Read How Come They're Happy and I'm Not? Online
Authors: Peter Bongiorno
How Come They're Happy and I'm Not? (8 page)
Even when people eat well and often enough, sometimes they can have low blood sugar because their insulin levels are too high. Insulin is the hormone that transports the glucose absorbed from the sugar or carbohydrates you eat into your blood cells. Insulin is also responsible for storing fat and causing inflammation in
the body and the brain. As we discussed in the previous chapter, inflammation in the brain can cause depression.
People with hyperglycemia (high blood sugar) or high insulin levels are also predisposed to depression. A study of adults in their late twenties and early thirties showed that when blood sugar or insulin was high, chances of depression rose 150 to 200 percent.
I recommend running blood sugar tests because knowing your fasting blood sugar and insulin levels helps you make better choices about how you eat, how you exercise, and what supplements you take to help your mood.
If you suffer from mood issues and blood sugar difficulties, I recommend checking your blood sugar on your own throughout the day for one or two days. Please download the Blood Sugar Monitor chart provided on my website (
www.drpeterbongiorno.com/happybloodsugar
) to help track when you eat, what you eat, your activities, and your blood sugar levels. If you have a new glucose meter, or if you do not know if your meter is accurate, talk to your pharmacist and have it calibrated. You can also bring it with you to a blood test—after the phlebotomist tests your blood, you can check your own blood sugar with your monitor and compare the results.
The benefit of checking your blood sugar is to see if it is too low or too high during regular time periods of your day. While anyone can have occasional fluctuations, people who are experiencing levels too high or low will be predisposed to mood issues. If this is you, the information below will be an especially important part of your treatment to health.
I recommend the following tips for patients who experience blood sugar levels dropping below 70, elevating above 120 when they have not eaten for eight hours or above 200 at any point after eating, or if their blood tests show that insulin levels are too high:
- Eat breakfast. This simple step has been shown to help people stay happier during the day.
- Eat small, frequent meals, up to five times a day.
- Avoid all simple flour and carbohydrate foods (bread, cookies, pasta, cake).
- Alternate strength training and cardiovascular exercise six days per week.
- Take 400 mcg of chromium per day with food.
- Sprinkle a half teaspoon of cinnamon on your food once each day.
Doing these actions for as little as a week can help poor mood caused by low or high blood sugar. Anxious and irritable people tend to calm down, and depressed people often perk up.
People who have hyperglycemia may also have diabetes, and diabetic patients are known to have vastly higher rates of depressive illness. If you have high blood sugar or diabetes, stabilizing your blood sugar is crucial to treating depression and mood issues.
A chemistry panel (also known as a chem panel) is basically a shotgun test to look at many aspects of your physiology. It takes a snapshot of what is happening with your lungs, liver, and kidneys as well as gauges levels of calcium, protein, and electrolytes. If the results are abnormal in any of these categories, talk with your doctor about working on the underlying problems. Abnormalities with any of the organ systems related to these levels can cause symptoms that contribute to depressive illness. Every comprehensive blood test should include a chemistry panel.
If you thought cholesterol when you read that header, you were right. A lipid panel basically checks the fasting baseline levels of the fats running around in your blood. Cardiologists and primary doctors usually check these to make sure they are not too high, but I want you to check them to make sure they are not too low. Let me explain.
I have seen low total cholesterol play a role in many depression cases. Although your psychiatrist or cardiologist may not be thinking about this, the research is very clear. Cholesterol is an important mood molecule for two reasons: it helps produce your steroid hormones, and it helps your brain recognize and use serotonin. As the parent of many important molecules in your body, cholesterol is the precursor to all steroid hormones, including glucocorticoids (for blood sugar regulation), mineralocorticoids (which maintain mineral balance and blood pressure regulation), and sex hormones (which have a strong role in mood, as we will discuss). It seems likely that low cholesterol may restrict the availability of steroidal compounds for your body. Maintaining normal cholesterol levels is also important for the function of the receptors in the brain that recognize serotonin.
While antidepressants are the most prescribed drugs in America, cholesterol-lowering medications are the number one moneymaking medication in this country—and around the world. In the marketed interest of saving more hearts, the cut-off range for high cholesterol has been lowered in the last few years, allowing more prescriptions. However, mounting medical research tells us that the more we lower cholesterol, the worse our mood can get.
Known as statins, cholesterol medications work by blocking a key enzyme involved in the body's production of cholesterol. Lab tests have shown that statin medication significantly disturbs the structure and function of serotonin cell receptors. When researchers added cholesterol to cells treated with statins, they came back to normal and responded to serotonin.
Other studies have suggested that statins lower needed polyunsaturated fatty acids in the brain as well. Some studies demonstrate that low postpartum levels of total cholesterol have been associated with symptoms of depression and increased relapse rates in people who have already suffered from depression.
Low levels of high-density lipoprotein (HDL—the good cholesterol) are a known risk factor in cardiovascular disease. HDL carries bad cholesterol away from the artery walls and plays a role in toxin removal. HDL cholesterol levels are also found to be low in major depression patients and even lower in people who think about suicide. One study looked at HDL levels and mood and concluded that HDL cholesterol can be used as a marker for major depression and suicidal behavior.
While conventional doctors consider low HDL to be under 40, I recommend that anyone with HDL levels under 60 work to increase them. This can be done with natural medicine treatments such as stopping smoking, exercising, and taking fish oil. Moderate alcohol consumption (one to two drinks per day) can also help increase HDL cholesterol levels. Foods that can help include oranges, dark chocolate, extra virgin olive oil, hibiscus, and black tea. The fiber supplement beta-glucan can also raise good cholesterol levels. I have a number of healthy patients with HDL levels way above 100—as of this writing, I know no reason to be concerned about high HDL levels. It seems the higher, the better.
Homocysteine is an independent risk factor for cardiovascular disease and a well-known marker of inflammation. Some medical professionals believe it to be a more accurate marker of inflammation than even cholesterol. The plasma level of this amino acid usually increases with age. In a large study of 3,752 men age seventy and older, an increase in homocysteine was associated with a significantly increased risk of depression. This evidence suggests that lower levels of homocysteine may decrease the incidence of depression in the elderly.
It has been found that homocysteinemia (high homocysteine in the blood) causes a decrease in S-adenosyl-L-methionine (SAMe—a compound that has been shown to help depression—more about SAMe in
chapter 5
). This decrease in SAMe impairs your body's ability to make neurotransmitters for the brain and negatively affects the fats and nerves of your brain. There's a strong correlation between high homocysteine and vessel damage leading to atherosclerosis, cardiovascular disease, and depressive disease. This may be why people who are depressed have high rates of cardiovascular disease, and vice versa.
The Homocysteine-Depression Connection
:
High Homocysteine → Low SAMe → Low Neurotransmitters,
Damaged Nerves and Vessels → Depression and
Cardiovascular Disease
There's controversy as to whether using natural therapies such as B vitamins, folic acid, and tri-methylglycine or betaine supplements is useful to lower homocysteine and ultimately protect against cardiovascular illness. However, it's clear to me that SAMe and folic acid help depression, so for anyone with high homocysteine, I typically recommend:
- SAMe: Start a dosage of 200 mg twice the first two days and then increase to 400 mg twice daily on day three, then to 400 mg three times daily on day ten, and finally to the full dose of 400 mg four times daily.
- B-complex vitamin with folate: Take B vitamin that includes 800 mcg of folate (L-5-methyltetrahydrofolate form) per day. If you are taking medications that are not effective, you may increase the folate level to 10 mg per day.
- Betaine (also called trimethylglycine): Take 3,600 mg every day.
CLINICAL CASE: MEL AND RESOLUTION, PASSION, AND HOMOCYSTEINE
A fifty-one-year-old engineer named Mel came into my office to work on a case of intractable depression. It seems about twelve years before, Mel had experienced his first bout with depression after starting a new job at an engineering firm. His work at the firm started becoming erratic—even the simple tasks of finishing paperwork became too difficult for him. As Mel described it, he tried to “hide underground” and get away from it all. At the time, he realized he was not happy with his life's work and was questioning his family life too.
Mel was prescribed Prozac, which helped his symptoms within a few weeks. He also started psychotherapy, which focused on tools to help Mel get back into the swing of work. Mel continued on the Prozac until about two months prior to our first visit, when he attempted, seemingly out of the blue to take his life. Fortunately, the attempt was unsuccessful, but the fact that his depression had returned with a vengeance was undeniable. Now his doctor had prescribed him imipramine, a medication used for severe depression.
At our first visit, I asked Mel what exactly had happened during the first bout with depression. At first he couldn't remember what it was about, for, he said, “It was so long ago, and I have not even thought of it.” After I pried a bit, he remembered thinking he was saddened by a job he had “no passion for, and could not think of going there every day”—the very same feelings that prompted the recent suicide attempt.
I explained to Mel that these feelings, and this concern for the importance of his work, needed to be explored. His body had been holding on to that feeling for years, and now the pot had boiled over. This knowledge was good in a way—now Mel had an opportunity to realize his concerns and make a positive change toward enjoying his daily life. Mel didn't know what he would enjoy, so I told him he didn't need every answer right then—he just needed to start the process. When I asked what he used to enjoy, he mentioned watching his favorite baseball team and cooking chocolate chip pancakes for the kids. I helped him make a plan to schedule a baseball game and to cook breakfast one day each weekend.
I also placed Mel on a regimen of fish oils, a multiple vitamin, and acupuncture designed to help support his liver and spleen. During his initial acupuncture treatment, I burned sage and explained Native American rituals with sage (see
chapter 5
for more on sage).
When Mel came back for his second visit, I noticed a faint smile and a sense of being present, something that had been missing in the first visit. Although still depressed and unable to face his work, he told me that he had thought about the need for change, and although he knew it would be hard, it was the first time he'd felt hope in a long time.
During the third visit, he complained about experiencing more anxiety and a “stuck” feeling in his stomach area, but he also reported that he'd cracked a joke with some friends and laughed heartily—something he had not been able to do in a while. At that visit, we also reviewed his completed lab tests, which included high homocysteine, low total testosterone, low normal serum carnitine, and surprisingly high vitamin D. As of this writing, I am planning on placing Mel on supplements to lower homocysteine (B
6
, B
12
, trimethyl-glycine, and folate) as well as 200 mg of SAMe twice a day. He will be visiting an endocrinologist for a second opinion about the testosterone level, and we will consider a testosterone transdermal patch.
I believe Mel's condition is multifaceted around his dislike for his work and his sense of being trapped at an unfulfilling job. I also see the high homocysteine, along with the low carnitine and testosterone, as a sign that his body has been primed for strong depression, and as we work to balance those physiologic factors, he should be much more resilient to depression.
Similar to homocysteine, C-reactive protein (CRP) is a blood test that records the level of a protein that is increased in your blood when the immune system is fighting a war, a war that beats up your arteries and your nervous system and causes depression and cardiovascular disease.
When your CRP is high, it means the war is raging and your mood is losing. High CRP levels have been shown to be quite related to depression in both men and women.
- Exercise: Start with walking for thirty minutes three times a week and increase.
- Reduce intake of highly cooked food: Chemicals called advanced glycation end products (with the appropriate acronym, AGES) from foods that are cooked at high temperatures increase CRP levels. Eating more raw and minimally cooked foods (boiled or poached) helps.
- Take fiber and psyllium seed husk: The first place to put out the inflammatory fire is in your digestive tract, for about 80 percent of your immune system resides there. Like using an extinguisher's foamy contents to douse a fire, regular intake of quality fiber calms the inflammation in your gut and allows the residual contents to be whisked away. I recommend 25 g of total fiber for the day. You can get about 5 g by mixing a teaspoon of psyllium seed husk in eight ounces of water. Do this twice a day, in the morning and evening. Consume the rest of your daily fiber by eating quality fruits, vegetables, and flax meal throughout the day.
- Take fish oil: One teaspoon per day balances inflammation in the body.
- Take vitamin C: Swallow 500 mg three times a day to reduce elevated CRP.
- Take vitamin E: Aim for 1,200 IU every day.