A: An estimated 5 to 7 percent of U.S. adults experience SAD, though the actual numbers may be higher. Using a light therapy box is often a first-line treatment, but there are many other things you can do to ease symptoms and boost your mood. As much as possible, try to let natural light into your home. If the weather permits, get outside for a dose of sunshine, especially in the morning. Sticking to a consis­tent sleep-wake schedule may help, too. Other­wise, try to focus on healthy lifestyle habits like regular exercise, moderate or no alcohol con­sumption, and a balanced diet. Social interac­tion should be another priority, as it can be easy to become isolated at home during the cold winter months. Isolation may exacerbate SAD symptoms, so make an extra effort to connect with family and friends during this time.

The post Treating Seasonal Affective Disorder appeared first on University Health News.

What’s Making You SAD?

It’s not entirely clear what causes SAD, but disruption to the body’s circadian system—essentially the body’s “master clock” when it comes to controlling biological processes—may play a role. The clock is located in a small region of the brain called the suprachiasmatic nuclei (SCN). “The SCN receives light from the retina, which is at the back of the eye, and signals the pineal gland to release a brain chemical called melatonin,” Dr. Figueiro explains. “Melatonin is released at night and under conditions of darkness. It tells the body it is nighttime and prepares the body to fall asleep. In the winter, the days become shorter and darkness sets in earlier, resulting in an increase in melatonin levels that disrupts a person’s usual day/night cycle. This may result in a noticeable change in mood, a greater need for sleep, and food cravings as we essentially go into hibernation.”

Research also suggests that people with SAD may have lower levels of serotonin, another chemical that helps to regulate mood. This may be worsened if you are deficient in vitamin D, since serotonin production depends on adequate vitamin D levels.

Location a Factor

Women are at greater risk of SAD, possibly because their SCN is more sensitive to changes in the number of daylight hours. You’re also more likely to develop SAD if you live above the 35th parallel, which cuts approximately midway across the contiguous United States from west to east. Dr. Figueiro notes that vitamin D is synthesized in the skin with exposure to the sun’s ultraviolet-B (UVB) rays. “However, in states that lie above the 35th parallel, the angle of the sun in winter significantly affects the availability of UVB,” she adds. “People who live in these states are at greater risk for low vitamin D, which increases their risk for SAD.”

Let There Be Light

If you suffer from SAD, getting as much bright daytime light as you can may help boost your mood. “Exposure to morning light especially may help resync your body clock, so if you are able, get outside in the morning and take a walk or sit on the porch,” Dr. Figueiro recommends. “Indoors, position your favorite seat near a window if possible, and turn on the lights.”

As director of Mount Sinai’s Light and Health Research Center, Dr. Figueiro has been involved in a number of studies investigating the benefits of light therapy for mood and cognition. She notes that light therapy is a recognized treatment for SAD, so you may want to consider using a therapeutic lightbox. These devices emit a much brighter glow than standard light bulbs, and the light is believed to cause chemical changes in the brain that lift one’s mood. If you have been diagnosed with SAD, your doctor may prescribe a lightbox (you may be reimbursed by your insurance company if you have a Medicare Advantage plan). You also can purchase a lightbox online or at pharmacies. Experts recommend choosing one that emits 1,000–10,000 lux (the units for light intensity).

Generally, a light box is used for 30 to 45 minutes each morning soon after you wake, but if you can’t commit to that kind of routine, a light visor may be the solution. These resemble baseball caps or visors and are comfortable to wear.

Another kind of light therapy is called a dawn simulator, and is activated by a timer. It is set up in your bedroom to mimic a natural sunrise, turning on early in the morning and gradually increasing in brightness so that you awaken naturally, without using an alarm.

Stick to Your Schedule

It may be tempting to sleep later on dark winter mornings, but try to avoid this, since excessive sleeping is associated with SAD. “If you don’t have a dawn simulator, it may be helpful to use a timer that turns on your bedroom lights 15 minutes before you awaken,” says Dr. Figueiro. “This may help when it comes to getting up at your regular time on dark mornings. Once you rise, immediately open the curtains in your bedroom to benefit from what light there is.”

Seek Help if Your Mood Doesn’t Improve

If these measures don’t relieve your depression, and feelings of sadness become overwhelming, talk to your doctor. Several antidepressants, including selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac®) and sertraline (Zoloft®) have been shown to be effective in SAD. SSRIs work by increasing levels of serotonin in the brain. Another type of antidepressant, bupropion (Wellbutrin®) also may help by increasing levels of another moodrelated brain chemical, dopamine. Your doctor also may suggest cognitive behavioral therapy (CBT), a type of “talk therapy” that may help you replace negative thoughts with positive ones. “Part of the approach to managing SAD with CBT includes behavioral activation, in which you are encouraged to engage in enjoyable outdoor activities that can help you combat the lethargy and lack of interest in activity that can accompany SAD,” Dr. Figueiro says.

The post Battle Winter Depression by Seeing the Light appeared first on University Health News.

Symptoms and Causes. SAD is an all-too-appropriate acronym for this subtype of major depressive disorder. Symptoms can include oversleeping, overeating, and social withdrawal, along with low mood, low energy, and trouble concentrating, and they last nearly five months on average, typically beginning in late fall or early winter and progressively worsening until they begin to fade in spring or summer. Even though SAD’s seasonality sets it apart from other types of depression, it is considered a major mental health disorder due to its duration, its annual recurrence, and the effect of its symptoms on daily quality of life.

Unfortunately, there’s no definitive explanation for what causes SAD. Some research suggests that people with SAD may have disrupted levels of serotonin, a brain chemical that regulates mood, and melatonin, a hormone that helps maintain the normal sleep-wake cycle. These disruptions would make it hard to adjust to seasonal changes in day length, explaining why SAD is more common and more severe in states where the sun rises the latest and sets the earliest in winter. While there’s evidence that nutrition can play a role in the treatment of mental health conditions, is this also true for SAD?

Food as Medicine? Conventional wisdom from the early days of SAD-awareness in the 1990s was that people with SAD should eat a high-carbohydrate diet to increase levels of serotonin. However, a 2020 systematic review found that while people with SAD experience stronger cravings for carbohydrate-rich foods, randomized controlled trials have found that actually eating more carbs doesn’t ease symptoms. What about vitamin D, the “sunshine vitamin”? While low vitamin D levels have been associated with increased risk of depression, this review cites a study that found that people randomly assigned to take a high dose of vitamin D for 12 weeks during the winter experienced no significant differences in depressive symptoms compared with participants assigned to take a placebo. A study looking at the effects of supplemental vitamin B12 also failed to find that it helped with SAD symptoms.

“While there absolutely is research showing correlations with nutrients and mental health, there are many limitations to this research, and people can often find themselves relying on expensive supplements without addressing the root cause,” says Anafer Barrera, a Colorado-based registered dietitian and Certified Intuitive Eating Counselor with experience in mental health. “When symptoms persist due to a lack of effect from the nutrient, people can often end up feeling worse, like there must be something really wrong with them if X supplement didn’t cure their blues.”

Gentle Nutrition. Barrera says the priority for someone with SAD should be to make sure they’re eating enough. “When anxiety and depression rise, food can become intolerable or just a hassle. The best thing to do is to find out how you can navigate these barriers to make sure you’re getting enough calories, protein, carbs, fat, and fiber to fuel your brain and body on a physical level.”

She recommends that people struggling with SAD meet themselves where they’re at in terms of how much time and energy they have to focus on nutrition. “Ideally, we’re getting a good variety of food, with a healthy dose of it made at home from fresh ingredients,” she says, with an important caveat: “Sometimes you desperately need convenience foods, simple recipes like cereal and milk, fruit and yogurt, quesadillas and avocado, or the classic boxed pasta and jarred pasta sauce to get your needs met and tackle the more important things in life.”

Disordered Eating and SAD. Barrera says while food can provide a sense of control, responsibility, and thus empowerment in our lives, which can be good for mental health—that sense of control can also be a major factor in the development of an eating disorder.

That 2020 review found that people with SAD are more likely than people without SAD to eat just because food is there—even if they aren’t hungry or are already full—including eating significantly larger dinners and snacking more in the evening. More alarmingly, people with SAD are at increased risk of engaging in emotional eating, binge eating, and other disordered eating behaviors, including those related to bulimia nervosa.

Bottom Line. Because there’s a shortage of high-quality research on the role of nutrition in managing SAD symptoms—in part because of lack of clarity on SAD’s underlying causes—don’t treat nutrition as an alternative to seeking mental health support. “Regardless of the cause, nutrition will likely only be a fraction of the solution,” Barrera says.

According to the National Institute of Mental Health, while psychotherapy and antidepressant medications are two treatment options, for those seeking a lifestyle-based approach, another primary treatment for SAD is light therapy—sitting in front of a special bright light box for 30-45 minutes a day—to try to make up for some of the sunlight missing in winter.

The post Can Seasonal Affective Disorder be Managed with Food? appeared first on University Health News.

A: Seasonal affective disorder (SAD) is a type of depression that usually starts in late fall and lasts through the winter. It tends to bring on feelings of sadness and lethargy. People who experience SAD often say they don’t feel like themselves and have trouble handling their daily activities. The consensus is that shorter days and reduced sunlight exposure in winter affects levels of the mood hormone serotonin, leading to depressive symptoms. People who experience SAD may also produce too much melatonin, a hormone that plays an important role in the sleep-wake cycle. Disruption in the hormones involved in the circadian rhythms that control sleep and other functions may be at the root of SAD symptoms.

As to your question, yes, “summer SAD” may also be a condition related to changes in sleep and mood hormones. While seasonal affective disorder in the summer months is less studied and not as well understood, some researchers suggest that the longer, sunnier days of summer may cause the body to produce such low levels of melatonin that insomnia or other sleep problems result. Insufficient sleep may cause depressive symptoms similar to those experienced by people who suffer from winter SAD.

The post Ask the Doctor: Summer Seasonal Affective Disorder appeared first on University Health News.

A: Yes, symptoms that seem to develop gradually may indicate a different type of dementia from the one that presents with more sudden-onset symptoms. But understand that there is no entirely reliable timetable for everyone who develops dementia.

Symptoms of Alzheimer’s disease, for example, tend to develop gradually and progress more slowly than other types of dementia. However, progression is sometimes faster in early-onset Alzheimer’s compared with the disease in older adults.

Vascular dementia, on the other hand, can often develop suddenly. Early symptoms can sometimes be difficult to detect, as they can include struggles with planning and concentration and subtle changes in mood or behavior. Memory loss, which is among the first signs of Alzheimer’s disease, is among the later symptoms of vascular dementia.

Whether cognitive changes occur slowly or quickly, they should not be ignored or written off as normal aging or as a mood disorder such as depression. If you are aware of changes in your thinking skills or those around you express their concerns, get a medical evaluation.

Q: When a stroke makes it difficult to walk, speak, or engage in other basic functions, is it possible to predict whether or how much of those skills might return?

A: Researchers continue to develop physical tests and computer models designed to do just what you’re asking—better predict the recovery of certain functions affected by stroke. And while we are learning more about what is reasonable or realistic to expect in stroke recovery, there are no guarantees because every person’s stroke experience is unique.

What we do know is that the first one to three months after a stroke continue to be the most important in terms of recovery. Most improvements usually occur during this time period, though with effort and patience, many stroke survivors can continue to experience improvements years after the event. The key is committing to physical, occupational, and speech therapies (as appropriate), and understanding that setbacks and detours on the road to recovery are to be expected. The medical community’s ability to treat stroke and enhance recovery has come a long way in recent years, and there is every reason to believe that progress will continue.

Q: After being widowed several years ago, I noticed that I get very sad every winter. I assumed it was the holiday blues, but a friend suggested it might be seasonal affective disorder (SAD). I don’t remember feeling this way when I was younger. Can SAD develop later in life?

A: SAD is diagnosed more often in younger adults than older adults, but various circumstances can affect when a person first notices symptoms or experiences a worsening of symptoms. Older adults, especially those living alone and susceptible to isolation or loneliness, can have a particularly difficult time with SAD.

It’s not always easy to distinguish between the “holiday blues” and SAD, but there are some important distinctions. SAD is a form of clinical depression and tends to be accompanied by significant changes in sleeping patterns, difficulty managing situations, feeling angrier and more irritable than usual, low energy, and often a desire to be alone. It may start in the fall and last well into the new year. The holiday blues tend to be fairly situational and limited to the holiday season or holiday events. It’s a psychological condition that brings on feelings of sadness, but after the holidays those feelings tend to ease up.

You may find it helpful to talk with your health­care provider and consider counseling and/
or medications, particularly if you notice that this time of year leads to negative, potentially harmful thinking or unhealthy behaviors. MMM

The post Ask the Doctor: January 2023 appeared first on University Health News.

SAD Symptoms, Causes, and Treatment. SAD is a biological and mood disorder that has a seasonal pattern, typically with symptoms beginning in late fall or  early winter and getting progressively worse until they begin to fade in spring or summer. Symptoms may include oversleeping, overeating, and social withdrawal, along with low mood, low energy, and trouble concentrating. SAD is a subtype of major depressive disorder, and even though SAD’s seasonality sets it apart because of its duration and recurrence— up to five percent of the U.S. population experiences SAD each year, with symptoms lasting for almost five months, on average—it is a major mental health disorder that affects daily quality of life.

Unfortunately, it’s not entirely clear what causes SAD. Some research suggests that people with SAD may have disrupted levels of serotonin, a brain chemical that regulates mood, and melatonin, a hormone that helps maintain the normal sleep-wake cycle. These disruptions would make it hard to adjust to seasonal changes in day length, explaining why SAD is more common and more severe in states where the sun rises the latest and sets the earliest in winter.  According to the National Institute of Mental Health, one of the primary treatments for SAD is light therapy—sitting in front of a special bright light box for 30-45 minutes a day to try to make up for some of the missing sunlight. Psychotherapy and antidepressant medications are the others. But what about nutrition?

The Role of Nutrition. It can be tempting to try a “food first” approach for managing physical or mental health concerns, including SAD, but San Diego-based registered dietitian Theresa Carmichael suggests we think twice. “Nutrition interventions do not replace psychological and clinical interventions that may be needed to address SAD,” she says, adding that while nutrition can be a valuable addition to treatment, setting up people for success as they work with a licensed mental health professional, it’s not a stand-alone option. “Using food as a ‘cure’ can be harmful and deter us from seeking adequate mental health support,” she says.

A 2020 systematic review published in Frontiers in Psychology found that while low vitamin D levels have been associated with increased risk of depression, one study that randomly assigned participants to take either a high dose of vitamin D or a placebo for 12 weeks during the winter found no significant differences between groups. A study of the effects of supplemental vitamin B12 had similar results. This review also reported that while people with SAD have stronger
cravings for carbohydrate-rich foods than usual, randomized controlled trials have found that eating more carbs does not help symptoms. This pokes a hole in conventional wisdom from the early days of SAD-awareness in the 1990s that SAD sufferers should eating a high-carbohydrate diet to increase levels of serotonin.

Carmichael said functional foods— foods that serve an additional function in the body beyond meeting energy needs—can be incorporated for optimal brain metabolism and mood regulation. Examples include eggs, fortified breakfast cereals, orange and yellow vegetables and fruits, rice, beans, and nuts. “Learning about these foods and then incorporating them in a way that feels best for you must be done intentionally and skillfully alongside a registered dietitian nutritionist who specializes in mental health treatment so that distorted and disordered thoughts don’t develop.”

Disordered Eating and SAD. That same 2020 systematic review found that people with SAD are more likely to eat in response to non-hunger or fullness cues (such as the sight, smell, and volume of food), eat significantly larger dinners, and do more evening snacking than people without SAD. More significantly, people with SAD are at increased risk of engaging in emotional eating, binge eating and other disordered eating behaviors, including those related to bulimia nervosa.

“In the treatment of SAD, we want to be sure to focus on food inclusion vs. food exclusion,” Carmichael says. “Incorporation of a variety of foods to meet physical and psychological dietary needs is necessary for recovery from many mental health disorders.” She said all foods can meet one or more of the body’s needs, so rather than focusing on which foods are “good” or “bad” for us—whether for physical or mental health—she recommends asking yourself, “What sounds good?”

Bottom Line. There’s a shortage of high-quality research on the role of nutrition in managing SAD symptoms. It’s not safe to assume that foods or nutrients that might help manage non-seasonal depression also help with SAD. Uncertainty about the precise underlying causes of SAD is one obstacle. The goal should be adequate symptom management, even if that means gently letting go of the idea of using food as medicine.

The post Can Nutrition Help Combat Seasonal Affective Disorder? appeared first on University Health News.

Q: Is the risk of Alzheimer’s higher if it runs in the family, like heart disease or cancer?

A: The role of genetics in Alzheimer’s disease (AD) is the subject of considerable research. Indeed, there is much about AD that is still a mystery. We do know, however, that you don’t need a family history of AD to develop the disease. And yet, we also know that if you have a parent or sibling with Alzheimer’s you are more likely to develop AD someday. Having more than one first-degree relative raises the risk even more. But it’s important to understand that AD risk is also associated with age, lifestyle and overall health. Having sustained a serious head injury, for example, may raise your risk of AD. Heart disease may also be a significant risk factor, as brain health is dependent on the healthy, uninterrupted circulation of oxygen-rich blood.

If you have a family history of AD, don’t assume it’s inevitable for you. Likewise, you should consider your family history as a red flag warning to maintain a healthy lifestyle that includes regular exercise, no smoking, and a heart-healthy diet. You should also do what you can to keep your brain occupied with challenging activities for as long as you can. And if you have questions about your genetic risk, talk with your doctor. Routine genetic testing for the APOE-e4 gene (a so-called “risk” gene associated with AD) isn’t generally recommended, though testing for the gene is often done as part of research studies.

Q: Is “working memory” the same as “short-term memory?”

A: The two terms are often used interchangeably, but they are not quite the same thing. Working memory is part of short-term memory, in that it allows the brain to retain information we will need later, but usually for a brief time while we’re doing something else. New information in working memory is usually temporary, though sometimes it’s encoded into long-term memory. A good example of working memory is getting directions from someone for how to get to a new location and keeping all the right-left-right instructions in mind while you drive. Learning someone’s name at a party and then recalling it later that evening is another example of working memory.

Q: Is there a summertime version of seasonal affective disorder?

A: Seasonal affective disorder (SAD) is a type of depression associated with a change of seasons, and for most people with SAD, this mood disorder occurs during the winter months. The causes of winter SAD are thought to be related to shorter days and less sunlight, which can affect your biological clock (circadian rhythms) and trigger depressive symptoms. Reduced sunlight may also affect your levels of serotonin, a chemical produced by nerve cells. It has many functions, including the regulation of mood.

But summer SAD is very much a real condition, though just not as common as the winter variety. It appears that SAD, whenever it occurs, is related to environmental factors, such as the shorter days and reduced sunlight of winter. In the summer, SAD may be triggered by heat and humidity. Research suggests that many people who experience SAD have higher sensory processing sensitivity, which makes them more vulnerable to environmental factors such as higher temperatures. Studies have also found that people who experience summer SAD symptoms find relief by spending the summer in the north, where it’s cooler. Summer SAD may also be caused by longer days and more sunshine.

If you notice a pattern of mood changes that occur regularly with a change of seasons, talk with your doctor or a therapist. There may be interventions as simple as avoiding the heat as much as possible and spending more time in a cooler, indoor environment.

The post Ask the Doctor: Risk of Alzheimers; Working Memory vs. Short-Term Memory; Summertime Seasonal Affective Disorder appeared first on University Health News.

The 25-hyroxyvitamin D blood test—often referred to as the 25(OH)D test—is the most accurate way to assess the amount of vitamin D in your body. It’s usually measured in nanograms per milliliter, or ng/mL. But again, what’s the right vitamin D level, according to research? This is where things get problematic.

Vitamin D Deficiency Symptoms

Vitamin D deficiency symptoms have been linked to numerous health problems, including heart disease, depression, and even cancer._[1] Here are 10 signs you’re not getting enough vitamin D:

1. Depression or anxiety
2. Bone softening (low bone density) or fractures
3. Fatigue and generalized weakness
4. Muscle cramps and weakness
5. Joint pain (most noticeable in the back and knees)
6. Blood sugar issues
7. Low immunity
8. Low calcium levels in the blood
9. Mood changes and irritability
10. Weight gain

Other symptoms of vitamin D deficiency include exhaustion and decreased endurance; impaired wound healing (click here); and spasms in the muscles of the hands and feet.

What Causes Vitamin D Deficiency Symptoms?

These are the most common causes of vitamin D deficiency symptoms:

1. Inadequate exposure to sunlight. Vitamin D is unlike any other vitamin because it is a “pro-hormone” produced in the skin with sunlight exposure. In particular, the sun is the main source of vitamin D3, a type of vitamin D that increases levels of “feel-good” chemicals in the brain called dopamine and serotonin. (Deficient levels of either of these neurochemicals can be an underlying cause of depression.) Therefore a lack of exposure to the sun or extended periods of time spent indoors can lead to vitamin D deficiency symptoms.
2. Getting a lack vitamin D from your food. Although the sun’s rays are the primary source of vitamin D, the nutrient can also be found in foods such as fish (salmon, tuna, mackerel and cod), oysters, shrimp, beef liver and eggs.
3. Age. As you age, your kidneys are less able to convert vitamin D to its active form, calcitriol, which can lead to a deficiency.
4. Digestive Issues. Problems in the digestive tract can cause inadequate absorption of vitamin D.
5. Obesity (Body Mass Index greater than 30). Vitamin D is extracted from the blood by fat cells. The more fat in the body, the less vitamin D is released into the circulation.
6. Kidney or liver disease. Kidney and liver diseases can impair vitamin D conversion to its active form.

Vitamin D Deficiency Symptoms: Why They Matter

Vitamin D deficiency symptoms in women and men, if left untreated, can lead to serious health problems, including:

• Osteopenia or osteoporosis
• Rickets in children
• Contracting the cold or the flu (weakened immune system)
• Asthma
• Tuberculosis
• Diabetes
• Periodontal disease
• Cardiovascular disease (high blood pressure and/or congestive heart failure)
• Major depressive disorder or seasonal affective disorder
• Multiple sclerosis
• Cancer

Vitamin D Level: Confusion Reigns

There is no universal agreement on what constitutes an ideal vitamin D level, and studies are contradictory. In 2007, Michael F. Holick, M.D., Ph.D. published an article in The New England Journal of Medicine stating that vitamin D levels ranging between 21 to 29 ng/mL were linked to an increased risk of various diseases, including cancer, diabetes, and depression, among others. Thus, he opined that the “normal” values at that time should be lowered to below 21.

Then, in 2010, the United States and Canadian governments asked the Institute of Medicine (IOM) to assess data on health outcomes associated with calcium and vitamin D. Their conclusion was a vitamin D level of 20 ng/ML or higher was “normal” and a vitamin D deficiency occurred only in levels below 20 ng/ML.

To make things even more confusing, in 2011 The Journal of Clinical Endocrinology & Metabolism published a study that suggested vitamin D levels of 30 ng/mL were considered “normal”—but to guarantee an optimal level, 40 to 60 ng/mL was recommended in adults and children.

So, what’s the right vitamin D level? Below 20 ng/ML? Above 20? Above 30? Above 40?

Vitamin D Level Standards

While the debate rages on among experts as to what blood vitamin D levels constitute “normal,” most would agree that levels of 10 ng/mL or lower suggest a real deficiency, and that people in high-risk groups should have a level above 20 to 30 ng/mL (including perimenopausal, pregnant, or lactating women as well as people with any type of bone disease). However, integrative doctors and naturopaths say “normal” levels should be as high as 50 to 70 ng/mL.

The conclusion? While some experts suggest a level above 20 would be adequate, all agree that vitamin D levels could reach 60 to 100 ng/mL without posing any safety risk. So while there is no “standard” level, taking into consideration all opinions would result in the following vitamin D level recommendations:

• < 30: deficient
• 30 to 40: adequate
• 40 to 60: optimal
• 60 to 100: therapeutic
• > 100: excess

It is important to make sure that levels do not go above 100 ng/mL.

Why Test Vitamin D Levels?

You’re likely aware of the huge surge in research showing that vitamin D plays a crucial role in a plethora of physiological and preventive functions. Not only does it regulate calcium and phosphate levels, as we thought, but vitamin D also has numerous extra-skeletal effects.

Acting as a hormone, vitamin D can have a significant impact on the cardiovascular system, central nervous system, endocrine system, and immune system.[4] Vitamin D receptors have now been found in most body cells. It is believed that when vitamin D binds to these receptors, it regulates a very large number of genes in the human genome.[5]

The research associates vitamin D deficiency with many acute and chronic illnesses, including autoimmune diseases [6], cancer [7], type 2 diabetes and insulin resistance [8], infectious diseases (including the common cold) [9], cardiovascular disease [10], cognitive decline [11], and more.

While more research is needed, many vitamin D researchers and physicians, including Boston University’s Dr. Michael Holick, PhD, MD, one of the one of the world’s most prominent vitamin D researchers, disagree with the JAMA author’s stance on staying with low-dose vitamin D. Instead, they support the idea of increasing vitamin D levels through high-dose supplementation.[12]

How to Get Tested for Vitamin D Deficiency

If your goal is to prevent these common conditions, achieve optimum health, or age more gracefully, you’ll want to regularly test your vitamin D levels and adjust your dose accordingly. Blood testing for 25(OH)D is only way to know whether you’re getting enough—or too much—vitamin D. March or April (the end of winter) is an excellent time of the year to test.

You have three options for a vitamin D deficiency test:Ask your doctor to order it.

• Order it yourself online from a “direct-to-consumer” business like Request A Test or DirectLabs, and go to a local laboratory draw site for the blood draw.
• Order an in-home finger prick test from a website like the Vitamin D Council or ZRT Laboratory. Options 2 and 3 are not permitted in all states.

Make sure the test is the correct one: Even some doctors mistakenly order a 1,25(OH)₂D test instead of the correct 25(OH)D test.

Vitamin D Dosage

What should you do if you’re vitamin D deficient?

First, you need to know that vitamin D is available in two different forms—D3 (cholecalciferol) and D2 (ergocalciferol). Vitamin D3 is the form of vitamin D that can be obtained via sunlight or exposure to a light therapy box. It’s also the form you’ll find in over-the-counter supplements. Vitamin D2, on the other hand, is the type of vitamin D most frequently prescribed by physicians.

A study published in The American Journal of Clinical Nutrition examined which type of vitamin D worked best to raise serum 25-hyroxyvitamin D levels. The results indicated that vitamin D3 was more effective, and was “the preferred choice for supplementation.”

Adults can take vitamin D3 supplements at levels between 1,000 IU and 5,000 IU per day. Generally, a dose of 3,000 to 5,000 IUs per day is required to maintain levels between 30 to 50 ng/mL. It is not recommended that you take more than 5,000 IUs per day unless under the direct supervision of a doctor. And, children should not take vitamin D supplements without consulting a family doctor or pediatrician.

After supplementing for 30 days, be sure to re-test your vitamin D levels and then adjust your daily intake of vitamin D accordingly.

You can learn more about vitamin D deficiency symptoms and the best vitamin D sources by clicking here to access our free guide.

Vitamin D in Fish

While few foods naturally contain vitamin D, fish is the major exception. The exact amount of vitamin D in fish varies greatly depending on the kind of fish, whether it’s wild or farmed, its diet, how it was prepared, and many other factors that researchers are still discovering. Salmon, especially wild salmon, tends to have the highest vitamin D content—sometimes as much as 1,500 IU per 3.5 oz serving._[1] Sardines and mackerel are typically high in vitamin D as well.

A recent analysis revealed that farmed salmon had only about 25 percent of the vitamin D content of wild salmon._[2] Farmed trout, blue fish, swordfish, and mahi had about half of the vitamin D content. Cod, grey sole, haddock, squid, and clams had less than 10 percent vitamin D content compared to wild caught salmon.

Vitamin D from Mushrooms

Mushrooms are a fascinating, complex, and somewhat controversial natural food source of vitamin D. They are low in calories, carbohydrates, and fat, and provide important nutrients, including vitamin D, selenium, potassium, riboflavin, niacin, protein, and fiber.

Mushrooms form vitamin D when exposed to either natural sunlight or artificial UV light.  Wild, foraged mushrooms—both fresh and dried—are typically very high in vitamin D, whereas commercially produced mushrooms, which are grown in the dark, are not, unless they have been purposely exposed to light. Many large-scale mushroom producers in the United States are now taking these measures so that many of the mushrooms on supermarket shelves contain appreciable amounts of vitamin D.

The post What’s the Right Vitamin D Level? appeared first on University Health News.

What Is Serotonin?

Serotonin, the “happy neurotransmitter,” is a powerful brain chemical intricately linked with mental health and is one of the best supplements for depression. Sufficient serotonin in the brain allows you to feel calm and optimistic and provides a sense of well-being, while serotonin deficiency has the opposite effect. Low serotonin levels (or abnormal serotonin function) is the most recognized underlying cause of depression.

Studies show that serotonin imbalances may not only lead to classic depression symptoms like sadness and pessimism, but other symptoms such as food cravings, sleep disturbances, aggression, panic, obsessiveness, and more. (See also our post “What Does Serotonin Do?“)

Watch for Serotonin Deficiency in the Aging Brain

As the brain ages, deficiencies in neurotransmitters such as serotonin are more likely to occur. Low serotonin is not so much a specific risk factor for mild cognitive impairment and Alzheimer’s as it is a sign that overall brain health and function are compromised. Likewise, boosting serotonin production may not necessarily prevent mild cognitive impairment or Alzheimer’s. Instead, low serotonin and the symptoms it causes should be seen as red flags that brain health is suffering, which increases the risk for mild cognitive impairment and Alzheimer’s.

Serotonin deficiency symptoms include:

• Depression
• Pessimism
• Anxiety
• Insomnia
• Repetitive thoughts and obsessive thinking
• Low self-esteem
• Irritability
• Shyness, fears, phobias or panic attacks
• PMS
• Cravings for sugar or carbohydrates
• Seasonal Affective Disorder (depression that’s worse in the winter)
• Feeling better after taking SSRIs (selective serotonin reuptake inhibitor antidepressant medications)

Many of the dietary and lifestyle pitfalls that increase the risk of mild cognitive impairment and Alzheimer’s can also deplete serotonin levels. These include processed diets based on sweets and starchy foods, lack of exercise, and chronic stress. But, the upside to this equation is the same factors that lower the risk of mild cognitive impairment and Alzheimer’s can also improve serotonin activity.

The aim is to lower inflammation in the body and brain, as inflammation blocks serotonin production. In fact, research increasingly shows depression to be a symptom of inflammation. Therefore, although diminished serotonin activity may be seen in patients with mild cognitive impairment and Alzheimer’s, it is most likely just one of many symptoms of a diet- and lifestyle-induced inflammatory process that has sabotaged and degenerated the brain to the point of memory loss and dementia.

How to Increase Serotonin Levels with Serotonin Supplements

The good news is that a number of serotonin supplements have been shown to increase serotonin and effectively treat symptoms of serotonin deficiency. SAM-e, 5-HTP, and L-tryptophan St. John’s Wort have each been shown in multiple human studies to affect serotonin imbalances and to treat depression. Let’s take a brief look at how to use each of these serotonin boosters to improve mood, treat insomnia, and ease other low serotonin symptoms.

5-HTP.  Your body makes 5-hydroxy tryptophan, or 5-HTP, from tryptophan, and then converts it into serotonin. When taken as a supplement, 5-HTP is well-absorbed and crosses the blood-brain barrier where it gets converted to serotonin. 5-HTP is believed to offer stronger serotonin support than L-tryptophan (see below). Clinical trials have confirmed the efficacy of 5-HTP supplements for depression, sleep disorders, binge eating and panic disorders._[1-3]

L-Tryptophan. L-Tryptophan is an essential amino acid required by the body to synthesize serotonin. As discussed above, the conversion of L-tryptophan to serotonin is a two-step process in which 5-HTP is synthesized as an intermediate step. Taking L-tryptophan as a serotonin supplement enhances the synthesis of serotonin and increases serotonin levels within the body._[4] Nevertheless, integrative practitioners report success with the use of L-tryptophan for insomnia, mild depression, and for people who do not tolerate 5-HTP since, compared to 5-HTP, L-tryptophan is generally considered more gentle. It has even been found to help non-depressed, healthy people process emotions in a more positive way._[5]

SAM-e. S-adenosyl methionine (SAM-e—pronounced Sammy), produced from the amino acid methionine, is present in all the body’s cells and is required for hundreds of reactions, including the synthesis of serotonin. As a supplement, SAM-e has been used extensively for treating depression in Europe for over 30 years, and a review of SAM-e studies published in the American Journal of Clinical Nutrition concluded that SAM-e supplementation was a safe and effective treatment for depression._[6] Drs. Richard Brown, M.D., of Columbia University and George Papakostas, M.D., of Harvard Medical School both advocate the use of SAM-e for clinical depression._[7,8]

Saint John’s Wort. Extracts of the flowering St. John’s wort plant exert their antidepressant actions by inhibiting the reuptake of serotonin as well as norepinephrine and dopamine, making more of these neurotransmitters available to the brain. For people suffering from mild to moderate depression, studies show that St. John’s wort extracts are significantly more effective than placebo._[9] They have been found to be better tolerated but to work just as well as standard antidepressant drugs._[9]

Safety First

Though having too little serotonin is not good for you, too much serotonin can cause harm. Do not take more than one serotonin booster at a time. Natural serotonin pills or other natural supplements for depression may not be appropriate for all types of depression and may not be compatible with certain types of depression medication. If you are taking an anti-depressant, vitamins for depression, or other natural supplements for anxiety and depression, consultation with a healthcare practitioner is strongly advised. A healthcare professional can also provide insight about the best supplements for anxiety treatment, or the best supplements for depression.

Other Natural Supplements for Anxiety and Depression

Depression, anxiety, and other mood disorders have other possible underlying causes in addition to serotonin deficiency. For example, read Could Your Depression Be Caused by a Sleep Disorder? Depression Can Be One of the Many Surprising Sleep Apnea Symptoms.

Other vitamins that help with depression include the neurotransmitter dopamine. Dopamine is also involved in mental-emotional health, and specific dopamine supplements may also be indicated. Learning more about all the potential underlying causes of depression and anxiety can help you target your natural treatment protocol.

For related reading, visit these posts:

• Serotonin: Vital Brain Chemical Affects Both Mood and Cognition
• It’s Difficult to Define Serotonin—This “Brain Chemical” Has Multiple Actions All Over the Body
• Serotonin Deficiency: A New Target for Mild Cognitive Impairment and Alzheimer’s
• Serotonin Deficiency: Is This Really a Cause of Depression?

Originally published in 2013, this post is regularly updated.

[1] Asian J Psychiatr. 2013 Feb;6(1):29-34.</a
[2] Eat Weight Disord. 2012 Mar;17(1):e22-8.
[3] Altern Med Rev. 1998 Aug;3(4):271-80.
[4] Anal Bioanal Chem. 2012 Feb;402(4):1593-600.
[5] Psychopharmacology (Berl). 2006 Jul;187(1):121-30.
[6] Am J Clin Nutr. 2002 Nov;76(5):1158S-61S.
[7] 141st APHA Annual Meeting. Abstract 283939. To be presented Nov 6, 2013.
[8] Can J Psychiatry. 2012 Jul;57(7):406-13.
[9] J Clin Psychiatry. 2009;70 Suppl 5:23-7.

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On the second Monday of every March, people in most of the United States drag themselves to work and school an hour earlier than usual. Since the 1970s, health experts from around the world—more than 60 countries follow some type of daylight saving time (DST)—have been questioning the health effects of this sleep disruption. Just one lost hour, they warn, can have significant consequences.

Health Concerns. In November 2019, a trio of researchers made the case in JAMA that there is ample medical evidence to support abolishing DST. They cited a wide range of ill effects:

    Stroke. Finnish researchers studied the association between DST and ischemic stroke from 2004 to 2013 and found that hospitalizations consistently rose in the first two days after the spring time change. They reported in Sleep Medicine that the association was strongest in women and people older than 65.

    Heart attack. A meta-analysis published in August 2019 in the Journal of Clinical Medicine showed a 5% higher risk of heart attack during the first two weeks after the spring shift to daylight saving time and a 3% higher risk two weeks after the fall transition back to standard time. Other studies have shown a reduction in risk in the fall.

    Traffic accidents and deaths. Investigators around the world have shown that accidents are more common for up to two weeks after the spring shift.

    Cluster headaches. DST can trigger cluster headaches that begin a few days after the change and last for a week to three months. This intense head pain is strongly associated with circadian disruption.

    Seasonal affective disorder. Danish researchers reported in Epidemiology in 2017 that the transition from summer to standard time was associated with an 11% increase in depressive episodes. Their data set consisted of nearly 200,000 medical records.

   Fatigue. The spring change robs most people of 20 to 40 minutes of sleep, leading to daytime sleepiness, inattention, reduced motivation, and increased hunger. It may make people less forgiving too: A 2016 study reported that judges give out harsher sentences the day after springing ahead.

Role of the Circadian Rhythm. At the core of these issues is the circadian rhythm, our body’s natural clock that controls everything from when we sleep and wake to how our blood pressure changes throughout the day. When the rhythm is disrupted by DST, it throws off the complicated choreography of multiple bodily functions, leading to an elevated risk of health complications. The studies cited above show that it does so with just a small disruption.

Easing In. If you live in a state that follows DST, gently adjusting your circadian clock may help reduce these risks.

• Ease your way into the spring shift by gradually going to bed and getting up earlier for several days to a week before the change.
•   In the fall, push your bedtime and wake time gradually back.
• Try to get exposure to morning sunlight to set your biological clock each day.
• Avoid caffeine after noon to improve the quality of your sleep at any time of year.
• Resist the urge to nap. Save that sleepiness for bedtime to help establish your new routine

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