found that this combo helped the patients get to sleep faster and it was more restful. [2] The downside is that in this study, because they used 3 supplements together, we can’t extrapolate the benefit just to the magnesium, especially as we know that melatonin can also help people with sleep.

Magnesium can also address issues of restless leg [3], muscle cramping and twitching, and cold hands.

As a side note, here’s a list of drugs that deplete magnesium in the body:

-Birth Control Pills

-sucralfate (Carafate)

-chloroquine

-docusate

-corticosteroids (ie prednisone, dexamethasone, fluticasone)

-divalproex (Depakote)

-phenytoin (Dilantin)

-triamterene/hydrochlorothiazide (Dyazide)

-estrogens

-hydrochlorothiazide (HCTZ)

-levetiracetam (Keppra)

-digoxin

-furosemide, torsemide, bumetanide

-gabapentin (Neurontin)

-amlodipine

-raloxifene

-senna (Ex-Lax)

I’ve said this before but it bears being repeated: Don’t take magnesium oxide! Magnesium oxide just doesn’t get absorbed well. If you want to use it to induce a visit to your nearest commode, then by all means, but if you’re actually looking to get magnesium into your blood there are better options.

There are lots of forms of magnesium. Be sure to get a good one.

There are lots of forms of magnesium. Be sure to get a good one.

Magnesium comes in various forms. Here are a few and some general uses:

1. Mag Oxide: As stated above this is good for getting a great laxative effect. This was the form used in the Italian study. It would have been interesting to see if another form had been used if it would have been even more effective.

2.Mag Glycinate: This one is well absorbed because of glycinate transporters in the gut. Both magnesium and glycinate have calming effects and may make this a good candidate for muscle hypertonicity and chronic pain. It has a small laxative effect compared to others.

3.Mag Malate: This one could be used for fibromyalgia as malate is a substrate for energy production. It is also well absorbed.

4. Mag Citrate: Well absorbed and a good all around option. Can still produce some loose stool though. This is the form I take.

5.Mag Orotate: This may be good for heart health as orotates get into the cell membranes easier and may benefit in cellular repair and energy production. [4,5] This may be good for people with cardiovascular disease

6. Mag Sulfate: This one is usually injected intravenously. It is also found in Epsom Salt baths.

These are just a few and there are more but if you stick to the above listed, minus the oxide, you’ll probably be just fine. 200-400 mg/day is likely what most people would need. You’ll have to titrate the dose depending on if you have really loose stool or not. Try some a couple of times a day without food.

If anybody has had any experience with magnesium and sleep please let me know about it. I’d love to hear what has worked for you.

CIAO

 

1.  Uusi-Oukari M, Heikkila J, Lovinger DM, Luddens H, Korpi ER. Magnesium potentiation of the function of native and recombinant GABA(A) receptors. Moykkynen T, . Neuroreport. 2001 Jul 20;12(10):2175-9

2.Rondanelli, Mariangela, et al. “The Effect of Melatonin, Magnesium, and Zinc on Primary Insomnia in Long‐Term Care Facility Residents in Italy: A Double‐Blind, Placebo‐Controlled Clinical Trial.” Journal of the American Geriatrics Society 59.1 (2011): 82-90.

3.Hornyak, Magdolna, et al. “Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.” Sleep 21.5 (1998): 501-505.

4.Stepura OB, Tomaeva FE, Zvereva TV. Orotic acid as a metabolic agent. Vestn Ross Akad Med Nauk. 2002; (2): 39-41.

5.Geiss, K-R., et al. “Effects of magnesium orotate on exercise tolerance in patients with coronary heart disease.” Cardiovascular drugs and therapy 12.2 (1998): 153-156.

 

Blood Pressure Apps

Happy New Year everyone!

I hope all is well in this new year and that any resolutions that have been made are realistic and being accomplished. This year I’m writing a book. It’s to be done by Christmas. I think it will be with time to spare. My hopes are to get it published one day.  Enough about me…

I wanted to start the new year by talking about something that interests me from a professional perspective, as well as personal; Apps.

Apps are on most everyone’s phone and tablet and even on your computer, depending on the browser you use. With Microsoft recently releasing Office for free for use on Android and iOS, I find myself writing my book on my iPad just as much as my computer and laptop. Dropbox and Google Drive are indispensable as my need for a thumb drive is all but vanished. My kids play Angry Birds, any assortment of Disney games and some interesting human body apps that teach about how the body works to kids. I even like going outside on a starry night with my Starry Night app and looking at the stars, learning names, and even following the paths of satellites as they cross into my field of view. Too much screen time is problematic of course, but we’ll save that for another post.

Apps seem to be as plentiful as bad ideas about health

Apps seem to be as plentiful as bad ideas about health

Health apps have been popular too. I’ve used MyFitnessPal to track calories and workouts. I just received a FitBit from my company as a Christmas gift. It measures steps taken, sleep, etc. It syncs with my phone and I can make alarms for multiple things, track calories eaten, and even has caller id which is nice so I don’t have to fish my phone out of my pocket, I can just look on my wrist. I don’t have the model that measures pulse, but I’m thinking about springing for one, who knows?

Some docs are using medical apps in their practice, at least for things like atrial fibrillation. AlliveCor is one such app, and will only set you back $200. It can read certain rhythms in the heart and show them on your phones screen. These apps can quite read if you’re having a heart attack and can’t replace a 12 lead scan, but they seem to be gaining popularity and could be a huge help in the future for a more tech savvy generation as it ages.

One very common app, the one I want to focus on a bit more, is one that measures blood pressure. Actually there are several. One of them is called “Instant Blood Pressure — Monitor Blood Pressure Using Only Your iPhone” and you only have to shell out $3.99 for it. You apparently put your finger over the camera and it is able to read your pulse, and then you put the mic to your chest. The combination of the two can then spit out a number. Not convinced? Yeah, me neither.

There are several others, several. Many of them have very favorable ratings. The problem I run into is I can’t find any information on comparisons that have been done to cuff readings. That’s a bit problematic in any event because if the app is giving you false data, what good is it? It’s not good, that’s the only correct answer, especially since blood pressure is a crucial part of living. Too low = bad, too high = bad. Like everything else there is a happy medium.

Think of it this way. Having some nice rib eye steak is good. Not having it ever is bad. Having it every night isn’t good because you’ll get sick of it, swear it off, and then never again enjoy the wonderful creation of rib eye steak, grilled and seasoned to perfection… oh man I think I need a steak.

In other words there is a happy medium. I don’t think anyone is really unaware of this in blood pressure. The problem though is the app. The interesting thing about the above mentioned app is there is a small fine print disclaimer stating that the app is for entertainment purposes only and not FDA approved. In other words the makers are admitting that you shouldn’t use it for actual blood pressure monitoring.

If a person were to base their decision to go see a doctor or to the ER based on an app like this because their readings were “normal” when in fact they aren’t, I’d be very worried about the outcomes for that patient, especially if they have hypertension.

I’m all for technology advancing and especially for the ability of phones and other devices to advance medical care. I think if something is useful and beneficial and if it can fit in your pocket then why not? We need to be careful though because sometimes, when we get into consumer mode (which is especially easy to do on a phone of tablet), we forget to double check what it is we’re actually getting. Health is something you don’t want to take casually like buying an app.

CIAO