How Come They're Happy and I'm Not? (14 page)

Another concern I have is about how natural medicines are researched and depicted. In May 2011, I read a headline that proclaimed: “Vitamin D does not prevent depression.” Of course I was interested in reading this. I have used vitamin D for years and have seen excellent results in mood issues, autoimmune diseases, and inflammatory problems. The short story is that a study published in the
British Journal of Psychiatry
, a well-respected journal, gave more than 2,200 females over seventy years old a whopping 500,000 IU shot of vitamin D once a year in the fall or wintertime. What they found out is (1) vitamin D seemed to cause an increased rate of falls and fractures, and (2) vitamin D didn't do anything to prevent mood problems. To me, this study moved so far away from the natural way a person's body works that it was destined to fail. When in the world would you receive 500,000 IU of vitamin D at one time in nature? I doubt the body has any idea how to handle that. Unfortunately, the message the media used was that “people took vitamin D, and it didn't prevent depression.” Spreading that skewed message will not help anyone.

If we are to benefit from using natural medicines, we need to study them by first asking the question: How does nature intend this item for our bodies, and can we somehow mimic that with our therapy? Then, we need to study it in a paradigm that also addresses a person's diet, lifestyle, sleep, environmental toxins, and stress. Considering all of these together as part of a synergistic plan helps people every day.

If we simplistically treat with natural medicines in the same way conventional medicine treats with drugs, we will continually yield similar results as the misguided conclusion that vitamin D is not helpful for depression. Medical research is a topic I am passionate about, and it's exasperating to me when the media sways
the public against natural remedies due to misinformation, poorly designed studies, and sensationalism.

Supplements are vitamins, herbs, and anything that can be placed in a capsule or made into a powder, tablet, or liquid and used to help the body heal itself. According to
Merriam-Webster's 11th Collegiate Dictionary
, a supplement is “something that completes or makes an addition.” Consider the way this book is organized: supplements are discussed only after revealing the basics of diet, lifestyle, sleep, spirit, and stress management. This is because those issues need to be addressed first to allow the body to truly heal the way I know it can. Then we can “complete” or enhance the treatment with the supplement, but supplements themselves are rarely the cure.

Please know I am not trying to dissuade you from using supplements. We talked about a number of them in the blood test section; now we will focus on others that may help you. I have certainly witnessed supplements help patients get better faster, and I have seen them serve as invaluable tools to support patients like you who want to safely and effectively wean themselves off their medications.

Healthy fat and oil intake is key for good mood. The brain is about 70% lipids (fats), so the quality and amounts of the oils we take in will play a strong role in the composition and function of our brain and nervous system.

As we touched on in
chapter 2
, fish oil is a needed support for brain function and good mood. It contains the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These help the body and brain build new nerve tissue by increasing nerve growth factor (NGF)—a protein needed for the growth and repair of nerve tissue. Fish oil supports the adrenal glands (the little
glands on top of the kidneys that help the body during times of stress) and creates a healthier cardiovascular system.

Fish oil creates cell membranes that are flexible, which lowers inflammatory response. Unhealthy saturated fats (from most meats and fried foods) create rigid membranes that keep the immune response red-hot and inflamed. Patients with depression have been shown to have lots of unhealthy arachidonic acid (omega-6 fatty acid) in comparison to omega-3 fatty acid. Taking in fish oil helps lower this ratio.

PET scan studies have helped correlate low levels of good fats in the brain with increased likelihood of depression. For example, low DHA levels in the anterior cingulate and prefrontal cortexes of the brain make these areas overactive. This makes decision making and conflict resolution much harder. Medical science's revered double-blind, placebo-controlled studies have shown that taking EPA and DHA induces longer periods of remission from depression. As such, there are a number of clinical studies supporting the use of fish oil for depression, bipolar disorder, schizophrenia, and even depression associated with Parkinson's disease.

The typical dosage of fish oil is 1 g a day of EPA and about 1.5 g of DHA. Read the EPA and DHA levels on the label of the fish oil you purchase. Read the label closely. If your fish oil product does not break the levels down for you, purchase another one that does. Also of note, you should look for high-quality, pharmaceutical-grade fish oils only, because the lesser-quality versions may have an increased chance of rancidity or contain more toxins or impurities. It's actually quite easy to remove toxins from fish oil through a process called molecular distillation. Any high-quality company uses this process to assure that you are getting clean and pure fish oil.

In my experience, a small percentage of patients experience reflux with fish oil. If this is the case for you, you can try dosing with a meal or on an empty stomach to learn which prevents reflux
symptoms. Sometimes capsules are better tolerated, while others think the liquid oil is best for them. Some patients report capsules kept in the refrigerator or freezer reduce reflux and fishy breath. If none of these suggestions eliminate reflux, try enteric-coated capsules. Although these capsules are typically more expensive and can be difficult to swallow, they are effective.

Fish oil is extremely safe to take. However, there is some concern about taking fish oil with anticlotting drugs. If you are on anticlotting medications and want to start fish oil, talk to your doctor about slowly adding small amounts of fish oil and checking your clotting factors regularly (using thrombin time, prothrombin time, and INR blood tests) until you are up to the full dose. Your doctor can adjust your medication as needed. If you and your doctor decide to use both treatments together, it's important to stay consistent with your daily fish oil intake and medication intake once you move up to the full dose.

Not surprisingly, fish is by far the number one source for fish oil. One small study supports the notion that portions of salmon or tuna twice weekly may be as effective as fish oil supplementation to raise omega-3 fatty acid levels. Other studies show that food intake may also allow for better omega-3 absorption. Small fish such as anchovies, herring, and sardines are potent omega-3 sources. Larger fish such as tuna, shark, swordfish, mackerel, and salmon may be contaminated with mercury and harmful pesticides, so use caution to learn origination when choosing caught fish. Chicken, eggs, and beef can also be sources of omega-3 fatty acids if the animals ate green plants and not just grains. Free-range, grass-fed animals are recommended.

Many patients ask me about using a vegetable oil, for they are practicing vegans and prefer not to take in any animal products. Vegan
fatty acids have not been well studied in mood disorder. In some cases, people with depression are not good at converting plant fatty acid to EPA, which suggests that fish oil may be a better choice.

If you will be using vegan oils, read the label to check for 4 g of alpha-linolenic acid (ALA). This level should ensure that the body forms significant amounts of EPA and DHA. However, it's also important for vegetarians to ensure that their intake of linoleic acid (LA) is not too high compared with ALA, as this imbalance interferes with the body's ALA to EPA and DHA conversion process. An LA-to-ALA ratio of 4:1 or slightly lower is optimum. The best vegan sources of omega-3 fatty acids are flaxseed, grape seed oil, walnuts, and tofu.

Related to healthy oils, gamma-linolenic acid (GLA) is a fat that can help produce prostaglandin E1 (PGE1), an immune system molecule that helps with mood. Many people who are depressed have a deficiency of delta-6 desaturase, the enzyme that converts LA to PGE1 (see diagram). Chronic stress, diabetes, obesity, age, excess insulin, coffee, trans fatty acids (hydrogenated oils), and alcohol also inhibit activity of this enzyme. For people with this enzyme deficiency, taking supplemental GLA can be helpful. The nutrients vitamin B
₆
, zinc, and magnesium also aid in this reaction.

GLA-PGE1 Pathway

Vegetable fats → Linoleic Acid (LA) + delta-6 desaturase →
Gamma-Linoleic Acid (GLA)→DGLA → PGE1
(Happy Mood)

People of certain ethnicities tend to have deficiencies of the delta-6 desaturase enzyme needed to make PGE1. This deficiency is especially common in people whose ancestry is 25 percent or higher Celtic, Irish, Scottish, Welsh, Scandinavian, or Native American—which are also groups known to have higher rates of alcoholism.

Have you ever wondered why alcoholics like to drink? Well, it might be because it helps their mood: alcohol can temporarily stimulate production of PGE1 and help lift mood, until PGE1 levels fall again and depression returns. For alcoholic individuals, this results in a cycle of looking to alcohol to feel better. Even individuals without delta-6 desaturase enzyme deficiency can deplete DGLA with repeated drinking by preventing timely replenishment from LA. The people also find the need for more and more alcohol to transiently increase PGE1 to lift mood. Fortunately, you can take in GLA in the form of evening primrose or borage oil, and it's easily converted to PGE1. For alcoholics, these oils can help eliminate both the depression and the need to drink for relief.

Good sources of GLA include evening primrose oil and borage oil. Recommended GLA dosage ranges from 1,000 mg to 2,500 mg once a day. In most preparations, evening primrose oil is usually dosed between 4,000 and 8,000 mg a day, and daily borage oil doses would be about 10,000 mg to achieve recommended levels of GLA. These dosages amount to less than 3,000 mg of GLA per day, which is the upper limit. Doses higher than 3,000 mg of GLA per day should be avoided due to possible exaggerated arachidonic acid levels, which may exacerbate inflammatory reactions. Premenstrual symptoms such as breast tenderness, feelings of depression, irritability, swelling, and bloating may also be indications for GLA supplementation.

Pregnant patients and those with epileptic history or prostate cancer risk should not use GLA supplementation.

Black currants are a source of GLA.

The following vitamins are discussed individually regarding their potential mood benefits. Some may be included in your multiple
vitamin, while some may be best taken as supplements. Follow the dosages given here to ensure for the best benefit.

Be careful to not overdose on vitamins, especially any fat-soluble vitamins (including vitamin A, vitamin D, vitamin E, and vitamin K). Although quite safe at suggested doses, fat-soluble vitamins can collect in your system and become toxic when the levels are too high.

Vitamin D is a critical hormone and co-factor for many body processes that regulate healthy immune function, cardiovascular function, and nervous system health. Please see
chapter 4
where I discuss how to test and dose this vitamin for best mood results.

Selenium is important as an antioxidant and for the thyroid. It's the cofactor for glutathione peroxidase, an enzyme that is important to help your body produce its most powerful antioxidant, glutathione. Regarding the thyroid, selenium helps convert the thyroid hormone T4 (thyroxine) to its active form of T3 (triiodothyronine), which helps with clear thinking, mood, fat burning, and even cholesterol levels. Research reports that low selenium is associated with increased depression, anxiety, confusion, and hostility. Conversely, high dietary or supplementary selenium has been shown to improve mood. Even more, when alcoholism and depression occur together with low selenium status, this deadly combination will increase the risk of suicide.

Given the tendency for low selenium status in alcoholics and the relationship between selenium levels and mood disorder, selenium supplementation is recommended for people struggling with depression, alcohol abuse or dependence, or both.

I use selenium for patients with thyroid issues and alcohol addiction. Common dosages range from 200 to 400 mcg. (Please note this is
not milligrams, but micrograms, which is 1/1000th of a milligram. So we are talking about very small amounts.) Overall, selenium is quite safe when taken in prescribed doses.

Nuts are a great source of this mineral, especially Brazil nuts. Other sources are fish (especially orange roughy and tuna) and whole wheat flour.

As we discussed in
chapter 4
, poor blood sugar control (low blood sugar, fluctuating blood sugars, or high blood sugar and diabetes) contributes to mood problems and has been correlated with moderate to severe depression. The essential trace element chromium is a component of your body's glucose tolerance factor, a complex molecule your body uses to help balance blood sugar. Chromium also helps by activating serotonin and increasing your body's ability to recognize insulin (known as insulin sensitivity—a big problem for diabetic patients).

Chromium picolinate is one of the few forms of chromium. One study of chromium picolinate looked at fifteen patients with atypical types of major depressive disorder, a type of depression that constitutes more than 20 percent of all cases of depression. This type of depression can be confusing to diagnose, and even more confusing to treat effectively. Atypical depression patients experience symptoms that are different from the majority of depressed patients, including a brightened mood in response to positive events and a depressed overreaction to perceived criticism or rejection. Also, they may have feelings of physical heaviness (lead legs) and struggle with weight gain, increased appetite and carbohydrate cravings, and too much sleep. Please see the following box for a summary of these symptoms.