Andrew is a 26 year old ex-army sergeant, suffering from depression for last 8 years. His GP prescribed Prozac, which helped initially but he feels that his symptoms are getting worse, especially when he is under lots of stress, which is most of the time. His mother and sister also suffer from depression and are both on medications.
Andrew does not lead a very healthy lifestyle; he smokes 40 cigarettes a day, drinks excessive alcohol and coffee, his diet is high in refined and processed foods and he eats hardly any vegetables, fruits or whole-grains and does not eat any oily fish.
Andrew tends to skip breakfast but snacks on crisps to keep him going, although he still experiences symptoms of blood glucose imbalance, including irritability when hungry.
His Health Programme Questionnaire indicates that he may have several nutrient deficiencies (discussed below) and quite a significant toxic profile, partly as the result of his occupation, working in the building sites and partly due to his 7 mercury fillings which may be leaking. Any fruit and vegetables that he does eat, he does not wash before eating and he drinks tap water.
Andrew also shows symptoms of underactive thyroid, which could in turn affect his depression. He was referred to his GP for an investigation.
An individual’s experience of depression is unique and symptoms experienced can vary greatly from person to person and can include disturbed sleep patterns, fatigue, difficulty concentrating, mood disturbances and possible loss of appetite (Puri & Lynam 2010: 330-1). Hypothyroidism can often bring about many of the symptoms of depression and it must be ruled out before a confident diagnosis of depression can be made (Puri & Lynam 2010: 331).
Depressed individuals often have a family history of the condition (as in your case), indicating a possible genetic predisposition to depression (Barden 2004), however, other factors including stress, possible nutritional deficiencies and inflammation may all contribute to the development of depressive illness.
Main Contributing Factors to Your Depression:-
1. High Stress possible (+ possibly high cortisol) as a result of chronic psychological stress, stressors (alcohol, caffeine, nicotine) & blood-sugar imbalance
Stress may be a trigger for your depression and many people develop depression following stressful life events (Barden 2004). The stress hormone, cortisol, which is released from the adrenal glands in response to stress, is found at elevated levels in depressed individuals (Rot et al 2009). Elevated cortisol levels are believed to reduce levels of the neurotransmitter serotonin by encouraging breakdown of the amino acid l-tryptophan that is essential for serotonin production (Cowen 2002). Serotonin can influence mood, emotions and sleep patterns and lower levels of this neurotransmitter have been found in depressed individuals (Jonnakuty & Gragnoli 2008) (your medication, Prozac, is designed to raise serotonin levels). Therefore stress may be promoting your symptoms of depression, moodiness, and poor sleep patterns by elevating cortisol levels and subsequently inhibiting serotonin production, rendering your medication less effective.
In addition to psychological stress, such as work-related stress or the stress that can elevate cortisol levels, the adrenal glands also release cortisol in response to a number of stimulants: alcohol (Badrick et al 2008), caffeine in coffee (Lovallo et al 2005) and the nicotine present in cigarettes (Xue et al 2010). You consume a cocktail of these stimulants on a daily basis including 40 cigarettes, alcohol in 8 pints of beer and caffeine in 4 cups of coffee, potentially resulting in a constant release of cortisol from the adrenal glands. In combination with psychological stress these stimulants can further contribute to elevated cortisol levels and lowered serotonin levels and depression.
A diet that is high in refined carbohydrates, such as white bread, and sugar in biscuits and cakes, combined with skipping breakfast can result in blood sugar levels that rise abruptly and then fall sharply, resulting in low blood-sugar levels (hypoglycaemia). Blood-sugar fluctuations are partly controlled by cortisol and when blood-sugar levels fall too low cortisol is released to ensure that they return to normal (Hoffman 2007). Therefore a diet that induces blood-sugar fluctuations every day can increase cortisol levels and could potentially play a role in onset of depression.
Recommendations: find ways to reduce stress such as meditation, yoga or taking up a new hobby. Reduce intake of stimulants coffee, alcohol and cigarettes. Aim to balance blood-sugar levels by replacing refined carbohydrates with whole-grains such as brown bread and brown rice, and always eat breakfast.
2. Inflammation as a result of saturated fat , arachidonic acid, trans & oxidized fats, trans fats, low omega-3 , smoking, high sugar and refined carbohydrates & low fruit and vegetables
Individuals with depression have been found to have elevated levels of pro-inflammatory messengers in the body, called cytokines (Schiepers et al 2005). These cytokines are believed to play a significant role in depression because they can induce breakdown of the amino acid tryptophan, which is essential for serotonin production (Schiepers et al 2005). Therefore these inflammatory messengers may inhibit production of the neurotransmitter serotonin and interfere with its role in regulating mood and emotions (Jonnakuty & Gragnoli 2008), potentially resulting in irritability, moodiness and depression.
The type of fats present in our diets can significantly influence the levels of pro-inflammatory cytokines in our body. Trans fats, present in crisps and processed food, saturated fat, from dairy products and red meat, and oxidized fats from deep-fried take-aways all increase the levels of pro-inflammatory cytokines present in the body (Basu et al 2006; Galli & Calder 2009), promoting inflammation. Red meat, such as pork, not only contains saturated fat it also contains a fat called arachidonic acid, which the body converts into chemical messengers called eicosanoids that can promote inflammation and pro-inflammatory cytokine release in the body (Grant 2000). Conversely the omega-3 fats that are present in oily fish and nuts and seeds can actually decrease the formation of these inflammatory substances and also produce substances called resolvins that are known to reduce the activity of pro-inflammatory cytokines (Calder 2010). A diet that contains a high content of red meat, and trans and oxidized fats, especially with no omega-3 intake to balance, will result in an increase in levels of pro-inflammatory cytokines in the body and could potentially reduce serotonin levels and contribute to depression.
Smoking is also known to stimulate production of inflammatory cytokines, and smokers have been found to have elevated levels of the pro-inflammatory cytokines Interleukin-6 and Tumour Necrosis Factor-α (Yanbaeva et al 2007). Smoking, through the production of pro-inflammatory cytokines may also contribute to reduced serotonin levels and depression. In fact smokers are 3 times more likely to experience depressive symptoms than non-smokers (Epstein et al 2009).
A diet that is high in refined carbohydrates, such as white bread, and sugar can lead to elevations in blood glucose levels and elevated blood glucose levels can stimulate the production of pro-inflammatory messengers (cytokines) (Dandona et al 2007). Therefore a diet high in refined carbohydrate and sugar may therefore contribute to elevated pro-inflammatory cytokine levels which are believed to play a role in depression.
A diet high in fruit and vegetables can help to control inflammation because plant chemicals, called flavonoids, that are present in all fruit and vegetables are capable of modulating inflammation by preventing production of pro-inflammatory cytokines (Pizzorno et al 2008: 417), and therefore may offer protection against the activity of pro-inflammatory cytokines that could potentially contribute to your depression. By consuming hardly any fruit and vegetables you are missing out on this protection.
Recommendations: reduce intake of red meat, trans fats, saturated fat and oxidized fats. Reduce intake of refined carbohydrates and sugars and increase fruit and vegetable intake to at least 5 portions daily. Try to stop smoking, or at least cut down.
3. Possible nutrient deficiencies as a result of lack of vitamin C (low fruit & vegetables, highly stressed stress, high sugar & smoking) , lack of vitamin B6 (alcohol, coffee & zinc deficiency), lack of vitamin D, lack of Zinc & EFAs deficiency
Your Health Programme Questionnaire indicates that you maybe deficient in a number of nutrients. Deficiencies of each of these nutrients could independently play a role in your depression.
Bleeding gums are a sign of vitamin C deficiency and a low intake of fruit and vegetables combined with stress (Miller et al 2008: 562) and smoking (Yanbaeva et al 2007) can all contribute to a deficiency. Vitamin C plays a crucial role in the production of the neurotransmitters serotonin (Stone & Townsley 1973), dopamine (Bland & Jones 2005:641) and noradrenaline (Grabowska et al 2004). Reduced levels and activity of these neurotransmitters is believed to play a fundamental role in depression (Waller et al 2005: 291); serotonin helps control mood, emotions and sleep patterns, noradrenaline also regulates mood and dreaming (Leger et al 2009), while dopamine plays a role in emotional responses, pleasure and concentration. Therefore reduced production of these neurotransmitters as a result of vitamin C deficiency could be contributing to your feeling of depression, moodiness, irritability, poor sleep patterns, poor dream recall and reduced concentration.
A high alcohol intake and smoking can contribute to a reduced vitamin B6 status (Lord & Redmond 2008: 30) and symptoms of poor dream recall, mood swings and depression are all linked with vitamin B6 deficiency. Vitamin B6 is essential for the production of serotonin and dopamine (Stiponuk & Watford 2000), neurotransmitters that help control of mood and emotions (Leger et al 2009). Vitamin B6 is also important for the conversion of a substance called homocysteine to cysteine and deficiency can result in elevated homocysteine levels (Lord & Redmond 2008: 30). Some depressed individuals have elevated homocysteine levels and it is believed that homocysteine may play a role in depression as it can damage brain cells and result in reduced neurotransmitter activity (Bottiglieri 2005). Therefore a deficiency of vitamin B6 may play a role in depression by reducing synthesis of neurotransmitters and by potentially allowing homocysteine levels to rise and damage neurons.
White marks on fingernails and stretch marks indicate that you may have a zinc deficiency and a high coffee intake will block absorption of zinc from your diet (Higden & Frei 2006). Low zinc status has been linked to depression and not only does it play a role in converting vitamin B6 to its active form (Ebadi et al 1984), making it essential for the activity of B6 in the synthesis of serotonin and dopamine, it is also believed to improve the signaling of serotonin in the brain and to support health of the part of brain cells necessary for neurotransmitter transmission (synapses) (Szewczyk et al 2008). Therefore, zinc can support healthy formation and transmission of neurotransmitters in the brain and therefore may support mood and prevent depression.
Excessive thirst is a sign of essential fatty acid (EFA) deficiency and an absence of oily fish or nuts and seeds from your diet means you have very little dietary intake of these essential fats. The brain is composed predominantly of fat and essential fatty acids in the brain can support healthy brain cell activity, including neurotransmitter transmission and a deficiency of omega-3 fatty acids (from oily fish, flax seeds and walnuts) has been shown to inhibit this process (Lord & Bralley 2008: 274). Therefore a deficiency of EFAs can result in reduced activity of the neurotransmitters serotonin, dopamine and noradrenaline, deficiency of which is believed to lead to depressive symptoms (Waller et al 2005: 291).
Vitamin D deficiency is strongly associated with depression and although the role that vitamin D plays in depression is still not fully understood there is some evidence that it may have a role in production of the neurotransmitters serotonin (Hoogendijk et al 2008) and noradrenaline (Bertone-Johnson 2009), neurotransmitters that help modulate mood and emotions. Vitamin D deficiency could potentially result in reduced serotonin and noradrenaline levels and depression. You have very little intake of dietary sources of vitamin D, such as eggs and oily fish, and living in the UK we do not have sufficient sunlight to produce vitamin D in the skin for at least 5 months of the year during autumn and winter (MacDonald et al 2008) making most of us susceptible to deficiency during those months.
Recommendations: increase consumption of vitamin C, vitamin B6, zinc and EFA-rich foods and request vitamin D test from GP to determine whether supplementation is necessary. Reduce consumption of coffee, cigarettes, and alcohol.
4. Possible exposure to heavy metals & compromised detoxification as a result of exposure to Mercury fillings, occupational exposure, non-organic fruit and vegetables, cigarette smoke & tap water and factors that inhibit removal (Zinc deficiency, possible vitamin C deficiency, high alcohol intake & medication).
The heavy metals mercury, alumimium and lead are all capable of crossing the barrier that protects the brain (the blood brain barrier) and interfering with healthy brain function (Verstraeten et al 2008; Ibrahim et al 2006; Fitzgerald et al 2008: 130). Elevated levels of mercury and aluminium are capable of interfering with healthy transmission of neurotransmitters (Ibrahim et al 2006; Verstraeten et al 2008) those chemical signals in the brain that control mood, memory and concentration and also directly damage the neurons (Patrick 2002; Fitzgerald et al 2008: 124). Lead can also directly damage neurons, cells in the brain and elevated levels are linked with mood and concentration disorders (Fitzgerald et al 2008: 130). Therefore exposure to a combination of these heavy metals may be interfering with healthy brain function and could be a factor in your depression. Factors that may have contributed to your exposure to these various heavy metals include:
Mercury: your mercury fillings are continuously releasing around 3-17 µg of mercury per day (Houston 2006: S125) and potential occupational exposure in solvent-thinned paints and wood preservatives (Fitzgerald et al 2008:123).
Lead: a packet of 20 cigarettes will expose you to 0.97-2.64 µg of inhaled lead (Ashraf 2012), potential occupational exposure to lead in lead-based paints, and from pesticides on unwashed non-organic fruit and vegetables (Fitzgerald et al 2008:123).
Aluminium: 5 glasses of tap water daily (aluminium is used in the treatment and processing of tap water (Flaten 2001), canned foods, processed cheese and exhaust fumes in urban areas (Fitzgerald et al 2008:123).
In addition to your exposure to these various sources of aluminium, lead and mercury, there are a number of diet and lifestyle factors that may be interfering with your ability to detoxify and remove these substances from your body.
Your medication Prozac, also known as Fluoxetine, can impair the detoxification ability of the liver (Liska et al 2005: 284) as can your high level of alcohol intake, because the metabolism of alcohol in the liver can interfere with the liver’s detoxification ability (Lyon et al 2005: 567). The white marks on your fingernails, stretch marks on your skin and bleeding gums indicate that you may be deficient in the mineral zinc and vitamin C. Both zinc and vitamin C are necessary for the production and activity of a substance called glutathione which plays is essential for safe elimination of heavy metals from the body (Lord & Bralley 208:503; Kojima-Yuasa et al 2003). Therefore a combination of increased exposure to heavy metals and a reduced ability to remove them from the body could be contributing to an increased level of these heavy metals in your body and potential interference with healthy neurotransmission, potentially resulting in depression.
Recommendations: aim to reduce sources of exposure to heavy metals by avoiding tap water, wear gloves and mask at work when necessary and reducing intake of non-organic, processed and timed foods. The Nutrient and Toxic Element analysis will reveal extent of exposure and indicate whether a detoxification regime is necessary. Reduce alcohol intake, increase consumption of vitamin C- and zinc-rich foods.
5. Blood sugar imbalance as a result of diet high in refined carbohydrates, sugar and high Glycemic Load foods, high alcohol & nutrient deficiencies (Chromium, EFA & vitamin D)
Your experiences of fatigue, irritability, problems concentrating and cravings for coffee and cigarettes are all indicative that you may have problems controlling your blood-sugar (glucose) levels. The brain uses glucose as its main energy source and depends on a steady supply of glucose for healthy functioning including neurotransmitter regulation (Neumann et al 2008). If blood sugar levels drop too low (hypoglycaemia) the brain is deprived of the constant supply of glucose it needs for energy and hypoglycaemia can trigger symptoms of panic, irritability, confusion and moodiness, while recurrent hypoglycaemia can lead to depression (Perlmuter et al 2008).
A diet that is high in refined carbohydrates, such as white bread, sugar, biscuits and cakes and other high GL foods (foods that result in elevated blood sugar levels), such as mashed potato and cornflakes, combined with skipping breakfast can contribute to blood sugar levels that fluctuate from high (hyperglycaemia) to low (hypoglycaemia). Hypoglycaemia can induce feelings of moodiness and irritability and therefore may contribute to, or worsen these symptoms. If such a diet is consumed every day and blood-sugar fluctuations are consistent it may contribute to your experience of depression (Perlmuter et al 2008).
A high alcohol intake, 8 pints of beer per day, will promote increased periods of low blood-sugar (hyoglycaemia) because when blood sugar levels drop alcohol can block the body’s ability to break down stored energy for conversion to glucose in order to bring blood-sugar levels back to normal (Hammerstadt et al 2011). Therefore a high alcohol intake, especially when combined with a diet high in refined carbohydrates and sugar may result in extended period of hypoglycaemia that can induce feelings of irritability and moodiness, which you experience and may contribute to your depression.
You appear to be deficient in a number of nutrients including chromium, Essential Fatty Acids (EFAs) and vitamin D, all of which can support healthy blood sugar balance. Craving stimulants, poor concentration and irritability all indicate that you may have a deficiency of chromium, and chromium plays a fundamental role in controlling blood-sugar levels by supporting action of the hormone insulin, which is responsible for ensuring that blood-sugar levels do not rise too high (Culp 2010:160). Excessive thirst indicates a possible EFA deficiency, EFAs support stable blood-sugar levels as they enhance the ability of insulin to clear glucose out of the bloodstream preventing periods of hyperglycaemia and subsequent hypoglycaemia (Culp 2010:155). Tooth decay can sometimes indicate a vitamin D deficiency and vitamin D also plays a role in healthy blood-sugar balance in that it can promote responsiveness to insulin and therefore support better management of blood-sugar levels (Combs 2008:165). A combination of these nutrient deficiencies may contribute to imbalances in blood-sugar levels that can result in episodes of hypoglycaemia that could be causing or at least exacerbating, your feelings of irritability, moodiness, poor concentration and depression.
Recommendations: reduce consumption of refined carbohydrates, sugar and high GL foods. Reduce alcohol intake and increase consumption of chromium and EFA-rich foods and request testing of vitamin D status from GP. A Nutrient and Toxic Element Analysis will indicate whether chromium deficiency exists.
6. Possible hypothyroidism as a result of chronic stress + Zinc deficiency + EFA deficiency + possible toxic exposure (tap water, mercury fillings, pesticides on fruit and vegetables)
There is a definite link between hypothyroidism and symptoms of depression and hypothyroidism can present with symptoms very similar to depression, hypothyroidism can affect brain function inducing symptoms of depression and difficulty concentrating (Pizzorno 2008: 380). There is some evidence that the active thyroid hormone (known as T3) plays a role in both the synthesis of serotonin in the brain and also in the activity of noradrenalin (Kirkegaard & Faber 1998) In fact before a diagnosis of depression can be made the possibility that the symptoms are a result of hypothyroidism must be ruled out (Puri & Lynam 2010: 331).
Your symptoms of depression, difficulty concentrating and diminished libido are consistent with possible hypothyroidism and a number of factors may be contributing to this:
Stress triggers your depressive symptoms and can also interfere with healthy functioning of the thyroid gland in a number of ways: elevated levels of the stress hormone cortisol can displace thyroid hormone from its carrier (Bland & Jones 2005: 644), preventing it from travelling around the body. In addition cortisol can prevent the thyroid hormone produced by the thyroid gland (known as T4) being converted to its active form (T3) (Hage & Azar 2012) and therefore will further reduce thyroid hormone activity in the body. Therefore, in its ability to alter thyroid hormone activity stress can induce depression.
The white marks on your fingernails and stretch marks on your skin indicate that you may have a zinc deficiency: zinc is necessary for production of the enzyme (5’deiodinase) that is necessary for the conversion of thyroid hormone to its active form (T4 to T3) (Nodder 2010:202) and therefore deficiency will result in reduced thyroid hormone activity in the body ad may therefore contribute to difficulty concentrating, diminished libido and depression
You may also have insufficient body stores of essential fatty acids (EFAs), indicated by symptoms of excessive thirst, these fats dictate the structure and permeability of the cell membranes throughout the body and thyroid hormones must bind to receptors on these membranes before they can become active and have an effect on the body’s cells (Bland & Jones 2005: 596). Therefore a deficiency of EFAs may result in cell membranes which are less responsive to circulating thyroid hormones and produce symptoms of hypothyroidism even when thyroid hormone levels are sufficient. Therefore an EFA deficiency can result in symptoms of hypothyroidism, including depression.
Exposure to toxins, such as the mercury in mercury fillings, pesticide traces on unwashed non-organic fruit and vegetables and fluoride in tap water can disturb healthy functioning of the thyroid gland. Toxins can accumulate in the kidneys and liver, the organs of elimination, however conversion of T4 to T3 occurs in the liver and kidneys (up to 30% in the kidneys (Malik & Hodgson 2002) and healthy kidney and liver function is fundamental to successful T4 to T3 conversion (Nodder 2010: 175), therefore exposure to toxins can impact upon this conversion process (Kelly 2000). Mercury can directly interfere with thyroid function; the inorganic mercury found in fillings can actually inhibit the production of thyroid hormone in the thyroid gland (Saldin et al 2008), whereas, fluoride from tap water can directly inhibit the formation of thyroid hormone by blocking the use of iodine (a necessary component of all thyroid hormones) by the thyroid gland (Bland & Jones 2005: 647). Pesticides traces present on unwashed non-organic fruit and vegetables are known to compete with thyroid hormones for the proteins that transport them in the bloodstream by mimicking the shape of these hormones, thereby preventing the thyroid hormones from travelling around the body (Bland & Jones 2005: 602). Exposure to toxins can potentially result in hypothyroidism in various ways and therefore may contribute to symptoms of depression.
Recommendations: consult with your GP and request a Thyroid function test and also conduct the Broda Barnes Thyroid test at home. The Nutrient and Toxic Element analysis will indicate level of exposure to toxic heavy metals and zinc status. Increase intake of EFA and zinc-rich foods. Replace tap water with filtered or mineral water and choose organic fruit and vegetables whenever possible.
About Your Supplement Programme
1. Multivitamin & mineral
Contains chromium to support blood-sugar balance (Culp 2010: 160), vitamin B6 and zinc to support neurotransmitter synthesis and depressive symptoms (Ebadi et al 1984; Stiponuk & Watford 2000) and plant-derived flavonoids that can control production of inflammatory mediators (Pizzorno et al 2008: 417) that may play a role in depression (Park et al 2008).
2. Omega-3 Fish Oil (60% EPA)
Omega-3 fish oils can produce substances called resolvins that reduce the activity of pro-inflammatory cytokines (Calder 2010), which are implicated in the development of depression (Schiepers et al 2005). Research indicates that omega-3 supplements containing at least 60% EPA are most effective in the treatment of depression (Sublette et al 2011).
|References available on request!|