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Blood sugar imbalances, allergies and deficiencies in vitamins, essential fats and amino acids have all been linked to low mood. If you suffer from depression, it’s best to start by correcting these. But there is much more that you can do, and that’s what this article explores in depth.
There’s no doubt that there is a need to counteract depression: the condition is 10 times more common today than it was in the 1950s. It is estimated that one in three doctor consultations involve patients with mental health issues such as depression.
Depression is also the primary cause of suicide, claiming 3 000 lives a year, and is now the second most common cause of death in young people aged 15 to 24. As depressing as all this sounds, there is a lot that can be done, both with nutrition and proper counselling.
The classic symptoms of depression include:
Feelings of worthlessness or guilt
Loss of energy, and fatigue
Thoughts of suicide or preoccupation with death
Loss or increase of appetite and weight
A disturbed sleep pattern
Slowing down (both physically and mentally)
Agitation (restlessness or anxiety).
If you are experiencing four or more of these, this article is for you. It’s important to realise that there is rarely one cause for a set of symptoms that we call ‘depression’, nor a single cure.
As a general rule, however, it’s a good idea to keep crucial neurotransmitters in balance. Low levels of serotonin are strongly associated with states of depression, while low levels of dopamine, adrenalin or noradrenalin are associated with a lack of motivation. Most prescription drugs aim to correct these imbalances, but have undesirable side effects. Instead, I recommend supplementing 100 mg up to 300 mg of the amino acid 5-hydroxytryptophan (5-HTP), twice a day, to boost your serotonin levels. Supplementing tyrosine at 500 mg to 1 000 mg twice a day helps boost motivation and may be helpful in those who feel a distinct lack of drive. Tyrosine is best taken on an empty stomach.
NATURAL WAYS TO BEAT THE BLUES
St John’s wort: the happiness herb
Another highly effective natural remedy is the herb St John’s wort (Hypericum perforatum). It is one of the most thoroughly researched of all natural remedies.
St John’s wort works just as well as tricyclic antidepressants, but has fewer side effects.1 Tricyclic antidepressants such as imipramine are widely prescribed but often produce undesirable side effects. For instance, in a recent study published in the British Medical Journal, 324 patients were randomly assigned to treatment with either St John’s wort or imipramine. Both were equally effective in treating patients with mild to moderate depression. However, St John’s wort was better tolerated than imipramine and fewer patients withdrew as a result of adverse effects.2
A 300 mg dose of St John’s wort (containing 0.3% hypericin) two or three times a day helps most people with mild depression, while twice this amount may help those who suffer severely. But don’t expect instant results. It often takes a couple of weeks to work.
Chromium and ‘atypical’ depression
It has long been known that supplementing the mineral chromium, usually provided in a 200 mcg tablet, helps stabilise blood sugar. This is because without chromium, insulin – the hormone that carries excess glucose out of the blood into the body and brain – can’t work. But thanks to research by Professor Malcolm McLeod from the University of North Carolina, chromium has proven to be not just a vital nutrient for blood sugar stability, but a highly effective antidepressant for those with ‘atypical’ depression – that is, depressed people who are gaining weight, feel tired all the time, crave carbohydrates and could sleep forever, unlike the classic ‘depressive’ who is suffering from weight loss and insomnia.3
These days I am seeing more and more patients with atypical depression and often, they will get instant relief by taking 400 to 600 mcg of chromium a day. A survey of several hundred depressed patients conducted by Andrew Nierenberg, associate director of the Depression and Clinical Research Program at Massachusetts General Hospital, found that atypical depression affects anywhere from 25 to 42% of people with depression, and an even higher percentage of depressed women.4 So given the number of people whose tendency of depression falls into this category, ‘atypical’ is a bit of a misnomer.
This link between depression and blood sugar has been around for a long time. Sir Thomas Willis, the 17th-century medical pioneer who conclusively established the diagnosis of diabetes, noted that ‘sadness and long sorrow often precedes this disease.’ Two epidemiologists at the Johns Hopkins School of Medicine found that the incidence of diabetes in depressed people is 2.5 times that of the general population.
Chromium is a remarkably safe mineral even at levels 100 times higher than this. McLeod gives three to five mcg per 0.5 kg of body weight, and sometimes more for people with diabetes. Some people need this amount to stay free from depression. McLeod recommends taking chromium twice a day, although you should take it in the morning (at breakfast and lunch) as it can cause insomnia and vivid dreaming.
Chromium levels decline with age so the older you are the more you need. Our diets are generally very deficient in this mineral anyway, but the more fast-releasing carbohydrates you eat, the more chromium you will lose. Stress also depletes chromium.
These results with chromium fit in well with other promising frontiers in the nutritional treatment of depression. 5-HTP, the precursor of serotonin, needs insulin to get from the blood into the brain – so chromium, which is essential for insulin to work, might be playing a leading role in this process. Omega-3s also improve serotonin reception. Given the role that stress, highly refined and high-sugar diets, and caffeine have on blood sugar, and the lack of chromium and omega-3s in most people’s diets, it isn’t perhaps so difficult to comprehend why the incidence of depression would be on the increase in the 21st century.
The magnesium method
Another mineral that might help boost your mood is magnesium. The role of magnesium in depression was first discovered in 1921 by P.G. Weston, who used magnesium to help 50 of his patients relax and sleep.5 Since then there have been many other studies demonstrating the important role played by magnesium in brain biochemistry and how it benefits mental health.
A study by George and Karen Eby in the US of patients with major depression found that they recovered rapidly, in less than a week, by taking 125 to 300 mg of magnesium with each meal and at bedtime. The participants suffered not just from depression but from a number of related and accompanying mental illnesses, including headache, suicidal thoughts, anxiety, irritability, insomnia, short-term memory loss and IQ loss, as well as cocaine, alcohol and tobacco abuse, and these conditions improved too.6
After zinc, magnesium is generally the second most commonly deficient mineral. A major reason for this is that food contains far less magnesium than it did 100 years ago. Not only is much of the food people eat refined and stripped of all its goodness, but the raw material itself often contains far fewer vital nutrients, including magnesium, because it’s grown in soil laced with chemical fertilisers. These deplete the health of the soil overall, and lower the capability of the crop to absorb nutrients. As the amount of magnesium in our diets has decreased, so the incidence of depression has increased.
But poor diet is not the only culprit. One study 7 has shown that chronic stress depletes magnesium while at the same time increasing oxidative stress in humans. So if you, like so many other people, are stressed out by the frenetic pace and complexities of 21st-century life, you need to ensure you are getting adequate amounts of magnesium.
Green, leafy vegetables are rich in magnesium because the mineral is part of the chlorophyll molecule, which makes plants green. So are nuts and seeds, particularly sesame, sunflower and pumpkin seeds. An ideal intake is probably 500 mg a day, which is almost double what most people achieve. Eating a tablespoon of seeds a day, and at least three servings of vegetables (including a dark green, leafy one), plus 100 mg of magnesium in a multivitamin and mineral, is a good way to ensure you’re getting enough. However, if you are depressed and the symptoms above sound like you, you may want to take an additional 100 mg of magnesium in the morning and at night for a few weeks and see if that helps. Don’t supplement more than 300 mg in total.
Bump up your Bs
If you’re depressed, you may well be low in B-vitamins. Four B-vitamins in particular (B2, B6, B12 and folic acid) are vital for methylation, the process that keeps the brain’s chemistry in balance; and that faulty methylation, indicated by a high level of homocysteine, is strongly associated with depression.
Low levels of folic acid, the B-vitamin that’s abundant in beans, nuts, seeds and vegetables, have consistently been reported in depressed people, as have high homocysteine levels. Somewhere around a third of people with depression are found to have low folic acid levels.8
Studies giving B12 supplements on their own have not proven as effective as those giving folic acid on its own. B12, which is only present in food of animal origin, is also much more likely to be deficient in older people, as its absorption depends on stomach acid and levels of that tend to decline with age. A survey in Rotterdam, the Netherlands, of almost 4 000 elderly people found that those with low B12 levels were almost twice as likely to be depressed.
We still have much more to learn about methylation and mood. My advice is not to supplement B-vitamins singly, but to take a combination of B2, B6, B12, folic acid and TMG (an amino acid that is also required to make stomach acid, which, in turn, helps you to absorb vitamin B12), all of which are required for proper methylation. These are often available in combination in homocysteine-lowering formulas. MethylB12 is also likely to be more effective. If your homocysteine level is high (above 10 mg/dl) I’d start with a supplement that provides 1 000 mcg of folic acid and 500 mcg of methylB12. Alternatively, if you can get it, you could try supplementing SAMe at 200 mg a day.
You might have wondered why the amounts of folic acid and other Bs I’m recommending here as homocysteine-busters are so much higher than those you’d get from a well-balanced diet. The answer is that we are biochemically unique and there is growing evidence that some people, perhaps those prone to severe depression and also schizophrenia, don’t methylate properly. As a result, these people will need more of these key nutrients than others, simply to function normally – let alone optimally.
You’ll remember that methylation goes on throughout the brain and body, helping to turn one neurotransmitter into another. For example, noradrenalin turns into adrenalin by having a ‘methyl group’, a kind of organic compound, added. Nutrients that can donate or receive methyl groups help the brain to function better; folic acid and SAMe, for example, help donate methyl groups. Depressed patients may not be good methylators and would therefore benefit from getting more of these nutrients.
SAMe, however, while often very effective with depression, can aggravate ‘manic’ symptoms, both in schizophrenia9 and manic depression. So use it with caution.
It’s all one great, big balancing act, helping your brain’s chemistry to get, and stay, in sync.
The right fats to keep you happy
Talking of balancing acts, B3, B6, B12 and folic acid also have a crucial role to play in how the brain makes its essential brain fats. To turn the essential fats from fish and seeds into building materials for the brain, for example in making the receptor sites for neurotransmitters, you need these B-vitamins too. That’s because they drive the enzymes that turn one essential fat into another. Essential fats are also converted into hormone-like prostaglandins by these B-vitamin-dependent enzymes. Both these enzymes and the prostaglandins themselves further promote the brain’s production of serotonin and other key neurotransmitters. It’s one big happy family of chemical reactions. Your job is simply to make sure that your brain gets enough of all the right pieces of the equation. These are:
Essential fats, especially omega-3 fats
Amino acids such as 5-HTP, tyrosine and SAMe or TMG.
Some studies show omega-3 supplementation can reverse major depression. One, published in the American Journal of Psychiatry, has confirmed that patients already on antidepressant medication who still have pronounced symptoms of depression experience major improvements in as little as three weeks when given daily supplements of concentrated EPA.10
To achieve a therapeutic amount of EPA of around 1 000 mg, you will need to take something like three 1 000 mg fish oil capsules and ensure the EPA provided adds up to the 1 000 mg; or you can take a special concentrated form called ethyl EPA, which is what was used in this study. In fact, the higher your blood levels of omega-3 fats, which help build the brain’s neurons, the more serotonin you are likely to make.
This also may explain why very slow intakes of fat or cholesterol can lead to depression. Low cholesterol is a potential predictor for depression and anxiety.11 An eight-year Finnish study of 29 000 men aged 50 to 69, published in the British Journal of Psychiatry, found that those reporting depression had significantly lower average blood cholesterol levels than those who did not, despite a similar diet.12 The best dietary way to ensure adequate cholesterol and essential fats is to eat cold-water fish such as herring, fresh tuna (in moderation), salmon, sardines and mackerel. It remains to be seen whether the current trend of putting millions of people on statin drugs, which are designed to lower cholesterol, will induce a tendency to depression as a side effect, especially in those whose cholesterol is already too low. It is not uncommon to be put on these drugs after a heart attack, even if the person’s cholesterol level is already low.
THE HISTAMINE CONNECTION
While supplementing folic acid has been seen to work in many cases of depression, it doesn’t do it for everybody. The late Dr Carl Pfeiffer, founder of Princeton’s Brain Bio Center, discovered that while many depressed patients get better with massive amounts of folic acid, some get worse. He wondered why, and found that those people who got worse had high blood histamine levels. These ‘histadelics’, as he called them, are genetically pre-programmed to overproduce histamine. High-dose folic acid supplements further stimulate the production of histamine in these people. And this can lead to serious depression, as we’ll see below.
His finding that some people get worse on massive doses of folic acid (that is, 15 mg a day) has since been confirmed by others as potentially triggering symptoms of sleep alterations, malaise, hyperactivity and irritability.13
Dr Pfeiffer’s discovery is yet another example of biochemical individuality, illustrating how each of us is unique. For this very reason, to diagnose depression purely on the basis of symptoms, and then treat everyone with the same drug, or even the same nutrient, ignoring the principles of synergy and biochemical individuality, is to ignore the many potential underlying reasons for depression, both biochemical and psychological.
I know about high-histamine types because I am one. I remember sitting in the waiting room of the Brain Bio Center at the age of 20, about to meet Dr Pfeiffer, this extraordinary pioneer in nutritional medicine and mental health. He took one look at me and my white, marked nails and said, ‘You’re high histamine. You need more zinc and B6. Do you wake up early, have a good appetite, an active mind, tend towards being compulsive and obsessive, suffer from allergies and rarely gain weight?’ Yes, that sounded like me.
And as Dr Pfeiffer spoke, all became clear. We all make histamine, but some more than others. This is a genetic trait nicknamed histadelia.
Histamine makes you more prone to compulsive behaviour and allergic reactions, as Dr Pfeiffer mentioned, as well as giving you a tendency towards increased production of mucus and saliva, hyperactivity and depression. Some of these traits can be an advantage, but when histamine levels become excessively high, they can lead to chronic depression and even suicide.
A faster metabolism means a greater need for nutrients, and insufficient nutrition leads the fast-burning high-histamine type to ‘burn out’ fast. Without the right nutrients, a high-histamine person can end up severely depressed. If this all sounds familiar, you can check yourself out on the mini-questionnaire online at www.foodforthebrain.org.
HOW’S YOUR THYROID?
Another classic cause of depression is having an underactive thyroid. In the US, thyroid medication is the fourth most commonly prescribed drug. The thyroid gland, in the base of the throat, makes the hormone thyroxine which tells all brain and body cells to keep active. Often as a long-term consequence of stress and sub-optimum nutrition, the thyroid gland can start to underproduce thyroxine. This is a classic cause of depression and lethargy, although symptoms of irritability, anxiety and panic attacks have also been reported in those with low thyroxine levels.
The telltale signs of an underactive thyroid are lethargy, depression, poor memory or concentration, indigestion or constipation, haemorrhoids, skin problems, feeling cold and not tolerating heat well, fluid retention and weight gain. Since thyroxine speeds up your metabolism, which produces heat, the definitive symptom is a drop in body temperature. This is something you can check yourself by taking your temperature with a thermometer. Here’s how you do it.
Shake out a thermometer and keep it by your bed. When you wake in the morning, and before getting up, put the thermometer under your arm and lie there for 10 minutes. Your basal temperature should be 36.5 to 36.7°C. Do this for at least two days. (Women should do this test on day two or three of their period as body temperature fluctuates during the cycle.) If either of your temperature readings is below 36.5°C, take your temperature again over a longer period, say a week, to see if it is low on a fairly regular basis. If it’s lower than 36.5°C, you probably have an underactive thyroid.
If you suspect you have a thyroid problem, your doctor can run a blood test to further investigate this possibility. However, an apparently normal thyroxine level, if at the low end of normal, backed up by lowered temperature and symptoms, may still be worth treating.
While the medical approach is to give you thyroxine, this hormone is made from tyrosine. Iodine is also needed to turn tyrosine into thyroxine. Recent research is indicating that both zinc and selenium are important too. So, try 1 000 mg of tyrosine on waking and at noon, taken on an empty stomach, together with a multimineral containing iodine, zinc and selenium. Exercise also stimulates the thyroid. If you suspect that you have a thyroid problem you may also want to visit www.thyroiduk.org.
BUILDING A HAPPY LIFESTYLE
Mood improvement doesn’t stop at nutrition. Modest exercise is a good place to start. A number of studies in which people exercised for 30 to 60 minutes 3 to 5 times a week found a significant improvement in their depression when tested with their Hamilton Rating Scale, an established method of measuring mood.
This was more than double the effect you would expect from antidepressants alone.14 In an Australian study published in 2005 and involving 60 adults over the age of 60, half took up high-intensity exercise three days a week, while the other half did low-intensity exercise. Of those on the high-intensity regime, 61% halved their Hamilton Rating Scale score, compared to only 29% of those doing low-intensity exercise.15 However, you’ve got to keep exercising to stay happy. An eight-year follow-up study of people prone to depression found that their depression returned if they stopped exercising.16
You may also consider seeing a counsellor or psychotherapist. As complex as the biochemistry of mental health is, so too is the nature of the psyche. Feeling bad about yourself and lacking someone supportive to listen to you can be a major cause of depression, however good your diet might be.17 A study by the University of Dundee that examined health behaviours in 1 289 lonely and non-lonely adults found an association between loneliness and depression.18
A problem shared really is a problem halved. While exercise and good nutrition will give you more mental and emotional energy to solve your problems, it doesn’t take away the underlying issues that fuel depression, or always give you all the tools you need to deal with it. For this reason, I recommend counselling and psychotherapy as well as nutritional approaches. The book Natural Highs, which I co-authored with Dr Hyla Cass, includes many ways to give yourself a mood boost. If you’ve struggled with low moods or more entrenched and serious conditions for years, it’s important to know that there’s much you can do to banish them, and get on with building a better, happier life.
Do you have atypical depression?
Do you crave sweets or other carbohydrates or tend to gain weight?
Are you tired for no obvious reason, or do your arms and legs feel heavy?
Do you tend to feel sleepy or groggy much of the time?
Are your feelings easily hurt by rejection from others?
Did your depression begin before the age of thirty?
If you answer yes to even one of these questions and you often feel low, the chances are chromium will help you.
A third of depressed volunteers who exercised in full-spectrum lighting experienced a major improvement in their depression (a 50% or more decrease in their Hamilton Rating Scale).19 Light affects the pineal gland, which produces serotonin’s close relative melatonin.
He, together with his team, carried out Britain’s biggest-ever health and diet survey, the 100% Health Survey, which has now been completed by over 60 000 people. His book, The 10 Secrets of 100% Healthy People, portrays the fascinating insights provided by the survey and his 30 years study of good health and how to achieve it.
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