Does Exercise Help Depression and Anxiety?

Running or jogging doesn't have to kill you to get benefit

Running or jogging doesn’t have to kill you to get benefit

I had an interesting conversation with a patient at the pharmacy that got me thinking about doing a post about this. This patient came a week or two ago and got a prescription for buspirone, which is used for anxiety. The patient was concerned with it because this person desperately wanted to get rid of the feeling of anxiety that they were suffering with.

The patient returned and I asked how it was going (We’ll call the patient Casey). The response was that not much had changed. Casey petitioned for more help, but this time to me, rather than the doctor.

My response?

Are you eating well? Are you doing any exercise at all?

Casey told me that neither was really in place. Casey also told me that a problem child at home was a great source of the anxiety. Casey also discussed how the previous week that he’d gone on a walk and that seemed to help a bit.

I’ve met others like Casey in the pharmacy before, and still see some of them. I’ve had people so anxious for their anxiety meds they were crying. I’ve seen people on the verge of hyperventilation. I’ve seen people, who on the surface appear normal, but after talking for a minute or two, they start divulging secrets about their lives that would make you and me stressed out too.

I used to get anxiety attacks. They would come at the most random times too. I remember once in high school in spanish class sitting at my desk, when suddenly I became hot and felt like I couldn’t breathe at all. I was more panicked about not feeling like I could breathe more than anything else. It wasn’t pleasant.

I don’t think during high school a lack of movement was my problem. I could eat anything and not gain a pound (being a male teenager has some advantages), but my diet probably was helping.

As I got older and started focusing more on my intake rather than my output, the attacks subsided. After learning about EFT (emotional freedom technique) or tapping, I was able to rid myself of the attacks all together.

Since I’ve graduated and been able to keep a more balanced routine, I haven’t had to do any tapping and the exercise is regular, rather than disjointed. Anxiety is nowhere to be seen, but I still get stressed from time to time. Between 4 kids, a wonderful wife, full-time job, blog, church duties, getting a house ready to sell, and writing a book, it’s hard to make sure I don’t go insane.

This is one reason I continue to exercise. It keeps my stress down, my happiness up, and bad things, like my wife’s recent trip where the windshield got busted, not so bad.

So What Kind of Exercise Should I Do?

In one study of depressed women [1], researchers found that aerobic running was just as good as weightlifting to reduce symptoms of depression compared to controls.

Another study showed pretty much the same thing; there was no real difference between aerobic and non-aerobic exercise in reducing depression. [2]

Another showed that aerobic exercise from 50-70% of maximal capacity was enough to decrease depression as well. [3]

One study showed that running was better than tennis which was better than softball, the latter having no effect. [4] While the findings were significant, even the authors noted that because they did nothing to conceal the reason behind the exercise, and even allowed some to choose which they were going to participate in, the results could have been different.

A study of men and women found that running helped more so with women than men, and was more influenced by the amount of physical fitness. [5]

In a study of men; exercise, meditation, and a comfy recliner all produced reductions in anxiety [6]. It should be noted that it was a quiet time in the recliner, not TV or kids time.

Another study showed similar benefits with walking/jogging at 70% maximum capacity. [7]

Of note, a study looking at relaxation training seemed to help introverts more than extroverts. [8] This really doesn’t have so much to do with exercise, but if you’re an introvert like me, relaxation may help in the anxiety department.

Swimmers seem to also derive benefit from exercise, feeling better after a swim than before. [9]

I think you get the point. Exercise is beneficial to reducing stress, anxiety and improving mood. Don’t worry if you can’t run a mile. Go for a walk. Don’t worry about not being able to do a push up, do knee push ups or on the wall. Do some squats. Take a walk with a significant other. Maybe you just need to run after the ice cream truck and give him a high-five for dispensing some of the best medication on earth (in moderation of course). Whatever it is, get moving and feel the anxiety or depression melt away.

CIAO

 

1.Doyne, Elizabeth J., et al. “Running versus weight lifting in the treatment of depression.” Journal of Consulting and Clinical Psychology 55.5 (1987): 748.

2.Martinsen, Egil W., Asle Hoffart, and Øyvind Solberg. “Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial.” Comprehensive psychiatry 30.4 (1989): 324-331.

3.Martinsen, Egil W., A. Medhus, and L. Sandvik. “Effects of aerobic exercise on depression: a controlled study.” BMJ 291.6488 (1985): 109-109.

4.Brown, Robert S., Donald E. Ramirez, and John M. Taub. “The prescription of exercise for depression.” The Physician and Sportsmedicine 6.12 (1978): 34-37.

5.Jasnoski, Mary L., David S. Holmes, and David L. Banks. “Changes in personality associated with changes in aerobic and anaerobic fitness in women and men.” Journal of psychosomatic research 32.3 (1988): 273-276.

6.Bahrke, Michael S., and William P. Morgan. “Anxiety reduction following exercise and meditation.” Cognitive therapy and research 2.4 (1978): 323-333.

7.Young, R. J. “The effect of regular exercise on cognitive functioning and personality.” British journal of sports medicine 13.3 (1979): 110-117.

8.Stoudenmire, John. “Effects of muscle relaxation training on state and trait anxiety in introverts and extraverts.” Journal of personality and social psychology 24.2 (1972): 273.

9.Berger, Bonnie G., and David R. Owen. “Mood Alteration with Swimming-Swimmers Really Do” Feel Better”.” Psychosomatic medicine 45.5 (1983): 425-433.

 

Advertisements

Do Beets Help Blood Pressure?

In one word….YES!

I could leave it at that and let the world either revel in the fact or find some way to avoid them altogether regardless of the hypertensive crushing power because of how they taste.

Seeing as this month is heart month, lets dive into why these red tubers are actually quite healthy and can play a most excellent part in a diet.

Beets may help lower your blood pressure

Beets may help lower your blood pressure

But first, the study.

Our British friends across the pond were the ones that did the study. They took 64 subjects with hypertension who either were on medications or who hadn’t yet been prescribed anything and assigned them to 2 beet juice groups; one group had nitrates in the juice (which are naturally occurring), and the other had no nitrates.

Now if the idea of drinking beet juice sounds revolting, hold on just a moment.

In the group that was receiving the nitrates in their juice, blood pressure was reduced by ~8/4 mmHg. [1] That’s on par with some blood pressure medications. Endothelial function also improved as well as arterial stiffness reduced. The article said that the treatment was well tolerated. I’m sure the only real side effect was that of red urine and stool. The dose was 250ml juice/day.

Another study done with 500ml daily found a reduction of 4-5 mmHg systolic pressure 6 hours after ingestion. [2]

Another study found that beets may increase exercise tolerance. [3]

Researchers at Wake Forest have shown increase blood flow to white matter in the anterior brain and believe that beet juice has potential to decrease the chances of poor cognition and dementia in older people. [4]

Beets are great! And they appear to have some great benefits. The only problem is you actually have to ingest them to get the benefit. So what’s a person to do?

Raw

You can eat beets raw, and there is nothing wrong with that. They are somewhat tough though, especially if they aren’t young. Slice em thin or cut them small to make them easier to masticate. Thinly sliced beets with some other veggie like celery or onion, with olive oil drizzled over and some salt or crushed garlic makes for a great appetizer.

Steamed

Roasted or steamed beets with oranges or other citrus and some crumbled cheese is a great salad

Roasted or steamed beets with oranges or other citrus and some crumbled cheese is a great salad

Steam those suckers and add a pinch of salt and pepper. Place them atop the beet greens and crumble some cheese on top.

Juiced

If you have a juicer, you can always juice them, just beware of staining. The pulp can be used in other recipes if you’re looking for some coloring or fibre. Also be aware that because you take the fibre out when you juice, you also increase the glycemic index of the food. Beets are no exception. Don’t drink 500ml of veggie and fruit juice a day and expect your triglycerides to stay low. Keep it to mostly veggies and maybe just a bit of fruit to keep the sugar level down.

Pickeled

You can do it yourself and this is probably the best method. Pickeled beets are great on salads or just straight.

Others

Add them to soups, any salad, bake them till soft and marinate them in some balsamic vinegar and salt. Borscht is also popular. Crush it up and put it in your gnocchi dough to make some red/purple gnocchi. Here’s one recipe you can try:

https://dobetter.wordpress.com/category/family-meals/beet-puree/

One word of caution. If you are a person with a history of oxalate kidney stones, be careful as to the amount of beets you actually consume. As beets have lots of oxalates, the risk for stones in this population would be increased.

Let me know how you eat your beets.

 

CIAO

 

 

1.Dietary nitrate provides sustained blood pressure lowering in hypertensive patients, Vikas Kapil, et al., Hypertension, doi:10.1161/HYPERTENSIONAHA.114.04675, published online 24 November 2014,

2.Coles, Leah T., and Peter M. Clifton. Effect of beetroot juice on lowering blood pressure in free-living, disease-free adults: a randomized, placebo-controlled trial. Diss. BioMed Central, 2012.

3.Bailey, Stephen J., et al. “Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans.” Journal of Applied Physiology 107.4 (2009): 1144-1155.

4.http://news.wfu.edu/2010/11/03/benefits-of-beet-juice/

Is Low Dose Naltrexone Helpful?

I always try to present the facts to anyone who reads this blog. I try not to stretch the truth. Maybe I haven’t been super successful in that regard, but I try to present accurate information without blowing it out of proportion. That’s what I want to do today, present some information and put it into context. For the record, I personally think naltrexone has promise for certain disease states.

Naltrexone is a drug that is specifically for narcotic overdose. It blocks receptors that normallyendongenous endorphins (and narcotics) will bind to create a sense of well being, euphoria, or analgesia (pain relief). Runners will often talk about the runner’s high they get after a good run. That’s endorphins. Mmm, endorphins (think Homer Simpson).

Homer trying to get that endorphin high

Homer trying to get that endorphin high

Naltrexone is wicked awesome, I used awesome not only as a superlative, but as in it’s crazy amazing to watch someone who should probably be dead because of no breathing from narcotic overdose, at reversing it completely. It’s bad to give the full dose all at once too because a person can go from not breathing to full withdrawal within a few seconds. It’s almost like watching someone raise the dead. ER docs will usually give it bits at a time and wait for response to avoid withdrawal.

So why use a revival agent for narcotics in something like rheumatoid arthritis or multiple sclerosis?

It has to do with what naltrexone actually does. You can think of it as an immune modulator. In autoimmune disorders like rheumatoid arthritis, the immune system is literally attacking the host body. Your immune cells are targeting you. No bueno. The only cases where we want this happening is when a cancer cell forms or a virus has infiltrated a cell.

For those that don’t want more nitty-gritty on the mechanism, you can skip this next part, but you should read it anyway and learn something new.

Naltrexone is known to bind the opiate receptors on cells. [1] This of course is how it helps prevent narcotics from doing their job, because they can’t do anything but float around aimlessly in the blood.

At a standard dose of 50mg, naltrexone causes blockade of opiates and if you were to take your Vicodin or Percocet, they wouldn’t do anything, other than the acetaminophen of course. What scientist have found is that when the dose is cut down to about 1/10 or so, blockade still occurs, but because there is little drug in the system, the body is able to clear it quickly and more endorphins are created to overcome the blockade.[2,3] In a normal dose or even a slightly higher dose, the naltrexone is present in enough quantities to stop the transient rise.

In the low dose, this rise creates the possibility of greater analgesia (pain relief) as well as immune modulation. These factors MAY increase quality of life, mood, and/or disease resilience. [4] It’s important to remember that word “may” because large trials haven’t been conducted in a placebo controlled, double-blind manner, which means we only have preliminary data to draw from.

It has been shown that naloxone can reduce inflammation cytokines (chemical messengers that incite inflammation from immune cells) in macrophages in the periphery.[5] This may help explain some of the immune modulation thought to produce effects in things like arthritis or Crohn’s disease. It should be noted that this was done with naloxone and not naltrexone. While similar, you can’t always transfer effects of one drug to another, even though while in the same class.

In the nervous system, naltrexone has been shown to affect microglia, which are immune cells. By reducing inflammatory cytokines, they may help in neurodegenerative disease brought on by inflammation. Indeed, both naloxone and naltrexone, seem to have a neuroprotective effect, at least in mice. [6]

So what about actual studies looking at disease?

Fibormylagia have you feeling fatigued? Maybe naltrexone could help.

Fibormylagia have you feeling fatigued? Maybe naltrexone could help.

In one looking at fibromyalgia, one study looked at 10 women with the disease and found that 6 out of 10 received relief to some degree over placebo, and showed that mechanical and heat thresholds were improved. [7]

In another of fibromyalgia, 30 women were treated with placebo or naltrexone and there was a significant reduction in pain for the naltrexone group over the placebo group. [8]

Another fibromyalgia study with a 50mg dose showed no difference in groups. [9] As discussed above, this could be do the dose, rather than the drug. Remember that at higher doses, the blockade of opiate receptors happens for a longer period and the increased endorphins can’t do their job.

In another study with 60 participants with multiple sclerosis, naltrexone was found to improve mental health quality over placebo. [10] The authors did point out this study did not assess the drug as a disease modifying agent, such as Copaxone. They did state there did seem to be no interactions with typical MS drugs.

In patients with Crohn’s Disease, 18 naltrexone patients had significantly more reduction in severity score associated with the disease over 16 placebo patients. [11]

A trial with children found that it also may be very effective. [12]

Because of its mechanism, it’s not improbable that it could help with other autoimmune conditions like rheumatoid arthritis because of the inflammatory effects of the disease. Others like lupus might also benefit.

Naltrexone seems to be tolerated well, especially since it is being used at a lower dose. Some nausea has been reported as well as abnormal dreams. People that have liver disease might be cautious, as it has been shown to cause liver problems, but those are in the 50-100mg/day dose range. 4.5, the common dose used in many studies, doesn’t seem to have that effect.

Naltrexone also must be compounded by a compounding pharmacy. The lowest commercial dose available to pharmacies is 50mg/tab, so they have to make it into caps or suspensions, depending on the dose. You can call a compounding pharmacy and ask how much it would be for 30 caps of 4.5mg naltrexone. Most will probably already know or be able to get you a number relatively quick.

It also must be an immediate release formulation, no extended release. One note of caution: if you do choose to use naltrexone and you take narcotics, you’ll want to wean off of them. Naltrexone, even at a small dose, will block the effect of your pain med and cause problems. Talk to your doc about that if that’s a concern.

Because no large studies have been done, it’s hard to gauge just how effective it is. I’ve read several personal anecdotes of people claiming it has done great things for their lives. I have hope for it as I think it has much promise. Hopefully someone will be able to do larger scale trials to give us a better idea of how well it actually works at a more general population level with a given disease.

I’ve read about some people seroconverting with HIV, while others have claimed that their viral load decreased. Again, I haven’t seen clinical data to back that up, but if true, would be a great thing for people battling that horrible virus.

In short, if you’re willing to give naltrexone a try, their probably shouldn’t be much problem, other than maybe convincing your doctor of writing a script.

CIAO

 

 

 

1.Wang D, Sun X, Sadee W. Different effects of opioid antagonists on mu-, delta-, and kappa-opioid receptors with and without agonist pretreatment. J Pharmacol Exp Ther. 2007;321:544–552

2.Tempel A, Gardner EL, Zukin RS. Neurochemical and functional correlates of naltrexone-induced opiate receptor up-regulation. J Pharmacol Exp Ther. 1985;232(2):439–444

3.Zagon IS, McLaughlin PJ. Gene-peptide relationships in the developing rat brain: the response of preproenkephalin mRNA and [Met5]-enkephalin to acute opioid antagonist (naltrexone) exposure. Brain Res Mol Brain Res. 1995;33(1):111–120

4.Brown N, Panksepp J. Low-dose naltrexone for disease prevention and quality of life. Med Hypotheses. 2009;72(3):333–337.

5.Liu SL, Li YH, Shi GY, Chen YH, Huang CW, Hong JS, Wu HL. A novel inhibitory effect of naloxone on macrophage activation and atherosclerosis formation in mice. J Am Coll Cardiol. 2006;48(9):1871–1879

6.Hutchinson MR, et al. Non-stereoselective reversal of neuropathic pain by naloxone and naltrexone: involvement of toll-like receptor 4 (TLR4) Eur J Neurosci. 2008;28(1):20–29.

7.Younger J, Mackey S. Fibromyalgia symptoms are reduced by low-dose naltrexone: a pilot study. Pain Med. 2009;10(4):663–672

8.Younger, Jarred, et al. “Low‐dose naltrexone for the treatment of fibromyalgia: Findings of a small, randomized, double‐blind, placebo‐controlled, counterbalanced, crossover trial assessing daily pain levels.” Arthritis & Rheumatism 65.2 (2013): 529-538.

9.Younger, Jarred W., Alex J. Zautra, and Eric T. Cummins. “Effects of naltrexone on pain sensitivity and mood in fibromyalgia: no evidence for endogenous opioid pathophysiology.” PloS one 4.4 (2009): e5180.

10.Cree, Bruce AC, Elena Kornyeyeva, and Douglas S. Goodin. “Pilot trial of low‐dose naltrexone and quality of life in multiple sclerosis.” Annals of neurology 68.2 (2010): 145-150.

11.Smith, Jill P., et al. “Low-dose naltrexone therapy improves active Crohn’s disease.” The American journal of gastroenterology 102.4 (2007): 820-828.

12.Smith, Jill P., et al. “Safety and tolerability of low dose naltrexone therapy in children with moderate to severe crohn’s disease: a pilot study.” Journal of clinical gastroenterology 47.4 (2013): 339.