Many New Zealanders start their day with a nutritious breakfast and a nutritional supplement or two for good measure.  While multivitamin and mineral tablets are a useful way of covering all the nutritional bases, specific nutrient therapy has  has much to offer in restoring balance to a frayed or depressed nervous system.

It is widespread knowledge that omega-3 essential fatty acids offer health giving benefits to the heart and cardiovascular system.   What is less widely known is their positive therapeutic effect in both the prevention and treatment of anxiety and depression.   EPA and DHA are components of the naturally occurring Omega-3 fatty acids found in fish oil.  Both EPA and DHA  are essential for healthy function of neurons, and low DHA levels are associated with accentuated stress response in the brain and nervous system, along with low levels of the neurotransmitter serotonin. This is important as depression is sometimes rather simplistically referred to as a “serotonin deficiency” syndrome. 

Depressed people often have lower than average levels of omega-3 content in their blood, and supplementing with high doses of fish oil frequently reduces depression and anxiety symptoms, even in people already using antidepressants.  Patients unresponsive to treatment with SSRI’s  often respond to the drugs when  omega-3′s and folate (a B vitamin) were added to their drug regime.  Women suffering from aggression and hostility related to Borderline Personality Disorder have been shown to have a marked decrease in mood reactivity when supplemented with 1g of EPA daily.  As little as 1000mg of fish oil a day can reduce symptoms of sadness, anxiety and insomnia in depressed people.

With the obsessive media emphasis on boosting dietary calcium intake, it’s not surprising that one of our most common mineral deficiencies escapes unnoticed. Australian studies found the daily intake of magnesium to be below the RDI for 50% of males tested, and 39% of women. Magnesium is found in grains and vegetables (and dairy products), but only when they are grown in magnesium rich soils.  Depleted soils, combined with food processing and a low intake of leafy green vegetables leads to magnesium deficiency.  Then there’s the magnesium depleting effects of the nightly glasses of wine, sipped to calm jangled nerves.  Stress stimulates the production of stress hormones which increase the amount of magnesium we flush down the toilet every time we pass water.  In a “catch-22” cycle, the resulting magnesium deficiency then causes an exaggerated release of these same stress hormones.   Have you ever sat in front of your computer screen and noticed an annoying rapidly twitching muscles in your eye lid?  Or woken at night with a leg in the vice like grip of cramp?  Other symptoms of low magnesium levels include depression, anxiety, restlessness, irritability, PMS, menstrual cramps and insomnia.

While magnesium supplements have been shown to decrease anxiety and depression, the results are even more dramatic when combined with B complex nutrients, especially vitamins B6 and folate. Boosting B vitamins can have a direct effect on the availability of important neurotransmitters in the brain, such as serotonin, norephinephrine and dopamine – the brain chemicals involved with regulation of mood.

5-HTP and SAM-e are two of the supplements supreme when it comes to the nutritional  treatment of depression and anxiety.  5-HTP is a natural derivative from an amino acid, and is a metabolic precursor to the neurotransmitter serotonin, vital for normal mood regulation.  Some studies have shown 50mg a day of 5-HTP to be as effective or better than the SSRI antidepressant Fluoxatine, with no negative side effects.  5-HTP works like SSRI drugs which increase the availability of serotonin in the junctions between brain neurons, by blocking the cell’s re-uptake.  Unlike SSRI’s 5-HTP also increases the availability of norepinephrine, which increases energy and alertness and dopamine, which increases the feelings of wellbeing.

SAM-e or S-adenosylmethionine is a molecule found naturally occurring in the body, but notably lower in people suffering from mood disorders.  There have been 40 mostly European studies involving 1400 depressed patients, that generally show SAM-e to elevate mood within a matter of days, with virtually no side effects.  The typical supplemental dose is 400mg twice daily, which has been increased to 1600mg a day in a number of studies.  A 1994  analysis of existing studies, done at the University of Rome concluded “the efficacy of SAM-e in treating depressive syndromes and disorders is superior to that of placebo and comparable to that of standard tricyclic antidepressants.  Since SAM-e is a naturally occurring compound with relatively few side-effects, it is a potentially important treatment for depression”.

A final note of caution.  If you are already taking antidepressant drugs do not stop or change your medication without medical supervision.  To obtain maximum benefit from clinical nutrition in the treatment of anxiety or depression, work with a health professional trained in clinical nutrition

Take broccoli for example, that green and crunchy vegetable loathed by children throughout the ages. My kids would flatly refuse to eat this nutritional goldmine when they were little. Brocoli is a rich source of a phytonutrient called d-glucarate, with proven powerful anti-cancer qualities, by enhancing the liver’s ability to detoxify toxins and pollutants. Regular intake of broccoli is associated with a reduced risk of lung, gastrointestinal and breast cancers. Another superfood cancer fighter found in this humble green vegetable is sulforaphane. This compound blocks the formation of tumours caused by chemical carcinogens, and actually causes cancer cells to die off. Sulforaphane also supports the important phase II liver detoxification enzyme systems. An even more potent way of receiving these broccoli health benefits is to add broccoli sprouts to your salads daily, as they contain 30 – 50 times more of these protective chemicals compared with broccoli itself.

As we’re talking green things and cancer prevention, we cant go past mentioning the powerfully antioxidant rich green tea as a vital addition to your healthy diet. This traditional dietary staple of the orient is bursting with antioxidant compounds, the most important of which is a polyphenol called EGCG. Test tube studies show that these compounds potently cause cancer cells to self destruct, while leaving healthy cells unaffected. Studies with animals show these same compounds inhibit the formation of cancerous tumours in the skin, lungs, liver, stomach, breasts and colon. That cup of steaming hot green liquid is not only working in the fight against cancer. Green tea is also an ally for your cardiovascular health, as EGCG helps to reduce the oxidation of “bad” LDL cholesterol, and it is this oxidation that increases the likelihood of LDL cholesterol actually sticking to artery walls and causing clogging. The more green tea you sup, the lower your risk of cardiovascular disease, including high blood pressure. If you’re worried about your gradually increasing blood glucose levels, start drinking 4 cups of strong green tea a day and you could well see blood sugar begin to drop.

If I’ve convinced you about the merits of green tea, invest in a tea pot and some quality green tea leaves. Don’t use the decaffeinated green tea as it is lower in naturally occurring antioxidants. Make the tea in the pot, ensuring the water is hot, but not boiling. Boiling water will make your tea taste bitter and unpalatable. Pour on your water, pop on the tea cozy and leave to steep for ten minutes before drinking, for maximum health benefits.

While supplementing with fish oil often doesn’t produce huge changes in total or LDL (bad) cholesterol levels, it works in a myriad of powerful ways to safeguard cardiovascular health.

In April 2005 the Archives of Internal Medicine published a review looking at the effects of various cholesterol lowering drugs, on overall mortality, and also death from cardiovascular disease in particular.  Researchers looked at 97 different trials, involving almost 140,000 treatment subjects, and just as many controls.  In other words, this was a significant analysis!

Researchers were interested in seeing the individual protective cardiovascular effects of using statins; fibrates or resins (all drugs used to lower cholesterol): dietary change; and supplementation with fish oil.

They found that fibrates showed no protective effect in terms of overall mortality.  Diet, resins and niacin all appeared to provide insignificant benefits (that really surprises me… diet showed no benefit?). It was the statins and the fish oil that came out tops in terms of lowering both overall mortality (from all causes), and the risk of cardiovascular related death.  And which intervention stole the title of most powerful cardiovascular protector?  Contrary to what you may have expected, it was fish oil that came out on top. 

Statin use lowered overall mortality by 13%, while fish oil achieved a 23% decrease.  What about the effect specifically on cardiovascular mortality?  Again, fish oil was the most powerful intervention, with a 32% decrease in mortality, compared with the 23% seen with statin use.

The take home message from this analysis, is that simply seeing lower numbers on a cholesterol test, is not the full picture when it comes to lowering cardiovascular risk.   Fish oil only reduces total cholesterol levels by a puny 2%, compared with a 20% reduction with statin use.  But preventing a heart attack or stroke is a lot more complex than simply lowering cholesterol levels. 

Fish oil, works to protect your cardiovascular health by reducing the likelihood of heart arrhythmias (irregular or rapid beats);  preventing blood clots by making your blood less sticky; and reducing inflammation in the blood vessels.  There are many studies which demonstrate that it’s not so much the presence of cholesterol in the arteries that increases your risk… it’s when that cholesterol becomes oxidized by free radicals, leading to arterial inflammation that your troubles start.  Fish oil works powerfully to preventing this cardiovascular inflammation.  As little as 2000mg a day of high purity fish oil confers these cardiovascular health benefits.

Two of the most common chronic diseases effecting women later in life are the “brittle bone” disease, osteoporosis; and cardiovascular disease including arterial plaquing or “clogging”.  Did you know that there is a direct connection between these two conditions, and women that develop osteoporosis are more likely to also have arterial disease… and the reverse is also true – women with arterial disease are more likely to develop osteoporosis?   Atherosclerosis involves hardening and calcification of the linings of the arteries, while osteoporosis involves the loss of calcium from the bones.

“What could possibly explain this connection”?, I hear you ask!  Well here’s a clue… the cells lining your arteries are multifunctioning, and as you age, these cells (called endothelial cells) can actually take on a new guise, and become osteoblasts (the cells that regulate your bone formation).

Two vital nutrients help to ensure the health of both your arteries and bones.  Vitamins K and D work together to ensure healthy calcification of your bones, and to prevent calcium deposition on blood vessel walls, where it will cause hardening and arterial disease.  One of the nutritional features shared by both arterial hardening, and osteoporosis is low blood levels of vitamin K.  This vitamin is vital for the proper functioning of special proteins found in bones and blood vessel walls.  These proteins help to balance calcium deposited in bones, while also preventing the improper laying down of calcium in blood vessel walls.  When there is not enough vitamin K in the body,  it makes it difficult for these proteins to balance calcium deposits.

Vitamin D, is also known as the “sunshine vitamin” due to the fact that we can manufacture vitamin D when we are exposed to sunlight on the skin.  Here in New Zealand where UV light levels are low for many months of the year, vitamin D deficiency is endemic. 

For many years we have understood that vitamin D is vital for the fixing of calcium into bones, and without it we are at risk of bone diseases such as rickets and osteoporosis.   What we have only recently come to understand is that vitamin D also plays a role in preventing calcium deposits in the arteries. 

So, what is the take home message and points of action for you?

Firstly have your vitamin D levels checked with a 25-hydroxyvitamin D blood test.  Ideally levels will be above 80ng/ml.  If not, more sunshine exposure combined with vitamin D3 supplements should boost levels quickly.

Boost vitamin K rich foods such as leafy green vegetables (spinach, kale, broccoli, cabbage, silverbeet).  You can make your own vitamin K in your gut, as long as gut bacteria are healthy and flourishing.  Supplementing with a quality probiotic to balance gut bacteria, while chowing down on dark greens regularly, will boost levels of vitamin K without resorting to supplements.   

The list of benefits associated with a high intake of omega 3 fatty acids (which are plentiful in fish oil) is long and impressive.  Not only do these fats safeguard the health of your cardiovascular system,  they also support optimal immune function; protect against various cancers including cancer of the breast and prostate; reduce incidence of anxiety and depression; and help protect against neurological diseases such as Alzheimers Disease. 

Type 2 diabetes (once called old age onset diabetes, but now effecting people from all age groups), is reaching epidemic proportions in many western countries, including here in New Zealand.  Most clearly a “life style” disease, type 2 diabetes effects obese and sedentary people in particular.  Besides losing weight, eating a healthy diet and exercising regularly, one of the most important aids to preventing this devastating disease, is the addition of generous amounts of omega 3 fats to the diet.

With type 2 diabetes, the body becomes resistant to the blood sugar regulating effects of the hormone insulin.  In a healthy body, consumption of sugars or carbohydrates starts to increase the levels of sugar in the blood.  In response to this, the pancreas begins to release insulin into the bloodstream.  It is the job of insulin to take glucose from the blood stream and shunt it across the cell membranes, into the cells.

Every cell has insulin receptors, which effectively allow insulin to communicate with the cell, and “open the door” allowing glucose to flow across the cell membrane.  With type II diabetes, these receptors become insensitive to insulin, and more and more of the hormone is required to move glucose into the cell.

Eventually, the pancreas becomes exhausted and unable to manufacture enough insulin to do the job of regulating blood sugar.  Insulin levels plummet, and blood sugar levels sore, cause havoc with the cardiovascular system, eyes and kidneys.

Wonderful fish oil comes to the rescue in multiple ways.  Firstly, fish oil helps to sensitise insulin receptors to the effects of insulin, preventing the receptor “burnout” characteristic of insulin resistance.

Secondly, fish oil helps to normalise blood fats, thus slowing or preventing much of the cardiovascular damage associated with high blood sugar.  Fish oils lower triglycerides, lower blood pressure, and increase protective HDL cholesterol, while leaving “bad” cholesterol levels unchanged.

Finally, fish oils works as a powerful natural anti-inflammatory.  High levels of inflammatory markers are associated with chronic diseases such as diabetes, cardiovascular disease, arthritis and allergies.

So, have I convinced you that daily fish oil supplements are your best friend?  Make sure the oil you choose is high quality, 100% purified and devoid of contaminants.  A basic daily dose of 2000mg is the suggested supplemental level for most healthy people.  Those with chronic illness should be taking higher doses, as advised by their nutritional health care professional.

It’s been an interesting week in the world of woman’s health… and in my clinic.  Most of my woman patients take a high quality multivitamin/mineral and antioxidant formula every day, as part of their nutritional wellness regime.  Just like me, they swallow their tablet alongside their porridge and fruit, secure in the knowledge that this daily ritual is an investment in good health.

Imagine the questions I have fielded this week, with the internet and newspapers abuzz with the news that their daily multivitamin actually INCREASES their likelihood of developing breast cancer.  I’ve read the reports… and have I stopped taking my multi?  No!  Here’s why….

The research causing all the fuss hails from the Karolinska Institute in Sweden.  Back in 1997 they recruited just over 35,000 women, between the ages of 49 and 83, to fill in a self assessment questionnaire.  Included, were questions relating to some (but not ALL) known risk factors for breast cancer, as well as questions relating to the use of a daily multivitamin.  Recently, the women were followed up to see how many of them had developed breast cancer in the intervening 10 years.  9,000 women claimed they were taking a multi, and of them 293 developed breast cancer, leaving 96.7% of the multi users not having developed breast cancer.  In the group of 26,000 non multi users, 681 women developed breast cancer.

Ok, so at first glance it all looks a bit of a worry doesn’t it?  Someone who actually understands the intricacies and fallibilities of experimental design is Professor of Epidemiology, Rod Jackson from the University of Auckland.  His take on the research?  “The study is non-randomised, so I wouldn’t take too much from it.  Cohort studies like this trial are just too prone to biases to be very helpful”.

Remember that the latest study found only an association between women using multi’s and breast cancer, not a CAUSE and EFFECT.  Of the women who eventually developed breast cancer, one common denominator was that they took multi’s, but from that, one can’t claim that the multis CAUSED the cancer.    All of the women taking a multi were lumped into one entity, and nowhere did the study look at the data of each woman individually.  Consequently it is impossible to surmise how taking a multivitamin may increase breast cancer risk in any individual woman.

As a  prescriber of clinical nutritional therapy for almost 25 years, I’m also concerned about use of the generic term “multivitamins” in this study.  What the heck does that mean? I know from clinical experience that not all multi’s are born equal.  Quite frankly, some of them are nothing more than a synthetic, poorly balanced recipe for expensive and smelly urine.  I would have been much more interested in the outcome of this study if individual women were examined in terms of the type of multivitamins they were taking.  Did these multi’s contain only vitamins?  Were there minerals in some, any or all of them?  Were they synthetic or organic forms? Did they contain added antioxidants? Did they contain selenium?  Were they iron free or containing iron?  Did they contain vitamin E and was it synthetic, or a complex of different tocopherols?… Blah, blah, blah, I could go on and on, but you get the gist of what I’m saying don’t you?    We have no idea what these women were taking as a “multi” each day, and whether a study in which they each took the same standardized high quality formula daily, would have produced the same results, or would have actually demonstrated a protective effect against breast cancer.

It’s worth noting that this latest warning about the dangers of multi’s flies in the face of some very well respected, large and well designed studies showing no increased risk of disease with multivitamin use in women.  One of the biggest and most respected of these, was the Woman’s Health Initiative study involving over 161,000 women, and running for 8 years.  Robustly constructed, this study failed to show any harm to women taking a multivitamin daily, over an 8 year period.  

Media hysteria aside, I will happily continue to take my multi with breakfast each day, and will prescribe the same high quality nutritional product to my patients, without concern.  I’ll wait for some more reliable research to come along before I’m convinced that my daily multi is a risk to my breast health.

If you are interested in finding out proactive ways of optimizing your breast health, read “Wellbeing”, by Lynda Wharton, published by Harper Collins.  Available in book stores, and online at www.lyndawharton.com