Sunday, July 29, 2007

Fat Soluble Vitamins---Vitamin D---Part III

I have been focusing mainly on the WLS aspects of these posts on vitamin D (Part I, Part II). Now I want to address it from a mental health point of view.

Part of my "Wellness Toolbox", includes spending at least 30 minutes a day outside. Without the sunscreen, I might add. It is essential for my overall health.More important is the connection to what it can do for my mental health. The Vitamin D Council has a paper that addresses this: Vitamin D and Mental Illness

Does Vitamin D Affect The Brain?

Vitamin D rapidly increases the in‑vitro genetic expression of tyrosine hydroxylase (the rate‑limiting enzyme for the catecholamine biosynthesis) by threefold.

Summer sunlight increases brain serotonin levels twice as much as winter sunlight, a finding compatible with both bright light in the visible spectrum and vitamin D affecting mood.

Vitamin D is widely involved in brain function with nuclear receptors for vitamin D localized in neurons and glial cells. Genes encoding the enzymes involved in the metabolism of vitamin D are expressed in brain cells. The reported biological effects of vitamin D in the nervous system include the biosynthesis of neurotrophic factors, inhibition of the synthesis of inducible nitric oxide synthase and increased glutathione levels, suggesting a role for the hormone in brain detoxification pathways.

Evidence suggests that vitamin D may help mood but that evidence is not conclusive. (Remember, the way our medical literature system works, scientists often do not publish negative studies). The two positive studies above used vitamin D to treat seasonal affective disorder, not major depression. We were unable to find any studies in the literature in which patients with depression were treated with enough natural sunlight, artificial sunlight or plain old cholecalciferol to raise their levels to 35 ng/mL or higher. We all know how we feel after a week at the beach, but is that bright light, vitamin D, or something else?

Evidence exists that major depression is associated with low vitamin D levels and that depression has increased in the last century as vitamin D levels have surely fallen. Evidence exists that depression is associated with heart disease, hypertension, diabetes, rheumatoid arthritis, cancer and low bone mineral density, all illnesses thought to be caused, in part, by vitamin D deficiency. Finally, vitamin D has profound effects on the brain including the neurotransmitters involved in major depression.

Further Research Needed

Therefore, vitamin D may help major depression. It is too early to say. To know for sure, patients with severe major depression would have to have baseline 25(OH)D blood levels, be treated with doses of vitamin D adequate to raise their levels to at least 35 ng/mL for several months and be compared to a normal control group treated with placebo. No one has ever published such a study.

However, it is not to early to heed the following advice: If you suffer from depression, get your 25(OH)D level checked and, if it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment. If you are not depressed, get your 25(OH)D level checked anyway. If it is lower than 35 ng/mL (87 nM/L), you are vitamin D deficient and should begin treatment.

To learn more about increasing rates of mental illness over the last 2.5 centuries I recommend the incredible book, The Invisible Plague: The Rise Of Mental Illness From 1750 To The Present, by E. Fuller Torrey—the scientist the Washington Post called "the most famous psychiatrist in America."

I have extreme difficulty with depression from around September until April. This is otherwise know as Seasonal Affective Disorder (SAD). I was prescribed "light therapy". It's this extremely expensive piece of equipment, measuring about 10"x13". It's the same concept behind a tanning bed.

Is depression associated with other conditions thought to be associated with vitamin D deficiency, such as heart disease, diabetes, hypertension, rheumatoid arthritis, cancer, or osteoporosis? For example, there is a strong association between heart disease and depression, and countless theories to explain it. The obvious one—that heart disease would cause anyone to get depressed—is incorrect. You see, depression often precedes the heart disease, suggesting a third factor causes both. Moreover, if depression were associated with heart disease, one would expect excess unexplained mortality in major depression, which is a well‑established finding.

Remember that association does not mean causation. If A is associated with B, then A could cause B, B could cause A, or a third factor(s), C, could cause both A and B. Therefore, if heart disease is associated with depression then the possibilities are depression caused the heart disease, heart disease caused the depression, or an unknown factor(s), perhaps vitamin D deficiency, caused some portion of both the depression and the heart disease. "Perhaps" being the key word. Remember, most of the serious errors in psychiatry (and medicine) are made when associations are confused with causation; or when subsequence is confused with consequence.

It is clearly a case of which came first, the chicken or the egg. It does you cause to want to look more closely at the available research. Well, it makes ME want to look more closely. Not everyone is as anal as I can be.

You can look anywhere online a find many opinions associated with the psych field. Some really blast the whole need for medications at all. They believe in using only a natural approach or don't believe in psychiatry to begin with. Then ther is the other end of the spectrum. Those who rely solely on their meds and firmly believe in them. I'm kinda in the middle. While I do rely on meds for my Bipolar Disorder, I firmly believe that the nutritional control of it plays a major role. As well as having therapy. I use a multifaceted approach, diet, exercise, meds, therapy, journaling, and connecting with others who have been through it.

The final post on Vitamin D will be focused solely on the research found as it pertains to WLS. So stay tuned for that.