This topic is widely discussed and nutritional deficiencies still effect many worldwide. Contrary to the belief that we are overfed. We are overfed but undernourished. Depression can often feel like a losing battle. There are people who have tried multiple things to feel “normal”. Depression effects our motivation, energy levels, distress tolerance, and our mood. It also effects our ability to feel positive, to feel joy, and to feel anything at all. There are many of my clients who come in on antidepressants and still don’t feel normal.
Lab Work
It should be common practice to check lab work before we start medications but there are a lot of providers who don’t. In the ER, it’s the first thing we do. Draw blood. We want to rule out organic causes of mental illness. Even when drawing blood not everything is tested as there are set lab work options. Usually the insurance companies need a reason to draw things that aren’t on general screenings.
But here’s the thing, what the National Institute of Health recommend isn’t always enough for optimal health. For instance, remember when the government said that fat was bad. Then studies came out show it was false. Whoops, now it’s a whole different story. But the studies say… Who funded the studies? What conflict of interests are there? And ARE THERE STUDIES? Unfortunately, when it comes to “more natural” aspects of health, there are less studies, because how are people going to make money? So there is no money for funding.
Slight nutritional deficiencies CAN have an effect on your mood. But is that the “fix”? It depends. Get your blood drawn by a prescriber (or functional medicine prescriber) and see if you have deficiencies. Don’t just assume you have them.
See A Prescriber
See a prescriber if your symptoms are so bad that you’re not functioning well. If you’re struggling to get out of bed, your grades are dropping, or your not doing well at work, see a professional as a medication may be called for. Don’t forget therapy too ;D
Vitamin D
Vitamin D have been linked to many mood disorders including anxiety and depression. It’s also been associated with autoimmune disorders, diabetes, and heart diseases including high blood pressure. With our current lifestyles vitamin D levels have gotten more difficult to meet. We spend less time in the sun and it’s relatively hard to get enough vitamin D from food sources.
There are two types of vitamin D forms (D2 and D3). Though not clinically significant at the moment, vitamin D3 is believed to sustain levels longer. Vitamin D is produced endogenously when ultraviolet rays from sunlight strike the skin and trigger vitamin D synthesis. Vitamin D is important in normal mineralization of bone (making them stronger and to help prevent osteoporosis in older adults), modulation of cell growth, neuromuscular and immune function, and reduction of inflammation [1].
Food Sources
Food sources to get vitamin D from include the flesh of fatty fish (salmon, tuna, and mackerel chime in here), egg yolks, milk, and fish oil tablets. In the 1930’s people were developing rickets so the United States started fortifying cereals, milk, and other processed foods with vitamin D. Most milks have been fortified with up to 100 IU’s a cup. More and more people are drinking less milk and consuming less fortified foods leading to a decrease in vitamin D levels overall.
Labs:
- Sufficient: 25(OH)D greater than 20 ng/ml (50 nmol/l).
- Insufficient: 25(OH)D less than 20 ng/ml (50 nmol/l).
- Deficient: 25(OH)D less than 12 ng/ml (25 nmol/l).
The IOM said that anything above 20 ng/ml is usually enough to meet the requirements of vitamin D in the body, but some (like Endocrine Society) say that closer to 30 ng/ml is better
Recommended Dosages
600 IU is recommended by the NIH (National Institute of Health) from age 1-70. After age 70 800 IU’s are recommended. Average intake levels for males from foods alone ranged from 204 to 288 IU/day. 61% of children in the United States have insufficient vitamin D levels and 41.6% of adults have insufficient levels.
With our lifestyles including less sunlight and less fortified foods, there arerecommendations that we should get at least 1000 IU’s daily.
Some even need higher dosages including 4000 IU’s like people who never get sun, who are menopausal, obese etc. Overdosing is extremely rare and would need to be taking 800,000 IU’s to cause death but that being said, supplementation should be talked about with your prescriber.
B Vitamins
Low levels of B vitamins are known to cause depression, anxiety, irritability, and fatigue. In particular, vitamins B6, B12, and folate (B9) are one of the nutritional deficiencies that can cause anxiety and depression and have been linked to a wide range of mental and physical health problems. Increasing intake of foods containing these essential nutrients can bring significant improvements for some people. You can get vitamin B from your diet or supplements (if you don’t have a well balanced diet consider supplementation).
B12
B12 supports myelin (which allows nerve communication) and when this vitamin is deficient, it is believed to drive symptoms such as dementia, multiple sclerosis, and issues with sensation. Clinically, B12 may be best-known for its role in red blood cell production. B12 helps different aspects of the body including making proteins more readable, producing more energy, cleaning up excess hormones and chemicals such as estrogen. It helps maintain homeostasis within our body. B12 also helps produce SAMe which naturally occurs in the body. SAMe helps produce and regulate hormones and maintain cell membranes.
Where can I get B12?
Vitamin B12 can come from animal products such as poultry, meat, dairy products, liver, citrus fruits, legumes, dark green leafy vegetables, and yeast extract containing folate. B12 should be taken along with the other B vitamins for maximum absorption. Another effective approach is to dissolve a sublingual tablet of methylcobalamin (1000 micrograms) under the tongue once or twice every day. This form of sublingual B12 is readily available as an inexpensive supplement but is slightly less bioavailable. B12 can also be given as an injection by a clinician so it’s important to get your levels drawn by your prescriber.
B6
Vitamin B6 is also sold under the names pyridoxal, pyridoxamine, pyridoxine hydrochloride, and pyridoxal-5-phosphate and can be found in oral supplements and liquid drops.
B6 helps create serotonin. If you’re deficient in other B vitamins it’s likely you’re deficient in B6 as well. B6 is tied to immune functioning, the nervous system, and inflammation.
Where can I get B6?
Vitamin B6 is found in chicken, leafy green vegetables, bananas and some kinds of seafood. Adults ages 19 to 50 years require 1.3 mg of B6 daily. Women 51 years and older require 1.5 mg daily. Pregnant and breastfeeding women require 1.9 mg daily.
B9
Vitamin B9 (folic acid) works with vitamins B6 and B12 and other nutrients to control blood levels of the amino acid homocysteine. It also works best when it is taken along with the other B vitamins; thus, taking a B vitamin complex supplement is best. Adults require 400 micrograms of folic acid per day. Pregnant women require 600 micrograms per day and breastfeeding women require 500 micrograms per day.
Folate is interesting because if you’re deficient it can actually hinder the usage of antidepressants https://www.ncbi.nlm.nih.gov/pubmed/15671130. Low plasma or serum folate has also been found in patients with recurrent mood disorders treated by lithium. A link between depression and low folate has similarly been found in patients with alcoholism https://www.ncbi.nlm.nih.gov/pubmed/15671130. SAMe also needs folate to it’s work.
Homocysteine
Homocysteine is an amino acid that is in the blood. It is converted to cysteine by reacting with B vitamins. Cysteine is an important protein in the body that has many roles. It is involved in the way proteins are folded in cells, how cells maintain their shape, and link to each other. It also helps process metals in the body and acts as an antioxidant. Without the B vitamins, cysteine isn’t created and homocysteine rises.
High Homocysteine levels are a marker for heart disease and poor lipid profiles. Homocysteine levels are higher in patients that are depressed. Smoking, coffee consumption, male age, and aging can also increase homocysteine levels.
Increased plasma homocysteine is a functional marker of both folate and vitamin B12 deficiency. In a large population study from Norway increased plasma homocysteine increased the risk of depression. There is now substantial evidence of a common decrease in serum/red blood cell folate, serum vitamin B12 and an increase in plasma homocysteine in depression.
B Vitamins in General
Vegetarians, vegans, and people on restrictive diets may need to take a vitamin B complex supplement. B vitamins are water soluble so consuming too much would be difficult. The excess will come out in your urine.
Iron
The element Iron is probably the most well known test for ruling out factors for depression and anxiety. Iron plays an important role as a cofactor for the synthesis of serotonin. Having low iron levels can lead to anemia and has been associated with fatigue, weakness, depression, anxiety and panic attacks. Iron deficiency can cause a range of symptoms similar to those of depression, including mental and physical fatigue, low mood and irritability.
According to the World Health Organization, iron deficiency is the number one nutritional disorder in the world. They estimate more than half of all pregnant women are low in iron.
Iron Labs
A doctor can diagnose anemia using a blood test to measure serum ferritin and hemoglobin levels. The World Health Organization (WHO) classifies mild anemia as having a hemoglobin level of:
less than 119 grams per liter (g/l) for adult females
less than 129 g/l for adult malesh
Where can I get Iron from?
Iron is obtained from multiple food items including shellfish, turkey, lean beef, and chicken, green leafy vegetables like spinach, cashews, beans, lentils, and fortified foods. Women aged 19 to 50 require 18 mg of iron daily as iron deficiency is often caused by menstruation. Post-menopausal women and men require 8 mg of iron daily.
Overall,
Getting your blood levels drawn are incredibly important to rule out organic factors for your depression and to get the the bottom of whether you are deficient. During this period, get a therapist as it’s incredibly important that you are functioning at the best of your ability to prevent further degradation. Also try to find a prescriber that you trust and can help you along the journey.
Talk soon,
Sarah
References
Fat Study: https://www.ncbi.nlm.nih.gov/pubmed/20071648
Vitamin D:
- Norman AW, Henry HH. Vitamin D. In: Bowman BA, Russell RM, eds. Present Knowledge in Nutrition, 9th ed. Washington DC: ILSI Press, 2006
https://health.gov/dietaryguidelines/2015/guidelines/appendix-7/
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698592/
B Vitamins
Iron
Zimmermann, M.B., et al. (2007) Nutritional iron deficiency. Lancet, 370, 511-20.
Chen, M.H., et al. (2013) Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry, 13, 161. 8.
Features, C. (2011) An Estimated 1 in 10 U.S. Adults Report Depression. http://www.cdc.gov/features/dsdepression/. Centers for Disease Control and Prevention, Atlanta, GA.
Click to access haemoglobin.pdf
