How Come They're Happy and I'm Not? (10 page)

DHEA levels should always be checked before starting supplementation. Taking too much for your body can cause problems by increasing levels of other hormones like testosterone and estrogen. Too much DHEA in women may cause male hormone-like skin effects (greasy skin and hair, acne, itchy scalp, hair loss, or facial and body hair, especially along the midline of the lower abdomen). Men with prostate cancer or benign prostatic hyperplasia (BPH) should check with their doctor before starting DHEA.

The only known food source for DHEA is the wild yam, but its levels are way too low to have a clinical effect.

Testosterone is the hormone most associated with being male—however, both men and women need it to maintain a good mood. Low testosterone levels may cause flattened mood, low sex drive,
loss of motivation, fatigue, and general loss of well-being in both women and men. This condition has been underdiagnosed due to the nonspecific symptoms that may appear identical to clinical depression and should be tested in anyone with depression symptoms.

Although oral versions of testosterone replacement are available, I recommend a transdermal patch to avoid interference by the liver. Anything you ingest goes through the liver, and when the liver sees all this extra hormone taken orally, it tries to bind it up by sending out a protein called sex hormone binding globulin (SHBG), which may block other hormones from working so well.

Studies show that it is safe for men to use antidepressants together with transdermal testosterone. Interestingly, it has been shown that selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed antidepressant medication, can cause infertility by lowering testosterone and sperm levels. So if a depressed man with normal serotonin but low testosterone is given an SSRI, it may make his depression even worse while also decreasing his chances of having children.

Too much testosterone can cause excess body and facial hair, acne, and may exacerbate prostate cancer risk, although newer studies are suggesting it may not be a risk to the prostate at all. Testosterone replacement should be monitored by a doctor using blood tests and checking for signs of excess.

Estrogen and progesterone are well known to factor into mood both from moment to moment and as hormonal change occurs over the years. While some women may have mood issues without necessarily having imbalances in estrogen and progesterone, these are worth checking. We will discuss estrogen and progesterone further in
chapter 8
.

Paralleling the increased intake of more bread and grain products in the past fifty years is a dramatic rise in the incidence of celiac disease—a strong inflammatory reaction to the gluten component of wheat, spelt grains, or amaranth. According to a 2004 panel at the National Institutes of Health, estimates suggest that one in one hundred people is affected, although the disease is considerably underdiagnosed.

There's a correlation between celiac disease and gluten sensitivity with mood disorder in adults and behavioral issues in both children and adults. Twenty percent of patients with celiac have overt psychiatric problems. But celiac disease holds greater risks than mood problems—undiagnosed disease has a fourfold increased risk of death.

One way you can learn if celiac disease is affecting your health and mood is to have a celiac panel as part of your next blood test. A celiac panel is composed of four tests: antigliadin antibodies IgG, antigliadin antibodies IgM, tissue transglutaminase (TTG), and secretory IgA. Together, these tests can help identify immune reactions to gluten. Although the panel is not perfect, it typically has an 80 to 90 percent accuracy rate. Accuracy can be improved by eating gluten products regularly a few weeks before the panel to ensure antibodies show up if you are producing them. The alternative gold-standard test for celiac disease is quite invasive: a biopsy of the small intestine's jejunum section, which I do not recommend unless your doctor believes there are digestive issues that warrant it.

The last test of the panel is secretory IgA. IgA stands for immunoglobulin A, which is an antibody needed to protect against infections in the mucous membranes lining the mouth, respiratory tube, and digestive tract. About 3 percent of the population is IgA deficient, suffering from a mild genetic issue that lowers this antibody. Low IgA can lead to problems with digestion and the intestinal environment. Regarding our discussion, if a person is IgA deficient, then the other celiac tests may show up falsely negative,
even if they actually have celiac disease. So if your IgA is low, you may need to work further on creating a healthier digestive tract (see the “Digestive Work” section later in this chapter), and then retest for celiac disease afterward.

Simply stated, if you have celiac disease, it's best to avoid all gluten proteins. These appear in wheat, spelt, and amaranth products. Gut linings can heal in three to six months after altering your diet—and in my experience, mood issues can improve within as little as two weeks. Most other grains like rice, quinoa, and millet are perfectly fine to eat. I recently noticed that Gino's, a well-known pizzeria in my hometown, now serves gluten-free crust. A large sign advertises this—quite a testament to the number of people who are finding gluten to be problematic in their diets.

A note about gluten allergy versus sensitivity: While people who have positive celiac tests should absolutely avoid gluten, I have seen clinically that many people who do not have a positive blood test are still obviously gluten sensitive, meaning this protein can cause inflammation in the body and contribute to mood issues even though the intestines are not overtly damaged and the celiac test was not positive.

While relatively scarce in our food supply a few hundreds years ago, now it is hard not to find gluten in some form in most of our everyday foods. Besides appearing in breads, it is used as a filler for many other foods, including imitation meats. Gluten grains are also used in animal feed, which is passed on to us when we eat the animals. As mentioned, many people who are celiac negative could still be sensitive to gluten. If you think this could be you, it is worth doing a trial of four weeks without gluten to see if your mood improves. Some people who are extra sensitive to gluten may need to stop eating it by weaning off slowly. Like a drug addiction, sometimes when you stop gluten too quickly, you can have withdrawal effects, which could temporarily make your mood feel worse.

Carnitine (affectionately known as L-3-hydroxy-4-N,N,N-trimethyl-aminobutyrate in the medical world) is an amino acid cofactor that serves to help turn fats into energy. Carnitine may play a neuroprotective role in mood by acting as an antioxidant and an anti-inflammatory. The supplement form of carnitine, called L-carnitine, has been shown to help mood, fatigue, and depression in patients with cancer.

Generally speaking, L-carnitine supplementation has an enhanced effect on energy level. I recommend 500 mg of carnitine twice a day, preferably not taken with food for best absorption. I also would recheck carnitine blood levels in six weeks to look for improvement. If there's no improvement, then you can increase the dose up to 3,000 mg per day and consider more digestive work (see next section), to help you absorb your nutrients better. Levels of 3,000 mg per day have not shown any toxicity.

The word
carnitine
comes from the Latin word
carne
, which means “meat.” The highest concentrations of carnitine are found in red meat. Other high concentrations are found in dairy products. Some lesser natural sources of carnitine include nuts and seeds, and smaller amounts in legumes, vegetables, and grains.

The word
folate
comes from the Latin word
folium
, which means “leaf,” for it was realized a long time ago that there was plenty of this nutrient in leafy greens. Known for preventing neurologic defects in newborns, folic acid also plays a strong role in the production of the neurotransmitters norepinephrine and epinephrine as well as the feel-good chemical prostaglandin. Folic acid is also needed to support dopamine production, while vitamin B
₁₂
is known to help in the synthesis of serotonin. There's some evidence that people with depression respond better to drug
treatment if they have higher levels of vitamin B
₁₂
and folic acid (see
chapter 7
).

Asian population studies suggest that people who eat traditional Chinese diets rich in folate (from healthy portions of green vegetables) have high serum folate concentrations and tend to have very low lifetime rates of major depression.

Folic acid deficiency has been noted among people with depression, and some estimates show as high as 33 percent of depressed individuals are folate deficient. poor diet, alcohol, antiepileptic medications, and birth control pills can all contribute to folate deficiency.

Some people have a genetic inability to convert the typical folic acid into L-methylfolate, the form the body uses. The methyltetra-hydrofolate reductase (MTHFR) gene variant test is a blood test to determine if you have that genetic inability.

Oral doses of both folic acid (800 mcg—15 mg daily) and vitamin B
₁₂
(1 mg daily) should be tried to improve treatment outcome in depression. B vitamins like folic acid and B
₁₂
are water soluble and generally safe.

If the MTHFR gene variant test suggests your ability to convert folic acid is challenged, you can bypass this problem by supplementing with the L-methylfolate form of folic acid.

Avoid folic acid if you are taking seizure medication or methotrexate for cancer, as it can block the effects. However, folate has been found to be liver protective for patients using methotrexate to treat rheumatoid arthritis (RA) without blocking its general effect.

Even if your levels of B
₁₂
and folic acid are normal, it may still be prudent to supplement with extra B
₁₂
and folic acid if other treatments, including medications, are not working. It's quite possible that you may have a deficiency in your body tissue while still showing reasonable levels in the blood.

Excellent food sources of folate are spinach, asparagus, romaine lettuce, turnip greens, mustard greens, calf's liver, collard greens,
cauliflower, broccoli, parsley, lentils, and beets. Excellent sources of B
₁₂
are snapper and calf's liver. Other sources of vitamin B
₁₂
include venison, shrimp, scallops, salmon, and beef. Vegetarian sources have significantly lower available B
₁₂
, and the best of these are sea plants (like kelp), algae (like blue-green algae), brewer's yeast, tempeh, miso, and tofu.

Most people associate vitamin D with healthy bones, but it also plays a central role in mood—to the point that some experts have dubbed it “the happy vitamin.” Vitamin D deficiency has also been connected to conditions like autoimmune and cardiovascular diseases, cancers, and chronic pain. One large study published in the
Archives of Internal Medicine
suggests that all causes of death may be lowered by giving supplemental vitamin D. Everyone who is breathing should have this vitamin checked.

Low levels of vitamin D are likely involved in depression in several ways. Vitamin D affects nerve growth factor, a molecule in the body that helps nervous tissue grow and repair. It's hard to have good mood without that repair mechanism. Vitamin D also helps produce serotonin, testosterone, and thyroid hormone. There's also an increase of depressive symptoms in adults whose mothers had low vitamin D while they were pregnant with them. Furthermore, many cells in the brain's center, called the hypothalamus, respond to vitamin D. The hypothalamus is responsible for some main controls of how the nervous system, hormones, and stress system work together. This system is called the hypothalamic-pituitary-adrenal axis and is most often imbalanced in depression.

Many studies show the benefits of vitamin D for mood problems. In a large study of one thousand older adults, mean levels of vitamin D were low in those with minor and major depression compared with controls. A smaller study focused on forty-four healthy participants in winter, when vitamin D levels are low. They were randomly assigned to five days of treatment with 400 or 800 IU
of vitamin D
₃
or placebo. Compared with the placebo group, both doses of the vitamin increased positive mood and decreased negative mood. A Norwegian study of 441 overweight people measured vitamin D levels. Those below 40 nmol/L (16 mg/dL) were shown to be more depressed. These subjects were then given 20,000 IU or 40.000 IU or placebo once a week. Those given 40,000 IU experienced a 33 percent reduction in depression levels, those given 20.000 IU had a 20 percent reduction, and the placebo group reported a 5 percent decrease.

The main food source of vitamin D is fish. Most people believe the healthy fats in fish can prevent depression, but given what you just read, you may decide it's the vitamin D.

Although there are a few forms of vitamin D in the body that can be tested, the test indicative of true vitamin D status is 25-hydroxy (OH) vitamin D. Make sure your doctor runs that exact one.

Normal levels of vitamin D range from 30 to 100. An ideal level of vitamin D is around 50. The most natural way to get vitamin D is to expose some bare skin to the sun. As we discussed in
chapter 3
, some sun is very healthy, and unless you have a high risk of skin cancer, it's a good idea to absorb sun until the point you start to get a little bit red. Food such as salmon, eggs, dairy, and butter have the most vitamin D, but may not be enough to raise levels. A general guideline I use to start supplemental vitamin D
₃
is to take 2.000 IU per day for each 10 units you would like to raise your levels. So, if your vitamin D level is 20 and you would like to raise it to 50, then 6,000 IU per day would be adequate. It's best to check blood levels one month after starting supplementation and adjust accordingly.