Archive for the ‘Commentary’ Category

Vitamin D for the Nursing Mother

July 30 2014

by alex

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a well-written blog post
by Dr. Robert Heaney


Health Outcomes in USA vs other Countries

June 11 2014

by alex

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Interesting and informative infographic comparing health care and health outcomes in various countries. Note that Japan seems to be doing something right.

For all of the research bestowed upon the Mediterranean diet, the Japanese diet is very likely responsible for much of the superior health outcomes. Omnivorous diet, abundant produce, abundant seafood and modest animal proteins.


America's Health Disadvantage


May 21 2014

by alex

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Read about this food additive on Cornucopia.
It is found in many of your foods as well as in canned pet foods.
You may wish to avoid it.


Cold? Flu? What to do?

December 4 2013

by alex

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1) Make sure that you are not deficient in Vitamin D.
Get your blood level tested (25 OH Vitamin D target = 40 – 60 ng/mL) and/or take a supplement.

2) Avoid being deficient in zinc, important for immune function.
Eat nuts 2-3 times per week or take a multivitamin with about 15 mg of zinc.
Do not use Zicam nasal; you can lose your sense of smell permanently.

3) Eat a nutrient-rich diet with plenty of produce and healthy fats.  Include raw garlic.
(see Garlic Oxymel recipe)

4) Remember to wash your hands frequently and clean frequently-touched surfaces.

5) Get enough rest.  Sleep deprivation impairs immune function.

6) Manage your stress levels.  Too much stress impairs immune function.

7) Regular exercise, as long as it isn’t excessive, improves immune function.

8) Vitamin C 500 mg 1 – 2 x daily reduces the incidence of URI / flu slightly.

9) There are some supplements that can reduce your risk of getting colds & flu with regular use:
(specific products* have clinical trial data)

ColdFX* – Canadian product – Panax quinquefolius (North American ginseng)

Astragalus – limited research, but long traditional use; Andrew Weil, MD uses it himself for prevention
(Nature’s Way purple top standardized is a good brand)

Probiotics – one specific blend reduces duration and severity of colds when taken preventatively:
Lactobaccillus GG + Bifidobacterium animalis ssp lactic BB-12
(sold as Pronutrients Probiotic* by Centrum)


What to do if you DO get a cold or influenza…


There are some things beyond medications that can ease your symptoms:

Drink plenty of fluids to stay hydrated and loosen mucous

Warm / hot beverages do help with some symptoms temporarily
(see Lemon Ginger Tea with Honey recipe)

Honey reduces cough (not safe for infants / children under 18 months of age)

Slippery elm (Thayer’s lozenges) – reduces cough, soothes sore throat

Licorice root – reduces cough, soothes sore throat (careful if you have high BP)


There are some things that can reduce the duration and severity:
(specific products with * have good clinical trial data showing safety and efficacy)

Get extra rest to help your immune system to do its job

Vitamin C – 1 g 2 – 4 x daily can reduce the duration of a cold (flu not studied);
antihistamine-like effect at higher dosages also reduces nasal congestion

Echinacea, various species – data is strongest for E. purpurea  (avoid if you have autoimmune disorder)
Echinaforce* by Bioforce USA used in several clinical trials

Garlic – antibicrobial effect best if raw (or see Garlic Oxymel recipe)

Ginger – expectorant and antimicrobial, can include in teas, foods
(see Lemon Ginger Tea w Honey recipe)

Swedish Herbal Institute Kan Jang* – Andrographis paniculata + Eleutherococcus senticosus
[Kan Jang Plus adds Sambucus nigra]

Nature’s Way Umka Cold Care*– Pelargonium sidoides

Sambucol* syrup – Sambucus nigra (kids like this)

ColdFX* – (Canadian) Panax quinquefolius (North American ginseng)


Note: This is not intended be to a comprehensive list. It focusses on lifestyle interventions and readily available products that have good evidence behind them.
In addition to foods, I keep on hand:
Vitamin C
Thayer’s Slippery Elm lozenges
Kan Jang Plus
Nature’s Way Cold Care
Garlic Oxymel

Gut Flora, Diet and Health

November 11 2013

by alex

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Gut Flora, Diet and Health

This article by VitalChoice Seafood is so well-written that I am linking it here. It discusses a recent study looking at the gut flora in healthy versus overweight and diabetic study participants along with other research that discusses how foods impact gut flora.
This interplay between nutrition, gut flora and health is being studied aggressively.
We are gaining a deeper understanding of how and why various aspects of nutrition matter, beyond just nutrient absorption.


Commentary on that fishy fish oil study

July 29 2013

by alex

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This video commentary is one of the best I have come across that addresses the study that associated fish oil with an increased risk of prostate cancer. The physician speaking, Snuffy Myers, MD, is an integrative oncologist specializing in prostate cancer.



Omega 3s + PCa from Jessica Myers-Schecter on Vimeo.

An Integrative Approach to Enhancing Fertility

July 12 2013

by alex

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Dr. Connie Deline wrote this commentary as an invited guest on the blog of Tian Shi Acupuncture. Please take a moment to visit their website: 

As a physician who included obstetrics in my practice in Canada, I cared for women pre-conception, during pregnancy, delivery and post-partum. Of course, I also cared for the newborns along with the whole family. I’ve seen the impact of lifestyle on conception rates, the course of pregnancies and the health of the newborns. There is an abundance of research about optimizing fertility and the health of new babies, yet sadly, much of it is not shared with prospective parents. For this discussion, I will focus on the lower tech aspects to consider pre-conception, not just for those struggling with infertility; but for anyone hoping to conceive. The balance of viewing a pregnancy in terms of creating an optimal environment for the fetus, but without obsessing excessively about every little detail, is an approach that makes the most sense to me.

For those couples planning a pregnancy, employing an integrative approach in optimizing health can optimize not only fertility, but the pregnancy outcomes and health of the baby.
An integrative approach can:
Make it easier to get pregnant
Reduce the risk of miscarriage
Reduce the risk of pre-term birth
Reduce the risk of birth defects
Enhance the health of the baby.
What is an integrative approach to fertility? In simple terms, it includes the high-tech diagnostics, medications and procedures that modern medicine offers but also includes the low-tech approaches such as nutrition, exercise, stress reduction, traditional Chinese Medicine and acupuncture to achieve the best outcomes for women and their babies.

There is no question that we have seen declines in human fertility in recent decades. Average sperm counts have decreased. Infertility rates even in young women have increased.

There are many known contributors to reduced fertility. These include age, genetics, general health, anatomical problems, nutrition, hormonal status, stress and environmental toxins. There may be male factors. Occasionally, undiagnosed celiac disease is the cause. There may be no identifiable factors. It makes sense to modify what we can. And even when we need to include the high-tech interventions, like IVF (in vitro fertilization), we shouldn’t ignore the low-tech, because it all matters.

Anatomical Problems
Anatomical problems, such as uterine fibroids, blocked fallopian tubes and endometriosis need to be addressed from a surgical perspective in many cases.

Problems with Ovulation
Ovulatory dysfunction arises from hormonal problems, including PCOS (polycystic ovarian syndrome), or from abnormalities of thyroid or pituitary hormone function. Stress can cause or contribute to this. While a reproductive endocrinologist or gynecologist may need to offer some help with hormonal manipulation, medications and/or procedures, there are situations where nutritional support, mind-body medicine and other interventions such as acupuncture, can have an impact on ovulation to improve success rates.

If we look at the body weight of a woman, we know from the research that the ideal BMI (body mass index) is between 20 and 24. Too thin or too heavy makes it harder to conceive. Higher BMI lowers pregnancy and live birth rates with IVF as well and increases risk of pre-term birth. Obese women who do become pregnant have more complications including more miscarriages, more pregnancy-induced hypertension, more gestational diabetes and more congenital anomalies in their children. Children of obese women have an increased risk of obesity, diabetes and heart disease.
In men, higher BMI is associated with lower sperm counts, lower sperm concentrations, poor sperm morphology, lowers sperm motility and lower testosterone levels, which reduce fertility. We also know that if the father is overweight at the time of conception, the future weight of his daughter will be affected.
When both partners are overweight the miscarriage rates are higher with both spontaneous conceptions and in assisted reproduction.

Male factors
This focuses mainly on sperm counts, motility and morphology. These are impacted by body weight, hormonal factors and nutrition.

While quitting smoking before trying to conceive seems to be obvious, it is worthwhile to understand exactly why. Smoking makes conception more difficult, it speeds up the process of ovarian egg depletion and shortens total number of fertile years. IVF failure is more common. Smoking while pregnant increases the risk for a long list of pregnancy complications and low birth weight. Children have higher rates of brain and behavioral problems such as anxiety, depression, ADHD and lower IQ.

Low levels of alcohol intake of than 1 drink per daily in women appear to have no effect on conception rates. One or more drinks per day does decrease fertility. Alcohol use during pregnancy is well known to cause fetal alcohol syndrome with a variety of congenital defects and lowered IQ.
In men, alcohol use can lower fertility by reducing sperm concentration, volume and motility.

Environmental chemicals
This is a huge concern. Many chemicals are endocrine disrupting, meaning that they have hormone-like actions in the body, disrupting normal hormone function and therefore fertility. But the concern of chemicals goes well beyond the issue of fertility. The developing fetus is exquisitely sensitive to toxic chemicals, much more so than the adult. The evidence is growing that prenatal exposures to a whole range of chemicals cause and contribute to disease later in life. We cannot control all of these exposures but we can minimize exposures to some extent.
> Seafood
Fish and other seafood can contain mercury, PCBs, other organophosphates.
Limiting exposure is facilitated by using online resources that list less contaminated types of fish.
> Pesticides
Pesticide exposure at home and from food can be minimized.
Choose not to use pesticides in and around your home.
Organically grown produce minimizes pesticide exposure but due to availability and expense, it isn’t that easy to consume 100% organic. The Environmental Working Group annually updates a list of the most and least pesticide-contaminated produce items. These are called “The Dirty Dozen” and “The Clean 15″. These lists are available on their website ewg.org. Smart-phone apps are also available. Look for “Dirty Dozen”.
When choosing animal-based foods, such as eggs, dairy and meats, organic is very important since environmental toxins can be concentrated. Pastured and conventionally-raised animals have very different nutritional profiles.
> GMO foods
This is a complex topic, too complex to address here, other than to say, the associations with infertility are strong. These foods are best to be avoided. The easiest way to avoid genetically modified foods is to buy organic. These foods are also, for the most part, heavily sprayed with pesticides.
> Plastics and phthalates
Plastics and phthalates are endocrine-disrupting. These negatively impact fertility and the developing fetus. These are everywhere: food packaging, cans, bottles, plastic storage containers. Phthalates are in plastics but also in personal care products, cosmetics and cleaning supplies.

Studies have shown is that couples with the greatest adherence to a Mediterranean diet have a lower incidence of difficulty with conceiving; also that couples undergoing IVF have a higher conception rate. Since this diet also reduces the risk for cardiovascular disease, cancer, dementia, obesity, diabetes, hypertension, dyslipidemia and autoimmune diseases, it is unquestionably good dietary pattern to adopt for the long-term. This diet is nutrient-dense with healthy fats, some fish and more plant-based than animal-based protein.
For those women who are overweight or have PCOS, paying extra attention to the glycemic load of the diet becomes more important. Glycemic load of a meal refers to the measure of the rise in blood sugar after a meal; the sugar load, which causes a rise in insulin. Having chronically high insulin levels is associated with many adverse effects, including impacting fertility and making it more difficult to lose weight. Carbohydrates that metabolize into sugar quickly include grains processed into flour (both gluten-grains and non-gluten grains), so keeping flour products and sugars to a minimum is important. Fruit juices have a high glycemic index whereas whole fruits have a little lower glycemic index, so whole fruits are a better way to consume them.
Additional research findings on nutrition specific to better fertility:
Lower trans fat
Lower sugar
Higher plant-based protein than animal-based
Higher fiber
More high-fat dairy / less low-fat dairy [low fat dairy is higher in androgens, IGF-1 and prolactin]
> Vitamin D
Vitamin D deficiency is associated with reduced fertility as well as pregnancy complications. Supplementation is best guided by the results of lab testing pre-conception, during pregnancy and during lactation. The amount in most multivitamins may not be enough.
> Iron
Iron supplementation pre-conception also reduces ovulatory infertility. The amount in a prenatal multivitamin will usually be enough. Men should not supplement with iron.
> Multivitamin
Multivitamin users, both prospective mothers and fathers, have higher conception rates. Birth weight and pregnancy outcomes are also improved. Risk of pediatric cancer is reduced. One study showed that women who took a multivitamin for just 1-3 months before conception lowered their risk of having a child with autism or severe language delay.
> n-3 fats (omega-3 fats)
Higher intake of n-3 fats from fish oil or marine algae is known to improve the morphology of the embryo with IVF.
Fertile men have higher blood and sperm levels of n-3 fats; supplementation improves sperm counts and concentration in men with low sperm counts.
n-3 fats, especially DHA, are critical for brain and eye development of the fetus, so the woman should try to have her levels replete. Low levels are also associated with a higher risk of post-partum depression.
> Vitamin B12
Vitamin B12 deficiency is more common in vegans or in women who have been on metformin or proton pump inhibitors. Deficiency increases the risks of repeated miscarriage and birth defects. The amount in a multivitamin often won’t be enough to correct this deficiency.
> Vitamin C
There is some evidence that Vitamin C supplementation improves fertility in women with a luteal phase defect.
> Other supplements
There are a number of other supplements, including CoQ10, N-acetyl-cysteine, myo-inositol, acetyl-L-carnitine, DHEA, melatonin and botanicals (herbs) that are used in men or women in specific circumstances.

For women, exercise impacts fertility with an upside-down U-shaped curve. Moderate exercise improves fertility, while too little or too much exercise decreases it. More vigorous exercise also appears to reduce fertility. In men, fertility is less impacted by exercise.

The link between stress and female fertility exists even when there are no measurable changes in stress hormones. Stress activates the HPA (hypothalamic-pituitary-adrenal) axis which impacts the gonadal hormone axis and other hormones as well. Stress impacts sperm quality and motility as well.
Stress management (or mind-body techniques) have been shown to increase pregnancy rates with IVF (where it has been more intently studied). More time relaxing and de-stressing is never a bad thing.

Acupuncture and Chinese Medicine
Chinese medicine offers much to women struggling with infertility. A long anecdotal record among Chinese medicine practitioners is now being supported by research. In 2012, a meta-analysis of 24 studies of acupuncture in fertility, which included 5800 patients, revealed significantly higher pregnancy rates in the acupuncture groups. The evidence for improved pregnancy rates is significant enough for it to be routinely recommended in mainstream fertility clinics.
The Chinese approach to enhancing fertility is to normalize the menstrual cycle, and ensure the abundance of qi, blood and essence. Attention is paid to harmonizing and balancing yin and yang. The uterine environment becomes more hospitable to a fertilized egg. The female body is supported well beyond what standard fertility approaches do. Many acupuncturists find that women seek their help only during IVF surrounding embryo transfer, but find that earlier intervention is often better.

Final Comments
When prospective parents optimize their own health, they optimize their fertility as a couple as well as the health of their child. An integrative approach to fertility includes the high-tech diagnostics, medications and procedures that modern medicine offers but also includes the low-tech approaches such as nutrition, exercise, stress reduction, traditional Chinese Medicine and acupuncture to achieve the best outcomes for women and their babies.

Connie Deline, MD

Probiotics a Must with Antibiotics

March 22 2013

by alex

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There has been high quality evidence showing that probiotics reduce the risk of antibiotic-associated diarrhea for years, yet very few physicians actually recommend the addition of a probiotic when an antibiotic is prescribed. The strength of the evidence is Grade “A”, the highest level.

This is a perfect example of physicians either not keeping up with the literature or simply ignoring the evidence.

Last year the Journal of the American Medical Association, a very mainstream medical publication, published a meta-analysis on this topic. Has this impacted physician behavior? Does your physician recoomend probiotics when antibiotics are prescribed?

This month, March 2013, the Journal of Family Practice published a PURL, a Priority Update from the Research Literature on this topic, referencing the JAMA meta-analysis. Will this encourage a change in the behavior of Family Physicians?

Probiotics for the Prevention and Treatment of Antibiotic-Associated DiarrheaA Systematic Review and Meta-analysis

Susanne Hempel, Sydne J. Newberry, Alicia R. Maher, Zhen Wang, Jeremy N. V. Miles, Roberta Shanman, Breanne Johnsen, Paul G. Shekelle
JAMA. 2012;307(18):1959-1969. doi:10.1001/jama.2012.3507

Context: Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use.

Objective: To evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD).

Data Sources: Twelve electronic databases were searched (DARE, Cochrane Library of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA) and references of included studies and reviews were screened from database inception to February 2012, without language restriction.

Study Selection: Two independent reviewers identified parallel randomized controlled trials (RCTs) of probiotics (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus) for the prevention or treatment of AAD.

Data Extraction: Two independent reviewers extracted the data and assessed trial quality.

Results: A total of 82 RCTs met inclusion criteria. The majority used Lactobacillus -based interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects meta-analysis of 63 RCTs, which included 11 811 participants, indicated a statistically significant association of probiotic administration with reduction in AAD (relative risk, 0.58; 95% CI, 0.50 to 0.68; P < .001; I2, 54%; [risk difference, −0.07; 95% CI, −0.10 to −0.05], [number needed to treat, 13; 95% CI, 10.3 to 19.1]) in trials reporting on the number of patients with AAD. This result was relatively insensitive to numerous subgroup analyses. However, there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation.

Conclusions: The pooled evidence suggests that probiotics are associated with a reduction in AAD. More research is needed to determine which probiotics are associated with the greatest efficacy and for which patients receiving which specific antibiotics.

Full text is open access:

For first time, Coca-Cola addressing obesity in two-minute TV Ad

January 15 2013

by alex

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The Associated Press
Published Monday, Jan. 14, 2013 9:23AM EST
Last Updated Monday, Jan. 14, 2013 9:29AM EST

NEW YORK — Coca-Cola became one of the world’s most powerful brands by equating its soft drinks with happiness. Now it’s taking to the airwaves for the first time to address a growing cloud over the industry: obesity.

The Atlanta-based company on Monday will begin airing a two-minute spot during the highest-rated shows on CNN, Fox News and MSNBC in hopes of becoming a stronger voice in the intensifying debate over sodas and their impact on public health. The ad lays out Coca-Cola’s record of providing drinks with fewer calories over the years and notes that weight gain is the result of consuming too many calories of any kind — not just soda.

Coca-Cola says the campaign will kick off a variety of moves that help address obesity in the year ahead, such as providing more diet options at soda fountains.

For Coca-Cola, the world’s No. 1 beverage company, the ads reflect the mounting pressures on the broader industry. Later this year, New York City is set to put into effect a first-in-the-nation cap on the size of soft drinks sold at restaurants, movie theaters, sports arenas and other venues. The mayor of Cambridge, Mass., has already proposed a similar measure, saying she was inspired by New York’s move.

And when PepsiCo Inc., the No. 2 soda maker, recently signed a wide-ranging endorsement deal with pop singer Beyonce, critics called for the singer to drop the contract or donate the funds to groups that fund health initiatives.

Diana Garza Ciarlante, a spokeswoman for Coca-Cola Co., said the new ads aren’t a reaction to any negative public sentiment but that the company felt it needed to address “the issue of the times” and be part of the discussion on obesity.

“We have not done a good enough job in telling our story and being consistent in telling our story,” she said, noting the company had to be careful in its messaging to remain consistent with its brand voice and avoid sounding “preachy.”

In the ad, a narrator notes that obesity is an issue that “concerns all of us” but that people can make a difference when they “come together.” The spot was produced by Brighthouse and Citizen2 and is intended to reflect Coca-Cola’s corporate responsibility among cable news viewers.

Another ad, which will run later this week during “American Idol” and before the Super Bowl, is much more reminiscent of catchy, upbeat advertising people have come to expect from Coca-Cola. It features a montage of activities that add up to burning off the “140 happy calories” in a can of Coke: walking a dog, dancing, sharing a laugh with friends and doing a victory dance after bowling a strike.

Garza Ciarlante said the 30-second ad, a version of which ran in Brazil last month, is intended to address confusion about the number of calories in soda. She said the company’s consumer research showed people thought there were as many as 900 calories in a can of soda.

Garza Ciarlante declined to give details on the actions Coca-Cola has planned for the year ahead. But among the options under consideration is putting the amount of activity needed to burn off the calories in a drink on cans and bottles.

Coca-Cola notes it has already made several moves to help customers make smarter choices, such as putting calorie counts on the front of its cans and bottles in the U.S. Last year, it also started posting calorie information on its vending machines ahead of a regulation that will require soda companies to do so by 2014.

Public concern over calories counts is apparent in Coca-Cola’s business. In North America, all the growth in its soda business over the past 15 years has come from low- and no-calorie drinks, such as Coke Zero. Diet sodas now account for nearly a third of its sales in the U.S. and Canada. Other beverages, such as sports drinks and bottled water, are also fueling growth.

Even with the growing popularity of diet sodas, however, overall soda consumption in the U.S. has declined steadily since 1998, according to the industry tracker Beverage Digest.

Read more: http://www.ctvnews.ca/health/for-first-time-coca-cola-addressing-obesity-in-two-minute-tv-ad-1.1113140#ixzz2I464NEXm

Exercise Gains Momentum as Psychiatric Treatment

November 26 2012

by alex

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The source of this article is medscape, and it reproduced here in it’s entirely. Having trained in Canada and practiced in both Canada and in the USA, I can tell you that the treatment approaches are quite different. The residency training of family physicians includes a great deal more training in psychiatry and psychotherapy as compared with American residencies, in part due to the difference in numbers of psychologists and psychiatrists. In Canada, exercise has long been prescribed routinely for patients with depression, anxiety or other psychiatric problems, due to proven efficacy, but often ignored by psychiatry in the USA. It is nice to see this trend.

The fact is that there are very few health conditions that do not benefit from exercise. Think of hypertension, diabetes, obesity, back pain, osteoporosis, Parkinson’s disease, irritable bowel syndrome — all have strong evidence of benefit from exercise. For many patients, a customized approach is needed and consulting with a physical therapist can be very helpful.

by Nancy A. Melville
Nov 16, 2012SAN DIEGO, California – The benefits of exercise in nearly every aspect of physical health are well known, but evidence in recent years suggests a unique effect on some psychiatric disorders, prompting mental health clinicians to rethink treatment strategies and to consider the possibility of exercise not just in therapy but as therapy. 

“Above and beyond the standard benefits of exercise in healthy living and general well-being, there is strong evidence demonstrating the ability of exercise to in fact treat mental illness and have significant benefits on a neurotrophic, neurobiologic basis,” Douglas Noordsy, MD, told delegates attending Psych Congress 2012: US Psychiatric and Mental Health Congress.

Some of the strongest evidence is seen in depression, where psychiatric benefits from exercise have been shown in some cases to match those achieved with pharmacologic interventions and to persist to prevent remission in the long term.

Dr. Noordsy referenced a study from researchers at Duke University in which 156 patients with major depressive disorder (MDD) were randomly assigned either to aerobic exercise, sertraline therapy (50 mg to 200 mg), or both for 4 months.

The difference in remission rates in the exercise and selective serotonin reuptake inhibitor (SSRI) groups after 4 months were not significant – 60% and 69%, respectively, but at a 10-month follow-up, the exercise group showed a significantly lower relapse rate ( P = .01) ( Psychosom Med 2000;62:633-638).

“The patients who were independently exercising on their own after the treatment period had half the odds for meeting the depression criteria 6 months later compared to patients who didn’t exercise after the 4-month study,” said Dr. Noordsy, an associate professor and director of psychosis services at the Geisel School of Medicine at Dartmouth College, in Hanover, New Hampshire.

A similar study from the same group of researchers 10 years later in a larger sample involving 202 patients assigned to supervised exercise, sertraline therapy (50 mg to 200 mg) or placebo showed remission rates of 46% at 4 months and 66% at the 16-month follow-up across both treatment groups, with no significant greater improvement with SSRIs compared with exercise in predicting MDD remission at 1 year ( Psychosom Med 2011 Feb-Mar;73:127-33; epub 2010 Dec 10).

Other studies have shown equally impressive results in exercise for a variety of populations, including pregnant women with depression, who have a high interest in avoiding medications, people with HIV, and even patients with heart failure, who showed not only a significant reduction in depression related to exercise but also reduced mortality ( Am J Cardiol 2011;107:64-68).


The evidence in relation to anxiety, although not as strong, still suggests a benefit, and the rigors of a cardiovascular workout seem particularly suited to addressing the physiologic effects associated with anxiety, Dr. Noordsy said.

“We know that with anxiety, the heart rate goes up, you start breathing fast, and it kind of snowballs with more anxiety, and that can trigger a panic attack,” he explained.

“So one of the important positive effects of physical exercise is it allows people to become conditioned to having their heart rate and respiratory rate increase when they’re not associated with anxiety, thereby addressing the triggers.”

Evidence is somewhat lacking in the area of bipolar disorder, but patients often have symptoms similar enough to depression to suggest a benefit, Dr. Noordsy said.

“The evidence on depression in bipolar disorder is strong enough that I certainly feel comfortable in talking about exercise as part of [bipolar patients’] management.”

In terms of more serious psychotic disorders such as schizophrenia, evidence is limited on benefits of exercise for the core symptoms of psychosis or cognition. However, several studies have shown improvement in comorbidities and metabolic issues related to antipsychotics that such patients commonly face.

One study of a jogging intervention among 80 inpatients with chronic schizophrenia, in which 40 patients jogged for 40 minutes 3 times a week, depression, anxiety, phobia, and obsessive-compulsive behaviors declined significantly compared with 40 inpatient control participants who were inactive and showed no improvement.

Dementia Prevention

The evidence on the benefits of exercise in cognitive function disorders, such as dementia and Alzheimer’s disease, is much more extensive, with as many as 8 strong studies on dementia alone in the last 3 years showing improvements with activities such as walking and strength training on memory and executive function.

Dr. Noordsy noted one particularly remarkable study in which researchers compared patients with and without the ApoE gene, which is linked strongly to late-onset Alzheimer’s disease.

In the study, patients who were ApoE-negative showed similarly low mean cortical binding potential, related to plaque buildup in the brain, regardless of whether they exercised or not.

But although ApoE-positive individuals (n = 39) had values that were substantially higher, the ApoE-positive patients who exercised (n = 13) had values similar to those who did not carry the gene ( Arch Neurol2012;69:636-643).

“You could look at these results and rightfully say physical exercise neutralizes your risk for developing Alzheimer’s disease if you’re ApoE positive,” Dr. Noordsy said.

How to Get Patients Moving

Perhaps the biggest caveat with all mental health conditions is how to motivate patients who are struggling with psychiatric disorders to exercise.

Dr. Noordsy offered some key suggestions:

  • Start with an assessment: “I start with an assessment of lifetime history of activity and current activity in my baseline assessment template,” Dr. Noordsy said. “I educate the patient on the potential effects of exercise on their disorder and how it fits on the menu of other treatment options.”
  • Make clear recommendations: “There is a lot of evidence in areas such as smoking cessation and in the addiction literature showing that a substantial subset of people will respond to very clear recommendations,” he said.
  • Offer motivational tools: A behavioral planner, for instance, that allows for goal setting, or connecting a patient with an exercise group can be helpful.
  • Consider the patient’s current activity capacity in recommending a regimen: “The general amount of exercise believed to result in a benefit is about 30 to 60 minutes per day, between 3 and 7 days per week.” Some studies have shown strength training to be as beneficial as aerobic activity. For the latter, Dr. Noordsy suggested that one easy method often used in determining maximum heart rate, in general, for people without heart disease or other conditions is to simply subtract their age from 220.
  • Help the patient find an activity that works best for them, rather than recommending anything specific, Dr. Noordsy suggested. “Have the patient choose the activity that is right for them.”
  • Help guide the patient to educational resources, such as information sources or books. “The book I’ve used the most with patients is John Ratey’s Spark: The Revolutionary New Science of Exercise and the Brain,” Dr. Noordsy recommended. “The book is very scientific and accessible to a lay audience,” he said.

Importantly, discussing the role of exercise in the context of human evolution might be a more effective approach with patients than the standard recommendation to get some exercise.

“Instead of ‘this is something you ought to be doing,’ we might instead say, ‘this is something humans are designed to do, and when we don’t do it, our bodies and brains fall apart’.”

Another important component in helping patients benefit from exercise is simply to improve awareness among clinicians, Dr. Noordsy added.

“We see evidence on the benefits of exercise for psychiatric conditions coming together, and there is a need to increase awareness of this among clinicians as well as reinforce the research community to be taking a more careful look at physical exercise,” he said.

“This may not have as much of an industrial backing as some of the other interventions we use, but I think it’s quite exciting.”

Psych Congress 2012: US Psychiatric and Mental Health Congress. Presented November 9, 2012.