Read How Come They're Happy and I'm Not? Online
Authors: Peter Bongiorno
How Come They're Happy and I'm Not? (11 page)
Research demonstrates that dosages of 4,000 IU of vitamin D per day in depressed patients tend to improve well-being, so if you do not know your levels, this may be a good and safe place to
start. In a clinical setting, weekly doses of 50,000 IU intramuscular are available. Although no long-term studies have reviewed this method from a natural perspective to date, it seems like a less natural way to present this vitamin to the body, for the body would not usually take in so much at one time. Studies of patients given long-term oral treatment of 14,000 IU per day seemed to have no toxicity and did show significantly decreased depression relapse rates.
Because vitamin D is fat soluble and can build up to toxic levels in your system—leading to high calcium in the blood, kidney issues, and excessive bone loss—it's advisable to run lab tests before taking this vitamin. Prudent research suggests that your blood levels should not exceed 100 ng/mL, but the exact amount of vitamin D required to induce toxicity is unknown and is probably a different number for each person. One researcher suggested in 1999 that this amount is 20,000 IU per day. However, many cases have administered much higher doses without side effects or toxicity. One recent meta-analysis looked at ordinary doses of 400 to 800 IU per day of long-term vitamin D supplementation and did not seem to be associated with any adverse effects.
There's contrasting information as to whether supplementing with the forms of vitamin D
2
(ergocalciferol) or D
3
(cholecalciferol) is optimal. Plants manufacture vitamin D
2
, whereas vitamin D
3
is synthesized by humans in the skin when it's exposed to UVB rays from sunlight. My experience has been with using D
3
, which seems to have a beneficial effect on blood levels and, as a result, mood. If vitamin D
3
does not seem to work for you, then you may want to try vitamin D
2
.
Mercury testing is used to detect excessive amounts of mercury, which can contribute to nervous system disorders, mood disorders, and cardiovascular disease. I recommend running this test to see if there has been acute or chronic exposure to increased levels of
mercury. It may also be ordered to monitor those who are regularly exposed to mercury. It does not, however, tell you if you have had an exposure of mercury that is sitting in your body tissues. I have seen high levels of mercury in patients experiencing a sudden onset of depression, so it's worth checking. We will talk more about how to treat both acute and long-term mercury and other metal poisonings later in this chapter (see “Detoxification and the Brain”).
While people generally know that blood type can affect the ability to give and receive blood, relatively few people are aware that blood type suggests a tendency for a person's body to respond favorably or poorly to specific foods, even among healthy choices. Knowing your blood type can help you make better choices regarding which foods may be pro-inflammatory and which may best support your repair. More about this can be learned by reading Dr. Peter D'Adamo's book
Eat Right 4 Your Type
. I have used the blood type diet successfully in a number of cases where other dietary changes didn't work. Running the ABO blood type and Rh test allows you to pursue this work further.
It's almost cliché in the world of naturopathic care to “treat the gut” when you are working with any health issue. As cliché as it may be, this tenet of naturopathic care may be the keystone in an effective healing plan for patients with depression.
Growing up, my brother used to tell me that if you don't poop, “your brain gets fuzzy.” Although he was a youngster, he was medically accurate. Without trying to be too graphic here, it's important to remember that a good poop can really make a person feel good.
For instance, bowel movements have been linked with female self-esteem as well as with maintaining relationships. In depression, self-esteem and relationships are strong challenges. A 2001 study from the journal
Gut
compared thirty-four women between the ages of nineteen and forty-five who had suffered from constipation for five years or more with those of the same age range who had no history of constipation. It was clearly shown that the constipated women had a worse score for overall health and felt less feminine. The constipated women also found it much harder to form close relationships than those with normal bowel functioning.
Interestingly, this study also looked at rectal blood flow, which reflects the function of nerve pathways from the brain to the gut. These nerve pathways are often affected by stress. Reduced rectal blood flow was strongly associated with anxiety, depression, bodily symptoms, and impaired social skills as well as feeling unfeminine. The higher the psychologically abnormal score, the lower was the rectal blood flow.
The authors of this study concluded that a woman's psychological makeup alters the function of the involuntary nerves linking the brain to the digestive system. Reduced activity of these nerves slows gut function, resulting in constipation. Because most neurotransmitters needed for good brain mood are made in the digestive tract, slowed digestive function may play a role in how a woman feels about herself and how she responds in a relationship. Other studies have also shown higher rates of psychiatric issues with persons who have bowel problems like Crohn's disease, colitis, or irritable bowel syndrome.
To learn the importance of good bowel movements, it makes sense to help get things moving. I often tell patients it's healthy to have a bowel movement every day. Although some medical texts recommend three times a week as normal, I believe once a day should be the minimum.
Water is the first step toward regular bowel movements. Besides helping the body absorb important amino acids, water keeps things flowing throughout the body. If we do not have enough water, the body steals it from the colon contents, making us constipated. Second, a little fiber (about 25 g a day) goes a long way for better mood—and for better relationships and self-esteem, according to the study. Add a plentiful amount of fruits and veggies to your diet. If this is not enough, sometimes flax meal, psyllium, or organic dried prunes may do the trick to, as my Great Uncle Joe used to say, “get the pipes moving.” Third, stress reduction via acupuncture, meditation, yoga, or other work may help to open up bowel movement.
Dubbed “the second brain” by Dr. Michael Gershon of Columbia University, the digestive tract and its accompanying bundle of nerves, called the enteric nervous system, play a major role in the production of neurotransmitters used by the brain. The nervous system around the digestive tract and the brain are very closely linked—in fact, they develop from the same embryonic tissue. And, 80 to 90 percent of the body's serotonin is produced and located in the gastrointestinal tract. serotonin is an amine that is formed from tryptophan in the digestive tract's enterochromaffin cells (EC) and in other similar cells called enterochromaffin-like cells (ECL). Both EC and ECL are widely distributed in the gastrointestinal tract.
Tryptophan → 5-Hydroxytryptophan → Serotonin → Better Mood
AN HONEST NOTE ABOUT SEROTONIN, RESEARCH, AND MEDICINE
There's an old joke that goes something like this: One night, a wino dropped his car keys in a mostly dark parking lot. As he was looking for them over and over in an area around the sole lamppost, some observant person came up to him and said, “Hey, friend, you could have lost your keys anywhere in this parking lot—why are you only looking over here?” The drunk man responded, “Because the light is better.”
As you continue reading this book, please remember that oftentimes in medicine, we tend to search where the light is better. The truth is, it's very simplistic to put up a diagram that has the word
serotonin
pointing to good mood. If life were really so simple, antidepressant medications like Prozac and Zoloft that increase serotonin levels would work 100 percent of the time. In this book, I tend to discuss certain factors like serotonin because those are included in available research at this time—and honestly, much of this research is likely driven by the need to sell drugs. The research is not perfect, but we can learn from it as long as we keep it in perspective as a part of the whole picture.
The delicate process of converting tryptophan, the amino acid which converts to 5-hydroxytryptophan and ultimately to serotonin, is vulnerable to malabsorption problems in the digestive tract, in which the body does not absorb the nutrients we eat. If food we eat irritates the EC, the digestive “brain” sees that as a possible poison. It reacts by pouring out large amounts of serotonin to increase movement so the gut empties and everything is cleared out. This may be why many people with mood disorders as well as those with high stress experience accompanying diarrhea.
As we discussed earlier in this chapter, one well-studied condition that leads to malabsorption problems is celiac disease. This is an inflammatory disease of the upper small intestine resulting from
gluten ingestion in genetically susceptible individuals. The immune system reacts to gluten lectins (or proteins) and creates a war-like effect, throwing chemical bombs in the hope of destroying the proteins. This inflammation causes the lining of the small intestine to be destroyed, which leads to malabsorption of several important nutrients. Both inflammation (which can kick off inflammation in the brain) and low nutrients can lead to mood and mental instability.
One study reported a prior history of psychiatric treatment in a high proportion of adults with celiac disease, even years before diagnosis. Researchers studying the blood of untreated celiac patients found the plasma tryptophan reading to be significantly lower compared with treated and control groups. Such studies show us that abnormally low amounts of tryptophan in patients with depression and behavior disorders are a likely marker of serotonergic dysfunction due to impaired availability of tryptophan. Importantly, this can be reversed to normal in those who follow a gluten-free diet.
While gluten is the center of attention when discussing celiac disease, it is important to remember that many other foods may also create sensitivity, inflammation, and eventual malabsorption. More information about using food modulation to treat depressive disorder will be discussed later.
This book spends a fair amount of time researching the benefits of supplements. Even if you are eating a perfect blend of healthy foods, these supplements may indeed be useful because your intestines are not absorbing the nutrients from the food you are eating. Even worse, if you are eating the standard American diet, then there's no way you are even getting the nutrients you need. So supplements can help. But, it's still most vital to remember that for true healing, eating the healthy foods and fixing the digestive tract so it can absorb these foods are necessary for your long-term health.
Even though the worlds of psychiatry and gastroenterology do not meet in conventional medical wisdom, you now know that there's
a strong correlation between a digestive tract that is not working properly and poor mental health. As we just learned, malabsorption problems in the digestive tract keep you from absorbing the nutrients you need to be healthy.
But there's a second, even more heated reason why a poorly functioning digestive tract makes your mood sour. It's inflammation. The Latin word for inflammation is
inflammare
, which means “to set on fire.” Inflammation is the mark of an immune system on high alert trying to get rid of an irritant or kill something it thinks does not belong—and the casualties of this war can be your brain, health, and mood. In fact, some researchers have described depression as a low-grade systemic inflammatory condition. This is why we spent time looking at inflammation markers in your blood earlier in this chapter.
When the immune system is on high alert, it chronically releases what the immunology world calls inflammatory mediators, which are cells and little chemical bombs that keep the war going. Some of these chemicals break down cell membranes and fats, some break bonds between cells, and some can even cause fever. Immune response in the digestive tract is known to lead to flu-like symptoms, fatigue, anxiety, and of course, depression.
When I researched at the National Institutes of Mental Health, part of my work was to study what inflammation could cause in the body. To do this, my research team and I gave rats regular doses of a bacterial coat compound called lipopolysaccaride (LPS). This prompted a strong inflammatory response in the animal's body. We wore masks to use LPS, for it can elicit a strong response in humans too. We studied what chronic inflammation could cause in the rats, and we found that the animals would show signs of sickness behavior—fatigue, low mood, low motivation, and other symptoms that clearly resembled depression. Similarly, overactivation of the immune system is observed in many depressed patients, and depression is more frequent in those with an overactive immune system. Furthermore, inflammation alters brain serotonin levels.
