Cognitive Function - Folic Acid and Vitamin B12 Deficiency and Homocysteine

Folic Acid and Vitamin B12 Deficiency - Cognitive Function, Mental Deterioration, Alzheimer’s and Dementia Linked to High Homocysteine Levels.

Findings from a broad range of studies show significant relationships between cognitive function and intakes of various nutrients, including long-chain polyunsaturated fatty acids, antioxidant vitamins, and folate and vitamin B12. (Proc Nutr Soc. 2001 Feb;60(1):135-43).

In cross-sectional studies, elevated plasma homocysteine levels have been associated with poor cognition and dementia. An increased plasma homocysteine level is a strong, independent risk factor for the development of dementia and Alzheimer's disease. (N Engl J Med 2002; 346: 476-483)

Elderly people are a vulnerable population group to specific nutrient deficiencies such as vitamin B12 and folic acid, which are closely related to mental functions deterioration, especially of cognitive functions. Elderly were at risk of deficiency for both vitamins and age and mental function were associated with this risk. (Invest Clin. 2005 Mar;46(1):53-63).

Scientists from the National Institute of Aging believe folic acid may help prevent Alzheimer's disease. They say it may control a substance in the brain known to cause damage to nerve cells. The researchers found that mice on a diet deficient in folic acid had higher levels of the amino acid homocysteine. They believe the high levels of homocysteine damage the DNA of the nerve cells. (Journal of Neuroscience, 2002;22:1752-1762).

Doctors in the US analysed data on the diets of 579 people aged 60 or over from the Baltimore Longitudinal Study of Aging to identify the relationship between dietary factors and Alzheimer's disease risk. The researchers found those who consumed at least the recommended daily amount of 400 micrograms of folic acid had a 55% reduced risk of going on to develop Alzheimer's compared to those consuming under that amount. (BBC NEWS 15/8/2005).

Several researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston, Massachusetts, are looking into whether elevated blood levels of the amino acid homocysteine are involved in cognitive decline-and if so, how.

Folate Fortification

Folate is one of the B vitamins that affect the balance of homocysteine levels. A link between high blood folate levels and relatively lower homocysteine levels has long been known.

Epidemiologists Paul Jacques and Martha Morris, biochemist Jacob Selhub, and ARS-funded physician Irwin H. Rosenberg recently completed a study of the interrelationships among the B vitamins and cognitive function in this age of folate fortification.

B vitamins are involved in the synthesis of chemicals crucial to brain function. Scientists have long known that being seriously deficient in vitamin B12 leads to impaired cognitive function due to neurological complications. The researchers used a combination of blood markers to classify subjects’ vitamin B12 ranking.

Morris, who led the study, found that among people aged 60 and older, those with high blood levels of folate and normal, or adequate, vitamin B12 status scored high on cognitive function tests. These seniors were given a test that required response speed, in addition to attentiveness, visual-spatial skills, associative learning, and memory.

But what about those who had low vitamin B12 blood levels—a status that is common among seniors due to the poorer gastrointestinal conditions that come with aging? Low vitamin B12 status was linked with lower scores on cognitive tests.

“The people with high folate and low B12 status were more likely to exhibit both cognitive impairment and anemia than those with normal folate and low B12 status,” says Jacques.

The researchers recommend that future studies examine the implications of having high folate status due to fortification and too little vitamin B12 due to aging.

Population researcher Katherine L. Tucker is focusing on vitamins and cognition in a series of community-based studies.

In the Normative Aging Study, a longitudinal study of originally healthy men in the Boston area, she and colleagues found that those with the best B-vitamin status at the start, or baseline, had little change in their cognitive-function test scores. But test scores went down significantly in the men with the lowest baseline B-vitamin status and highest homocysteine concentrations.

Rosenberg and Tucker are also working with another high-risk group: homebound elderly. “The Nutrition, Aging, and Memory in Elders, or NAME, study is designed to look at the relationships among levels of several nutrients and subsequent cognitive function,” says Tucker.

“We are studying folate, vitamin B6, vitamin B12, vitamin C, and vitamin E intakes among this population, along with each individual’s cognitive functioning,” she says. The data generated may be useful in developing dietary strategies and supplementation targets to help the elderly maintain their cognitive function.

These and future studies are essential to determining whether-and to what extent-nutritional factors can be used to prevent cognitive impairment as we age.

Related articles:

Cinnamon Improves Cognitive Function

References:

Proc Nutr Soc. 2001 Feb;60(1):135-43.

N Engl J Med 2002; 346: 476-483.

Invest Clin. 2005 Mar;46(1):53-63

Journal of Neuroscience, 2002;22:1752-1762.

BBC NEWS 15/8/2005.

Rosalie Marion Bliss, Agricultural Research Service Information Staff, USDA, Agricultural Research Service News & Events. 14/11/2007.
Used with permission. Photo courtesy of the USDA, ARS.

What Causes Cataracts?

The World Health Organization (WHO) estimates that 17.6 million people are blind from cataracts. Cataracts cause about 48% of all blindness.

A study published in the journal Clinical & Experimental Ophthalmology aimed to estimate the number of Australians over 50 with cataract in the years 2001 and 2021. It was estimated that the number of persons with cataract will rise to 2.7 million by 2021 (over 500,000 will have had cataract surgery). (Clinical & Experimental Ophthalmology, Volume 31, Number 3, June 2003 , pp. 233-236(4)).

A cataract is a clouding of the eye's lens. The lens is mostly made of water and protein. The protein is arranged in a specific way that keeps the lens clear and lets light pass through it. As we age, some of the protein may clump together and start to cloud a small area of the lens.

The most common type of cataract is a nuclear cataract. Nuclear cataracts occur when proteins of the nucleus (centre) degenerate and darken, causing light to scatter.

An important alliance occurs between a protein-degrading enzyme, called a proteasome, and a smart, omnipresent protein referred to, not surprisingly, as ubiquitin. Collectively called the “ubiquitin-proteasome pathway,” it helps balance the concentration of proteins within cells.

This balance is important because some proteins need to be cleared from the body’s cells, for example, after having become oxidized.

ARS-funded biochemists Allen Taylor and Fu Shang have reported findings about the workings of the ubiquitin-proteasome pathway that hold important implications for eye health. Both scientists are with the Laboratory for Nutrition and Vision Research at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, Massachusetts. Taylor heads the laboratory.

When damaged proteins gather within the eye’s lens, cloudiness occurs. These opacities are called cataracts. The protein buildup could also lead to age-related macular degeneration.

Taylor and Shang have found that an accumulation of damaged proteins indicates a breakdown of the protective ubiquitin-proteasome pathway.

How Does It Work?

Within cells, ubiquitin identifies and attaches to proteins that are ripe for degradation and removal. The resulting “ubiquitin-conjugated proteins” latch onto the proteasome enzyme, which degrades the proteins.

“During the last process of the pathway, the ubiquitin is recycled,” says Taylor.

Efficient removal of denatured proteins within the eye lens—or their repair by other proteins—is crucial for maintenance of lens transparency. When the lens accumulates too many damaged proteins, the resulting cataracts cause blindness.

Taylor, Shang, and colleagues were the first to observe the pathway in cells within the eye’s lens, retina, and cornea and have reported those findings in Experimental Eye Research, The Journal of Biological Chemistry, Investigative Ophthalmology and Visual Science, and other journals.

Obstructing the Pathway

The researchers have also shown that free radicals—highly active molecules that damage cells—actually attack ubiquitin, other components of the pathway, and other healthy proteins in the eye. Such activity wipes out the benefit-giving pathway.

Free radicals churn in the body as a result of normal metabolism as well as insults such as pollution and ingested toxins (think excessive alcohol or smoke).

“The ubiquitin-proteasome pathway acts as a defense system against oxidative stress,” says Shang, “but the pathway itself could be damaged by severe oxidative stress. Antioxidants, such as vitamins C and E, and antioxidant enzymes, such as superoxide dismutase and catalase, may play an important role in protecting the pathway.”

Taylor and Shang are now examining ways in which antioxidant nutrients might keep the pathway active longer.

Reference:

Rosalie Marion Bliss, Agricultural Research Service Information Staff. USDA, Agricultural Research Service.

Photo courtesy USDA, ARS.

Related articles:

Age Related Macular Degeneration – The Link to Fast-Acting Carbohydrates

Depression and Repressed Memories in the Aged

Depression may be caused by Repressed Memories in the Aged. Deprogramming repressed memories through encouragement counselling and using certain kinds of cognitive skills and abilities.

Repressed memories of past life experience can lead to depression in the aging population, according to a professor at Kansas State University.

Leon Rappaport, professor of psychology at K-State, said sometimes, in later life, a memory of a person or event from years earlier can trigger feelings of guilt, remorse or anxiety and lead to depression.

"Memories come back from occasions when the person may have done something they regret or have reasons for feelings of guilt," Rappaport said. "Frequently, this sort of thing may occur when people recall remote events or they are reminded of times when they may have behaved badly."

The recollection of repressed memories from years past is, according to Rappaport, caused by the deterioration of brain function as a result of the loss of neurons in the brain. This causes a shift in the ability to remember.

"Things that happened recently are easily forgotten and confused, but there are vivid images and memories of things that may have happened 50 or 60 years earlier," Rappaport said. "Cognitive control tends to deteriorate somewhat, and the consequence is that you don't get as much effective repression as earlier on."

Most often, Rappaport said these memories come in the form of a dream. Their causes, however, can vary greatly according to the individual.

"Sometimes it is brought on by them seeing someone that reminds them of someone else they knew long ago," Rappaport said. "Very frequently, it's family related."

Rappaport said the confusion of present with past events, or confabulation, often can trigger the recollection of repressed memories. Even this, however, can take different forms.

"Sometimes, an older person may meet someone new and confuse that person with someone they knew 50 years ago or they may see a film with actors who have been dead for a long time," Rappaport said. "Sometimes, anything that comes along like that can trigger recollection."

These conditions can be prevented and remedied through a number of different treatments. One way is through encouragement counselling.

"It is typically done to encourage the person to, not exactly relive, but to review their experiences," Rappaport said. "Just by talking about it, you reduce the feelings of guilt or anxiety and help them accept that nobody's perfect and everyone makes mistakes in life. They can forgive themselves."

Another way Rappaport said depression brought on by recollection of repressed memories can be averted is through adherence to the old adage of "use it or lose it." This includes keeping the mind sharp in abilities like mathematics and language, which help to maintain fit mental condition in later life.

"People who don't use certain kinds of cognitive skills and abilities just lose that skill that they had," Rappaport said. "Whereas if they keep up with whatever it is that they do with the abilities that they have, then those abilities tend to remain in pretty good shape."

Another way this type of cognitive maintenance can be achieved is through new technology. Rappaport said e-mail offers many older people an avenue for new knowledge, challenges and communication with others.

"E-mail becomes a type of social stimulation, so there's a lot of effort in that direction," Rappaport said. "That gives people new knowledge and stuff to talk about and new content to communicate, and that encourages this sense of remaining up with the contemporary culture."

Source: http://www.mediarelations.k-state.edu. News release prepared by: Jeff Caldwell. For more information contact Rappaport at 785-532-0616 or e-mail at [email protected]. Used with permission.

Pregnancy and Vitamin D Deficiency

It is well recognised that maternal vitamin D deficiency during pregnancy and during the period of breastfeeding contributes to the development of rickets in infancy.

However, seizures in infants during the first month after birth caused by a deficiency of calcium in the blood, as a consequence of maternal vitamin D deficiency is not well described in western societies.

In 1991, the Committee on Medical Aspects of Food Policy recommended that all pregnant and lactating mothers should receive 10 micrograms vitamin D (400 IU) daily (Department of Health Dietary reference values for food energy and nutrients for the United Kingdom London: HMSO 1991. Report on health and social subjects 41).

This policy has not been implemented widely.

It is not uncommon to find vitamin D insufficiency in otherwise, healthy pregnant women.

Infants born to such mothers have reduced umbilical cord blood concentrations of 25-hydroxycholecalciferol (the first step in the biologic conversion of vitamin D3 to the more active form, calcitriol. It is more potent than vitamin D3).

In addition, breast milk contains only about 1 microgram of vitamin D per litre. This varies according to maternal vitamin D status (Am J Dis Child 1985, 139:1134-7).

Infants born to mothers who are deficient in vitamin D and or calcium, usually due to cultural modifications in their diets or clothing habits, and in addition are breastfed, are at risk of developing vitamin D deficiency and a deficiency of calcium.

Researchers from Queensland, Australia, and the UK presented a case in the September 2007 issue of Nutrition Journal of neonatal seizures (seizures in an infant during the first month after birth) secondary to hypocalcaemia (a deficiency of calcium in the blood) where the only other abnormal findings were low vitamin D levels both in the infant and in the mother, and low levels of calcium in the baby.

Case Presentation

A one week old, full term male infant presented to Accident and Emergency with generalised seizures. He was exclusively breast fed since birth. Both parents were vegetarians, from Asian origin, and mother dressed in her cultural customs, where most of her body was covered. Mother was neither taking nutritional, nor vitamin supplements during pregnancy.

Physical as well as neurological examinations were within normal limits. His parents had recorded the "attacks" by video camera, and tonic-clonic generalised movements were well identified on the screen. Magnetic resonance imaging of the brain was normal. Electroencephalography showed no epileptiform phenomenon.

Other than low vitamin D and calcium levels all other laboratory results (liver function tests, urea and electrolytes, C reactive protein, lumbar puncture, blood culture, lactate) were normal.

Baby did not receive anti-epileptic medications.

Within 6 hours of admission, once the initial laboratory tests became available, the patient was commenced on vitamin D (100 nanograms/kg once a day, which were reduced to 50 nanograms/kg/day after 1 week), and calcium supplements (0.25 millimole/kg/day).

(Note: Very small amounts were administered for a very young baby).

After four days the calcium levels had returned to normal. He remained on vitamin D until ten weeks of age and then was changed onto Abidec 0.6 mls/day (vitamin A, B, C and D supplement).

His seizures ceased within three days of starting treatment.

After 6 months, the baby was doing well, with normal calcium levels and normal total vitamin D levels, and his development was according to his chronological age.

Our case illustrates the importance of checking the calcium levels in neonates (infants during the first month after birth) who present with seizures and in those found to have a deficiency of calcium in the blood to check their vitamin D status as this is an easily correctable condition.

Extracted and adapted from: Laxmi Camadoo, Rebecca Tibbott and Fernando Isaza. Maternal vitamin D deficiency associated with neonatal hypocalcaemic convulsions. Nutrition Journal 2007, 6:23doi:10.1186/1475-2891-6-23. © 2007 Camadoo et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)


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Pregnancy and Depression Seeking Support – Part 5

Pregnancy and Depression Seeking Support. Management and treatment of their depression. Support from husbands, parents, siblings and friends?

Intervening condition that influenced becoming the best mom that I can.

The condition that intervened and influenced becoming the best mom that I can was the type and degree of support that women perceived to be available to them. Most women in this study were in stable marital relationships and described their husbands as providing (in the main) practical and emotional support.

Their husbands accompanied them, on at least one occasion, to the psychiatrist, and participated in discussions about treatment strategies.

However, being seen by their husbands as “not having a grip on things” was upsetting and embarrassing for the women. Some women were not entirely convinced that their husbands, as supportive as they were, were totally aware of the depth of their emotional problems.

He boosts me up, but at the same time, sometimes I feel like he's
really missing the point sometimes, or do you really know that I
am really struggling here to keep it together.

Three women perceived their partners to be unsupportive. Those women actively excluded their partners from participation in, or discussion of, the management and treatment of their depression.

Few women described seeking support from parents or siblings. The majority delayed telling their families about their depression until after they had sought professional care; some women did not want to be a “burden”, others were “ashamed”. A number of women, who described their parents as being very ill or their families of origin as “dysfunctional”, delayed, avoided, or simply were unable to discuss their concerns.

None of the women sought support from friends. Many were embarrassed about how they were feeling, convinced that they would not be understood, and feared that they would be “judged”:

I mean it felt like a failure to me. I felt if I told my friends, I felt
like I might be judged by it.

We’re pretty judgmental about mothers; I mean mothers are the
worse culprits, mothers judging other mothers. Then non-mothers
judging non-mothers, and sometimes I think women are
harder on each other than men are.

Unable to talk to others, the women’s sense of loneliness and their sense of “being the only one” was intensified.

Strategies for becoming the best mom that I can - Confronting and confining the threat.

In the presence of the contextual and the intervening conditions, the women began the process of confronting and confining the threat. For the women in this study, that process involved seeking care from a psychiatrist experienced in the field of reproductive mental health and consisted of three stages: Overcoming barriers, Gaining knowledge, and Taking control. Each stage was composed of several properties.

Stage 1. Overcoming barriers

Facing personal obstacles
Women who had not experienced depression prior to pregnancy struggled to understand what was happening and challenged themselves saying, “there is no reason – there is no physical reason why I couldn’t do more”. (#20) They were ashamed and concerned that they would be viewed by others as being “incredibly lazy”, or “wanting attention”, and that what they were feeling would not be seen as “real”. The act of asking for help was seen to be an admission of failure:

So, just swallowing my pride and going outside of the home, was
a big step. Once I committed to saying that I have to tell someone, it was easier. (#16) (Note: As mentioned in Part 1, confidentiality was maintained by assigning each participant a code number).

For some women, feelings of shame continued unabated throughout the period of their treatment. One woman explained how she felt when attending her scheduled appointments with the psychiatrist as:

Even when I was going to the psychiatrist in the hospital, I was
worried that I would run into somebody. (#10)

Navigating the healthcare system
Having committed to telling someone the women approached their obstetric care provider or their family physician for help. For many, this resulted in being referred directly to a mental healthcare professional. One woman, who had been under the care of a midwife, said:

They [midwives] were fantastic. I don’t know what I
would have done, really and honestly had I not had them
noticing stuff and asking me questions, because I was really, really withdrawn. They actually gave me a referral and all of that. (#4)

Others encountered obstacles as they endeavored to navigate the health care system.

“Obstetricians were regularly considered to be “too busy” or to have “zero interest in me as a person”. Women perceived that “there really wasn’t time to talk” with their obstetricians about their emotional health and that they were considered as “purely a body”. One woman, who had a particularly difficult time finding professional help said:

I guess she didn't have time for the counseling or to look into it,
to talk to me further about it. She made it clear from the
beginning that if you had any other medical problems other than
pregnancy, that you would have to see your other doctor. (#15)>

Making a connection

Making a connection with “the right” mental health professional was not immediate for all women. Because of their fear of not being believed, they needed to speak to someone who would understand and not judge.

They needed “somebody who specializes in this area”, someone who “recognized the complexity of my life as a woman and a mother”, that they felt was “asking me the right questions”, who was “understanding, sympathetic” and one who had “the time to listen”.

One woman “instantly felt better” because there was a good connection with her psychiatrist. Some women felt more comfortable when they were able “to speak to a woman”. As one woman stated:

Someone that I could tell my problems to and who won't judge
me, who won't say you are bad. I mean just imagine someone
sitting there and you're getting to spill the beans, and knowing
that whatever you say is going to be confidential. She's not
going to criticize you. (#17)

Women who did not make a connection with the healthcare provider simply stopped seeing them. As one woman said, “Well, I tried to find other therapists, and I saw one intermittently, and I feel like it's not really that helpful, so haven't continued in that.” (#11)

Part 6 will be published soon.

The researchers were Heather Bennett, Heather Boon, Sarah Romans and Paul Grootendorst. The above is a partially modified reproduction of their research. Also their references have been omitted for ease of reading.

Related articles:

Dealing with Depression during Pregnancy – Part 1

Depression During Pregnancy – Part 2

Women With Depression During Pregnancy – Part 3

Pregnancy: Depression, Antidepressant Drugs and The Baby – Part 4

Depressed? Drink Tea

Reference:

Bennett HA, Boon HS, Romans SE, Grootendorst P. Becoming the best mom that I can: women's experiences of managing depression during pregnancy – a qualitative study. BMC Women's Health 2007, 7:13 (11 September 2007). © 2007 Bennett et al., licensee BioMed Central Ltd.
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Omega 3 Fish Oil and Depression

Omega 3 Fish Oil and Depression - A number of studies have found decreased omega-3 content in the blood of depressed patients. Omega-3 fatty acids play a critical role in the development and function of the central nervous system. Emerging research is establishing an association between omega-3 fatty acids (alpha-linolenic, eicosapentaenoic, docosahexaenoic) and major depressive disorder.

This article includes the effects of eicosapentaenoic acid (EPA) in depressive symptoms, premenstrual syndrome, anorexia nervosa syndrome, bipolar depression, borderline personality disorder and agoraphobia.

Evidence from epidemiological [population], laboratory and clinical studies suggest that dietary lipids [fats] and other associated nutritional factors may influence vulnerability and outcome in depressive disorders. Research in this area is growing at a rapid pace.

The goal of this report is to integrate various branches of research in order to update mental health professionals.

Major depressive disorder (MDD) is a recurrent, debilitating, and potentially life threatening illness. Over the last 100 years, the age of onset of major depression has decreased, and its overall incidence has increased in Western countries.

The increases in depression, up to 20-fold higher post 1945, cannot be fully explained by changes in attitudes of health professionals or society, diagnostic criteria, reporting bias, institutional or other artifacts.

Despite advances in pharmacotherapy, and the increasing sophistication of cognitive/behavioural interventions, there are many patients with major depressive disorder who remain treatment resistant.

Depression is undoubtedly an extremely complex and heterogeneous condition. This is reflected by the non-universal results obtained using cognitive-behavior and antidepressant medications.

As research continues to mount, it is becoming clear that neurobiology/physiology, genetics, life stressors, and environmental factors can all contribute to vulnerability to depression.

While much attention has been given to genetics and life stressors, only a small group of international researchers have focused on nutritional influences on depressive symptoms.

Collectively, the results of this relatively small body of research indicate that nutritional influences on major depressive disorder are currently underestimated. (Note: Since this review a great deal of studies on nutritional influences, such as omega-3 fish oils, have confirmed the role of nutrition in depression).

Omega-3 fatty acids in particular represent an exciting area of research, with eicosapentaenoic acid (EPA) emerging as a new potential agent in the treatment of depression.

Dietary fish and seafood provide varying amounts of pre-formed EPA and DHA.

Science Daily reported in February 2006 that Dr. Cunnane, a metabolic physiologist at the University of Sherbrooke in Quebec, stated that something had to start the process of brain expansion and he thinks it was early humans eating clams, frogs, bird eggs and fish from shoreline environments. “This is what created the necessary physiological conditions for explosive brain growth," says Dr. Cunnane. Her study of fossil material excavated from numerous Homo habilis sites in eastern Africa revealed a bevy of chewed fish bones, particularly catfish. (Science Daily 22/2/2006).

The dietary intake of omega-3 fatty acids has dramatically declined in Western countries over the last century. The North American diet currently has omega-6 fats outnumbering omega-3 by a ratio of up to 20:1. There are a number of reasons for this skewed ratio, most notably the mass introduction of omega-6 rich oils into the food supply, either directly or through animal rearing practices

The ideal dietary ratio of omega-6 to omega-3 has been recommended by an international panel of lipid experts to be approximately 2:1 [9]. Given that approximately 20% of the dry weight of the brain is made up of polyunsaturated fatty acids (PUFA) and that one out of every three fatty acids in the central nervous system are PUFA, the importance of these fats cannot be argued.

Considering that highly-consumed vegetable oils have significant omega-6 to omega-3 ratios, it is quite plausible that, for some individuals, inadequate intake of omega-3 fatty acids may have neuropsychiatric consequences.

A number of epidemiological (population) studies support a connection between dietary fish/seafood consumption and a lower prevalence of depression. Significant negative correlations have been reported between worldwide fish consumption and rates of depression.

Examination of fish/seafood consumption throughout nations has also been correlated with protection against post-partum depression, bipolar disorder and seasonal affective disorder.

Separate research involving a random sample within a nation confirms the global findings, as frequent fish consumption in the general population is associated with a decreased risk of depression and suicidal ideation.

In addition, a cross-sectional study from New Zealand found that fish consumption is significantly associated with higher self-reported mental health status.

The epidemiological (population) studies which support a connection between dietary fish and depression clearly do not prove causation. There are a number of cultural, economic and social factors which may confound the results. Most significantly, those who do consume more fish may generally have healthier lifestyle habits, including exercise and stress management. Despite the limitations, the epidemiological data certainly justify a closer examination of omega-3 fatty acids in those actually with depression.

A number of studies have found decreased omega-3 content in the blood of depressed patients. Furthermore, the eicosapentaenoic acid (EPA) content in red blood cell phospholipids is negatively linked with the severity of depression, and the omega-6 to EPA ratio positively correlates with the clinical symptoms of depression.

Relationships between omega-3 status and post-partum depression have also been investigated. In a cohort of 380 Australian women, blood plasma DHA was investigated at 6 months post-partum. Logistic regression analysis indicated that a 1% increase in plasma docosahexaenoic (DHA) was associated with a 59% reduction in the reporting of depressive symptoms.

It is well known that during pregnancy there is a significant transfer (up to 2.2 g/day) essential fatty acids (EFAs) to the developing fetus. Increased risk of post-partum depressive symptoms has recently been associated with a slower normalization of DHA levels after pregnancy.

Suicide attempts have also been associated with low levels of red blood cell EPA. In a study involving 100 suicide attempt cases in China compared to 100 hospital admission controls, there was an eightfold difference in suicide attempt risk between the lowest and highest red blood cell EPA level quartiles.

The seasonality of depression and suicide has been described by investigators, with more deaths in spring and summer vs. autumn and winter. Total serum cholesterol has been highly significantly synchronized with the annual rhythms in violent suicide deaths. Recently, investigators found that EFA levels also vary by season. The authors of this study suggest that the seasonal variation in EPA or DHA may, in part, explain seasonality of violent suicide occurrence.

The overlap between cardiovascular disease and depression has also been noted, with omega-3 status emerging as a common thread.

Major depression in acute coronary syndrome patients is associated with significantly lower plasma levels of omega-3 fatty acids, particularly DHA. In addition, elevated homocysteine levels, a known risk factor for cardiovascular disease, has been associated with the excess omega-6 fatty acids found in the Western diet.

Finally, lowered intake of the parent omega-3 alpha linolenic acid has been associated with depression in 771 Japanese patients with newly diagnosed lung cancer.

It is important to note that not every study supports an association between lowered omega-3 status and depression.

The epidemiological (population) and laboratory studies, along with the research which shows depressed patients appear to have lowered omega-3 status, have naturally led to clinical investigations.

A number of case reports have appeared in the literature, the first of which was over 20 years ago. In this initial series of case reports, flaxseed oil (source of the parent omega-3 ALA) at various dosages, was reported to improve the symptoms of bipolar depression and agoraphobia.

An additional case report documented an improvement in depressive symptoms during pregnancy with the use of 4 g EPA/2 g DHA per day. Interestingly, improvements in symptoms occurred at four weeks, and with the exception of insomnia and anxious thoughts, all symptoms resolved at six weeks.

A series of case reports also suggest that 1-4 g of pure eicosapentaenoic acid (EPA) may be helpful in anorexia nervosa, a condition with the highest risk of morbidity and mortality among psychiatric disorders. In all six of the cases, EPA was reported to improve mood to varying degrees. For some, discontinuing EPA therapy resulted in deteriorations in mood and other psychiatric symptoms.

An interesting study examined fish oil vs. marine oil extracted from Antarctic krill in premenstrual syndrome. Krill is similar to fish oil, with the exception that it contains naturally-occurring phospholipids, and contains more EPA per gram than standard fish oil capsules (240 mg/g EPA in krill vs.180 mg/g in standard fish oil).

In the 3-month trial, 70 patients received 2 g of krill oil or 2 g fish oil daily for one month, then for eight days prior to, and two days during, menstruation for the following two months.

Evaluation at 45 days and three months showed that krill oil significantly improved depressive symptoms of premenstrual syndrome. The absence of significant effects of fish oil on mood suggests that the presence of the phospholipids and/or higher amounts of EPA may be responsible for the therapeutic effect of krill oil.

There have been some controlled studies that have examined omega-3 fatty acids and a placebo intervention in depression. The first small clinical study with 30 participants showed that four months of treatment with 9.6 g of omega-3 fatty acids (6.2 g EPA/3.4 g DHA) was of therapeutic value in bipolar disorder. Specifically, this study showed a highly significant effect in treating depression.

In a separate double-blind, placebo-controlled study with 22 participants, the addition of 2 g of pure EPA to standard antidepressant medication enhanced the effectiveness of that medication vs. medication and placebo. This 3-week study, involving patients with treatment-resistant depression, showed that EPA had an effect on insomnia, depressed mood, and feelings of guilt and worthlessness. There were no clinically relevant side effects noticed.

In a small pilot study involving 30 participants, Harvard researchers found that just 1 g of EPA could reduce aggression and depressive symptom scores among borderline personality disorder patients. The results of this 2-month, placebo-controlled study are encouraging, given the difficulty in treating borderline personality disorder. It is also of note that 90 percent of participants remained in the study and no clinically relevant side effects were noticed with EPA.

In a double-blind, placebo-controlled trial over two months, high dose fish oil (9.6 g/day) was added to standard antidepressant therapy in 28 patients with major depressive disorder (MDD). In this study the patients who received the omega-3 fish oil capsules had a significantly decreased score on the HRSD compared to those taking the placebo. Once again, the fish oil, even at this high dose, was well tolerated with no adverse events reported.

Various doses of pure EPA have also been investigated in depression. In a 12-week, randomized, double-blind, placebo-controlled study, 70 patients were given ethyl-EPA at doses of 1g, 2g or 4g.

The patients in this case had experienced persistent depression, despite ongoing standard antidepressant pharmacotherapy at adequate does.

Interestingly, in this study, "less was more." Those in the 1g per day group had the best outcome. The patients who received 1 g per day of EPA were the only group to show statistically significant improvements. Among the 1 g/day group, 53 percent achieved a 50 percent reduction in HRSD scores.

The 1g EPA led to improvements in depression, anxiety, sleep, lassitude, libido, and suicidal ideation. These findings suggest that omega-3 fatty acids can augment antidepressant pharmacotherapy and/or alleviate depression by entirely different means than standard medications.

To date, the published data on supplementation with pure EPA on major depressive disorder or depressive symptoms have been positive.

With regard to docosahexaenoic (DHA) or a combination of EPA and DHA, there have been three negative reports.

A trial on DHA alone as monotherapy in the treatment of major depressive disorder was recently reported. In this study, 2g pure DHA or placebo was administered to 36 patients with depression for six weeks. The response differences between the groups did not reach statistical significance.

In an open label pilot study, the combination of 1.7 g of EPA and 1.2 g of DHA failed to show benefits among seven women with a past history of post-partum depression. The omega-3 monotherapy was initiated between the 34th-36th week of pregnancy and was assessed through 12 weeks post-partum. In these women the fish oil combination did not reduce the risk of relapse.

Finally, a pure docosahexaenoic (DHA) supplement, at low doses of 200 mg per day for 4 months post-partum, did not improve self-rated or diagnostic measures of depression over placebo. However, the 89 women enrolled in this study were not clinically depressed as a group, which precludes interpretation that DHA is ineffective in post-partum depression.

Other dietary considerations

It is important to consider the nutrients which can ultimately influence omega-3 status. Among them, four important dietary factors also relate to major depressive disorder: zinc, selenium, folic acid and dietary antioxidants.

A number of studies have shown that zinc levels are lower among patients with depression and a recent study found that 25 mg zinc supplementation may improve depressive symptoms.

Interestingly, 25 mg of zinc supplemented for two months has also been shown to significantly increase omega-3 status in the plasma phospholipids at the expense of saturated fat.

Lowered levels of selenium have been associated with negative mood scores in at least 5 studies. Selenium plays a significant role in the human antioxidant defence system. In addition, selenium deficiency can interfere with the normal conversion of alpha linolenic acid (ALA) into eicosapentaenoic (EPA) and docosahexaenoic (DHA), and results in an increase in the omega-6:omega-3 ratio.

Regarding folic acid, a growing body of research has documented the low levels of folic acid among patients with depression.

In addition, there are small clinical trials showing a beneficial effect of folic acid in depression, and its ability to enhance the effectiveness of antidepressant medications at just 500 mcg. It is of relevance here because folic acid has been shown to increase omega-3 status when supplemented, and decrease omega-3 status when it is in deficiency in the animal model.

Given the current excess intake of omega-6 rich oils, and the emerging research on omega-3 fatty acids and major depressive disorder, all mental health professionals should at least ensure adequate intake of omega-3 fatty acids among patients with major depressive disorder. The current average North American intake of EPA and DHA is approximately 130 mg per day, well short of the minimum 650 mg recommended by the international panel of lipid experts.

While it is not necessary for mental health professionals to become clinical nutritionists, consideration of a patient's dietary quality may be worthwhile. Hopefully future research will determine if dietary modifications or supplementation can influence the outcome of standard care.

Related articles:

ADHD: Fish oil increases attention, reduces hyperactivity, restlessness and impulsivity

Dealing with Depression during Pregnancy – Part 1

Depression During Pregnancy – Part 2

Women With Depression During Pregnancy – Part 3

Pregnancy: Depression, Antidepressant Drugs and The Baby – Part 4

Depressed? Drink Tea

Extracted and modified from: Alan C Logan, “Omega-3 fatty acids and major depression: A primer for the mental health professional”. Lipids in Health and Disease 2004, 3:25 (9 November 2004).

© 2004 Logan; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0).

Diabetes - Alpha-Lipoic Acid and Neuropathy

Diabetes - Alpha-Lipoic Acid and Neuropathy - One of alpha-lipoic acid's primary uses is to treat nerve damage, including diabetic neuropathy, a dangerous long-term complication of diabetes that causes pain and loss of feeling in the limbs.

Alpha lipoic acid enhances glucose uptake in type 2 diabetes, inhibits glycosylation (the abnormal attachment of sugar to protein), and has been used to improve diabetic nerve damage and reduce pain associated with that nerve damage. (Free Radic Biol Med 1995;19:227-50).

Over the past 20 years, the number of adults diagnosed with diabetes has more than doubled, and children are being diagnosed with diabetes in alarming numbers. Diabetes has rapidly emerged as a leading culprit in the epidemic of heart disease that is sweeping the country, and it is a leading cause of amputation and blindness among adults.

As a powerful antioxidant, alpha lipoic acid positively affects important aspects of diabetes, including blood sugar control and the development of long-term complications such as disease of the heart, kidneys, and small blood vessels. (Arzneimittelforschung. 1995 Aug;45(8):872–4; Free Radic Biol Med. 1999 Aug;27(3-4):309–14; J Am Soc Nephrol. 2002 Jan;13(1):108–16; Diabetes Care. 1995 Aug;18(8):1160–7; Biochem Biophys Res Commun. 2005 Jan 7;326(1):197–202).

Lipoic acid plays a role in preventing diabetes by reducing fat accumulation. In animal studies, lipoic acid reduced body weight, protected pancreatic beta cells from destruction, and reduced triglyceride accumulation in skeletal muscle and pancreatic islets (Expert Opin Investig Drugs. 2004 Dec;13(12):1641–3; Biochem Biophys Res Commun. 2005 Jan 7;326(1):197–202).

It's difficult, however, to obtain therapeutic amounts of this vitamin like substance through diet alone. Instead, many experts recommend using supplements to get the full benefits of alpha lipoic acid.

Alpha lipoic acid is an approved treatment for diabetic neuropathy in Germany. Many studies in both animals and humans have produced promising results with lipoic acid in preventing diabetic neuropathy. It has been used for years for this purpose in Europe.

German researchers, reporting in the Journal Free radical biology & medicine, conducted a placebo-controlled study of 72 patients with type-2 diabetes. Some participants were supplemented with alpha-lipoic acid in various doses while the others were given a placebo (sugar pill).

They concluded that the results suggest oral administration of alpha-lipoic acid can improve insulin sensitivity by 25% after 4 weeks of treatment in patients with type-2 diabetes. All benefited from lowered glucose levels. There were no significant differences among the three doses of Alpha lipoic acid, suggesting that 600 mg/day may be the maximum effective dose. (Free Radic Biol Med. 1999 Aug;27(3-4):309-14).

Alpha lipoic acid speeds the removal of glucose from the bloodstream, partly by enhancing insulin function, and it reduces insulin resistance, a foundation of many cases of coronary heart disease and obesity.

In the treatment of diabetes, the recommended dose is 300 to 600 mg daily. Alpha lipoic acid supplementation is very safe. In over 30 years of extensive use and testing in European clinical trials in the treatment of diabetic neuropathy, there have been no reported side effects. (Quillin,1998, Murray, 1996).

Because alpha-lipoic acid has been associated with improved blood sugar control, people with diabetes should follow their blood sugar levels carefully when taking this supplement in order to avoid hypoglycemia (low blood sugar). Your doctor may decide that a reduction in dosage of insulin or oral blood sugar-lowering drugs is needed if you are taking this supplement.

It should also be noted that 600 mg/day doses were mainly used for diabetic neuropathy. Lower doses can be effective in diabetes blood sugar control, especially when included with other products such as gymnema, vanadium, bitter melon, fenugreek and chromium (which itself helps prevent and possibly reverse diabetic neuropathy).

Many healthcare practitioners suggest a limit of 100 milligrams per day unless specifically advised for a specific condition such as diabetes.

Alpha lipoic acid has a dual role in human health; it is a powerful antioxidant and is a key component for producing cellular energy. It is involved in the metabolic process of converting carbohydrates into energy. Carbohydrates, protein and fat are all broken down and formed into ATP, the universal energy source used by the body.

Alpha-lipoic acid assists the body’s energy production and acts as a powerful antioxidant, helping to treat diabetic neuropathy (nerve-damage caused by the disease), protecting the liver, preventing cataracts, boosting immune function, and possibly helping to slow the progression of Alzheimer’s disease. Because alpha-lipoic acid can pass easily into the brain, it has protective effects on brain and nerve tissue and shows promise as a treatment for stroke and other brain disorders involving free radical damage.

It has been suggested that alpha lipoic acid may slow aging of the brain and that it may be an anti-aging substance in general.

In the November 2006 edition of Diabetes Care, researchers from Russia and Israel reported on a 5 week randomized, double-blinded, placebo-controlled trial using alpha lipoic acid in 181 patients suffering with high blood sugar and damaged nerve endings.

Researchers measured various symptoms including stabbing and burning pain, tingling and numbness in the feet in these patients who suffered with malfunction of the peripheral nerves. The groups that received alpha lipoic acid 600 mg to 1,800 mg daily had an overall reduction in symptoms by about 50% compared to the placebo group. (Diabetes Care. 2006 29: 2365-2370).

Evidence indicates that 150 mg of alpha lipoic acid, taken daily for one month, improves visual function in people with glaucoma. (Vestn Oftalmol 1995;111:6-8).

Researchers have demonstrated, in a 16-week randomized trial, that lipoic acid, in oral doses of 600 milligrams daily for eight weeks, significantly inhibits the oxidation of LDL-cholesterol in healthy humans.

In addition, our supplies of several different antioxidants, including vitamins E and C, cannot be successfully maintained in the absence of lipoic acid. It appears to recycle available vitamin C and E.

Other antioxidants seem to benefit equally from the presence of lipoic acid. These antioxidants include coenzyme Q, glutathione, and NADH (a form of niacin). Because lipoic acid is used to help regulate blood sugar, individuals with diabetes may be at special risk of deficiency. (Worlds Healthiest Foods).

Conclusions from various studies – From 2004 - 1992:

Alpha-Lipoic acid supplementation represents an achievable adjunct therapy to help prevent vision loss in diabetic patients. (Diabetes. 2004 Dec; 53(12): 3233-8).

The blood pressure-lowering effect of lipoic acid in fructose rats may be related to improvement in insulin sensitivity. (J-Comp-Physiol-[B]. 2004 Nov; 174(8): 587-92).

The combined antioxidant and hypoglycemic (lowering the concentration of glucose in the blood) actions of lipoic acid both may contribute to its utility in preventing renal (kidney) injury and other complications of diabetes. (J-Am-Soc-Nephrol. 2002 Jan; 13(1): 108-16).

These data indicate that lipoic acid is effective in the prevention of early diabetic glomerular injury (capillary blood vessels in the kidneys) and suggest that this agent may have advantages over high doses of either vitamin E or vitamin C. (J-Am-Soc-Nephrol. 2001 Jan; 12(1): 124-33).

…recent trials have demonstrated that lipoic acid improves glucose disposal in patients with type II diabetes. In experimental and clinical studies, lipoic acid markedly reduced the symptoms of diabetic pathologies, including cataract formation, vascular damage, and polyneuropathy [Polyneuropathy is a neurological disorder that occurs when many peripheral nerves throughout the body malfunction simultaneously]. (Nutrition. 2001 Oct; 17(10): 888-95).

The results suggest that oral administration of alpha-lipoic acid can improve insulin sensitivity in patients with type-2 diabetes. (Free-Radic-Biol-Med. 1999 Aug; 27(3-4): 309-14).

These data provide evidence that treatment with alpha-lipoic acid improves significantly the imbalance between increased oxidative stress and depleted antioxidant defence even in patients with poor glycemic control and albuminuria. (Free-Radic-Biol-Med. 1999 Jun; 26(11-12): 1495-500). Albuminuria is the presence of excessive protein (chiefly albumin but also globulin) in the urine; usually a symptom of kidney disorder.

In conclusion, intravenous treatment with alpha-lipoic acid (600 mg/day) over 3 weeks is safe and effective in reducing symptoms of diabetic peripheral neuropathy, and oral treatment with 800 mg/day for 4 months may improve cardiac autonomic dysfunction in NIDDM [non insulin dependant diabetes mellitus – type 2 diabetes]. (Diabetes. 1997 Sep; 46 Suppl 2S62-6).

This is the first clinical study to show that alpha-lipoic acid increases insulin stimulated glucose disposal in NIDDM [non insulin dependant diabetes mellitus – type 2 diabetes]. The mode of action of ALA and its potential use as an anti-hyperglycemic agent require further investigation. (Arzneimittelforschung. 1995 Aug; 45(8): 872-4).

These results suggest a potential for the therapeutic use of lipoic acid against diabetes-induced complications. (Free-Radic-Res-Commun. 1992; 17(3): 211-7).

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Men’s Health Issues in Australia – Policy Concerns

Men’s Health Issues in Australia – Defining men’s health as a policy problem.

In Australia professional interest in men’s health has grown markedly over the past decade. The last two years alone has seen both the Australian Medical Association and the Royal Australian College of General Practice release position statements relating to men’s health.

The Medical Journal of Australia even dedicated a special edition to men’s health in October 2006. While there are inconsistent ways of defining men’s health, a common concern raised in almost all recent scholarship relating to men’s health in Australia is the lack of commitment to developing and implementing men’s health policies at state and federal levels. This concern is best summarised by Greg Malcher the National Convenor of GPs4Men who claims:

Australia still has no national men’s health policy, despite the existence of a women’s health policy since 1989. It would be naïve to suggest that simply developing a policy would be sufficient to deal with all the challenges of men’s health – policy without adequately funded programs = “piffle”. Yet, for those of us involved in men’s health, there remains an overwhelming desire to see a formal acknowledgement by the federal government (whether a policy, position statement or other document) of the broad and unique issues of men’s health, and a preparedness to fund a national program to address these issues.

Currently, New South Wales is the only state in Australia to have succeeded in producing a men’s health policy document that has been endorsed by a state Health Minister. It is worth noting, however, that this document - Moving Forward in Men’s Health - was never explicitly labelled as a policy.

This is a clear indication of the reluctance to use the word policy in the context of men’s health. So why is there a reticence to implement state and national men’s health policies in Australia and what can be done to rectify this significant public health concern?

Firstly, debates relating to men’s health policy development in Australia are not new. Indeed, there has been ongoing policy discussion at state and federal levels for quite some time.

A review of relevant literature reveals that many draft men’s health policy documents have been developed during the past two decades, but that there have been major impediments to their formal endorsement and subsequent implementation.

There are four broad issues relating to the preclusion of men’s health policy from state and federal agendas in Australia. These relate to medical dominance, the lack of a men’s social movement, the Australian political and policy climate, and aspects of Australian men’s culture.

Other commentators have argued that the lack of a well articulated theoretical orientation to direct men’s health policy development has been problematic. Divergent, narrow or inadequate definitions of men’s health have also hindered policy responses. It is this latter concern that I discuss in this paper.

Defining men’s health: A policy problem

‘Men’s health’ is a term frequently used by the media, academics, health practitioners and the general public. However, there are subtle differences between how men’s health can, or should, be defined.

While there is a wide recognition that men’s health extends beyond male-specific conditions of the reproductive organs, such as prostate problems, testicular concerns and erectile dysfunction, these concerns have remained a prominent feature of the international discourse relating to men’s health.

Epidemiological data has also been a central feature of men’s health commentary, with comparisons between the status of men’s and women’s health predominating this discussion.

These definitions have contributed to a broader conceptualisation which suggests that men’s health is perceived as being akin to a disease or condition unique to men, more prevalent in men, more serious among men, for which risk factors are different for men or for which different interventions are required for men. Yet, even this definition has its limitations.

More recent commentary has drawn attention to the usefulness of understanding men’s health in relation to social and economic determinants of health. As such, health equity has become a central focus of this contemporary men’s health discourse, where an emphasis has been placed on shifting resources towards the most vulnerable and disadvantaged groups of men.

Other considerations which complicate efforts to define men’s health have also emerged, such as the burgeoning body of research relating to hegemonic masculinity and multiple masculinities. At this juncture it is worth considering what this definitional dilemma means for men’s health policy development in Australia.

Collectively these understandings of men’s health raise concern over whether men’s health policy discussion should be focused on mainstream men’s health issues – where all men are perceived to be the same, vulnerable groups of men – where variation between men is acknowledged, or perhaps both?

Irrespective of the policy approach advocated, the above evidence clearly demonstrates that a broader, more appropriate view of men’s health is needed to develop a comprehensive national policy.

One way of embedding a broader conceptualisation of men’s health into the current policy discussion, and one which has remained almost entirely absent from this discussion to date, is the inclusion of lay perspectives of health.

There is no academic scholarship originating in Australia, of which the author is aware, that specifically links men’s lay perspectives of their health with key policy concerns relating to men’s help seeking practices, health service use and the way in which men navigate the current health system.

Closing the gap: Lay knowledge in men’s health policy discussion

Public health commentators have argued that there is a need to move beyond traditional forms of scientific knowledge to guide development of both healthy public policy and local public health programs. In particular, previous commentary has shown that lay perspectives are particularly useful in understanding and addressing significant public health concerns.

Moreover, qualitative studies exploring lay knowledge are considered to be more persuasive in influencing policy makers than expert knowledge. When there are differences in perspective among stakeholders in how to address particular health issues, as is the case in men’s health, there is a need to explore the interface between professional and community understandings to maximise potential health gains.

A criticism of the discourse employed by health professionals about men’s health - particularly that associated with hegemonic masculinity - has been the perpetuation of a ‘men behaving badly’ stance. The inclusion of lay perspectives of men’s health increases the capacity to move beyond this male-deficit model by providing an opportunity to understand men as real people, who live, work and play within multiple communities.

To provide a more persuasive men’s health policy argument in Australia, and to facilitate a broader conceptualisation of what men’s health constitutes, male consumer viewpoints ought to be considered when describing men’s health.

Yet, specific empirical data on male lay perspectives of health and well-being have largely remained absent in research on men’s health, and this has been a contributing factor that has stalled the development and implementation of men’s health policy in Australia.

Indeed, successes in women’s health policy development in Australia have arisen out of a political discourse that has paid particular attention to women’s lived experiences. While it would seem sensible to conduct such research with men, there has been limited stimulus to determine men’s understandings of health and well-being in Australia. Yet, this has not been the case in other parts of the world.

There is a growing body of public health research emerging from the Republic of Ireland, Scotland and England which has shown an appreciation of lay perspectives of men’s health. This has assisted in understanding how ‘health’ is conceptualised differently between marginalised groups of men, such as gay men and disabled men. More importantly this has been used to describe their differential use of health services.

For example, the way in which men interpret, and respond to their chest pain, or the way in which men conceptualise their health, particularly in relation to risk. While there is little evidence of the effective translation of this research into policy discussion, potential exists to do so.

Interestingly, gender sensitive care in Britain has been supported by a policy emphasis on the importance of eliminating inequalities in the provision of health care, which intersects with this type of exploratory research. Likewise, men’s health discussion papers considered to be precursors to the development of a men’s health policy in the Republic of Ireland have also paid attention to the ways men define certain aspects of their health.

Conclusion

The aim of improving the health status of men should, undoubtedly, be focused on developing valid and reliable data on men’s perceptions of their health, their health practices and their health needs. More importantly this data must be used to advocate for, and frame, emerging men’s health policy responses in Australia. Of course, there are other considerations such as financial constraints and shifting timescales that influence this approach.

However, it is time for Australian men’s health researchers, practitioners and policy makers to consider the achievements of their colleagues in the UK and the Republic of Ireland to adopt a consumer-focused public health response to develop and implement a national men’s health policy here in Australia. Political will is required to make this happen.

The author of this paper dedicated it to a dear colleague of his, the late Gary Bowes, who was an inspirational and passionate men’s health advocate.

Reproduced in part from (references omitted for ease of reading): James A Smith. Addressing men's health policy concerns in Australia: what can be done? Australia and New Zealand Health Policy 2007, 4:20 doi:10.1186/1743-8462-4-20.

© 2007 Smith, licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Physical Activity or Exercise? - Making a New Year's Resolution

Being fit in the New Year does not have to mean going to the gym.

MANHATTAN - When starting a new fitness program this year, David Dzewaltowski recommends focusing on the term "physical activity" as opposed to "exercise."

Dzewaltowski, head of the department of kinesiology at Kansas State University, said the word "exercise" may conjure up ideas of a workout at the gym or a structured aerobics dance class.

"I like to give people the term 'physical activity' to talk about or think about when making a New Year's resolution," Dzewaltowski said. "It puts the focus on increasing activity throughout the day rather than limiting yourself to thinking structured exercise is the only option. It might be a good option for some people, but it's not the only option."

The goal is to accumulate 30 minutes of exercise each day. This could mean taking three 10-minute walks per day, shoveling the driveway or working around the house, he said. Or, it could mean going to the exercise club and participating in structured exercise.

"Most people set a goal that's way too difficult," Dzewaltowski said. "It's not really how hard you exercise that is the key to achieving some of the things people want from exercise - like improved health or weight loss.

The key is really sticking with exercise. You're better doing a little bit for three to six months or a year, than doing a lot and getting tired and sore and quitting after two weeks."

Dzewaltowski said a good way to put more activity into each day is to start realizing what modern industrial society has taken out of our lives. We used to have to walk for transportation, labor physically at work, and, when it was time for recreation, we also played physically, he said.
Now we might drive right up to the door of our office, have a sedentary job, and when we go home, we do a sedentary activity, like watch television.

Some of the health benefits of regular exercise are well-known, like the reduced risk of cardiovascular disease, Dzewaltowski said. However, recent studies are showing exercise will reduce the risk for some cancers, such as colon cancer. Anxiety and depression are also shown to decrease with regular activity.

But besides disease prevention, exercise will help prolong the general quality of life for many individuals.

"What that means is they are able to function and do daily living tasks at a greater level of performance than people who are not active. They can carry their groceries, go to the store and shop and work in their garden.

They can do the recreation that people think they're going to do when they retire - the things a lot of people find they can't do because they haven't maintained their health well enough so they can do those daily living activities."

Used with permission.

Pregnancy: Depression, Antidepressant Drugs and The Baby – Part 4

Depression During Pregnancy – Depression Deepens – Doubt: Can they cope throughout the pregnancy and after the baby is born. Perceived consequences of depression and antidepressant use and the baby. Conflicting information provided by physicians and psychiatrists.

Phenomena resulting from traveling into despair - Conceiving the threat.

This category represents the phenomena that result from the conditions encountered in traveling into despair. It occurs when the women try to make sense of their feelings and are unable to do so. Their ability to understand what is happening wanes as the symptoms of depression continue unabated.

Initially, the women “denied a lot of the stuff, kept it in, denied it, deluded myself and just kept going.” They attributed their emotional state to being “too busy at work” or “I’m just pregnant, nothing is wrong”.

The women described their efforts to maintain a sense of normalcy in their lives as “putting on a happy face”. By denying or ignoring what they were feeling they were able, at least for the short term, to pretend to themselves and to those around them that everything was on track. “So, that’s what I do, I wear a mask for people, so be it.”

As the women failed to improve they attempted to alleviate the way they felt by meditating, tuning out, and turning to comfort food. One woman, who found relief by watching television said, “It would be the only way that I could tune my brain out, stop the thoughts, you know, thinking”.

However, none found the relief for which they were searching. Despite their best efforts their coping strategies were not adequate. This was explained as, “Normally you can kind of problem solve your way out of it, but there was just no problem solving”.

They acknowledged “that there was something wrong”, that they “can’t do it anymore” and they saw themselves as needing help. They feared that the depression was “a risk for the baby more than it is for me”, they made the decision that they will “deal with this, and do whatever I have to do” to be “better before this baby comes.” All women described an urgency that they attend to their depression prior to the birth of their baby.

The core categories of the subjective phenomena are; Loss of control, Altered perception of self, and Doubting maternal ability.

Loss of control
A frightening loss of control permeated every aspect of the women’s lives. They were unable to control their feelings, emotions, thoughts, and actions. The practicalities of the everyday were seen to be outside of their control; they had difficulty imagining how they would cope throughout the pregnancy and after the baby was born.

It was really frightening. I felt out of control. The anxiety that
that provoked for me was just like right over the top. I thought
how am I ever going to function, how can I possibly get through
the entire pregnancy like this. (#18) (Note: As mentioned in Part 1, confidentiality was maintained by assigning each participant a code number).

Altered perception of self
The women looked to the familiar to try to come to grips with how they were feeling. They compared the current self with the previous self, with previous pregnancies and with others who were pregnant.

You see other pregnant women are jogging, buying baby clothes,
working up until the last possible moment. You think why aren't
I doing that. (#20)

For all women the current self was in conflict with their image of the pregnant self; many no longer recognized the current self as the old self.

I think that's initially what got me down the path, was just
thinking this isn't like me. (#20)

Doubting maternal ability
Many questioned their ability to mother, their decision to become pregnant in the first place, their ability to continue with the pregnancy, and they lacked hope for the future.

I just questioned a lot of like what am I doing, why am I
pregnant, why did I try to get pregnant. (#16)

In addition, many women believed that their antenatal depression would harm their developing baby; they feared that they would develop postpartum depression (PPD), and that they would be unable to care for their family and the coming baby.

I just had lots of fears that I wasn’t going to be able to be a mom,
because I sometimes felt so disabled. (#24)

Context in which the strategies of becoming the best mom that I can developed.

The strategies employed by the women in becoming the best mom that I can developed within the following interacting contexts: duration and intensity of depressive symptoms, perceived consequences of depression and of antidepressant use, personal, interpersonal, and societal influences, and availability of information.

These contexts, which were influenced by both the causal conditions and the resultant phenomena, were paradoxical and interacted to create a tension that intensified the women’s uncertainty about their strategies.

The women saw themselves as “getting worse”, when they had “more bad days than good”. Many described a depression so intense that it “affected every minute of the day” and that they “couldn't see it ending”.

They compared how they were feeling to their expectations of pregnancy which were shaped by past experiences and from what they had read in “pregnancy books, parenting magazines, and talking to others who were pregnant”.

Women who had been pregnant previously and had not experienced depression recognized their mood as inconsistent with their previous pregnancy. It was that knowledge that helped them to determine their need for professional help.

Women who had experienced depression and its management prior to pregnancy had the knowledge that enabled them to assess their level of depression. They recognized when they needed to seek professional help and they had intimate knowledge of the effect of counseling and antidepressant use on their mood.

For women who were expecting their first baby and had not been depressed prior to pregnancy the decision was based upon their expectations. Many imagined the pregnant self would be “all roses and just so excited and everything”.

I think that I had this expectation that when you are pregnant
everything is rosy and perfect, and you are aglow. All these things
we’re sort of led to believe. So, I think when reality hit, I felt like
c..p. (#13)

On the other hand, personal, interpersonal, and societal influences, and availability of information acted as obstacles to their actions. Some women were embarrassed to seek care, others experienced difficulties forming therapeutic alliances with healthcare providers.

Some women were fiercely “against medications” and others feared that they would be judged to be a bad mother if they took antidepressants while pregnant. When information provided by physicians and psychiatrists conflicted, women were confused and uncertain as to their course of action.

Part 5 will be published soon. Support from husbands, parents, siblings and friends?

Realted articles:

Dealing with Depression during Pregnancy – Part 1

Depression During Pregnancy – Part 2

Women With Depression During Pregnancy – Part 3

The researchers were Heather Bennett, Heather Boon, Sarah Romans and Paul Grootendorst. The above is a partially modified reproduction of their research. Also their references have been omitted for ease of reading.
Reference:

Bennett HA, Boon HS, Romans SE, Grootendorst P. Becoming the best mom that I can: women's experiences of managing depression during pregnancy – a qualitative study. BMC Women's Health 2007, 7:13 (11 September 2007). © 2007 Bennett et al., licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Green Tea: Weight Loss and Fat Burner

Green Tea and Dieting - Loose Weight and Burn Fat

A new study shows that drinking green tea may fight fat. The study showed that people who drank a bottle of tea fortified with green tea extract every day for three months lost more body fat than those who drank a bottle of regular oolong tea.

Researchers say the results indicate that substances found in green tea known as catechins may trigger weight loss by stimulating the body to burn calories and decreasing body fat.

The findings appear in the January issue of the American Journal of Clinical Nutrition.

Green Tea: Fat Fighter?

Black tea, oolong tea, and green tea come from the same Camellia sinensis plant. But unlike the other two varieties, green tea leaves are not fermented before steaming and drying.

Most teas contain large amounts of polyphenols, which are plant-based substances that have been shown to have antioxidant, anticancer, and antiviral properties.

However, green tea is particularly rich in a type of polyphenols called catechins. These substances have also been shown to have anti-inflammatory and anticancer properties, but recent research in animals show that catechins may also affect body fat accumulation and cholesterol levels.

In this study, researchers looked at the effects of catechins on body fat reduction and weight loss in a group of 35 Japanese men. The men had similar weights based on their BMI (body mass index, an indicator of body fat) and waist sizes.

The men were divided into two groups. For three months, the first group drank a bottle of oolong tea fortified with green tea extract containing 690 milligrams of catechins, and the other group drank a bottle of oolong tea with 22 milligrams of catechins.

During this time, the men ate identical breakfasts and dinners and were instructed to control their calorie and fat intake at all times so that overall total diets were similar.

After three months, the study showed that the men who drank the green tea extract lost more weight (5.3 pounds vs. 2.9 pounds) and experienced a significantly greater decrease in BMI, waist size, and total body fat.

In addition, LDL "bad" cholesterol went down in the men who drank the green tea extract.

The catechin content varies by amount of green tea used and steeping time. But general recommendations, based on previous studies on the benefits of green tea, are at least 4 cups a day. Green tea extract supplements are also available.

Researchers say the results indicate that catechins in green tea not only help burn calories and lower LDL cholesterol but may also be able to mildly reduce body fat.

"These results suggest that catechins contribute to the prevention of and improvement in various lifestyle-related diseases, particularly obesity," write researcher Tomonori Nagao of Health Care Products Research Laboratories in Tokyo, and colleagues.

SOURCE: Nagao, T. American Journal of Clinical Nutrition, January 2005; vol 81: 122-129.