Depressed Due to Vitamin Deficiency?

April 11, 2005

Several reports show a connection between depression and Vitamin E deficiency. There is a similar relation between depression and lack of Vitamin C and selenium. So far this gives food for thought.

Could it be that lack of vitamin E plays a role in depression? Something in that direction according to a preliminary Australian survey.

By: Vitality Council

References:
1. Owen AJ et al. Low plasma vitamin E levels in major depression: Diet or disease? Eur J Clin Nutr 2005;59:304-6.
2. Tiemeier H et al. Vitamin E and depressive symptoms are not related. The Rotterdam Study. J Affect Disord 2002;72:79-83.
3. Maes M et al. Lower seriúm vitamin E concentration in major depression. Another marker of lowered antioxidant defense in that disease. J Affect Disord 2000;58:241-6.
4. Benton D et al. The impact of selenium supplementation on mood. Biol Psychiatry 1991;29:1092-8.

www.nature.com/ejcn/index.html
www.sciencedirect.com
www.iom.dk

St. John’s Wort Outdoes Antidepressant Drugs

February 14, 2005

It is better to take St. John’s Wort than Anti-Depressant Drugs, even when suffering from a moderate to a severe depression. It not only works better but it has fewer side effects. But every second patient needs a double dose.”…

Taking St. John’s wort is better than taking antidepressant drugs, even in the case of moderate to severe depressions. The effect is better and it has fewer adverse effects. However, every other patients needs a double dose for the herb to be effective.

The fact that St. John’s wort can be used for other things than making schnapps has been known for some time. As early as in 1994 it turned out that the plant can be used for even serious depressions, and St. John’s wort has been an unlicenced herbal remedy for some time now.

On account of the usual hypocrisy of the authorities, the remedy is only approved for treating “melancholy, despondency, and sadness”; concepts that are not used in the scientific world of approved licensed medical drugs. It has been documented, however, that St. John’s wort is effective against depression; but the hyprocrisy forbids informing about this even though it is specifically the word of “depression” that is used in the scientific articles.

In Germany, the authorities are truthful and here, St. John’s wort has been officially approved for “mental disturbances, depressive conditions, anxiety, and nervous restlessness” since 1984.

For this reason, German doctors have used far more St. John’s wort than their British colleagues and have spared their patients of nausea, tiredness, impotence, oral dryness, dizziness, sleeplessness, and what else might come from using antidepressants – also called SSRI preparations. In Germany, St. John’s wort is prescribed twice as often as standard antidepressants.

So far, it has been known that St. John’s wort is just as effective against light depression as SSRI preparations and other antidepressants. When it comes to severe depressions, there has been more doubt about its effectiveness even though a study indicated that the effect was fully equal to prescription drugs. However, the study was too small for the results to be valid.

This uncertainty has now been removed. An unusually well accomplished German study performed with typical German thoroughness has documented that not only is St. John’s wort fully equal to the SSRI remedies; it actually outdoes them. In a study involving 244 severely depressed patients, St. John’s wort had both a better effect and caused fewer adverse effects than the widely used SSRI preparation paroxetine.

The study showed that adverse effects only appeared half as often in the group receiving St. John’s wort as in the group receiving paroxetine. After six weeks, the patients who had been treated with St. John’s wort noted a decrease in depression score of 57% while the patients who had been treated with paroxetine could only note a decrease of 45% – scored on the basis of the so-called Hamilton depression rating scale.

In all respects, this study lives up to the highest standards. There are therefore very strong reasons for preferring St. John’s wort to other remedies – in both mild and moderate to severe depression.

You should be aware of two things, however: First of all, the recommended dose in the over-the-counter drugs is generally too small: They advise you to take e.g. 3 – 6 tablets which gives you a total of 900 – 1800 mg of hypericin if the content of hypericin is 300 mg per tablet. The 900 mg is too small a dose.

In the German study, 900 mg was the starting dosage. Approximately every other patient had that dosage doubled after 14 days due to a lacking effect. This means that with Danish pills (450 milligrams hypericum / tablet) you either have to start with 2 and possibly increase to 4 tablets a day to get the same effect as the German trial subjects!

The second thing you should know is that St. John’s wort reduces the effect of several kinds of drugs, including prescription drugs such as contraceptive pills and anticoagulants. The reason for this is that St. John’s wort promotes the breakdown of the drugs in the liver. If you are taking any kind of medicine, you should consult your doctor before starting self-treatment with St. John’s wort!

By: Vitality Council

References:
1. Szgedi A et al. Acute treatrment of moderate to severe depression with hypericum extract WS 5570 (St Johns Wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ online 11.2.2005, page 1-6.
2. de Smet P.A.G. et al. St Johns wort as an antidepressant. BMJ 1996;313:241-2 (L).
3. Linde K et al. St Johns wort for depression – an overview and meta analysis of randomised clinical trials. BMJ 1996;313:253-7.

bmj.bmjjournals.com
www.iom.dk

Folic Acid: It Seems Wise to Take a Supplement

February 7, 2005

Folic acid reduces the blood pressure, but only if you take a folic acid supplement, as you will not get enough simply through your diet. At the same time, folic acid protects your heart and brain from blood clots.

Since long, it has been documented that the B-vitamin folic acid (B9) prevents congenital neural tube defects. In Canada, all kinds of flour have been enriched with folic acid during the past 8 years, and 80% of the congenital neural tube defects have thus been prevented. In the USA, enrichment is also obligatory, but in Britain, expectant mothers are left to themselves. They have to figure out for themselves to take a supplement – before they become pregnant!

The main source of folic acid is leafy green vegetables (the latin “folium” means “leaf”). Many people do not like these leafy greens and folic acid deficiency is therefore more common than any other vitamin deficiency. Unfortunately, the deficiency probably does not only harm the unborn baby but does also increase the mortality of coronary thrombosis and cerebral apoplexy in adults. But this is not all: Folic acid deficiency probably also increases the risk of hypertension.

The connection between folic acid deficiency and hypertension that has been unknown till now was discovered when an eight-year study was concluded involving 156,000 American nurses *1). The risk of the nurses having hypertension while being 27 – 44 years of age was only half as great when they took 1 mg (1000 mcg.) of folic acid a day compared to when they took 0.2 mg. In both the US and Britain, 0.2 mg. is just below the average daily folic acid intake which is 0.25 mg. It is almost impossible to get 1 mg. of folic acid a day – which is four times as much – without taking a supplement.

With regard to apoplexy and coronary thrombosis, much interesting knowledge has been produced during recent years:
In the US, where enrichment of flour with folic acid began in 1996, the mortality rate following apoplexy has droppped dramatically – in all groups of society, that is, and for both men and women – so the results are rather regardless of lifestyle, etc.

Before 1996, the annual drop in mortality as a result of apoplexy was about 1%. This drop was the result of improved treatment and prophylaxis. However, in the succeeding three years, mortality rates dropped three times as fast, i.e. with a total of 10 – 15%! Statistically, this has been explained by the fact that the average American now has twice as much folic acid in his/her blood as before *2).

Moreover, apoplexy is far more dangerous if you are deficient in folic acid. This was recently demonstrated on mice. They were given an artificial apoplexy in that their cerebral artery was simply clamped. It turned out that the cerebral damage was only half as great in the mice that had been given enough folic acid *3).

Folic acid seems to be able to protect the heart as well. This appeared most recently when Italian doctors studied 900 patients hospitalized with or without coronary thrombosis. The patients were divided into three groups according to their estimated daily intake of folic acid. Among the patients admitted to the cardiology department, most of them belonged to the group that got the least folic acid!

The third of the patients that got the least folic acid had twice as great a risk compared to the third of the patients that got the most folic acid. When vitamin B6 intake was also taken into account (vitamin B6 collaborates with folic acid), the ones who got the most folic acid only had a relative risk of 29% *4).

It is not the folic acid itself that protects the heart and the brain. However, folic acid reduces the blood content of the harmful amino acid homocysteine which attacks the blood vessels.

About 10% of the population are unaware that they have a hereditarily increased homocysteine level in their blood (and therefore need more folic acid). Recently, it was discovered that these 10% suffer apoplexy significantly more often than others *5, 6). It was already known that these people already have an increased risk of suffering coronary thrombosis *7).

Nobody has yet performed a blinded study in which supplements have been used to efficiently lower the blood contents of homocysteine. However, this kind of research is now being encouraged *8). Yet, with our existing knowledge, it seems wise to take a folic acid supplement. The ideal dosage may be around 0.8 mg. (800 mcg.) a day.

By: Vitality Council

References:
1. Forman JP, Rimm EB, Stampfer MJ, Curhan GC. Folate intake and the risk of incident hypertension among US women. JAMA. 2005 Jan 19;293(3):320-9.
2. American Heart Association’s 44th annual Conference on Cardiovascular Disease Epidemiology and Prevention.carole.bullock@heart.org
3. Endres M, Ahmadi M, Kruman I, Biniszkiewicz D, Meisel A, Gertz K. Folate deficiency increases postischemic brain injury. Stroke. 2005 Feb;36(2):321-5.
4. Taivani A et al. Folate and vitamin B6 intake and risk of acute myocardial infarct in Italy. Eur J Clin Nutr 2004;58:1266-72
5. Al-Delaimy WK, Rexrode KM, Hu FB, Albert CM, Stampfer MJ, Willett WC, Manson JE. Folate intake and risk of stroke among women. Stroke. 2004 Jun;35(6):1259-63.
6. Casas JP et al. Homocysteine and stroke: Evidence on a causal link from mendelian randomisation. The Lancet 2005;365: 224-32
7. Klerk M, Verhoef P, Clarke R, Blom HJ, Kok FJ, Schouten EG; MTHFR Studies Collaboration Group. MTHFR 677C–>T polymorphism and risk of coronary heart disease: a meta-analysis. JAMA. 2002 Oct 23-30; 288(16):2023-31.
8. S Schwammenthal et al. Homocysteine, B-vitamin supplementation, and stroke prevention. From observational to interventional trials. Lancet Neurol. 2004;3(8):493-5.

jama.ama-assn.org
www.lancet.com
stroke.ahajournals.org
www.iom.dk

Vitamin E Against Alzheimer’s Disease and Colds

October 11, 2004

The World’s leading experts in vitamin E participated in a congress in New York in the spring which was sponsored by the New York Academy of Sciences. The last time such a congress was held was in 1989 and some of the news have now been described in the October issue of the Academy’s scientific magazine.

It is astounding that we are still discussing nature’s purpose of Vitamin E. It can actually be difficult to find obvious deficiency symptoms in humans. However, it is certain that the vitamin is highly important. All higher animals – including fish – produce the protein TTT with the single task of transporting vitamin E in the blood. Natures probably would not have gone to such trouble of making a transport protein for a substance that the body could easily do without.

“When nature has chosen exactly alpha-tocopherol from the thousands of antioxidants in our surroundings, there must be a reason”, declared Angelo Azzi of the University of Bern. Vitamin E slows down the blood platelets when they are about to clog and form blood clots.

This is significant to the tendency of other cells to stick to each other, divide, and to send signals to each other. Furthermore, it increases the production of nitric oxide (NO) which is an important signalling molecule that relaxes the blood vessels and thereby lowers the blood pressure. How can we translate these fundamental abilities into something we can see and feel, though?

The participants at the congress presented results showing that Vitamin E delays Alzheimer’s disease. According to a French study, the combination of vitamin C and vitamin E can prevent the disease from occuring in the first place. The same combination of vitamins also prevents pre-eclampsia. Finally, a randomized trial has shown that vitamin E reduces the frequency of colds in elderly people by 25%.

A constant controversial question is why only a single randomized trial have been able to show that vitamin E prevents coronary thrombosis when there are so many other indications of this effect. The explanation could be that synthetic Vitamin E has often been used instead of natural vitamin E. Synthetic Vitamin E consists of eight different substances of which only a single one is present in nature.

Another reason might be that the Vitamin E has not been supplemented with vitamin C; automatic supplementation with Vitamin C happens in animals because of their ability to produce Vitamin C themselves.

However, the reason might also be that the participants of almost all the studies had been severely atherosclerotic from the start. “Once calcification has damaged an artery, the damage will heal very poorly”, professor Meydani of Tufts University, USA. Vitamin E is probably better at preventing than curing diseases!

Professor Maret Traber from Oregon estimates that 70 – 80% of all adults get less than the recommended 30 mg. of Vitamin E weekly. Her advice is to live healthily and that there is no harm in taking an extra Vitamin E supplement.
The exact reason for its beneficial effect will perhaps not be elucidated for another 15 years.

By: Vitality Council

Reference:
Hopkin K. New York Academy of Sciences Magazine 2004; October: 4-6.

www.nyas.org/publications
www.iom.dk

Overlooked B-vitamin Might Prevent Alzheimer’s Disease

September 27, 2004

In the search for substances that might prevent Alzheimer’s disease, the focus has mainly been on antioxidants like Vitamin E and Gingko biloba as well as the B-vitamins B12, B6, and folic acid. However, an American study now indicates that the quite unnoticed B-vitamin Niacin as being able to play a role too.

For 90 years, it has been clear that niacin is important to the nervous system and that severe niacin deficiency can cause dementia – as part of the deficiency disease pellagra. The wonder is that, until now, nobody has made a link between this kind of dementia and Alzheimer’s disease.

So far, the study has involved 6158 inhabitants of Chicago. They were all above 65 years of age and the plan was to register their diet and follow them every third year with psychological tests for dementia. They succeeded in doing so with 3718 of the trial subjects. Among these, 815 people who did not have Alzheimer’s disease at the beginning of the trial were randomly chosen. They were divided into five groups according to their intake of niacin.

131 people in the latter group were diagnosed with Alzheimer’s disease during the following four years. It turned out, however, that in the 20% who had the lowest intake of niacin (on average 12.5 mg. a day), the incidence of Alzheimer’s disease was more than three times as high compared to the ones with the highest intake (22.4 mg. a day or more). This was the result after statistical adjustments for known or suspected causes of the disease had been performed.

Both dietary niacin and niacin from vitamin tablets were included in the study. Good dietary sources of niacin are whole meal, liver, meat, fish, milk, legumes, – and coffee! Brewer’s yeast is also a good source of niacin, but, unfortunately, the same does not apply for beer! The average Englishman gets 2/3 of his niacin from meat, beverages, milk, and cheese, while only 1/8 comes from vegetables.

By: Vitality Council

References:
1. Morris MC, Evans DA, Bienias JL, Scherr PA, Tangney CC, Hebert LE, Bennett DA, Wilson RS, Aggarwal N. Dietary niacin and the risk of incident Alzheimer’s disease and of cognitive decline. J Neurol Neurosurg Psychiatry. 2004;75(8):1093-9.
2. National Food Agency of Denmark (Levnedsmiddelstyrelsen): Nutrient recommendations, 1992 (Naeringsstofanbefalinger, 1992).

jnnp.bmjjournals.com
www.fvst.dk
www.iom.dk

Q10 Prevents Migraine

July 26, 2004

The antioxidant Q10 is an efficient remedy for the treating of migraine without side effects. This has been demonstrated by Swiss researchers at the University Hospital in Zürich. The discovery was presented in San Francisco at a congress for neurologists immediately prior the summer holidays.

The Swiss study is the second successive study to show that Q10 prevents migraine. Two years ago, the treatment was tested in a so-called open trial at Jefferson University of Pennsylvania.

32 severely affected migraine patients were included – they had an average of eight migraine attacks a month. During the course of three months, they were each given 150 mg. of Q10 a day and the frequency of migraine attacks were gradually reduced to less than three a month.

The result from Pennsylvania made such a big impression that a more thorough study was found necessary. This study has now been completed in Switzerland as a randomized trial with 42 participants. Before the trial, the participants suffered an average of 4-5 migraine attacks a month.

During the trial, 50% of the participants were given placebo while the other 50% were given 300 mg. of Q10 divided into three doses a day. After three months, 48% of the ones who had been given Q10 had achieved a 50% reduction in the frequency of migraine attacks while only 14% of the placebo group achieved the same effect. As a net result, 36% had substancially benefited from the treatment. A result of this magnitude can certainly be compared with the best working of the presently used treatments.

The leader of the Swiss trial, the neurologist Peter S. Sandor, underlines the absence of adverse effects as a decisive factor – particularly to young women who might fear that the conventional treatment could have teratogenic effects.

However, the result also opens up to other interesting perspectives in the understanding of migraine. Q10 is a natural substance necessary to the cells’ energy production and the theory behind the study is that migraine may be caused by a lack of chemical energy in the nerve cells.

According to David Dodick, professor in neurology at the respected Mayo clinic in Arizona, this new study was well performed and the result is statistically robust. He believes that Q10 can be an attractive form of treatment to those who prefer a natural alternative to prescription drugs.

By: Vitality Council

Reference:
Sandor P. et al. Water-soluble Coenzyme Q10 demonstrates significant migraine prophylaxis. American Academy of Neurology. 56th Annual Meeting: Abstract S43.004, 2004.

www.aan.com/professionals
www.iom.dk

Inertia on folic acid has caused thousands of unnecessary deaths

May 17, 2003

As many as 350,000 deaths could have been prevented over the last decade if the UK government had acted on the compelling evidence for the benefits of folic acid, a conference was told last week. Had flour been fortified with folic acid when the evidence regarding neural tube defects was published, thousands of people would not have died from coronary heart disease.

Godfrey Oakley, visiting professor at the department of epidemiology at the Rollin School of Public Health of Emory University, Atlanta, said: “The failure to require mandatory fortification of flour with folic acid is public health malpractice.” He was speaking at a conference in London organised by Dr Jean-Pierre Lin, consultant paediatric neurologist responsible for the spina bifida services at Guy’s and St Thomas’s hospitals on behalf of the charity the Little Foundation and MacKeith meetings (a product of publishers MacKeith Press).

Recent evidence shows not only the benefits of folic acid in preventing neural tube defects but that it is protective against heart disease, strokes, deep vein thrombosis, and pulmonary embolism. Folic acid lowers concentrations of homocysteine, an amino acid that for about 15 years has been believed to be associated with heart attacks and strokes.

Dr David Wald, a cardiologist at Southampton General Hospital, said: “Until public health agencies fortify our diet with sufficient folic acid, people should consider taking an 800 µg supplement each day, especially if they have coronary heart disease.”

The Medical Research Council vitamin study was published in 1991 and gave compelling evidence that taking folic acid prevents up to three quarters of neural tube defects, such as spina bifida (Lancet 1991;338:132-7). Despite the publicity that the report generated, the incidence of neural tube defects has not declined in the United Kingdom over the last decade, despite quite a steep decline between 1970 and 1992.

The government recommends that women who are trying to conceive take 400 µg of folic acid a day. But experts point out that about half of pregnancies are unplanned, meaning that many women start taking the vitamin only once they find out they are pregnant or not at all. Specialists say that the optimal time for women to take the vitamin is from stopping contraception to 12 weeks after conception.

Public health doctors and charities such as the Association of Spina Bifida and Hydrocephalus have called on the UK government many times to fortify flour with folic acid. They point out that 39 countries around the world, including the United States and Canada, now either fortify flour or have agreed to do so, and that the rate of neural tube defects has fallen in these countries. In Nova Scotia, where fortification was implemented in 1998, the incidence fell from 2.58 per thousand people in 1991-7 to 1.17 per thousand people in 1998-2000 (Canadian Medical Association Journal 2002;167:241-5).

No country in the European Union, however, has yet decided to fortify flour. The folic acid working group of the European Surveillance of Congenital Anomalies is soon to publish a report, concluding that most women in Europe do not take folic acid around the time of conception, despite education programmes in some countries encouraging them to do so.

The group collated data from 17 countries showing that the overall incidence of neural tube defects in Europe has not declined over the 1990s. Even women who do take folic acid often do not start until after conception. The report will recommend that EU countries adopt a policy of fortifying flour with folic acid.

If flour were fortified at the recommended level on a worldwide scale 100 000 pregnancies resulting in neural tube defect would be prevented each year, according to Professor Nick Wald, of the St Bartholomew’s and the Royal London School of Medicine and Dentistry.

He said, “There is no evidence or reason to regard fortification at any of the doses proposed as a risk to health, and there is compelling evidence that failure to fortify causes considerable harm.”

The meeting was held the day before the UK’s Food Standards Agency issued a report warning people against taking too many vitamin supplements. The Birth Defects Foundation issued a press release urging women to keep taking folic acid, after receiving a flood of calls to its telephone.

By: Anna Ellis,

BMJ. 2003;326(7398):1054.