Oct
26
2013

Being SAD in Fall (Seasonal Affective Disorders)

By | Abdominal Pain, Hormones, Insomnia, Mental Health, Pain, Prevention, Stress management, Vitamins and supplements

Any general practitioner knows that fall and winter are the time when patients come in with a variety of complaints like a lack of energy, problems sleeping, inability to cope with stress, but often there may be non-specific pains like muscle spasm in the back, the shoulders, or indigestion. These symptoms can all be part of seasonal affective disorders (SAD) like depression, the winter blues, often coupled with anxiety.

Emotional health does not fit easily into our health care model. The receptionist will warn the doctor that this is going to be a “difficult” patient. If the doctor has only time for a 5 or 10-minute visit, where only one or two problems can be dealt with, then this does not fit when a patient with SAD has a problem concentrating, falling asleep, and presents with a long list of other complaints. Even 20 minutes or 30 minutes may not be enough to deal with this patient adequately. It is easier to send the patient for tests and to prescribe an antidepressant and a sleeping pill and reschedule for a follow-up appointment. But this likely will result in normal blood tests and investigations, added health care costs, but no solution to the patient’s problem when he  or she simply states “doctor, I feel so sick”.

I thought it would be interesting to review how our emotions can get out of balance and review an integrative approach to SAD.

Definition of SAD

Seasonal depression (also called seasonal affective disorder) occurs during fall (autumn) and winter, but this alternates with no depressive episodes during spring and summer. A person defined to suffer from SAD would have suffered from two major depressive episodes during the past 2 years with no depressive episodes in the intervening seasons of spring and summer (Ref.1). Alternative names for SAD are winter depression and wintertime blues. Typically SAD lasts about 5 months.

Brain hormone disbalance

Around 2002 it was detected that in mice there was a second light sensitive pathway from ganglion cells in the retina that were responsible for circadian hormone rhythms. This was later confirmed to be true also in humans, where photosensitive retinal ganglion cells buried deep in the retina and containing the pigment melanopsin absorb blue light in the visible light spectrum. The electrical signals are sent along the retinohypothalamic tract, so that light from the retina regulates the hormone circadian rhythm (daily hormone fluctuations including the sleep/wake cycle) in the hypothalamus. The hypothalamus is one of the major hormone centers in the center of the brain. As this publication shows there are minor genetic sequence changes for the retinal photopigment, melanopsin in patients with SAD. This affects about 1 to 2% of the American population. Many more have probably partial defects in the function of this pigment.

Being SAD in Fall (Seasonal Affective Disorders)

Being SAD in Fall (Seasonal Affective Disorders)

Many hormones in our brain experience a circadian rhythm.

When the sun goes down, melatonin is produced making us sleepy. In the morning serotonin production goes up and stays up all day, which normally prevents depression. There are other hormones that cycle during the course of the day. Cortisol is highest in the morning and low in the evening and at night. Growth hormone and prolactin are highest during sleep.

There is a lack of serotonin in the brains of patients with SAD and depression.

Symptoms of SAD

A person affected by SAD or any other patient with ordinary depression will present with symptoms of lack of energy, with tearfulness, negative thought patterns, sleep disturbances, lack of appetite and weight loss and possible suicidal thoughts. On the other hand symptoms may be more atypical presenting with irritability and overindulging in food with weight gain. Some patients somaticize as already mentioned in the beginning of this review experiencing a multitude of functional symptoms without any demonstrable underlying disease. It is estimated that up to 30 to 40% of patients attending a general practitioner’s office have some form of depression and in the fall and winter season a large percentage of them are due to SAD.

Treatment approaches to SAD

There are several natural approaches to SAD. However, before deciding to go this route, a psychiatrist should assess the patient to determine the risk for suicide. When a patient is not suicidal, light therapy can be utilized.

1. Light therapy: According to Ref. 2 a light box from Sun Box or Northern Light Technologies should be used for 30 minutes every morning during the fall and winter months. The box should emit at least 10,000 lux. Improvement can occur within 2 to 4 days of starting light therapy, but often takes up to 4 weeks to reach its full benefit (Ref.2).

2. Exercise reduces the amount of depression. The more exercise is done the less depression remains. A regular gym workout, dancing, walking, aerobics and involvement in sports are all useful.

3. Folate and vitamin B12: Up to 1/3 of depressed people have folate deficiency. Supplementation with 400 mcg to 1 mg of folic acid is recommended. Vitamin B12 should also be taken to not mask a B12 deficiency (Ref.3). Folate and vitamin B12 are methyl donors for several brain neuropeptides.

4. Vitamin D3 supplementation: A large Dutch study showed that a high percentage of depressed patients above the age of 65 were deficient for vitamin D3. Supplementation with vitamin D3 is recommended. (Ref.3). Take 3000 to 4000 IU per day, particularly during the winter time.

5. St. John’s Wort (Hypericum perforatum) has been found useful for minor to moderate depression. It is superior in terms of having fewer side effects than standard antidepressant therapy (Ref.3).

6. Standard antidepressants (bupropion, fluoxetine, sertraline and paroxetine) are the treatment of choice by psychiatrists and treating physicians when a faster onset of the antidepressant effect is needed (Ref.3).

7. Electro acupuncture has been shown in many studies to be effective in ameliorating the symptoms of depression and seems to work through the release of neurotransmitters in the brain (Ref.4).

8. A balanced nutrition (Mediterranean type diet) including multiple vitamins and supplements (particularly the vitamin B group and omega-3 fatty acids) also stabilize a person’s mood (Ref.3). Pay particular attention to hidden sugar intake, as sugar consumption is responsible for a lot of depression found in the general population.

9. Restore sleep deprivation by adding melatonin 3 to 6 mg at bedtime. This helps also to restore the circadian hormone rhythm.

Conclusion

Seasonal affective disorder is triggered by a lack of light exposure in a sensitive subpopulation. An integrative approach as described can reduce the amount of antidepressants that would have been used in the past in treating this condition. This will reduce the amount of side effects. The use of a light box can reduce the symptoms of this type of depression within a few days. But the addition of electro acupuncture and St. John’s Wort may be all that is required for treatment of many SAD cases. Regular exercise and a balanced nutrition (with no sugar) and including vitamin supplements complete this treatment. If the depression gets worse, seek the advice of a psychiatrist and make sure your doctor has ordered thyroid tests and hormone tests to rule out other causes where depression is merely a secondary symptom.

More information on depression: http://nethealthbook.com/mental-illness-mental-disorders/mood-disorders/depression/

References

  1. Ferri: Ferri’s Clinical Advisor 2014, 1st ed. © 2013 Mosby.
  2. Cleveland Clinic: Current Clinical Medicine, 2nd ed. © 2010 Saunders.
  3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders.
  4. George A. Ulett, M.D., Ph.D. and SongPing Han, B.M., Ph.D.: “The Biology of Acupuncture”, copyright 2002, Warren H. Green Inc., Saint Louis, Missouri, 63132 USA

Last edited Nov. 7, 2014

Jun
01
2008

Boost Babies’ Health with Mom’s Diet

By | Allergies, Asthma, Health, Nutrition, obstetrics, Prevention, Vitamins and supplements

Prenatal supplements and good advice on proper nutrition during pregnancy have long been included in proper prenatal care. Importance has been placed on folic acid to prevent neural tube defects in the fetal development. Calcium is recommended, often in the form of dairy products, but it does not end there: just swallowing the supplement and adding some more milk may be helpful but not quite enough. Certain dietary habits have been found more beneficial, such as the eating habits in the Mediterranean countries. A research team from the University of Crete in Heraclion, Greece included women who were involved in antenatal care at all general practices in Menorca, Spain. The study took place in the time frame of 12 month starting in 1997. After six and a half years 460 children were also included in the analysis.

Dietary habits were studied and assessed by food questionnaires and the children were assessed for the development of allergies and asthma.

Boost Babies’ Health with Mom’s Diet

Boost Babies’ Health with Mom’s Diet

The children of mothers who consumed the most vegetables, fish and legumes were almost 80% less likely to have persistent wheeze and more than 40 % less likely to have allergies. The results are consistent with the fact that a high level of adherence to the Mediterranean diet during pregnancy is protective not only to the mother but also to the child.

More information about prenatal visits (where nutritional habits are checked as well): http://nethealthbook.com/womens-health-gynecology-and-obstetrics/pregnancy-labor-delivery-2/prenatal-visits/

Reference: The Medical Post, April 22, 2008, page 25

Last edited December 18, 2014

Dec
01
2006

Cinnamon And Multivitamins May Boost Fertility

By | Health, Nutrition, obstetrics, Vitamins and supplements, Women’s Diseases

Prenatal vitamin supplements are the norm, as folic acid has been known to play a role in the prevention of neural tube defect. Generally they are taken once pregnancy has been confirmed.
Dr Jorge Chavarro from the department of nutrition at the Harvard School of Public Health in Boston pointed out, that multivitamin supplementation has its place earlier than just after the pregnancy test has become positive. In one of the largest studies involving 18,000 married pre-menopausal women, regular use of multivitamin supplements were associated with a decrease of infertility. The key is in the regular use. Women who took two multivitamin tablets per week had similar infertility rates as women who did not take supplements at all. Those who took 6 or more multivitamins had a 40% lower risk of anovultation, a condition where no eggs are released by the ovaries.
Most of the women were Caucasian between the ages 24 and 42.
The importance of nutrition is coming increasingly into the forefront in reproductive medicine. One condition known as polycystic ovary syndrome (PCOS) is often a reason for infertility. It is one of the red flags that point to the condition of insulin resistance, and it manifests itself in menstrual irregularity and higher levels of androgens, often showing as increased facial hair. As the metabolism is headed for trouble, diabetes, high blood pressure, high cholesterol and heart disease would tend to develop.
Researchers at Columbia University in New York conducted a pilot study to see if insulin sensitivity in women with PCOS could be improved. Cinnamon, a well-known spice, has been known to have a favorable effect on the insulin response of the body. Researchers found that eight weeks of treatment with cinnamon extract significantly decreased fasting glucose and insulin resistance in women with polycystic ovary syndrome.

Cinnamon And Multivitamins May Boost Fertility

Cinnamon And Multivitamins May Boost Fertility

Dr. Jeff Wang who conducted the study reported that no side effects or adverse reactions were reported throughout the study period. If large-scale prospective studies confirm these findings, then recommending cinnamon as a dietary factor may be a simple, inexpensive lifestyle change that can be easily followed. Reducing insulin resistance is a key to improve the overall health status in patients with PCOS, and it ties in with reproductive health benefits as well.

More information about infertility: http://nethealthbook.com/womens-health-gynecology-and-obstetrics/infertility-php/

Reference: The Medical Post, November 14, 2006, page 32

Last edited November 2, 2014

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Nov
01
2006

Eat Your Salad Greens, But No Spinach

By | Cancer, Heart Disease, Infectious Disease, Nutrition

Spinach has traditionally been regarded as a healthy, green leafy vegetable and a valuable source of vitamins and minerals, in particular iron. The tedious chore of cleaning the tender greens and removing soil and sand traces has been taken care of by packinghouses. As a result, the consumer could purchase ready to eat spinach in plastic bags. These greens were a welcome ingredient for spinach salads or other dishes.
Lately all spinach has been recalled from the world’s largest producer of organic produce. Natural Selection Food has recalled a total of 34 brands that were distributed nationwide, and some of which were available also in Canada. Consumers are still being warned not to eat fresh spinach from the U.S., even though there have been no reported cases of ill effects or diseases in Canada itself. Problems have surfaced in September in form of food borne illness in the U.S. The culprit seems to be contamination with E. coli 0157:H7. Food borne illness can be serious. So far there have been 109 cases of illness in the U.S. and possibly two deaths. The worst affected area so far is Wisconsin, where 29 illnesses were reported and one person died of the disease.
As a result of this alert, salad mixes that contained a variety of greens including spinach leaves have also been pulled from the shelf. It should be mentioned that washing the spinach leaves does not make it safe to consume, as the E.coli bacteria stick to the leaves.
While it seems good-bye to spinach leaves for now, it remains important to eat your greens. Researchers at University of California in Los Angeles and colleagues at Louisiana State University analyzed the salad consumption based on the intake of salad, raw vegetables and salad dressing on 9,406 women and 8,282 men. The researchers also found from their studies that daily consumption of salad and raw vegetables is not the norm in any population group and even less prevalent among African Americans.

Eat Your Salad Greens, But No Spinach

Eat Your Salad Greens, But No Spinach

There were data from lab tests on serum nutrient levels, and it showed that consumption of salads was positively associated with above-median serum micronutrient levels of folic acid, vitamin C and E, lycopene, and alpha carotene and beta carotene. All of these nutrients are important for healthy daily functioning. They are weapons that help fight infection, heart disease and cancers. The consumption of salad and raw vegetables remains the most effective strategy for increasing the intake of important nutrients.

Reference: The Medical Post, October 3, 2006, page 21

Here is a follow-up on this story: Apparently the outbreak was caused by a wild boar and by a nearby cattle field:  http://www.foodsafetynews.com/2009/09/meaningful-outbreak-7-dole-spinach-e-coli-outbreak/#.VFaWXPTF-88

More information about food safety: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/food-safety/

Last edited November 2, 2014

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Jun
01
2003

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

By | Heart Disease, Nutrition, Prevention, Vitamins and supplements

The May 2003 issue of the medical journal “Clinical Practice” contains an article by the dietician Andrea Miller (pages 46 to 49) about supplementation with these vitamins in relation to hardening of the arteries from too much of the amino acid homocysteine.

Homocysteine is an amino acid that contains sulfur, which is formed from the metabolism of methionine, an essential amino acid that we depend on in our food for maintaining a normal metabolism. There are complex metabolic pathways that involve several enzymes to function normally, which involve the three vitamins B-6, B-12 and folic acid (folate) to balance everything.

If one of these vitamins or any of the enzymes involved malfunction, a surplus of homocysteine results with an accelerated hardening of the arteries throughout the body. A certain percentage of the population does not have the full concentration of one or more of the metabolic enzymes in their system. If the food we eat is also relatively deficient in the above named vitamins, the body runs out of alternative metabolic options and produces dangerous levels of homocysteine. A normal blood level of homocysteine is between about 5 and 10 micro-mol per liter. This is not routinely measured by screening tests unless the doctor suspects a genetic trait in the family where family members tend to get heart attacks at an early age (mid 30’s to early 40’s). When the level of homocysteine is elevated to 12 micro-mols per liter, a supplement with folic acid of 1 mg per day would reduce this by 25% to safe levels of 9 micro-mols per liter. This results in a 15% decrease of the death rate from heart attacks.

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

Vitamin B-6, Vitamin B-12, Folic Acid To Control Hardening Of Arteries

Vitamin B-12 is found in animal products such as meat, poultry and dairy products. Vegetarians may not get enough Vit. B-12 and should supplement as should persons above the age of 50. A lack of B-12 vitamin leads to pernicious anemia.

Vitamin B-6 is found widely distributed in meat, fortified grains and poultry and usually is in our food supply to a satisfactory degree.

Folate (folic acid) is contained in orange fruits, beans, lentils and green vegetables. However, not everybody eats well banced meals and the food supply could be marginally deficient in folate.

Recommendation: The take home message is that a good multivitamin tablet containing about 400 to 600 micrograms (=0.4 to 0.6 mg) of folate (folic acid), 5 mg of vitamin B-6 and 20 micrograms of vitamin B-12 would be providing an adequate amount of these vitamins and reduce homocysteine levels in most people to safe levels. It is not recommended to take single vitamin supplements of these vitamins as this could lead to toxicity. Also, there is no point in taking higher doses of the vitamins as this also would lead to toxic reactions.

Link to information about balanced nutrition: http://www.nethealthbook.com/articles/nutrition.php

Last edited December 9, 2012

Dec
01
2002

Folic Acid In Cereal Reduces Abnormalities Of The Brain and Spine In The Unborn Child

By | Nutrition, Other neurological conditions, Prevention, Women’s Diseases

In 1998 the Canadian government approved the mandatory addition of folic acid in cereal products as studies in the past had shown that pregnant women did not always take their prenatal folic acid supplements to prevent neural tube defects (abnormalities in brain and spine formation).

A total of 336,963 children of women who were either pregnant before or after the 1998 folic acid fortification program was institued, were screened for open neural tube defects. The result was that prior to the legislation there were 113 cases per 100,000 pregnancies. After 1998 there were only 58 per 100,000 pregnancies found.

Dr. Joel G. Ray from the Sunnybrook and Women’s College Health Sciences Center in Toronto who was the lead researcher stated that a food fortification program with folic acid in addition to the regular prenatal folic acid tablet supplementation is essential. To a large extent this will prevent these devastating congenital malformations that cause disabilities or death.

Folic Acid In Cereal Reduces Abnormalities Of The Brain In The Unborn Child

Folic Acid In Cereal Reduces Abnormalities Of The Brain In The Unborn Child

Based on: Lancet 2002;360:2047-2048.

Comments: It is also important for women to know that folic acid tablets need to be taken already before, around and after conception to be most effective with regard to preventing brain and spinal malformations. The nervous tissue is one of the fastest growing tissues in the first few weeks of pregnancy. Any deficiency of cell differentiation, for which folic acid is an essential ingredient, has devastating longterm consequences for the child.

Last edited December 10, 2012