Feb
17
Because I’m currently doing a series on positive psychology, when I was in the library the other day this book caught my eye: Happy At Last: The Thinking Person’s Guide to Finding Joy, by Richard O’Connor. He comes well credentialled, since not only is he a psychologist working with people with depression (his previous books include Undoing Depression), but he has struggled with depression himself. As anyone who’s experienced depression knows, that really focusses your attention on what makes you happy.
I’ll probably do a few posts on this book; it’s very good. Today, I want to look at a passing mention he makes which intrigued me. Out of the ten most prescribed medicines in the USA, eight deal with effects of stress.
 photo credit: rodrigo senna
The picture is the same in New Zealand, I found. Pharmac, the government drug-subsidy agency, in its annual review for 2008 lists the 20 most prescribed subsidized drugs in New Zealand. They are, with number of prescriptions and purpose (according to Pharmac – doctors may also be prescribing them for other things):
- paracetamol 1,760,000 – pain relief
- aspirin 1,280,000 – prevents heart attack and
stroke (cardiovascular risk)
- simvastatin (brand name LIPEX) 1,170,000 – impaired cholesterol
(cardiovascular risk)
- omeprazole (brand name Losec or Omezol) 1,100,000 – heartburn, stomach ulcers
- amoxycillin 890,000 – bacterial infections
- metoprolol succinate 820,000 – raised blood pressure, heart
disease
- amoxycillin clavulanate 800,000 – bacterial infections
- salbutamol 740,000 – asthma symptoms
- diclofenac sodium 530,000 – pain/arthritis
- cilazapril (brand name Inhibase) 510,000 – raised blood pressure
(cardiovascular risk)
- zopiclone 470,000 – insomnia
- prednisone 450,000 – steroid treatment for asthma
attacks, arthritis etc
- frusemide 440,000 – heart failure
- bendrofluazide 430,000 – raised blood pressure
(cardiovascular risk)
- quinapril 400,000 – raised blood pressure, heart
disease, diabetes
- fluticasone 410,313 – prevents asthma
- calcium carbonate 377,527 – osteoporosis
- flucloxacillin sodium 390,000 – bacterial infections
- thyroxine 380,000 – underactive thyroid gland
- felodipine 380,000 – raised blood pressure, heart
disease
For perspective on the figures, the population of New Zealand is just over 4.2 million. Just these 20 drugs were prescribed 13.7 million times in one year, which is 3.3 prescriptions per head of population. The top four alone account for 5.3 million of these prescriptions, or almost 40%.
So let’s do a count. Out of these 20 (which were also the top 20 in 2007, though the order varied slightly), how many are for conditions which can also be improved by non-drug treatment and a healthy lifestyle?
photo credit: Pink Sherbet Photography
Well, exercise reduces cardiovascular risk and (indirectly) diabetes risk, and improves blood pressure and sleep. Diet reduces cardiovascular risk, diabetes risk and osteoporosis (though that is a long-term proposition and you have to start early in life), and can improve blood pressure for some people. Relaxation and managing stress can reduce cardiovascular risk and blood pressure, improves sleep, and can be used in the treatment of asthma, pain, and even arthritis.
Stress also negatively affects the immune system, so managing stress can reduce the need for antibacterial drugs. There is also a stress link to many illnesses of the gastrointestinal system, as I’ve explored before. Finally, the most common cause of an underactive thyroid gland is Hashimoto’s thyroiditis, an autoimmune disease. Its underlying cause is unknown, but other immune disorders have been linked to stress.
So out of the 20, the number where exercise, diet and stress management could potentially make a difference is… 20. All of them. (Oh, all right, 19 – I don’t have any scientific evidence for the thyroid one, but it would surprise me if there wasn’t a stress link.)
Of course, I’m not for a moment suggesting that diet, exercise and stress management would remove all need for these drugs, even if somehow, miraculously, the whole population could be convinced to make use of them. All I’m suggesting is that improving diet, exercise and stress management could significantly reduce our reliance on drugs for health – drugs that, in some cases, have unpleasant side-effects which tend to get treated with, yes, more drugs.
For more on this, take a look at my posts Exercise is Medicine and The Blue Prescription, and my starting points for a healthy lifestyle.
 Relevant Product: Manage Pain Naturally (MP3 download)
Technorati Tags: drugs, prescription, non-drug alternatives, exercise, nutrition, diet, relaxation, stress, stress management
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Jan
14
For over 10 years now, New Zealand general practitioners and other primary healthcare providers have been giving “green prescriptions” – written advice to patients to be physically active, as a way of improving their health. Research published in the British Medical Journal indicates that it works.
photo credit: Celso Flores
I’m all for this. Not only am I all for improving health by non-drug means, I’m very much in favour of encouraging health professionals to think about ways of doing so and communicate those to their patients or clients.
So here’s a further idea: the “blue prescription”.
Let’s say that your patient presents with elevated blood pressure, digestive problems, general malaise, sleeping difficulties or headaches, is nervous and jumpy, irritable or anxious, or gets ill a lot with colds and other minor infections. You have some tests run and there is nothing serious wrong with them, but they feel unwell and tired nearly all the time. They’re perhaps a person in their middle years with a growing family and an all-too-slowly-shrinking mortgage, who’s consistently working overtime, or who works on long-term projects with a lot of pressure, or who holds a job with a lot of responsibility which they feel is a bit beyond them. What do you do?
photo credit: a.drian
Well, some doctors will either tell them there’s nothing really wrong with them and send them home (that’ll be $45, thanks), or prescribe medication that they may or may not really need or benefit from – antidepressants, perhaps, sleeping pills, or the ever-popular Losec to reduce the acidity of their stomach.
I propose, instead, the “blue prescription”. Just as the “green prescription” is a written recommendation for exercise, the “blue prescription” is a written recommendation for deliberate relaxation, with a referral to a yoga class, meditation teacher or (best of all, in my of course unbiased opinion) hypnotherapist.
For those without the means or inclination to go to someone else, you could provide a small brochure like the bookmarks that I give my clients outlining Dr Herbert Benson’s “relaxation response” practice, or even a recording like my therapeutic relaxation track. (It’s free for download from the page just linked to, and you can use it as long as you acknowledge me as the source.)
So there’s the challenge: start prescribing relaxation. We need more of it.
photo credit: exfordy
Technorati Tags: green prescription, blue prescription, relaxation, stress, drug alternatives, exercise, medicine, doctor, general practice
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Jan
13
Wouldn’t it be great to have a second brain to take care of some routine tasks?
photo credit: *madalena-pestana*
Well, actually, we already do. I’m studying anatomy and physiology as part of my Health Science course, and I’ve just been learning about the “enteric nervous system” – the brain in your gut.
Inside your digestive system is a complex control mechanism which contains more neurons than your spinal cord and uses many of the same neurotransmitters as the brain in your head. The process of digestion involves a lot of complicated chemistry, rather like running a sophisticated chemical plant, and of course must adapt to a wide range of different foods with different chemical compositions and to different amounts of food at different, sometimes unpredictable times. It also needs to protect itself against infection. No wonder it needs its own brain.
photo credit: euthman
The thing is, because the two brains are linked (through the vagus nerve and prevertebral ganglia as well as by chemical messengers), what affects one affects the other. If you’re emotionally upset, you can get an “upset stomach”, ranging from “butterflies” to diarrhea or even vomiting. Antidepressants can affect the digestion – they both affect serotonin, a neurochemical which the gut uses even more than the brain. And the connection goes both ways, as anyone who pays attention to how they feel emotionally after different meals will know.
The brain-gut link is well accepted now, and there’s a field known as “neurogastroenterology” which studies the interactions between the two. My anatomy and physiology textbook (Marieb and Hoehn) even includes emotional distress as a factor in one of its diagrams about digestion.
And yet, many medical professionals don’t consider the link. An overseas-based friend of mine had a very stressful and unrewarding job for several years, and was suffering from irritable bowel syndrome. He went to a gastroenterologist, who didn’t even ask him about his stress levels – yet when he was laid off from the job, his problems vanished almost immediately.
photo credit: Arturo J. Paniagua
The brain-gut link is through the autonomic (“self-governing”) nervous system. Textbooks will tell you that we don’t voluntarily or consciously control the autonomic nervous system, and while this is true, it’s a bit like saying that the government doesn’t control the economy. While we can’t control our digestive system the way we can, for example, wiggle our fingers, there are things that we can do consciously and deliberately to improve our digestive functioning through the brain-gut link.
A 2004 article in Neurogastroenterology and Motility, for example, reports that patients can learn to use biofeedback to affect the electrical activity of their gastric muscles. The gut functions best when this activity is rhythmic and at approximately 3 cycles per second, and the study taught the participants to use relaxation methods together with a monitoring device to increase the amount of time that their gut was behaving in this way.
Actually, relaxation practices in general can improve gut function, as Herbert Benson and his colleagues have been finding for decades. Engaging the parasympathetic branch of the autonomic nervous system – which is a technical way of saying “relaxing” – enhances blood flow and nerve and chemical signals to the gut and puts it into an improved state for carrying out its functions. Stress, on the other hand, moves us into the sympathetic nervous system response, which takes priority away from digestion in order to focus on fighting or running away. This is why prolonged stress often has a negative impact on digestive function.
photo credit: maessive
I have a number of posts on relaxation here in the Living Skillfully blog, which will give you some tools and techniques to use if more relaxation would be a benefit in your life. Hypnotherapy is known to be one of the more effective treatments for irritable bowel syndrome and similar issues. And in a future post, I’ll talk about the concept of a “blue prescription” and why doctors should start giving them.
Technorati Tags: neurogastroenterology, gut, stomach, digestion, indigestion, nausea, vomiting, diarrhea, brain, enteric nervous system, irritable bowel syndrome, IBS, stress, relaxation, anxiety
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