The Lost Art

I am sick in an invisible way that people cant really see, and I don’t really feel – much. I can take a pill and make it mostly unnoticeable. Except for the fact that my hair falls out in handfuls with a certain kind of stress…

I consider myself an expert in self-care. And yet, I can hardly find the time to do the “little” things that I know could help. Like, nettle hair rinses, getting at least 8 hours of sleep every night, taking my fish oil, and eating more protein. Instead, I keep myself too busy and dull myself with things that make me feel better for a few hours, but never in the long run. I have fallen into the mindlessness of  modern health care where I want a pill to do the work of healing for me. Dammit!

We all have levels of health maintenance we are willing to do on a regular basis. Vitamins, exercise, water, organics, therapy, whatever. We each have a certain degree of self care required to maintain the status quo of daily function. But, what happens when that balance is tipped and we need to actually recover from an illness, injury, or accident?

I offer you an invitation to step off the rat wheel of everyday living, and create a luminal space for healing. A luminal space is an anthropology term that refers to a period of time “outside of time” – a step out of everyday living. Some health crisis force this through body fluid effluvia that ties one to the bathroom, or physical disability that prevents mobility. Too often we are able to power through a cold, or anxiety attack or injury and do not engage in the art of self care to allow actual healing. This is what snowballs into chronic illness / disease or chronic pain.

I have been “sick” for at least 9 months, but I haven’t made more than a few half-hearted efforts to engage in deep self care. I have taken lots of prescriptions and had lots of blood tests, but is that truly healing medicine? I finally broke my baby toe last week, and have been suddenly forced to slow down by immobility. I am doing hydrotherapy, making castor oil packs, cooking and eating good food, meditating, saying no to social engagements I don’t deeply want to do, and getting sleep. These are some of the cornerstones of deep self care.

It is very difficult to give ones self approval to close the door on society and expectations and family, and friends, and chores, and domestic duties, and distractions, and choose to do something solely for the self instead. We are culturally programmed to take care of business, pleasure, family, kids, dogs, and our homes before we take care of the inner self. If you are sick, at any level, you will heal faster, and better if you take the time to practice deep medicine by taking the time to take care of your self.

I am here to help you do that. And, I give myself permission to offer that same wisdom and practice for my self. The pills and the maintenance are not enough. We must engage the luminal, lost art of deep self care for complete health and healing.

 

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Ideal Weight Program

photo 3Welcome to a new way of working with body image, metabolism, eating patterns and ultimately, weight management. This is not a diet. Let me repeat. This is not a diet.

Study after study have shown that only 2% of people who lose weight by dieting are able to keep it off for life; 98%  of dieters gain back the weight they have lost plus more. This endless cycle slowly but surely adds pounds while eroding your sense of self worth. It also creates chaos within the blood sugar, hormone and neurotransmitter system that leads to further metabolic disruption.

Now is the time to change the old patterns. With awareness and a commitment to change, you can rewrite the story of your body. Your cells are constantly regenerating themselves; with direction from your mind and an individualized, functional medicine approach to improving structure and function you can reach your ideal metabolism, energy, and physique.

This program is divided into four phases. Each phase is at least 90 days long. Some people will need more time in an individual section, and can stay in each section as long as needed. The four sections are like a wheel, and where you start depends on your health, area of interest, and life circumstances. Some people will move in a linear direction through each step, and others will hopscotch from one area to the other. The secret to success is that we follow your body, your life, and your needs to unlock your ideal.

The four treatment sections are: FOOD, DIGESTION, STRESS, HORMONES

FOOD:  It only makes sense to work with food when addressing weight. Food is actually a very complicated topic, and one that most people have layers and layers of  complex conditioning around. We will start with a comprehensive 200 food ALCAT sensitivity test that will empower and educate you to make food choices based on YOUR immune system reactions to food (food sensitivities.) There are so many diets, so much information, so many food gurus and opinions out there! This test allows you to claim your own power around food choices based on your body’s unique message. In this section we will also teach you how to identify when you are hungry, and when you are full. These simple intuitive eating approaches build awareness and compassion, connecting you to your own primitive need for food as fuel.

DIGESTION: Effective food breakdown and waste elimination is crucial to a healthy body. Nausea, bad breath, appetite fluctuations, heartburn, indigestion, gas, cramping, bloating, constipation, hard stools, soft stools and diarrhea are all signs that your body is not digesting effectively. We will use a CDSA (Comprehensive Digestive Stool Analysis) to investigate all parameters of digestion including beneficial and pathogenic flora levels to truly repair and restore your digestive tract. This will have multiple health benefits including a more balanced immune response, increased energy,  regular bowel movements, potential pain relief and much more. As your digestive system is renewed you will be able to maintain your ideal weight more effectively as the body processes the food you eat with ease.

STRESS: Our brain decides when we are hungry, and when we are full. It also decides when we will eat. These two actions are not neccessarily in harmony. By looking at neurotransmitter levels that are intricately linked to food and well-being, we can understand some of the complexity of the mind-body-food relationship. During this time we will assess the stress in your life, and build stress management skills. Using botanical medicine we will tonify your endocrine system, enhancing your capacity to experience stress with ease and resiliency. At the same time, awareness exercises continue the weight-related exploration of finding and maintaining your ideal physical body with a healthy, relaxed mind.

HORMONES: Most people gain weight when their hormones begin to decline. This usually refers to reproductive hormones like estrogen, progesterone and testosterone, but  thyroid and adrenal hormones are also crucial to a vibrant and efficient metabolism. Finally, Human Growth Hormone levels dictate the speed at which we age.  This section utilizes the Age Management comprehensive hormone blood work panel to thoroughly investigate the state of your hormones. Using cutting edge anti-aging therapies and Bioidentical hormone treatments we will optimize your hormones, rejeuvenating your sex life, cognitive function, energy levels and more.  Some participants may also choose to do a 26 day HCG diet as part of this personally tailored hormonal wellness program for more radical weight loss.

Each of these components make up the whole that is your living body and each have a profound effect on weight. Whether you want to lose 10 lbs or 100lbs, or even want to learn how to maintain your current weight in a more relaxed fashion, our Ideal Weight Management program will bring you closer to that which we all seek – your ideal Self. As your awareness of the triggers behind your disordered eating patterns come clear, your need to medicate with food will shift. Functional issues like constipation, heartburn, and nausea will transform into easy, successful elimination of your body’s waste, allowing a more effective fuel-burning metabolism to emerge. And, you will feel more energized and better able to handle the stresses of everyday living without food as a crutch.

This program is not for the faint of heart. It is for people who have dieted all their life. It is for all genders and all ages. There is no standardized program that you must sacrifice and change to be accepted into – this is a truly individualized series of sessions that unearths the inner you …that you will adore.

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The Longest Night of the Year

December is not always mistletoe and gingerbread. It can be one of the hardest times of the year for many people. People aren’t supposed to die on Christmas and relationships aren’t supposed to end around the holidays…. but they do. The myth of the happy family is only a reality for a portion of the population; and even those who do celebrate Christmas with family can have significant stress and sorrow around money, relationships, and more.

So, for those who are alone this month, or in the midst of tragedy or change or trauma, I wanted to offer some self-care advice. From a metaphysical perspective, no matter what your religion is, this time of year IS about the miracle of returning light. The first few weeks of the month bring ever increasing darkness. Light some lights in your own home, whether they are candles or Christmas lights, reflecting your own inner flame. No matter how dark the world appears, each of us has the light of our soul to guide us. Connect with yours.

broken_heart_remedy_compoundFor those with heartache, there are many botanicals that offer gentle physical and emotional support. Avena botanicals makes a Broken Heart herbal tincture and a lovely sweet Rose Petal Elixir. The elixir is in a glycerin base and is used to gently lift the spirits and open the heart. It tastes like a rose smells on a hot summer day! Many herbalists make their own rose petal elixirs at the summer solstice, in preparation for this dark time of year. Herbal medicines like these affect our body, mind and spirit. By using self-care medicines we are making a commitment to our Self to move through this time of change with as much gentle strength and internal fortitude as possible. http://www.avenabotanicals.com/rose-petal-elixir.html 

Many people have seasonal affective disorder (SAD) or just simply hate the cold. We have had a particularly cold pre-winter here in Maine, which makes getting out to enjoy our gorgeous local landscape more difficult. Prevention is key for SAD – once it takes hold it is harder to manage. Adequate levels of Vitamin D3 are especially important. I generally recommend 2,000-5,000 IU daily depending on your body weight and Vitamin D reserves. Have you had your blood levels of Vitamin D checked yet this fall? High quality fish oil is a good adjunct to Vitamin D, enhances its absorption and can help with mental health. Fish oil contains two chemical constituents – EPA and DHA. The EPA is the part that helps with depression. Aim for a minimum of 650 mg of EPA daily, taken with your D3.

Saint Johnswort is another classic treatment for SAD. This herb affects the metabolism of many medications. Therefore, I only suggest using St Johnswort if you are not on any other meds. Dosage must be 900 mg per day, taken *every day.* This herb acts like SSRI antidepressants in that it takes about 4 weeks to get the full effect, and it needs to be taken daily for best results. This herb has evidence of use back to 400AD by Hippocrates. It is an ancient and magical herb with an association to light. It is no mistake that it is useful for SAD! If you do take medications like birth control, daily pain medication or blood pressure medication but would like some mood support you can consider 5-HTP. This is a serotonin precursor that is naturally produced in the body, and is available in supplement form. It can be helpful for anxiety, depression, insomnia and “the blues.” It is quite safe in general, although it should not be taken along with antidepressant medications unless specifically advised by an Integrative Medicine Dr. Typical dosage for 5-HTP is to start with 50 mg twice a day, and increase to up 150 mg twice a day as needed.

Exercise and meditation are two other valuable tools for getting through hard times. Exercise releases endorphins which simply make us feel good! It can be a walk around the block or a cross-fit class or hot yoga. The type of exercise does not matter as much as the act of getting into your body and out of your head. Meditation offers ways to step outside the constant chatter of our ego. I recommend a guided meditation for beginners. I use this Buddhist body-focused beginner set by Reginald Ray, but there are many more available! http://www.soundstrue.com/shop/promotion/1047.pd

At the end of the day, we each need to get through our darkest times in the ways we know how. Alcohol, television and drugs are all effective in their own way, but they also exacerbate the feelings of isolation and despair. Connecting to your inner light source and fanning your fires of spirit and confidence and strength will help grant you the courage to move through these difficult times. Some of us need more help than others to connect to our strengths, and supplements like herbal remedies, vitamin D, fish oil, St Johnswort and 5HTp can be great support systems. I love the rose petal elixir for its sweet uplifting taste of summer in these harsh cold days of winter.

For personal support on transforming your own journey or connecting to your inner strengths, book an appointment with Dr. Wright. She is available for consults during the month of December including December 27, 2013.

Call 207-774-1356 now.

References:

The ABC Clinical Guide to Herbs. American Botanical Council, Thieme Publishing 2003. Currently out of print.

Encyclopedia of Natural Medicine. Michael Murray ND and Joseph Pizzorno ND. Prima Publishing, Rocklin, CA 1998

www.avenabotanicals.com

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September 2013

IMG_1626Apples are in season again, so it must be time to go back to school. This year, I will be the one in front of the classroom! This is completely new for me, and I have been anxiously preparing mentally (and literally) for most of the summer. Academics are an important part of a doctors CV, and an area that I have studiously avoided in my career thus far. But when Corinne Martin at University of Southern Maine Nursing School contacted me about the program she has been developing as a holistic health minor for USM the fear was less than the excitement. I am honored to be teaching CON 284 Botanical Therapies for the fall semester. The course is an introductory level exploration some of the issues that surround medicinal plant use including historical dynamics, ecological effects and cultural perceptions of herbs. I will also be teaching practical clinical use of commonly used botanicals. We have guest speakers coming in, a practical how-to workshop on medicinal preparations, and a diverse reading list. Plant medicine has been foundational to my practice, and I am grateful for the opportunity to expand my own understanding and become more of a community resource!

I work primarily at the Age Management Center these days, with a strong focus on hormone health. I work with Dr. Michael Bedecs who is a Men’s Health expert, and is extremely experienced in hormone replacement. I am grateful to say he has taken me under his wing, and I have found a permanent place for my private practice here in Maine (and beyond.) It took almost two years to find the right work environment and business associate after owning my own clinic for 11 years in Toronto. Stay tuned for new articles on fertility,  perimenopause and transgender/transsexual health care. When working with hormones, it is impossible not to consider trans* health care, as this is a population often dependent on hormone use. Dr. Bedecs and I will continue to merge his extensive knowledge of hormone use with my specific integrative medicine training, community commitment, and health care activism to create a concierge style medical practice to serve all genders equally with cutting edge comprehensive treatment plans.

The other work I have been doing is more personal, learning how to trust my gut. Who is good at this? Tips? Strategies? It is so hard in this mixed modern world for me to be able to sift through the messages that come from outside vs. those that come from inside. What I have learned, is that if the inner messages are not heeded, outside havoc will soon result. Or, an event will occur with a big “I Told You So” tag on it. This is part of my process as a human – what is your process? We all have evolutionary issues that we work though, each as unique as stars. Having good guides – as partners, therapists, teachers, doctors, friends – is key to actually learning from our process and not repeating the same mistakes. I am lucky to have all of the above right now – except a good Dr. That is next on my list!

Thank you for reading through, for listening. My health story is mirrored in my life, and I know all of yours are too. It is the details of life that illustrate the pathways of disease and also those of health. Find yourself a Dr that will listen for the details, and trace paths. Take a new course. Call someone you miss. Step outside your comfort zone and do something professionally that scares you! It is September 2013, the time is ripe!

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Reflections from the Philadelphia Trans Health Conference 2013

What a phenomenal catalyst for change. June 13-15 was the 12th annual Trans Health Conference in Philly. It was a massive collection of workshops on many different aspects of Transgender, Transsexual and differently gendered health and healing including medical, legal, spiritual, practical aspects, self-empowerment and so much more. I was honored to be a presenter this year on Naturopathic Medicine and Trans Health. It was my first time attending the conference, and I am so impressed by the caliber of the event. I primarily attended medical style workshops including presentations on the most recent research being done with the trans community.

My talk was a great learning process for me. Not only from the questions asked by the diverse and well informed crowd, but also as a reflection of self. I am very comfortable in the trans community, consider myself an ally, and am aware of the multidimensional and sometimes fragile nature of trans identities. And yet, twice during my presentation I wrongly identified someone as a woman and a man when calling on people for questions. Under pressure, my highly educated nervous system switched back to my reptilian brain of the binary He-She world – and this with all the *knowing* that I have of the great diversity of gender expression. I was disappointed in myself.  It is a lesson that in working with this community, it is especially important to be conscious of language. The old ways of thinking are simply not progressive enough to enter the dialogue. For example, when referencing  people, we as a society need to step outside of classifying people by sex (and race.) Instead of saying “the woman in the yellow shirt”, say “the person in the yellow shirt is ….” The majority of the time our binary classification may be right, but there is a significant proportion of times when our 2D classifiers are actually incorrect, and those can be very painful moments for the individual inhabiting the misread gender identity.

I also talked about adrenal health, and was pleased to learn of new research that evidences salivary cortisol levels are indeed raised higher in the transitioning trans population than in controls. Meaning – stress is huge. Everyone working with trans people of all identifications will need to do stress management and adrenal support. Adrenals are also a source of endogenous hormones including DHEA, which could be a resource for transmasculine and transfeminine people not taking hormones as it has the potential to shift to both testosterone and estrogen internally.  There were many questions about the use of botanicals that have been evidenced to have steroid-like action. This is an area I need much more clinical experience in.

I was heartened to meet 3 other Naturopathic Doctors and two herbalists working in this field at the conference, all of who gave presentations as well.  They reminded me of some of the important preventative medicine aspects of working with people on hormone therapies like hypertension, osteoporosis, calcium quality, high cholesterol and so much more. There were also acupuncturists, and ayruvedic practitioners offering other traditional perspectives. Next year I hope to cultivate a workshop where we all meet to share information! I know I was left with more questions than answers.

I learned important information about our trans youth, and ways to support them better from both a practical level in schools, around mental health, and medically. Dori Midnight, a Massachusettes healer and fairy witch did workshops in mental health, herbalism and ancestral trans magics. I also got to share a room with her, which was a delightful meeting of the minds with gluten-free snacks. There were many sessions on identity development and closed meetings for specific gendered health care needs that looked inspiring and transformational. There were many fantastic workshops I did not get a chance to attend, including a 2 day medical training stream which I will certainly do next year.

Overall, the experience was one that provoked intense introspection and profound leaps of knowledge. It was an event that is crucially important to modern medicine, to understand not only the vernacular but also the urgency of the need for competent health care providers AND self care within the transgender, transsexual and gender non-conforming communities.

A few links and resources from the conference:

http://www.trans-health.org/

http://www.dorilandia.com/html/home.html

http://thirdroot.org/

http://www.rainbowhealthontario.ca/admin/contentEngine/contentDocuments/Gender_Independent_Children_final.pdf

www.riverstoneconsult.com

www.gendercreativekids.ca

www.fenwayhealth.org/transhealth

 

 

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#TTC – Safe Treatments for Fertility & First Trimester Anxiety

The work of becoming/being pregnant marks a time in a woman’s life when the game changes. Alcohol is no longer an option for stress management. Most herbs and even common teas are viewed with suspicion, and many medications are frowned on. Many of our crutches for managing the stresses of daily life are taken away, and the stress of in/fertility is added. However, there are natural treatments available for this time period to reduce stress, ease anxiety, and support a healthy first trimester.

Flower Essences are very safe for all expecting and #TTC moms, and are especially useful for women using multiple fertility and metabolic medications as they have no interactions or side effects! Flower remedies are literally essences of the particular flower in a brandy solution. Bach flower essences are the most commercially available. FES (Flower Essence Society,) Alaskan Essences, Perelandra and more are other well respected flower essence brands. Bach has 38 different flower remedies available; however the following are especially pertinent for fertility and first trimester. Dosage is 3-5 drops in water 2-4 times daily or as needed. The very small amount of alcohol in these medications will not cause any fetal problems as it is so minute a dose.

Aspen: For apprehension and vague fears

Gorse: Brightens perspective and increases optimism.

Holly: For envy or jealousy of others

Larch: Gets one out of the success/failure paradigm and increases self-confidence

Wild Rose: Restores interest and joy when feeling apathetic or resigned.

White Chestnut: Restores a peaceful mind when caught in repetitive thoughts

Botanical Medicine: Some herbs are appropriate for this time period, however most herbs are best set aside until the pregnancy is well established or beyond breastfeeding. One herb that is a #TTC and first trimester best friend is viburnum prunifolium otherwise known as black haw. This is different from viburnum opulus aka cramp bark – do not mix the two! Black haw quiets an “irritable” uterus, and prevents miscarriage. It is very safe and quite effective. I recommend 1/4 to 1/2 tsp daily for the first trimester as needed. For questions and concerns, refer to your local Naturopathic Doctor who can take your full history and prescribe according to your individual health care needs. Oatstraw or avena sativa is also a wonderful tonic that is nourishing to the body and calming to the mind. This herb is best taken as a tea. It is gluten free, hydrating with rich minerals (therefore great for morning sickness) and soothing to frazzled nerves. Valerian is perfect for nighttime anxiety. It is safe in pregnancy, breastfeeding, and for pediatrics. This is Mother Nature’s truly sedative herb. Used in doses of 5-30 drops before bed, this can help quiet the mind and improve the duration and quality of sleep. I like it as an alcohol free (glycerite) tincture as the taste is slightly sweeter than the alcohol based formula. Capsules are also an option although I prefer the smaller dosing options of the liquid form. (Valerian is very well researched, please contact me for a formal monograph if desired.)

imagesFinally, lavender essential oil has a time honored place in the treatment of anxiety.  For those whom lavender has a calming effect you can use lavender products liberally that have the real essential oil in them – avoid synthetic fragrance analogues. There are now lavender essential oil capsules that are quite effective for treating occasional or situational anxiety. These act quickly and safely to diminish feelings of panic, irritability and stress. Typically essential oils should not be used internally during pregnancy, so these lavender caps are best used only until the day of ovulation. There is a lavender glycerite tincture also available which can be used sparingly while pregnant in doses of 1-2 drops for anxiety and panic as needed. There is some (internet) controversy surrounding the use of lavender in pregnancy; however, it is not listed in any of the classic literature as a herb to avoid in first trimester.  My opinion is that if this botanical medicine is the one thing that works to soothe your fears, use it in moderation. If it increases your anxiety due to the multitudes of internet opinions, avoid it! Here is a link to a well researched blog post on the safety of lavender essential oil in pregnancy: http://roberttisserand.com/2011/07/lavender-oil-and-pregnancy/

Acupuncture and Registered Massage Therapy are also fabulous safe care therapies for anxiety and stress while #TTC. Acupuncture has a proven track record of efficacy when it comes to enhancing not only assisted reproduction but also all conception. Studies have shown that weekly acupuncture greatly reduces the rate of miscarriage during first trimester, especially for women with a previous miscarriage. This is in part due to its ability to support the expectant mom through the first 12 weeks. The therapeutic touch offered by massage therapy also has the ability to soothe anxiety, ease depression, and support the physical changes of pregnancy. The resulting relaxation offers an anxious expecting mom a few moments to quiet the mind, which can have great positive effects overall. It is important to see an acupuncturist or massage therapist trained in pregnancy massage as there are specific techniques and positions used for this treatment.

All in all, this is such a time of mystery, of waiting, and of trust that it can be overwhelming to have to “go with the flow.” Every couple experiences some level of anxiety, and some have a very hard time as #BFN’s happen again and again.  Flower essences, black haw, oatstraw and lavender glycerite are natural remedies that any couple can use to support their own mental and emotional wellness on the road to becoming a family. There are many more herbs, vitamins, and therapies available for #TTC and expectant moms that are based on the individualized medicine offered by a licensed Naturopathic Doctor.

Links and Resources:

http://www.gowonderworks.com/flower_essences

http://www.bachflower.com

http://www.fesflowers.com

http://www.biomedcentral.com/1472-6882/12/20

http://www.fertilityfactor.com/infertility_acupuncture.html

http://americanpregnancy.org/pregnancyhealth/prenatalmassage.html

 

 

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Improving Libido with Naturopathic Medicine

Sex, sex drive and inherent libido are all very complex subjects in modern culture, affected by our extremely long TO DO lists tagged onto the ends of busy days. Here is an article I wrote for QueeriesMag.com February 2013 on Naturopathic Medicine to increase sex drive.Let me know what you think!

http://queeriesmag.com/index.php/2013/02/14/on-the-kitchen-table/

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Essential Fatty Acids and Mental Health by Tori Hudson, N.D.

~ This article was published in the Emerson Ecologics Womens Health Email update December 2011.

When it comes to the biological basis for mental health disorders, the presumption is an abnormality of neurotransmitters- whether it be excess, deficiency, or abnormal interactions with receptors or transporters. While the focus of current pharmacological therapy is the neurotransmitter and its proteins, the impressive role of lipids, particularly long-chain polyunsaturated fatty acids (LC-PUFAs), cannot be overstated. The weight of the brain is roughly 80% lipid, the richest source of fatty acids in the body and 15-30% of those lipids are essential fatty acids (EFAs) and LC-PUFAs. Nerve cell function, membrane fluidity, neuron membrane dynamics and the subsequent receptor, transporter and neurotransmitter function are profoundly affected by the lipids that we take in from our diet and supplementation. Considerable research including randomised controlled trials now demonstrate the role and efficacy of EFAs in numerous psychiatric disorders.

Depression

According to the American Journal of Psychiatry, depression is one of the 10 most frequent indications for the use of complementary and alternative medicine.1 While many nutraceuticals and botanicals have published evidence to their benefits, omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) are among the more commonly used.2

Epidemiologic studies in several countries suggest that decreased omega-3 fatty acid consumption correlates with increasing rates of depression. One researcher who studied the relationship of fish consumption and the incidence of depression correlated the annual incidence of major depression per 100 people in nine countries with the consumption of fish.3 He found a high incidence of depression in countries with low fish consumption. For example, New Zealanders have an annual fish consumption of about 40 pounds and they had an annual incidence rate of depression of 5.8%. Japan on the other hand, with a fish consumption of almost 150 pounds per year, had the lowest incidence of major depression, at .12%. His group also demonstrated that prevalence rates for bipolar affective disorder rise when the annual fish intake falls below 75 lbs of fish per person annually. In Taiwan for example, there is a 0.04% rate and their fish intake is 81.6 lb per person per year as compared to Germany, the rate is 6.5% at 27.6 lb of fish per person annually. In a survey of 3,204 Finnish adults, infrequent fish consumption was associated with depression in women and although not statistically significant, a trend was seen in men.4 Fish intake also appears to have an influence on suicide with a reduced risk of death from suicide in individuals with daily fish consumption.5

In a study of 20 patients with moderate to severe depression, the relationship between depression and levels and ratios of omega-3 and omega-6 fatty acids in plasma and erythrocyte phospholipids was studied.6 Using two commonly accepted scales and methods of evaluation depression, researchers found a significant correlation between the ratio of phospholipids arachidonic acid to EPA and the severity of depression. The greater the omega-6 to omega-3 ration, the greater the severity of the depression.

In 2010, researchers found that patients with major depressive disorders, exhibited significantly lower erythrocyte DHA composition compared to healthy controls and those with bipolar disorder appeared to have an even lower DHA level.7

Other investigations have confirmed that a high concentration of blood plasma of docosahexanoic acid (DHA), an essential fatty acid found in fish, has been linked to increased serotonin turnover with lower rates of depression and even suicide. Switching to a cholesterol-lowering diet may also result in reductions in measures of depression,8 although not all studies demonstrate this. It appears as though there is a consistent positive association between depression and coronary heart disease and heart attacks.9 They may in fact carry a common cause, that of elevated cholesterol. Since there is such a strong correlation between depression and coronary artery disease, and a predictive correlation between elevated cholesterol and heart disease, elevated serum cholesterol should also predict increased depression.

Depression, secondary to alcoholism, is quite common and occurs in up to 59% of alcoholics. Alcoholism is certainly a complicated illness with social, psychological, hereditary, physiological and physical factors to consider. We know that alcohol is a pro-oxidant that leads to increased lipid peroxidation and a consequence of increased lipid peroxidation may be a decrease in the concentrations of the more highly unsaturated species of fats. Several studies have demonstrated that chronic alcohol abuse depletes long-chain n-3 polyunsaturated fatty acids from neuronal membranes.10 It is hypothesized that the subsequent effect on the membranes may promote the development of depression.

Higher intakes of fish, EPA or DHA did not have a protective role against suicide in more severe situations and has not been associated with a lower risk for suicide in Japan, but women in Japan with very low intakes of fish, did have an increased risk of suicidal death.11

A search of the literature examining the therapeutic efficacy of essential fatty acids for depression was published in 2006.12 One double-blind placebo controlled RCT examined the use of omega-3 fatty acids in 30 men and women.13 The intervention group received 9.6 gm of omega-3 fatty acids from fish oil in addition to their standard pharmacological treatment for 4 months. A Kaplan-Meier survival analysis found that the fish oil group had a significantly longer period of remission than the placebo group and performed better than the placebo group in other outcome measures. Three case control studies of adults with major depression and non-depressed healthy adults all showed a definite difference in omega-3 polyunsaturated fatty acids (PUFAs) between depressed and non-depressed adults.14, 15, 16 A review article suggests that DHA is beneficial for depression as well as several other conditions.17 Another review article discussed the effects of dietary intake patterns on fatty acid balance and potential effect on mood.18

Other intervention studies have been done since the initial literature review that concluded in 2001. The only intervention trial up until that point was the Stoll study on bipolar disorder. Since then, RCT trials have been done that assessed the role of omega-3 PUFAs in the treatment of major depression. 2/g of DHA or placebo in 36 depressed patients found no significant difference between the DHA and the placebo, although there was a better overall response rate in the DHA group.19 In another of 28 patients with major depression, 9.6 g/day showed significant improvement compared to the placebo group.20 In a study of EPA, 1gm/day demonstrated significant improvement in two different depression scales compared to placebo and no further improvement was seen in higher doses of EPA than 1gm/day.21 A combination of EPA or placebo and conventional pharmaceutical antidepressant treatment in unipolar depression demonstrated that those in the EPA group had significantly better effects by the third week. In an eight weeks, single-blind placebo trial, peri or postmenopausal women with depressive disorders and hot flashes were given 6 gm/day of EPA and DHA. The response rate was 70% and a decrease of 50% or more on the Montgomery-Asberg Depression Rating Scale (MADRS).22

Several probable mechanisms may explain the link between EFAs and depression. EFAs can modify 5-HT receptors, serotonin and dopamine metabolism, lower monoamine oxidase B, modulate cytokine production and enhance signal transduction. The composition of cell membranes, neurotransmission and prostaglandin metabolism are all affected by the amounts of EFAs and while clinical trials are few, there is substantial laboratory and observational evidence of the correlation between low essential fatty acid levels and depression.

Bipolar disorder

It is generally thought that bipolar disorder involves an overactivity in the signal pathways of neurons. Omega-3 fatty acids are known to dampen this overactivitiy and a previous hypothesis was confirmed in a landmark study at Harvard Medical School. The double-blind placebo controlled study of men and women with bipolar disorder were given either seven fish oil capsules twice a day or a placebo of olive oil capsules.23 Each capsule contained 440 mg of EPA and 240 mg of DHA. More than twice as many individuals in the fish oil group completed four months of the study without a major episode of mania or depression than those in the placebo group. In addition, nine individuals in the placebo group had worsening depression during the study compared to none in the fish oil group. The average decline in depression rating was almost 50% in the fish oil group compared to an increase of 25% in the control group.

Schizophrenia

Research is limited but intriguing regarding the hypothesis and evidence that symptoms of schizophrenia may result from altered neuronal membrane structure and metabolism. Several studies have shown that individuals with schizophrenia often have low levels of particular EFAs necessary for normal nerve cell membrane metabolism.24 Although the evidence is small, one initial open label study indicating efficacy which led to two small double-blind pilot studies is encouraging. In the pilot study, EPA showed a statistical superiority over DHA and placebo on the total Positive and Negative Syndrome Scale (PANSS).25 In the first small study, 45 schizophrenic patients who were stable on antipsychotic medications but still symptomatic were treated with either PEA, DHA or placebo for three months.26 The EPA group’s PANSS was significantly superior to both DHA and placebo, and EPA was significantly superior to DHA for positive symptoms using the analysis of variance (ANOVA). In the second placebo-controlled study, only EPA was used, although antipsychotic medications were permitted if necessary.26 By the end of the study, 8 of the 14 patients on EPA were taking medications and all had improved PANSS scores, while all 12 on placebo were taking antipsychotic drugs.

It is surprising that EPA was the most therapeutic in the first study, given that DHA is a major constituent of neuronal membrane phospholipids. The positive results of these pilot studies and the observed abnormal PUFA and phospholipids metabolism in individuals with schizophrenia is supportive of the potential for the role of EFAs in prevention and management.

 Summary

 I look forward to more research on prevention and intervention with omega-3 fatty acids in mental health disorders. While three conditions were discussed in this article, there are other promising areas of research in the areas of aggressive behavior, personality disorders and attention deficit disorder. Psychiatric disorders, behavioral problems and neurodegenerative disorders are some of our society’s most prevalent and serious challenges. Dietary changes in decreasing saturated fats and increasing seeds and fish along with supplementation, particularly fish oil, hold great promise for improving our brain function and the diseases affected by health EFA metabolism and the brain.

Lastly, in the search for high quality fish oils, I recommend looking for products that perform and supply third party testing on peroxides, total oxidation, PCBs, heavy metals and dioxins.

Sources

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