Does Exercise Help Depression and Anxiety?

Running or jogging doesn't have to kill you to get benefit

Running or jogging doesn’t have to kill you to get benefit

I had an interesting conversation with a patient at the pharmacy that got me thinking about doing a post about this. This patient came a week or two ago and got a prescription for buspirone, which is used for anxiety. The patient was concerned with it because this person desperately wanted to get rid of the feeling of anxiety that they were suffering with.

The patient returned and I asked how it was going (We’ll call the patient Casey). The response was that not much had changed. Casey petitioned for more help, but this time to me, rather than the doctor.

My response?

Are you eating well? Are you doing any exercise at all?

Casey told me that neither was really in place. Casey also told me that a problem child at home was a great source of the anxiety. Casey also discussed how the previous week that he’d gone on a walk and that seemed to help a bit.

I’ve met others like Casey in the pharmacy before, and still see some of them. I’ve had people so anxious for their anxiety meds they were crying. I’ve seen people on the verge of hyperventilation. I’ve seen people, who on the surface appear normal, but after talking for a minute or two, they start divulging secrets about their lives that would make you and me stressed out too.

I used to get anxiety attacks. They would come at the most random times too. I remember once in high school in spanish class sitting at my desk, when suddenly I became hot and felt like I couldn’t breathe at all. I was more panicked about not feeling like I could breathe more than anything else. It wasn’t pleasant.

I don’t think during high school a lack of movement was my problem. I could eat anything and not gain a pound (being a male teenager has some advantages), but my diet probably was helping.

As I got older and started focusing more on my intake rather than my output, the attacks subsided. After learning about EFT (emotional freedom technique) or tapping, I was able to rid myself of the attacks all together.

Since I’ve graduated and been able to keep a more balanced routine, I haven’t had to do any tapping and the exercise is regular, rather than disjointed. Anxiety is nowhere to be seen, but I still get stressed from time to time. Between 4 kids, a wonderful wife, full-time job, blog, church duties, getting a house ready to sell, and writing a book, it’s hard to make sure I don’t go insane.

This is one reason I continue to exercise. It keeps my stress down, my happiness up, and bad things, like my wife’s recent trip where the windshield got busted, not so bad.

So What Kind of Exercise Should I Do?

In one study of depressed women [1], researchers found that aerobic running was just as good as weightlifting to reduce symptoms of depression compared to controls.

Another study showed pretty much the same thing; there was no real difference between aerobic and non-aerobic exercise in reducing depression. [2]

Another showed that aerobic exercise from 50-70% of maximal capacity was enough to decrease depression as well. [3]

One study showed that running was better than tennis which was better than softball, the latter having no effect. [4] While the findings were significant, even the authors noted that because they did nothing to conceal the reason behind the exercise, and even allowed some to choose which they were going to participate in, the results could have been different.

A study of men and women found that running helped more so with women than men, and was more influenced by the amount of physical fitness. [5]

In a study of men; exercise, meditation, and a comfy recliner all produced reductions in anxiety [6]. It should be noted that it was a quiet time in the recliner, not TV or kids time.

Another study showed similar benefits with walking/jogging at 70% maximum capacity. [7]

Of note, a study looking at relaxation training seemed to help introverts more than extroverts. [8] This really doesn’t have so much to do with exercise, but if you’re an introvert like me, relaxation may help in the anxiety department.

Swimmers seem to also derive benefit from exercise, feeling better after a swim than before. [9]

I think you get the point. Exercise is beneficial to reducing stress, anxiety and improving mood. Don’t worry if you can’t run a mile. Go for a walk. Don’t worry about not being able to do a push up, do knee push ups or on the wall. Do some squats. Take a walk with a significant other. Maybe you just need to run after the ice cream truck and give him a high-five for dispensing some of the best medication on earth (in moderation of course). Whatever it is, get moving and feel the anxiety or depression melt away.

CIAO

 

1.Doyne, Elizabeth J., et al. “Running versus weight lifting in the treatment of depression.” Journal of Consulting and Clinical Psychology 55.5 (1987): 748.

2.Martinsen, Egil W., Asle Hoffart, and Øyvind Solberg. “Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial.” Comprehensive psychiatry 30.4 (1989): 324-331.

3.Martinsen, Egil W., A. Medhus, and L. Sandvik. “Effects of aerobic exercise on depression: a controlled study.” BMJ 291.6488 (1985): 109-109.

4.Brown, Robert S., Donald E. Ramirez, and John M. Taub. “The prescription of exercise for depression.” The Physician and Sportsmedicine 6.12 (1978): 34-37.

5.Jasnoski, Mary L., David S. Holmes, and David L. Banks. “Changes in personality associated with changes in aerobic and anaerobic fitness in women and men.” Journal of psychosomatic research 32.3 (1988): 273-276.

6.Bahrke, Michael S., and William P. Morgan. “Anxiety reduction following exercise and meditation.” Cognitive therapy and research 2.4 (1978): 323-333.

7.Young, R. J. “The effect of regular exercise on cognitive functioning and personality.” British journal of sports medicine 13.3 (1979): 110-117.

8.Stoudenmire, John. “Effects of muscle relaxation training on state and trait anxiety in introverts and extraverts.” Journal of personality and social psychology 24.2 (1972): 273.

9.Berger, Bonnie G., and David R. Owen. “Mood Alteration with Swimming-Swimmers Really Do” Feel Better”.” Psychosomatic medicine 45.5 (1983): 425-433.

 

Writing Your Way to Health

Unleash your mind power with a good ol fashion pen and paper

Unleash your mind power with good ol fashion pen and paper

Writing is something that all of us have done from time to time. Maybe it hasn’t been a novel or a movie script, but even a grocery list counts as writing. Keeping a journal also counts. I’ve heard over the years that writing can be therapeutic in different ways and wanted to discuss just a few of these things today, especially since drugs aren’t always the answer and finding other avenues of treatment for the mind is useful, especially when it’s free.

In a study of college students, researchers looked at how writing would affect depressive symptoms in those students. College, after all, can be a trying time for many a student. The students were instructed to write on their “deepest thoughts and feelings on current and past emotional upheavals” (intervention) or “time management conditions” (control). [1] It was set for three consecutive 20 minute sessions, plus a booster session 5 weeks later. Depressive symptoms were measured just before the first of three session, just before the 5 week booster and 6 months later.

Students in the “feelings” group did report lower depression scores than those in the control group. The 5 week booster seemed to have no effect. It would be interesting to see if this study was repeated, but with more writing sessions instead of 4, and on a more consistent basis.

In a study with cancer patients, subjects were asked to write about their feelings and thoughts of the cancer, or neutral topics, on four different occasions. Patients writing about their feelings exhibited better physical functioning scores and seemed to improve the cancer related symptoms. [2]

In another intervention in marriages, couples who were experiencing discord and disagreements were assigned to a control or writing group. The writing group was asked 3 specific questions and they were given time to write about them. The writing wasn’t started until a year into the study. The couples who wrote had their downward spiral level off, while the couples who didn’t write, continued in decline. [3] It’s not to say that writing fixed all the problems in the relationship, but it did make an environment from which they could come together and not continue to grow apart.

Writing about it may also be an important step. And I mean actually taking out a pen or pencil and paper and writing, rather than just typing on a keyboard. In a study looking at brain scans and writing, good writers showed more activation in areas of “cognition, language, and executive functions, consistent with predictions, and also in working memory, motor planning, and timing”. [4] This may be beneficial when helping a person really use their brain in coping or figuring out emotional problems.

In another look at typing vs longhand, it was found that people who write notes tend to assimilate information and process it to write it down, whereas typers just assimilate and type the facts. In other words, writing notes longhand while learning allow people to understand concepts better than if they were to type. Actual facts are maintained about the same in both groups. [5]

I think this is some good advice in general; to write regularly and to try to write instead of type. I’ve noticed in my own writing, my style changes when I’m brainstorming or just rambling vs when I’m being direct or making a point. When I write a prescription for example, my writing is neat, organized, and very legible. When I’m taking notes in a class or a meeting, it is more sloppy and all over the place, and not just because I’m trying to be quick.

Does this mean anything? I think it is reflective of different parts of my brain being utilized when writing, I think that’s obvious. It probably goes deeper than that, but I’m no neuro-expert. What I am convinced of is that writing can be beneficial for all sorts of things, but you have to do it to get the benefit. It also appears that focusing on your thoughts and feelings, in other words, what is actually being processed by you, is far more important than just writing about what you did or what you’re going to do, say in a schedule.

Maybe this writing doesn’t have to be everyday, but regularly, whatever that is, would probably be best. Maybe that’s a journal once a week or month. Maybe writing is part of work and your sick of writing already. Sometimes a break from the things we do is part of health as well, or at least changing what we write about.

Writing blog posts regularly can sometimes be a bit boring, so I’m writing a novel on the side for fun. It has reinvigorated my love for writing and now the blog doesn’t seem like a chore as sometimes it can.

Being intentional about writing can be useful too. In the studies listed above, postive outcomes were seen when subjects were answering specific questions about what problems they were facing. So write specifically. If you don’t want to, then at least try writing.

So if any of you want to try a different approach to depression, pain, cancer, crazy children, or anything else, I give you this challenge; write about it.

I’d love to hear any experiences anyone has had with this in the comments.

CIAO

 

1.Gortner, Eva-Maria, Stephanie S. Rude, and James W. Pennebaker. “Benefits of expressive writing in lowering rumination and depressive symptoms.” Behavior therapy 37.3 (2006): 292-303.

2.Milbury, Kathrin, et al. “Randomized controlled trial of expressive writing for patients with renal cell carcinoma.” Journal of Clinical Oncology 32.7 (2014): 663-670.

3.Finkel, Eli J., et al. “A brief intervention to promote conflict reappraisal preserves marital quality over time.” Psychological science (2013): 0956797612474938.

4.Berninger, Virginia W., et al. “fMRI activation related to nature of ideas generated and differences between good and poor writers during idea generation.” BJEP Monograph Series II, Number 6-Teaching and Learning Writing. Vol. 77. No. 93. British Psychological Society, 2009. 77-93.

5.Mueller, Pam A., and Daniel M. Oppenheimer. “The Pen Is Mightier Than the Keyboard Advantages of Longhand Over Laptop Note Taking.” Psychological science (2014): 0956797614524581.

 

Anxiety and Sleep Medications

Anxiety and sleep medications can be dangerous, especially when used inappropriately. Zolpidem (Ambien) is a very common one that many people take to get to sleep at night. Alprazolam (Xanax) and clonazepam (Valium) are also fairly common drugs that are seen in the pharmacies and in the cupboards of many people. They are taken whenever a person feels anxious, which these days seems like all the time.

Zolpidem is classified as a sedative-hypnotic. It puts you to sleep and that is why so many people like it. Take one sometime before bed and it’s lights out for the next few hours. So what’s the problem?

Zolpidem affects a specific omega-subtype of the GABA receptor in the central nervous system. This subtype is what puts you to sleep but doesn’t seem to affect muscle tone and doesn’t show anxiolytic properties (anti-anxiety). This also may be why so many people have reported all kinds of crazy incidences of sleep walking or other activities without remembering a thing. You can read about some of those here:

http://www.peoplespharmacy.com/2013/01/10/fda-lowers-dose-of-popular-sleeping-pill-ambien-zolpidem/

As with many receptors it’s also likely that since they are being activated so often by meds like zolpidem they get down regulated with time and people don’t get the benefit of the drug. I’ve talked with several people in the pharmacy about this. They are so frustrated that they can’t get sleep. Some take double the dose that is normally prescribed and still only sleep a couple of hours.

This quite honestly scares me. I’m worried that some people are going to take it too far one day for that one night of sleep and then not wake up. We Americans especially forget that more isn’t better to a problem that actually requires less.

Another problems that scares me is the sharing of these types of meds between family and friends. This is especially true among teenagers. A recent article talks about this:

http://www.foxnews.com/health/2014/11/24/abuse-sleep-anti-anxiety-drugs-growing-issue-among-teenagers-study-shows/

SAMSHA (Substance Abuse and Mental Health Administration) reported that “the estimated number of emergency department visits involving zolpidem overmedication (taking more than the prescribed amount) nearly doubled from 21,824 visits in 2005-2006 to 42,274 visits in 2009-2010” [1]. By comparison they report that in 2010 there were a total of 4,916,328 drug-related visits to emergency departments throughout the nation.

It’s not the most abused drug in the country but it is on the rise.

Drugs like clonazepam mentioned earlier aren’t so selective as zolpidem and can cause other problems. Originally they were developed for people with seizure disorders and they work well for that. People now take them primarily for finding relief from anxiety and stress.

Like zolpidem, people can become tolerant to them over time and require higher and higher doses to get the desired effect. It’s no different from a person on pain medications. These are more likely to cause a euphoric effect on a person than the zolpidem and many become psychologically dependant. It’s very important to note that people wishing to discontinue these after having been on them for some time must do so slowly. The withdrawal symptoms in people on high enough doses can actually land them in the hospital and cause death. While going cold turkey off narcotics isn’t recommended it typically doesn’t cause death like the benzodiazepines (clonazepam, alprazolam) can.

What can a person do to help with sleep?

insomnia

Exercise seems to be beneficial to those who have insomnia. In a study with insomniacs, researchers looked at walking on the treadmill for 50 minutes at a time, 3 days a week for 6 months. What they found was that participants were able to fall asleep faster and had decreased amounts of wakefulness during the night. [2] The effect was seen in both the morning and evening groups.

Another study found similar results but the best were achieved in those performing moderate amounts of activity and not all out, balls to the wall type of stuff. It was also done on the treadmill for 50 minute intervals.[3]

In another analysis done in diabetics, the loss of belly fat with diet or exercise or a combination of both resulted in better sleep. [4]

There are other things that can help. Getting into a sleep schedule and actually going to sleep at the same time every day. I know that seems impossible or at best unlikely but it does help.

Managing a proper diet and exercise/activity level also decreases anxiety and symptoms of depression. I realize the catch-22 of people with depression. They don’t want to do anything, especially exercise. They don’t have the energy to do it and even if it makes sense logically that it will help, emotionally they are too drained to even think about it. If that’s you I encourage you to do whatever you can, even if it is walk to the mailbox. Any start is better than nothing.

CIAO

 

1.http://www.samhsa.gov/newsroom/press-announcements/201408111015

2.Passos, Giselle Soares, et al. “Effects of moderate aerobic exercise training on chronic primary insomnia.” Sleep medicine 12.10 (2011): 1018-1027.

3.Passos, Giselle S., et al. “Effect of acute physical exercise on patients with chronic primary insomnia.” Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 6.3 (2010): 270.

4.http://www.hopkinsmedicine.org/news/media/releases/losing_weight_especially_in_the_belly_improves_sleep_quality_according_to_a_johns_hopkins_study

Folate, Folic Acid, L-methylfolate and You

I’ve talked about this particular supplement a few times and wanted to review it again seeing as how we just discussed B-12. B-9 is the number for folate. Unfortunately we won’t get to talk about B-4. Sorry Star Trek fans.

Folate is a term for for naturally occurring folate, as well as folic acid, the synthetic vitamin. This is unfortunate because there are some difference that we will see.

Science

Folate is necessary for single carbon transfers in DNA and RNA synthesis. Without it those molecules are unable to properly be formed. The methylation of deoxyuridylate to thymidylate in the formation of DNA is required for cell division, something that folate mediates. This most commonly shows up as megaloblastic anemia, or folate deficiency anemia. It is also necessary for conversion of homocysteine to methionine.

In the gut, folate is hydrolyzed and then actively transported across into the blood. Before entering the bloodstream, it is converted to either the methyl or formyl forms of tetrahydrafolate (THF). In the plasma the most common form is 5-methyl-THF.

Folic acid, the synthetic version of real folate, can be measured in the blood, but doesn’t indicate that it actually has activity. Folic acid must enter the liver to be metabolized by dihydrofolate reductase, an enzyme to convert it to allow it to enter into the pathway that fully converts it into 5MTHFR or l-methylfolate (biologically active folate). This conversion does happen to some extent, however the amount of people who take full advantage of this conversion is limited.

Around  60% of the population are intermediate metabolizers of folate or heterozygous for genetic polymorphism of the MTHFR enzyme, whereas up to 25% of certain populations are homozygous for these genetic variations. [1] In varying degrees, these polymorphisms impair the conversion of folate to its active form, l-methylfolate. In essence, just because you take folic acid doesn’t mean you’ll convert every micro-gram into something usable. Some people are unable to convert any folate of any kind in l-methylfolate. These people must supplement.

Problems

One possible hazard with too much folic acid is the development of cancer. As one news report tells, in Chile colon cancer rose for both males and females after fortification of the food supply with folic acid became mandatory [2] and in the United States, a similar increase was seen in the late 90’s and into 2000’s when supplementation became mandatory here. [3] It has also been linked with lung and prostate cancers.

Scientist think that when a person has precancerous cells, folic acid may act like gas on a fire and allow the cells to become full blown cancer cells.[3] Excess blood folic acid is also associated with natural killer cell cytotoxicity [4]. This is the power with which natural killer cells can take out renegade cells and keep things like infections at bay. The interesting thing about this study is that women who had a folate poor diet and supplemented had increased activity in natural killer cells. Those who ate a folate rich diet and supplemented with folic acid had the reduced activity. Too much folate is not always good….no surprise there.

What to Do?

There are lots of things a person can do to get adequate folate. Eating organ meats like liver is a good start. Greens are another great form. Folic acid isn’t the best because it’s folic acid and we just learned that isn’t a form that is ideal, in fact it’s probably bad for you in some cases.

There are also a ton of supplements that you can buy and they aren’t all the same. Lets examine these. This information comes from: http://mthfr.net/l-methylfolate-methylfolate-5-mthf/2012/04/05/   This is a site dedicated to teaching people that have MTHFR genetic disorder.

  • Methylfolate
  • L-MTHF
  • L-Methylfolate
  • L-Methylfolate Calcium
  • D-Methylfolate
  • D-5-Methylfolate
  • Levomefolic Acid
  • Metafolin
  • 5-MTHF
  • 5-Methylfolate
  • 5-Methyltetrahydrofolate
  • L-5-MTHF
  • L-5-Methyltetrahydrofolate
  • 6(S)-5-MTHF
  • 6(S)-5-Methyltetrahydrofolate
  • 6(R)-5-MTHF
  • 6(R)-5-methyltetrahydrofolate
  • Quatrefolic

That’s a bunch of terms. They aren’t all the same either.

L-5-MTHF = L-5-Methyltetrahydrofolate = 6(S)-L-MTHF = 6(S)-L-Methyltetrahydrofolate

These are good.

L-Methylfolate Calcium = Metafolin = Levomefolic Acid

These are good

D-5-MTHF = D-5-Methyltetrahydrofolate = 6(R)-L-MTHF = 6(R)-L-Methyltetrahydrofolate

These ARE NOT good

The difference between 6(S) and 6(R) is they have different properties. They look similar to each other but don’t necessarily do the same thing. It’s kind of like the Star Wars original movies and the prequels. They both give you a dose of Star Wars, but in very different ways. The prequels of course causing cancer while the originals cure depression.

Yup, taking folic acid is like only getting the prequels, it just doesn't cut it.

Yup, taking folic acid is like only getting the prequels, it just doesn’t cut it.

So what to look for:

The forms of methylfolate that are biologically active are:

  • L forms
  • 6(S) forms
  • L-5 forms
  • Metafolin
  • L-Methylfolate Calcium
  • Levomefolic Acid
  • Quatrefolic

The forms of methylfolate that are NOT biologically active are:

  • D forms
  • 6(R) forms

The forms of methylfolate that may or may not be biologically active are the:

  • forms which do not specify L, 6(S) or trademarked name of Metafolin
  • 5-MTHF
  • 5-methylfolate
  • 5-methyltetrahydrofolate

Take a look at this product from Thorne:

http://www.thorne.com/Products/Circulatory-Support/Cardiovascular_Health/prd~B132.jsp

The website states that it is 5-MTHF. You have to look at the ingredient list to see “L-5-Methyltetrahydrofolate” So by looking at that you can conclude that it is indeed an “L-5” form and should be active.

Another page:

http://www.professionalsupplementcenter.com/DouglasLaboratoriesMethylFolateL5MTHF.htm?referrer=googleshopping&device=c&network=g&matchtype=&gclid=CKjIoYK2170CFY6RfgodtokArg

This shows “L-methylfolate, Metafolin” which again would be ok.

Yet another site:

http://www.camformulas.com/5-mthf-120-caps-priority-one.html?utm_source=googlepepla&utm_medium=adwords&id=67148442831&gclid=CJ7-sL62170CFVKIfgodiTkA2g

shows the active ingredient as “ 5-Methyltetrahydrofolate”. By this alone you don’t know if it is active or not active. This would require you to talk with the manufacturer to find out what they use specifically. If they don’t know or just repeat back what the label says, think about looking elsewhere. 

If you receive a prescription from your doctor for the following:

  • Metanx
  • Deplin
  • Cerefolin
  • CerefolinNAC
  • Neevo
  • NeevoDHA

you can be sure that these are the active forms. They are also ridiculously expensive but are higher doses so depending on where you buy it might end up being the same. I have talked to 2 patients that use Deplin and they’ve said it makes all the difference. One said she was finally able to get pregnant and have a child because of the Deplin. She said no amount of folic acid would do it.

It’s worth noting that there are drug interactions with folate in the body.

Interactions

 

  • Antacids, H2 blockers, proton pump inhibitors (these pesky things again)
  • Bile acid sequestrants (Cholestyramine)
  • Carbamazepine
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) ie ibuprofen or naproxen
  • Sulfasalazine
  • Triamterene
  • Methotrexate


If you take any of these drugs or any others you’re not sure ok, talk with your pharmacist. If they don’t know and won’t look, leave a message in the comments.

Folate is vitally important for people to function properly, just like any of the other B vitamins and since you can’t make it yourself you have to ingest it in some form. For people with depression I’ve heard them say Deplin (prescription only) works better than their antidepressants. Having an adequate amount of folate is definitely important.

CIAO

 

 

 

1.Greenberg, James A., et al. “Folic acid supplementation and pregnancy: more than just neural tube defect prevention.” Reviews in obstetrics and gynecology4.2 (2011): 52.

2.Hirsch, Sandra, et al. “Colon cancer in Chile before and after the start of the flour fortification program with folic acid.” European journal of gastroenterology & hepatology 21.4 (2009): 346-349.

3.http://www.nbcnews.com/id/35874922/ns/health-diet_and_nutrition/t/your-breakfast-giving-you-cancer/#.U0dHuPl91XE

4.Troen, Aron M., et al. “Unmetabolized folic acid in plasma is associated with reduced natural killer cell cytotoxicity among postmenopausal women.” The Journal of nutrition 136.1 (2006): 189-194.

B12: Are You Getting Enough?

B12Many people in the United States suffer from what very well could be a vitamin deficiency. In fact it wouldn’t surprise me at all. With the food supply seriously lacking in essential nutrients and minerals it isn’t a surprise at all that people are having issues with things like lethargy, anxiety and depression, and even disorders such as Alzheimer’s. These are just a few problems associated with B12 (cobalamin) deficiency. So lets talk about it shall we?

B12 is a vitamin responsible for healthy nerves, blood cells, DNA production….essentially stuff to keep you alive. B12 is available in many foods including but not limited to; shellfish, liver, fish, meat, eggs, and dairy. It is very noteworthy that plant products don’t have significant amounts of B12. Don’t be fooled by claims that state otherwise. Many of these foods are fortified with B12, but don’t have it naturally occurring or at very small amounts. And the foods that do, like seaweed, have pseudovitamin B12, which competes for absorption with regular B12. [1] One exception may be green and purple lavers, a type of algae. [2]

This is corroborated by studies that show that vegetarians and vegans are 50% and 80% deficient respectively. [3,4]

If you choose to not eat any animal products whatsoever, you need to supplement. More about that in a minute.

As mentioned above, B12 is really important for certain functions in the body. One problem associated with low B12 is many people don’t even know they are deficient. Working in a clinic I do see lab tests a lot, mostly for CBC’s and Cholesterol or A1c’s for diabetics. I don’t see B12 tests unless the doctor suspects something like anemia. But if there is neurological dysfunction, I don’t see it. The point is that since it isn’t something routinely checked for, it gets missed.

As Chris Kresser pointed out in an article:

In Japan and Europe, the lower limit for B12 is between 500-550 pg/mL, the level associated with psychological and behavioral manifestations such as cognitive decline, dementia and memory loss. Some experts have speculated that the acceptance of higher levels as normal in Japan and the willingness to treat levels considered “normal” in the U.S. explain the low rates of Alzheimer’s and dementia in that country.” [5]

The normal reference range in the USA by comparison is 247-911 pg/mL. That’s like the Rockies, one big mother range.

On top of that, a good deal of the population may have deficiency. [6] According to this study as many as 2/5 of America may have a problem. That’s around 125,000,000 people. While not everyone with deficiency show signs, it is still disconcerting. The article which I linked said that there was nothing to worry about though because we can get adequate B12 from more dairy and fortified cereals…..

……

……

……

 

 

 

Modern dietary advice giving us the only reasonable response.

Modern dietary advice giving us the only reasonable response.

Yeah because hey, fortified cereals are where it’s at nutritionally.   ……NOT!

Make no mistake, the addition of niacin to the US flour supply was probably one of the very few smart things the federal government was able to do to actually influence in a POSITIVE manner the population’s health. By helping people get enough niacin they were able to eliminate pellagra, a very serious condition that resembles schizophrenia. The problem with fortified cereals are the only nutrition you get from them are the spray on vitamins. That might be helpful for some, but meat or liver or fish is probably the much better option.

Another issue is that people experience symptoms even when their levels on are on the lower end of “normal”. It’s entirely possible that our range, like many other medical ranges may be off and probably needs to be increased.

Lets Talk About Absorption Baby, Lets Talk about You and Me!

If you don’t remember back or are new to the blog, a few weeks ago I discussed the adverse effects of taking acid reducers chronically. Here’s the link:

https://pharmacybrute.wordpress.com/2013/12/10/acid-supressing-drugs-lower-nutrients/

Acid in the stomach is an important part of the process to get B12 absorbed in the body. Acid cleaves B12 from the carrier it resides on so that it can be attached to intrinsic factor, allowing for absorption. No acid, no cleavage, no absorption. Other drugs can cause problems too. If you’re diabetic, metformin is known to reduce not only B12 but the other B vitamins as well.

People that have leaky gut or other inflammatory processes going on in the gut may have impaired absorption as well. Don’t assume just because you are a meat eater you’re getting all the B12 you need. Fixing your gut is important for many reasons and B12 is definitely one of those reasons.

Pernicious Problems

If you have problems with energy and have been able to rule out blood sugar dysregulation and sleep as potential problems, B12 might be a great place to look. People with anemia can have B12 or iron deficiencies. Since B12 is also required for myelin sheaths (the insulation on the nerves) it is thought that it is important for prevention of neurodegenerative disorders such as Alzheimer’s and Multiple Sclerosis. It may also play a part in anxiety and depression as well as autism and learning disabilities in children.

Maternal breast milk has a content of B12 that is linked with intake from mom. So if a mom is a vegetarian or a vegan, it is extremely important that she supplement to get adequate supplies for the baby.

Supplementation

You can find B12 in just about any B-Complex. It typically comes in the form of cyanocobalamin. I want to point out that this form of cobalamin is linked with cyanide, hence cyanocobalamin. This form is usually injected at a doctor’s visit. Methylcobalamin on the other hand seems to be the form that is most useful, especially in neurological problems. [7] This is the form most used by the Japanese. In fact they don’t use cyanocobalamin anymore because it doesn’t work very well if at all.

The British also don’t use cyanocobalamin. They use hydroxocobalamin. In a paper addressing some concerns about cyanocobalamin, researchers point out that hydroxocobalamin is preferrable to cyanocobalamin and that it’s use should be discontinued. [8]

Cyanocobalamin, methylcobalamin and hydroxocobalamin are the most common forms.

So if you need it, what do you use? I would recommend methylcobalamin in the oral form. There are sub-lingual tabs which absorb and bypass the gut altogether:

http://www.amazon.com/Source-Naturals-MethylCobalamin-Flavored-Sublingual/dp/B001G7R8J2/ref=sr_1_2?ie=UTF8&qid=1334825392&sr=8-2

This would be a good option to start with if you use acid reducers or have gut problems. The one I listed is 1mg which is likely enough. For those fighting off peripheral neuropathies or trying for nerve regeneration much higher doses are likely required, as in doses used in injections.

I would stay away from cyanocobalamin if possible. I know it’s cheap and for a simple anemia where a low dose is effective then it might be ok. But to really maintain good health it’s better to use the other forms. Much like folic acid is synthetic and not naturally occurring folate, cyanocobalamin is cheap (yes I said cheap) and not as effective.

Get the best forms from your food. Fish, shellfish, meat, liver and dairy are good sources. If your gut is in need of help, get it the help it needs so you can get the B12 you need from food. If you are a vegetarian or vegan please make sure to get enough through supplements. I recommend food first of course.

CIAO

1.Watanabe, Fumio, et al. “Pseudovitamin B12 is the predominant cobamide of an algal health food, spirulina tablets.” Journal of agricultural and food chemistry 47.11 (1999): 4736-4741.

2.Watanabe, Fumio, et al. “Characterization and bioavailability of vitamin B12-compounds from edible algae.” Journal of nutritional science and vitaminology 48.5 (2002): 325-331.

3.Antony, Aśok C. “Vegetarianism and vitamin B-12 (cobalamin) deficiency.” The American journal of clinical nutrition 78.1 (2003): 3-6.

4.Bissoli, L., et al. “Effect of vegetarian diet on homocysteine levels.” Annals of nutrition and metabolism 46.2 (2002): 73-79.

5.http://chriskresser.com/b12-deficiency-a-silent-epidemic-with-serious-consequences

6.http://www.ars.usda.gov/is/pr/2000/000802.htm

7.http://www.nutritionaltest.com/methyl.html

8.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697096/

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

Anxiety and Depression Part Deux

Again I want to emphasize that I do think depression is real and I know anxiety is real too. They are an ever growing part of many people’s lives. I also want tor re-emphasize that there is no “silver bullet” for either. Like so many other things in life it takes time and usually a multifaceted approach. I guess a good analogy would be trying to fix an old pick up truck that isn’t running by just putting gas in it. Sometimes having enough gas isn’t the problem. Spark plugs may need to be changed, a new seal here or there, a new battery, maybe a new starter or all of the above are required or maybe more. This is the thing that irks me so much about a lot of medical practice. I know not all docs are trying to treat numbers or just brush things off as irrelevant, but it is becoming increasingly difficult to find a person who will spend time with you rather than getting you out the door so they can see the next patient. Money talks I guess.

So lets get the ball rolling. Lets start with anxiety. I want to introduce you to my new friend. His name is niacin or vitamin B3. Niacin was the third b vitamin discovered, hence the “3”, and it’s actual name is nicotinic acid. It sounds very similar to nicotine, although I’m not recommending nicotine for anxiety (even though you smokers out there know it works) for obvious reasons.

First let me discuss the different forms of niacin. There are 3 main forms that can easily be purchased over the counter. There is (in no particular order): niacin, niacinamide, and inositol hexanicotinate. All 3 are effective forms and interchangeable in the body for use. Niacin is known for causing the “flush” where a person can become as red as a lobster and feel like they’re having a hot flash. Niacinamide doesn’t seem to have this problem except in a few cases of people who take it. Niacinamide also is more responsible for nausea than niacin, although all three forms can cause it. Inositol hexanicotinate and niacin will affect blood lipids while niacinamide will not. Inositol hexanicotinate is also more expensive.

Let me also digress for a moment and discuss the flush. I know people who will not take niacin because of the flush. They can’t stand the feeling of it. It can feel like a sunburn. It starts at the top of the head a works its way down the body. I first experienced the flush this way. The top of my head began to tingle, and then the heat rushed down my face and neck, continued down my arms and before I knew it I looked like I had been out in the sun naked all day long in the middle of summer. It lasted for about 30 minutes before calming down. I had what I can only describe as a runner’s high afterward. I felt good. I felt calm and I wanted to do it again. Some people will not want this, I don’t mind it. The reason is as follows;

The flush will begin to subside as you continue to take niacin, especially if taken after a meal, which is what I recommend. I still flush after some doses, and don’t flush after others, but the flush I get now is mellow by comparison to the first one I had. I personally take about 750mg of niacin right now after meals and the flush continues to be less and less. If you take it with no food in the stomach, you are in for an experience. The more you take it though, the less pronounced the flush will become. I really don’t mind it at all. My wife’s flushes vary in intensity as well, but they are much less intense than the first time it happened. All I can really recommend is give it a try. If you don’t like it, try the niacinamide. Do take niacin after a meal. The other thing is start small and go slow. try 50mg twice a day and move from there. After a few days, increase to 75mg twice a day. Keep increasing by small amounts. You will feel the flush at some point if you didn’t from the start. Have a doctor who knows how to use niacin to help you if possible. If not, then try the niacinamide. As for me, I’m staying on the niacin.

For anxiety try taking some niacin (in any form) a few times day with meals. Since it is a water soluble vitamin what doesn’t get used will likely be tossed out with your urine so keeping a saturated level is easier with multiple doses. In other words 250mg 8 times a day is better than 1gm twice a day. Some people won’t be able to take it 8 times a day simply because it’s hard to remember and we all have busy lives, but divided is more useful if possible. It does seem to have a calming effect. It may not work overnight (although there are case reports where people do feel better that way), but keep on it. I would also note that taking niacin should be accompanied by a B-complex. The best reason why is that they work together as a team. You can’t play baseball with just a pitcher, you need everyone. You can take a B-complex with the niacin at meals. If you have a B-100, you could split it in two and take 1/2 in the morning and the other half in the evening with meals.

Anxiety can lead to depression and a host of other problems. Bill W., the founder of Alcoholics Anonymous, suffered from depression. When introduced to niacin he started taking 1gm three times a day with meals. In two weeks, he was feeling better. He liked it so much that he began recommending it to all of the AA members and many of them began to see improvements in their mood and depression levels. 30 friends in all were started on the vitamin. 10 were better withing a month, 10 more withing 2 months, and the remaining 10 in the third month. Imagine had they all been put on antidepressants. I wonder how well they would’ve done then? Probably not so well.

Dr. Abram Hoffer, one of the pioneers in niacin therapy, remarked how the vitamin seemed to increase the sedative effect of phenobarbital, an anti-convulsant. He studied how it affected agitation and anxiety, with positive results. To read more about this I recommend the book Niacin:The Real Story. You can also look at orthomolecular.org where there are many studies published, not only about niacin, but other vitamin therapies. I know that my story is just a simple anecdotal report, but I will say again that I feel more calm when I take niacin. I don’t think I’m an overly anxious person, but I do notice a difference. Another thing to look at is a good multivitamin. Some people who are deficient in minerals like zinc or selenium can have problems with depression. I will try to address that in another post. In the meantime, despite what big pharma will have you believe regarding vitamin use, a good multivitamin is a good investment, but like I said, look for one with minerals and non-synthetic vitamins (again something I will address in another post).

One study looked at niacinamide in sleeping patterns in adults. Patients taking 500 mg twice daily during one week, 1,000 mg twice daily during the second week, and 1,000 mg three times daily during the third week experienced more REM sleep, less awake time at night, and more sleep efficiency. The benefits were lost when discontinued. Sleep is always a great help in reducing anxiety and depression. I might add that it helps me get to sleep, but doesn’t put me to sleep like zolpidem (Ambien) would.

Niacin is not a silver bullet as I’ve said, but I thinks it’s very useful. Here’s another option. A supplement that I recommend for heart disease treatment or prevention that may benefit anxiety is fish oil. That’s right, that tasty fishy oily substance that provides us with those wonderful omega-3 fatty acids. In a trial involving college students, researchers looked at anxiety and depression in two groups, one on fish oil and the other on placebo. After 12 weeks what they found was “compared to controls, those students who received n-3 showed a 14% decrease in lipopolysaccharide (LPS) stimulated interleukin 6 (IL-6)production and a 20% reduction in anxiety symptoms, without significant change in depressive symptoms”. (my emphasis added) It didn’t seem to affect depression but anxiety was reduced. That was 12 weeks. I wonder if a longer period of time would have helped. My suspicion is that it would, but it needs to be tested. Another thing to note is that it was 2.5gm of omega-3 per day. Keep that in mind when taking fish oil. 1 or 2 gel caps probably isn’t going to cut it.

You can find the link to the study here: http://europepmc.org/articles/PMC3191260?pdf=render

Vitamin C is a great way to reduce cortisol levels and adrenaline in the blood. Cortisol is known to hammer you body in large quantities. Bodybuilders know this is especially true when trying to retain lean muscle. Cortisol tells the muscles to break down. Vitamin C reduces those levels. In one study of marathon runners, vitamin C was given to runners at 500mg/day and 1500mg/day for 7 days before, during, and 2 days after a race. The blood was drawn and showed that the higher dose group had significantly less cortisol.2

Another vitamin c trial looked at subjects and their responses to stress. Subject were given 3gm/day vitamin divided over 3 doses. Blood pressure, subjective stress levels, and salivary cortisol recovery was better than in placebo.3 Vitamin C is also a great combo with niacin for schizophrenia. We might cover that at a later time.

Another thing I will add before making this post mind numbingly long is this; look at your point of view. One of the best pieces of advice I ever got was from a very wise woman I met in Spain. She was actually Norwegian and not Spanish. She told me the following, “If there is a problem and you can fix it don’t worry about it. If there is a problem and you can’t fix it then don’t worry about it”. How true it is! Worrying about every little things becomes tedious and monotonous and yet so many of us, including myself, do it over and over to the point we stress ourselves out over everything and we don’t chill. Sometimes a good hose down would probably benefit all of us from time to time, and with really cold water. Learn to look at things differently. If you have a flat tire on the side of the road and you can fix it, then fix it rather than stressing that you have to fix it and be grateful you have your spare. If you have to call someone to come haul you to a shop, then do it and don’t worry that you have to or are doing it. I know this requires practice, but the more you practice something like this the more it becomes  habit and the less you will stress, saving your heart, mind and strength.

So give niacin a shot. Give it some time and build up to a good dose. Try to get to up to 1-3 grams a day. Do so with the help of a practitioner who knows about niacin. Try some higher dose vitamin c and maybe some fish oil and for the love, quit worrying about everything. Remember that like all things, time and energy must go into something to be done right. A baby doesn’t pop out of the womb in a week nor does a diabetic reverse diabetes in a month. The body has an amazing capacity to heal itself with the right nutrients and attitude but it takes some time. If these things don’t help in a week or month keep at it. And remember there is not silver bullet to anything.

CIAO

The Brute

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

1.Robinson CR, Pegram GV, Hyde PR, et al. The effects of nicotinamide upon sleep in humans.Biol Psychiatry1977;12:139-143

2.Peters, E. M., et al. “Vitamin C supplementation attenuates the increases in circulating cortisol, adrenaline and anti-inflammatory polypeptides following ultramarathon running.” International journal of sports medicine 22.7 (2001): 537-543.

3.Brody, Stuart, et al. “A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress.” Psychopharmacology 159.3 (2002): 319-324.

Anxiety and Depression

So about a month ago I wrote a little about some psyche issues that plague many people. Today I want to delve a bit into anxiety and depression. This is a big problem these days. I dispense medication everyday for both of these ailments. For some people they do work however they aren’t without their consequences. I’ve had many people tell me that while trying to get off of them have had what they describe as “brain shocks” or “zaps”. Many others have nausea, sweats and insomnia.

Lets go through some of the effects of SSRI’s and SNRI’s (drugs like citalopram and velafaxine). First, as I mentioned in the last post these drugs are only effective in about 50% of people who use them and are more effective in the more depressed. The SSRI’s like citalopram or sertraline can cause nausea, insomnia, sexual dysfunction, drowsiness, sweating, anorexia, hypertension and suicidal ideation (albeit rare). SNRI’s like venlafaxine can cause all of the above and more likely to cause problems with hypertension and irregular heart rhythms. What’s worse is that both can in some cases cause a worsening of the depression or anxiety symptoms that are being treated! The following is anecdotal but most of the people I talk to that are depressed and on these meds are having problems with sleep. And guess what many of them are taking? Sleep aids of course. The most commonly prescribed sleep medication that I see is zolpidem. Lets take a look at zolpidem.

Zolpidem works with GABA receptors in the brain and turns them “on”. GABA receptors are the “chill out” part of your brain that tell your body to calm down and sleep. For those of you who know, I realize that is a gross over-simplification of GABA but bear with me. So when zolpidem turns on GABA receptors, the signals then sent to your brain and body are that it’s time to relax and go to sleep. It is able to get people into deep sleep. So what’s wrong with that you might ask? Well in the short term probably nothing, but lets take a look at side effects; depression exacerbation, suicidal ideation, amnesia (those are the serious ones), lethargy, diarrhea, palpitations, depression and constipation. So depression is actually a side effect. I will grant that it only happens in 1-2% of patients, but I don’t know of any long term studies showing any psychological issues with the use of zolpidem. I always question the use of a drug that affects neurotransmission in the brain.

You can see that there is the possiblity of falling into a vicious circle of taking meds to treat the very things they are causing. I know a lot of what I’m presenting is from my own personal experience, but it’s hard to ignore what I see over and over again, both in my professional life and in my personal life with friends and family who are affected by this.

I think it’s important to note, more especially with depression and anxiety, that there is no magic bullet for these conditions. Many things can go into causing either problem and either problem can lead to the other. I will spend some more time on the next post discussing some of the possible treatment options that are non-prescription and that you can do. They do involve some dietary advice as well as some supplement advice. I don’t believe however it is one change that will eliminate depression or anxiety from one’s life. I think that is the sad truth that drug companies don’t want you to know. The phrase “there’s a pill for that” I believe has done more harm than good, especially here in the United States.

CIAO

The Brute

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.