A link between diet soda and depression

The United States Department of Agriculture announced on Friday a proposal for "new standards to provide healthy food options in schools."

Note that this is a proposal and there is a call for the public's input, and a web address is provided in the news release.  So, the announcement does not necessarily mean a fait accomplit although the soft drink lobby is quite powerful.

Among the proposals is the availability of diet sodas for high school students and the choice of one diet soda each day for lunch.

At the same time, neuroscientists and presumably some members of the public are aware that an NIH study released in January reported a link between diet soda and depression!  Among the media reporting this was US News and World Report.

Earlier on my blog I wrote about the potential dangers of aspartame, an artificial sweetener found in many versions of diet soda.  I was surprised to find that the Mayo Clinic has actually addressed the question that I raised about phenylalanine.  

Here's a Mayo Clinic response to the question of phenylalanine,a substance found in diet soda.  Short answer - it can be harmful.

Today (March 14, 2013) another article that appears in the Huffington Post, this one by Dr.  Joseph Mercola titled Aspartame Pathway reports on the toxicity of another substance that appears when aspartame is broken down by the human body -  methanol.  From the article:  "Methanol acts as a Trojan horse: It's carried into susceptible tissues in your body, like your brain and bone marrow, where the alcohol dehydrogenase (ADH) enzyme converts it into formaldehyde, which wreaks havoc with sensitive proteins and DNA."

I hope more parents and the general public will become more aware of research that is uncovering links between aspartame and brain circuit disorders.  Perhaps in the meantime, if one wants a coca-cola, one might want to lobby their Costco or whatever to bring coca-cola that is bottled in Mexico (with cane sugar) to their locale.  Perhaps other soda manufacturers might want to return to real sugar, as well.

Yes, real sugar as well as sodas can be harmful, too, taken in excess.  In fact, studies have shown that some people became addicted to sugar when it first became widely available in our country in the 1800's.

Moderation is the key in all things.

Important step: Asking for Help

[revised - thought of some points while hiking later today]

Earlier this week I received an email from Real Age titled "4 Tips to Break Bad Habits."  One of the tips is "enlist support -- ask for help."

I've learned over the years while listening at conferences and support groups, and reading literature that the concept of asking for help can be quite difficult for those with an eating disorder, particularly those with a perfectionistic bent and whose cultural norm is self-sufficiency, a norm heavily promoted by our society in my experience.  Think of all those self-help books one finds on bookshelves.

Our sons and daughters who enter treatment at a residential or out-patient facility or even independent treatment with (hopefully) a skilled eating disorder therapist, are often given what are called tools to combat their brain disorder.   The goal of those tools is to help them choose an alternative course of action rather than to turn to the behaviors that are endangering their lives or slowly killing them.

What is missing from the tool box, it seems to me, is the creation of a list of human resources -- people -- who will help the person in the moment thwart the desire to binge/purge or refrain from eating.

Many find they have a very hard time picking up that thousand pound telephone, even a cellphone can weigh that much when confronted with the need to call someone for help.  Yet these contacts are critical - a buddy system, if you will.   The buddy system is used in the Army when recruits are going through Basic Training. 

Although much research continues on eating disorders, many have pointed to clues that the behaviors involved in eating disorders become actual habits that are rewarded by the release of dopamine and other substances that either bring pleasure or relief or reduction of anxiety/fear (among other things).

The goal is to change that habit.

Before release from treatment in a residential facility or before leaving the day program for home or while working with a therapist in a 50-minute session, the person with an ED would be well-served with the creation by him/her working with the therapist of a people resources list that might even be laminated and carried with him/her at all times or entered into a cellphone database.

Many treatment facilities will forbid a visit to the rest room for an hour after meals.  That's great but who will become the monitor after the fact?  Instead, provide practice sessions where the person graduates to no monitoring but is encouraged to go find help if the urge sneaks up on them to purge.  In real life situations out on pass, for example, encourage the person to ask for help before the urge to grab a handful of aspartame packets at the coffee shop or give a sandwich to a friend during school rather than eat it for lunch takes over.  I'm sure there could be lots of other examples and I mention only a few to avoid triggers for those reading this.

There are Facebook pages and individual blogs out there used by people in recovery who reach out when they find themselves struggling -- another great way to ask for help.

Asking for help is part of the new behavior that must be developed for the person to survive.  Some might be able to turn to their own inner resources immediately (possibly because they're sick of being sick and tired), but most will need this extra step to make it all fit together, I think.  Perhaps the lack of this is one contributor to the relapse rate?

Encourage the creation of a multiple buddy system of people who will support the endeavor to get well rather than enable the person to continue with their behavior!

Just maybe we cannot do "it" alone.

[I write this piece with thanks to a therapeutic clinical treatment team that has developed this approach.  I think the approach makes a world of sense.]

The Buddha and the Borderline: A Memoir

Normally I would write a substantive essay before posting here; however, I want to highlight Kiera Van Gelder's book, The Buddha and the Borderline - A Memoir:  my recovery from borderline personality disorder through dialectical behavior therapy, buddhism, and online dating (New Harbinger Publications, Inc., Oakland, CA, 2010) now and write more about the book later after I figure out how I'm going to present it in terms of being a family member.

After perusing Kiera Van Gelder's work but setting it aside late last Spring to read and review Borderline Personality Disorder: New Reasons for Hope by Francis Mark Mondimore, M.D. and Patrick Kelly, M.D., earlier this week I picked it up again and read it word for word  because I wanted to get a first-hand up-to-date look at BPD from the perspective of a person who takes the reader on her journey with BPD (meaning she introduces the reader to BPD, to the effective (for her and why) therapies used, and how her life has played out - at least until 2010 when the book was published).

I learned so much from this book! and recognized my loved one's behaviors more times than I can convey here.  I highly recommend this book, too, as do many well-recognized to the field of BPD people among them (from the pages just inside the cover) Robert O. Friedel, MD, author of Borderline Personality Disorder Demystified; Perry Hoffman, Ph.D, president (2010) of the National Education Alliance for Borderline Personality Disorder; Blaise Aguirre, MD, medical director of the Adolescent Dialectical Behavior Therapy Residential Program at McLean Hospital in Belmont, MA.; Tami Green, internationally recognized speaker, life coach and advocate for those in recovery from mental illness, Roy Krawitz, author of Borderline Personality Disorder The Facts; Randi Kreger, author of Stop Walking on Eggshells and The Essential Family Guide to Borderline Personality Disorder -- this latter book by Randi Kreger helped me a lot!) and several more.

As Robert O. Friedel, MD, notes - "A must-read for people with this disorder, their families and loved ones, and mental health professionals."

I hope to illustrate why and how Kiera spoke to me through her writing.

More later.

The dilemma of long term illness

I've put down my "pen" for awhile.  I took a long break for myself secure in the knowledge that a team of very dedicated people was figuring out how to move forward on literally a day-to-day basis and that I not only needed to emotionally disengage but also needed to trust the process.

Earlier this year I did pull together a few articles and news items about entrenched eating disorders.  Eating Disorders can be long term battles.

After this hiatus that included a wonderful change of scenery, I returned to reading (I had thought I would just lurk) posts in a variety of places and came across a discussion about "walking away."

I believe "walking away" is different from "emotionally disengaging" - at least the semantics to me indicate a difference.  And, I have chosen never to do this in the more than 24 years that ED has been present in the life of my loved one.

Here's a piece (somewhat modified) that I recently wrote to address why I will not walk away.  The quote at the beginning of my post below is thoughtful and important.   However, there's more to the picture and here's my take.

Quote:

As it has been said many times, sometimes it's only when those individuals finally get tired of what their lives have become that change occurs.

I fully agree with this statement.

However, in some cases the likelihood of death occurring before this status is reached can be very high.  I know this.  I have witnessed this.  Scarily close.

If insurance companies are starting to redflag people who "fail" treatment [apparently this is happening], I would ask whose failure is it really? It's not just that of the person whose brain is altered by starvation and purging or binging.

I firmly support the idea that re-nourishment and re-establishment of positive behaviors takes more than 3 months and I become furious when I hear that an insurance company has stopped payment for treatment of this insidious set of diseases.  I would advocate for a year! and early on there was a program, I believe in California, that did offer a year.  But this was many years ago and funding dried up.  As I've written here before, not all families have the wherewithall to put Maudsley into practice in their home.  In addition, sometimes family based therapy in combination with re-feeding at home just doesn't work.
 
It's a very rare insurance company that provides treatment for longer than three months. And the thing is, more time is absolutely necessary to break the bonds that ED has formed with the brain of the person with the disease/brain circuit disorder.

The second problem that can develop is, for example, as a person with Borderline Personality Disorder as a co-diagnosis (and even this is a hurdle because many doctors, therapists and therefore insurance companies do not yet accept/recognize BPD as a brain circuit disorder; rather they identify BPD as a personality disorder) who starts to get a handle on what is going on, it's as though a red cape is unfurled in front of some of them instigating behaviors that completely disrupt their ability to continue in an environment labeled "willing to be here." Private facilities require that an adult client be "willing to be here."

I have witnessed this so many times. I can personally recount the experience of my loved one making the firm decision to get well and taking the responsibility of getting into a facility her responsibility. For one month I drove her at her request to obtain physicals and labs and doctor's visits and therapy, etc., etc., etc. to obtain all the documentation she needed to be admitted to a facility. She did the work; I provided the transportation. All was set. She was accepted. She struggled in the beginning to eat as do most who have an ED. She gained weight. She gained strength and then bingo! her BPD/ED combo took charge and she was asked to leave even though the part of her who knew she needed to stay begged to stay while the other part totally interfered. I know this happened.  Nadia Shivak in her book Inside Out: A Portrait of an Eating Disorder illustrated this very simply in words and drawn pictures.   [The reference is in my list of books on my blog.]

I wish private residential facilities would change their policy of not continuing to work with a client who isn't willing.  I believe this hurdle must change even if it's against the person's will because that will is still dominated by disordered and distorted thinking (refer here to the Keyes Starvation Study) for several months.

I don't think this hurdle is only for those with BPD, either. An addiction is a terrible brain chemical change that undermines a person, whatever that addiction is. It takes a change of heart and mind to be willing to get on the road to recovery and to avoid whatever it is that's addictive.

How? I think this is the question of the hour. When it comes to food -- which is life, along with water here in the desert -- this particular addiction (which I believe an eating disorder becomes) is deadly in a different sense. Alcohol isn't a source of life; neither is, for example, heroin or crack or percocet. There is a difference.  

Researchers and doctors and insurance companies and parents and loved ones must come to recognize this fact.

One extraordinary team has come to this conclusion and is doing all it can to create an environment to bring about this change of mind in the sense of ingrained behavioral patterns. The will to live has never left the person I am talking about but the disease and the addiction it created interfered big time and the claws of that disease and addiction go very deep.   I believe this change can happen.

May I respectfully say that "walking away" isn't the way I would word what must be done for people with eating disorders whose disease is entrenched. Having stood by as an ally for 24 years, I firmly believe this. As a survivor of anorexia/bulimia, I firmly believe this. I didn't have the additional brain circuit disorder component nor, thank God, was I cursed with an addictive brain so strong as to turn to other behaviors that further interfered with my choosing (yes, finally choosing) to get well. Others aren't that lucky.