Obesogens –Another Cause of Obesity?

There is no debate that most obesity comes from poor diet and insufficient exercise.

But a third cause may exist. The effects on humans are yet unclear, though it has a compelling draw.

The third group of causes is known as obesogens. They are chemical compounds that disrupt normal lipid and endocrine systems. Many of these suspect chemicals are pesticides and plasticizers (chemicals added to rubbers and resins to impart flexibility, workability, or stretchability).

More than 30% of adults are obese. Scientists increasingly think that exposure to some environmental chemicals may be another, yet under-recognized factor, in the obesity epidemic.

In 2006, Grün and Blumberg coined the term obesogen, and other authors suggested that obesogens make it hard to lose weight. A flurry of ideas followed – for example, that the fungicide tolylfluanid interfered with normal insulin signaling, which in mice were found to cause weight gain.  Other research suggests plasticizers, like phthalates, induce fat-cell production. Estrogen mimicking endocrine disruptors, such as BPA (bisphenol A, used in plastics and resins, may leach into food from containers coated with BPA) given to pregnant mice will cause obese offspring.  Other research work implicates that obesogens activates the fatty acid receptor PPARy – this is one of the master regulators of fat-cell development. The list is long, and the chemistry is quite complex.

What we need to know is if, and how much, do obesogens effect human health?  Trasande from NYU reports that white children, but not black or Hispanic children, exposed to BPA had double the incidence of obesity.  Li did a study in China which produced similar results – but both studies raise the question of if these were completely true-positive observations – might there be another variable yet unknown?

One bureaucratic challenge is the EPA’s current inability to ban chemicals and do research on such matters. Efforts to change so to be able to more aggressively initiate these activities is underway.

But even as the scientific debate continues, and the continuing strong intellectual draw towards that the possibility that obesogens may contribute to obesity in humans, it’s critical that we insist that hard research be done, that there isn’t an over-simplification or over-extension of some evidence into “truths”, and that we try to reduce our exposure to chemicals that could be problematic.

But in a society inundated with processed, treated, or modified products, that will not be easy.


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Holiday Affective Disorder – An Interesting Concept

“I hate holidays.”

Which begs for the obvious follow up “why?”

“You know me, what a mess I have in life, the mistakes – the whole of me. And then comes joyful Thanksgiving – and families get comfortably together – except for me…”

Okay, okay. So what do we do about it?”

“Stop the holiday’s from coming. Every year, a covetous, almanac, filthy mocker of my life. It makes me depressed and no medicine can fix it.”

“Maybe a seasonal affective disorder?”

“My, my, — no. Not so fancy. I call it HAD – Holiday Affective Disorder. I’ll be better on January 3rd.”


A poignantly useful description.

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Disposing Unused Medications — The How’s

With all the discussion of environmental pollution, we tend to overlook a very influential local factor – namely the improper disposal of unused medications.
The FDA has a site to recommend techniques and lists specific drugs with disposal techniques. However, differences exist in how to dispose and remove narcotics or stimulants – the intent is not to tempt people with improper use of these medications. FDA recommends flushing many of them (see the above website), but this puts the medications into our water supply, albeit diluted. But other organizations, such as DisposeMyMeds offer more detailed information about the how many medications are found in our drinking water. The US Fish and Wildlife Service has a set of recommendations which is easy to read,  easy to follow, and summarized here: (1) Pour the medication in a sealable plastic bag; (2) crush it or add water to dissolve it. (3) Then add kitty litter, sawdust or coffee grounds to the solution. (4) Seal the plastic bag and dispose of it in the trash. (5) Also scrape off any identifying names from the bottle or package. Inhaler devices can also explode if incinerated – it’s important to read the specific disposal instructions that comes with the medication. Every state has their own regulations, but many follow the Federal ones. Florida has a detailed site, and they do not recommend flushing unused medications.

The U S EPA also has a detailed website which discusses these very issues. Hospices follow rigorous protocols to remove the medications from a home once they are no longer needed.

There remains a discussion about the patch delivery systems. The Federal government suggests flushing, but it’s best to return them to a facility set up to accept back these medications. Ask your pharmacist or visit the DEA’s website for more information. Check for National Prescription Drug Take-Back Day events and to locate a DEA-authorized collector Or call the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539 to find a nearby authorized collector—but be prepared for the reality that nothing exists for many miles, if at all.

We tend to forget that our actions, as innocent and simple as they may seem, do indeed contribute to the pollution of our environment. Improperly disposed medications are as environmental contaminants as much as any industrial toxic run off.

And unused medications at home can lead to accidental overdoses or improper uses.

I’d like to see collection boxes for unused medications at the local hospitals since they have the protocols and ability to properly dispose of these items.

Doctors and pharmacists need to discuss these issues. Let’s start a campaign – “we teach you how to use the medications – let’s also teach you how to dispose of them.”

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Post Traumatic Protective Disorder (PTPD) – The Child of PTSD

Just over two years ago a SUV sped through a red light and hit my car.

I survived. My car did not.

It took over a year before I could drive through that same intersection, and I still prefer other travel routes if possible. Big black SUV’s continue to peak my defensive awareness. It’s not a fair thing to so profile other SUV’s and their drivers.

I slow down and take extra looks at each intersection. I do so more than I realized —  others asked me why I’d become like a school bus driver at railroad tracks.

It was by chance that I realized that my PTSD changed into a PTPD.  PTPD, as term, does not officially exist, so I’ll coin PTPD as a new term. It ought to be granted the status of a formal label because it is the child of  PSTD and because it makes sense.  PTPD has made me more careful, more aware of vulnerabilities, reduced the anger over an event that I cannot undo,  and added just a touch of fear sufficient to better avoid additional accidents. PTPD has worked for me several times in similar driving situations where I took extra notice of other’s driving habits (or, to be more accurate,of their driving sloppiness and arrogance’s) to avoid a collision.

PTSD  kept me stale and relatively un-moving; the metabolite of PTSD , which is PTPD, make me better. Therapists unknowingly, as was I, had long been using this unknown metabolite as a therapeutic tool.

Some folks think we should work to the point where the original injury is defused and deflated such that  we do not allow it to be such a big part of our daily lives. (“You need to have something else and good  in your life…”) If I’d been hurt and every step I took since then made pain shoot into my body or mind, then the injury is still living.  My PTSD is unlike the combat implanted ones because the gestalt of combat is one of the truly ultimate and risky of businesses, and once removed from the war theater, there ought not to be the chance of another, additional combat  PTSD event. My PTST-PTPD refers to the ordinary dangers of everyday life, without the combat levels of risk, though many with horrible and lasting non-combat injuries do wonder if another injury will fall upon them.

PTSD reminded me of how random life can be and that other people will still make decisions that can hurt me. None of us live in a bubble, and now I work extra hard to help my patients know that the best help I can give them is the developing of a non-self-destructive mental approach to the randomness and unfairness  in life. Part of this treatment is the development of a philosophy or attitude that allows for what had happened, and to put it into a workable perspective with a goal. Substance abuse or other reactive mental health problems too commonly reflect the lack of this understanding and goal. (Appropriate medications may be needed but not to the exclusion of verbal therapies.) If there is no other perspective to soften the fear and pain (e.g., “you can’t erase that I was in a war zone,” or “I was a crime or abuse victim.”), then the task is to build a life around it.  One way is to convert the PTSD into PTPD  — this uses the event to help prevent it from happening again. The pain can still exist, but pain cannot be wasted –with the right help,  pain can be the strongest of  the healing and changing driving forces.

This is the season of gift giving. PTPD was an unexpected gift. Actually, PTPD is more like a kit, with ‘lots of assembly’ required. I prefer kits to pre-assembled items because the kit gives me an hands-on experience into how and why the item works.

I’m pleased to have PTPD.

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Psychotherapy Notes — IQ’s and the death penalty

The US Supreme Court has agreed to hear this Florida case about the death penalty and IQ.

Conceptually key too, for us, is the search for a ‘bright-line’ diagnosis  Arriving at a precise psychiatric diagnosis is challenging; it is not always possible. A good psychiatric diagnosis is the product of current symptoms and the person’s history. This court case stems from another process –the assigning of a number to rate a psychiatric condition. The punishment — in this case a death penalty — depends on the number.

The bright line diagnosis hopes to give us a clear and ‘bright’ line of demarcation between a condition or not. At issue is whether the mentally retarded can be executed; In 2002 the US Supreme Court held that execution of the mentally retarded violates the 8th Amendment. The Florida defendant in this 2013 case, Freddie L Hall, has an IQ that has varied from 60 to 71. The bright line for retardation in Florida is an IQ of 70.  One of the issues is the accuracy of the testing instruments, which is known as SEM – the standard error of measurement. The court’s ruling may impact some of the how’s and why’s of precise psychiatric diagnosing.

An US Federal statute, Rosa’s Law (Public Law 111-256) replaces mental retardation with intellectual disability, and the severity of the condition now in DSM-5 (started May 2013) is ranked as mild, moderate, severe or profound – there is no direct use of  numbers. It will be fascinating to watch the court grapple with these DSM changes since the older DSM-IV used ranking numbers.  Read the section on comprehensive assessment:  DSM-V

The defendant in this case is reported to have also been horribly abused as a child.

This is the link to US Supreme Court Case

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Psychotherapy Notes – Cyberbullying

The BBC produced a remarkable documentary on cyber bullying.  The recent Florida events highlight its critical importance. The link is posted below.

People rationalize their bullying in a manner that becomes just another type of domestic violence; it is all in the process of getting some sort of joy in those who bully as they get a controlling and painful reaction from the victims. It is a despicable side of human nature. It is sadism. 

There is no social benefit to cyber bullying. It is a perverse and greedy rationalization fed by the apparent shield of anonymity because people do not have to stand in front of their victim. It is a cowardly way of making a point. And an added element exists because the victims have no real mechanism of stopping it. Imagine the psychological trauma of knowing that there is no way to protect oneself from the onslaught; one cannot at least try to physically fight back, and running away  to freedom is not possible. Too many people have been emotionally traumatized by this cruel game, and we know of too many cases where the trauma was only ended by suicide.

I’m struck by how there is a similarity to the very bad side of some video games. The video game is a two-dimensional experience, but the concept is three-dimensional – an enemy is found and beaten. The third dimension is the joy of the success. This same third dimension exists for those who cyber bully.

Those who cyber bully reflect the cruel side of people; those who suffer do not find any comfort  in  the expression of free speech notions. Victims find no justification of any bullying.  I wonder how many of those who bully would still do so if they were forced to do this sitting face to face with their victim?  And would those who join in with the bully also do so in public?  Massive cyber-bullying is akin to a pathetic feeding frenzy, a crowd who applauds while watching a death at the Coliseum. What human comfort follows knowing they have watched someone else’s pain and suffering. Is there a joy? Is there some sense of decency and human bonding? Do those who bully believe it cannot happen to them? It rings of arrogance and cockiness.  It’s also amazing how many from around the world join in with the bully — the joiners have no connection at to the victim other than the adrenaline from the frenzy.

Bullying can be lethal, just as a gun is.

This no way we can easily limit or regulate a world as internationally massive as the Internet. Stronger laws, other than of malicious communications, need to be written, but would they apply across political boundaries?  

The answer is to dilute out the response to bullying. Teachers, parents,  older siblings, politicians, and everyone else,  need to teach how to pull away from any bullying. The process may require rapid maturation. It may require getting off of all social medias for a long while. It’s as simple as turning off the computer.

But mostly it requires that the victim be reassured that the comments being made are not valid.

But  for the very sensitive, or with those with a fragile ego, or if some other vulnerability exists that is being abused by the bully, then help and guidance must immediately start to build their ego up enough so they can resist the allegations. It’s not always easy. But it certainly is possible. Even the stronger but naively curious person needs to understand what windows in their lives they open when then ‘go online’.

Teenagers should not look to allegedly benign sites, such as littlegossip.com, for emotional guidance and reassurance.  The internet is not inherently dangerous, but there is a blind trust that it is safer than it is. The Internet knows no boundaries and thousands fall into its black holes every day. It’s safer to talk to our friends face-to-face than message them on Facebook. Facebook says “look at me!” We need to accept that it is not always necessary for the world to know all our business.

Be able to physically touch your friends.

Click here for the BBC link.

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Psychotherapy Notes – Navy Yard Shooting -Sept 2013

Every shooting seems to be followed by questions of whether or not mental health treatment might have stopped the tragedies.

The honest answer is maybe. But maybe is better than not at all.

Things are particularly tragic if we also learn that the assailant was refused mental health treatment because of the financial or bureaucratic crevices in our healthcare system. Apparently Aaron Alexis, the Navy Yard shooter, was suspected by friends to be paranoid; likewise, when Alexis heard voices and called the police, little was done other than make reports.

Ironically it seems Alexis wanted some level of help.

Allocating resources to mental health care is an emotional and political decision. It should not mostly occur in response to an illegal action.

Part of the problem is that treatment is not always successful. But the penny has another side, and many – if not most people – benefit from solid treatment. And yes, it is expensive in terms of introspection, time, and money. But how many of the shooters would have not shot because their treatments kept them on the good side of the penny.

Guns plus mental illness doesn’t automatically convert to danger. Guns plus certain types of uncontrolled mental illness could.

As for gun control, the problem is not that criminals will ‘get the guns anyway.’ The problem is when the non-criminal out-of-control mentally ill gets guns that end up causing violence, be it against themselves or others.

I’ve even heard talk that people with any mental health disorder will be stripped of their security clearances. The possibility of “veteran + PSTD = no job” is daunting. People will be less inclined to get help, enlarging the pool of the untreated.

Let’s prioritize: revamp the mental health system and spend less time arguing about the gun control system. The problem is that it is cheaper to buy a gun than pay for mental health care.


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