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From the Townsend Letter
October 2017

Letter from the Publisher
by Jonathan Collin, MD
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Have Smartphones Destroyed a Generation?
The byline of this September 2017 Atlantic magazine article by Jean Twenge summarizes the effect of smartphones on the iGen generation born after 1994: & "More comfortable online than out partying, post-Millennials are safer, physically, than adolescents have ever been. But they're on the brink of a mental-health crisis." Twenge is a psychologist at San Diego State University who studies differences between the & "generations" who come of age. Generally, generational characteristics of behavior and beliefs change gradually. Millennials are noted to be very individualistic, but baby boomers have also been individualistic, while millennials demonstrated a slightly greater level of individualism. What Twenge has observed is among the adolescents born after 1994, whom she refers to as the iGen generation because they have come of age since the internet has evolved; the degree of change in boys and girls is not a gradual change, but a profound shift in behaviors and beliefs. Twenge's studies reveal that the change became & "seismic" after 2011 when nearly 50% of the US population owned smartphones. Among 8th graders, 10th graders, and 12th graders, the trend is identical for studied characteristics: & "Times per week teenagers go out without their parents," & "Percentage of 12th graders who drive," & "Percentage of teenagers who ever go out on dates," and & "Percentage of high-school students who have ever had sex," all show a sharp decline among adolescents now compared to similar-aged members of the millennial and baby boomer generations. On the other hand, study of & "The percentage of 8th, 10th, and 12th graders, who agree with the statement, 'I often feel left out of things' or 'A lot of times I feel lonely,'" sharply increased in the iGen generation. Similarly, they are more likely to have less than seven hours of sleep on most nights compared to millennials.

What could be behind this marked change of behaviors and beliefs in adolescents? Twenge hypothesizes that the extensive amount of time boys and girls spend texting on social media is responsible. It is not unusual for a teen to spend 2-3 hours daily on SnapChat, Facebook, and other sites. Why interact with a friend in person when one could do this comfortably from one's bedroom with no interference from parents? There is no need for being chauffeured to another location, no money is required, and if a friend is not responsive or boring, there is always another friend to text. Moreover, when the teen is obliged to go with parents to events or visits, one can hang back and text without engaging in the activity or sharing directly in conversation.
Without work, teens don't experience the responsibility of doing productive activity nor do they earn money for their shopping needs. True, most teens don't seek to drink alcohol; and without dating, they don't engage in physical sex. (However, Twenge's work does not address the rampant problem of drug addiction nationwide.) Still, despite the excess amount of time on social media, most teens complain of loneliness, feeling depressed, and not getting sufficient sleep. The incidence of suicide is nearly triple among girls and double among boys in 2015 compared to 2005. Not unexpectedly, because so many stay at home the homicide rate among teens has sharply declined.
Antidepressant use has dramatically increased in the US population as a whole. Drugs are considered an easy solution for anxiety and depression. The increased time spent on social media makes teens more anxious and depressed. When their social media posting is ignored, the teen becomes anxious. Worse, bullying which previously meant physical violence, is now carried out by mean-spirited trolling on the internet frequented by classmates. Twenge's work found a direct correlation between greater time spent on texting or social media and psychiatric disorders; contrarily, more time spent engaged in physical activities and interacting directly with others socially, reduced the risk of depression and anxiety.
Twenge's message is discussed more fully in her book, iGen – Why Today's Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy – and Completely Unprepared for Adulthood – and What that Means for the Rest of Us.

Researched NutritionalsAre Unresolved Urinary Tract Infections Linked to Dementia?
In the August 2017 issue of Alternatives: For the Health Conscious Individual by Dr. David Williams, the author writes about the surprising connection of elderly individuals with dementia and unresolved cystitis. Williams worries that too many of them are institutionalized and treated with anti-psychotic medication when the primary problem is an unresolved urinary tract infection. He hypothesizes that the recurrent urinary tract infection negatively impacts the body's microbiome, and that, in turn, has an adverse effect on thinking and brain functioning. Williams' report explains that the urinary tract infection in the elderly does not necessarily present as pain on urination. Instead, the individual may develop an abrupt change in behavior and thinking, becoming confused, unable to perform their normal tasks. In extreme cases there may be hallucinations, emotional outbursts, paranoid ideation, and inability to express oneself logically. Of course, the UTI may still present with hematuria, and there can be generalized malaise, nausea, fatigue, anorexia, and incidents of falling.
Could this be a major problem in a patient with dementia?
Williams writes about the failure of antibiotics in recurrent cystitis; bacterial resistance has become ubiquitous. Instead he recommends the use of cranberry extract and d-mannose. He suggests a cocktail of 1/4 teaspoon (400 mg) of cranberry extract, 1 teaspoon (2,000 mg) of d-mannose powder, and 1/2 teaspoon of sodium bicarbonate to be taken twice daily. Restoring the microbiome with effective prebiotics and probiotics is also critical.
One thing that Williams did not discuss but was reviewed in the August/September 2017 issue of the Townsend Letter by Dr. Michael Gerber is the problem of infected teeth and dental roots. Chronically infected teeth and roots will prevent satisfactory resolution of recurrent urinary tract infections (and other chronic disorders) and need to be addressed as well.

James Greenblatt, MD
Our cover story features Dr. James Greenblatt, Chief Medical Officer and Vice-President of Medical Services of Walden Behavioral Care. Dr. Greenblatt serves as an assistant clinical professor of psychiatry at Tufts University School of Medicine and Dartmouth Geisel School of Medicine. An acknowledged expert in integrative medicine, Dr. Greenblatt has lectured throughout the US on the scientific evidence for nutritional interventions in psychiatry and mental illness. He has authored many books that integrate psychiatric practice with nutritional medicine.
In 2011, he authored Answers to Anorexia and The Breakthrough Depression Solution. Based on his experience with eating disorders, Dr. Greenblatt wrote a paper in the Oct. 2011 issue of the Townsend Letter entitled & "Malorexia: Anorexia Nervosa Redefined." Dr. Greenblatt's review of the psychiatric literature attests to the medical profession's view that anorexia nervosa was a nervous disorder, once considered a form of hysteria, more recently seen as a dysfunctional child upbringing. Psychiatrists particularly blame our culture's fixation on thin women who are considered paragons of beauty. Greenblatt asserts that it is not our preoccupation with slimness that brings on anorexia; instead, the caloric restriction itself damages the brain and perpetuates the brain's cessation of appetite.
How does Greenblatt propose to treat the adolescent's or young adult's anorexia? Not by scheduling psychological therapy. First, he redefines the condition as malorexia or bad eating: & "It is a complicated illness of restrictive eating and self-starvation initiated by diverse factors leading to severe malnutrition and consequent biochemical disturbances in the brain." Treatment for malorexia requires feeding the starving brain essential nutrients to quiet the chronic thoughts of fear. Greenblatt states that patients with malorexia suffer from chronic fear.
Greenblatt's approach to anorexia includes testing for zinc status; testing for elevated levels of urinary peptides, screening for celiac disease, doing EEGs to determine if psychiatric medication is required; and testing for and treating macro- and micro-nutrient status. With appropriate psychiatric medication (as needed) as well as adhering to nutritional dietary changes, the anorexic patient is expected to recover a normal appetite and no longer be dealing with anorexia.
In this issue, Dr. Greenblatt and Winnie Lee, RN, write about optimizing attention-deficit hyperactivity disorder (ADHD) treatment with oligomeric proanthocyanidins (OPCs). Greenblatt and Lee review that ADHD has become the prevalent childhood disorder in the US. The most common treatments for ADHD has been the prescription of Ritalin, Adderall, or dexamphetamine. While these treatments have been shown to provide partial effectiveness, they fail to provide complete relief on a long-term basis in 70% of patients.
Recent studies have demonstrated the effectiveness of neurofeedback in comparison to drug therapy. However, neurofeedback is costly and time consuming, leading to poor patient compliance. Greenblatt and Lee are impressed with treatment results using plant-based oligomeric proanthocyanidins (OPCs) as & "adjuvant therapy" in treating ADHD. OPCs are available in plants that are strongly pigmented such as blueberries, cranberries, and grapes but are also available in grapeseed, ginkgo biloba, and pine bark. Treating patients with OPC supplements, such as pycnogenol derived from pine bark, has proven to be an effective approach in managing ADHD.
Greenblatt's work with ADHD is more extensively examined in his recently published book, Finally Focused: The Breakthrough Natural Treatment Plan for ADHD that Restores Attention, Minimizes Hyperactivity, and Helps Eliminate Drug Side Effects, coauthored with Bill Gottlieb, Harmony Books, 2017. Greenblatt and Lee have coauthored Breakthrough Depression Solution: Mastering Your Mood with Nutrition, Diet and Supplementation available through Sunrise River Press, 2016.

Jonathan Collin, MD

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