Is it faux depression?

Where I live, the Thames riverside is gorgeous at the moment, lined with golden leafed trees. But let’s not forget that these are also a sign that we are in the season of melancholy – the time when, once the clocks change, next week, we will all start talking about SAD – even if we don’t actually suffer from it ourselves.

It is a condition that is supposedly relieved by a bit of extra vitamin D and sunshine, or light treatment, but there are many other causes of faux depression too.

. It could be your hormones...

We all know about PMS – but in its most severe form, it can be mistaken for clinical depression, with weepiness, loss of self-confidence, energy and libido. Unfortunately no amount of antidepressants will help – and your condition will just continue to get worse. Suspect your hormones if you were well balanced in pregnancy but then suffered postnatal depression, and dramatic mood swings (sometimes mistaken for bipolar disorder) or a permanent dip in mood after having your baby. The pattern of mood changes isn’t always clearly linked to your period when it’s this severe, but treatment with oestrogen gel together with testosterone and seven days of progesterone pills a month stabilises hormones and successfully treats this type of depression, according to Professor John Studd of the London PMS and Menopause Centre.

 

. You may need a test for vitamin B12 

Vitamin B12 (from animal products such as fish, meat, poultry, eggs and milk) helps with the manufacture of key brain chemicals affecting mood, and if you’re not getting enough from your diet, this can leave you feeling weepy and drained with mood swings, poor concentration, and fear of social situations. Again, classic symptoms of depression! Some people develop an inability to absorb B12 from the digestive tract – a condition known as Pernicious Anaemia, which has to be diagnosed by a specific blood test. ‘In an ideal world everyone going to their doctor with symptoms of depression should be tested for B12 deficiency,’ says Carrie-Anne Carr of the Pernicious Anaemia Society. ‘Three of our members have been sectioned when all they needed was B12 treatment. It costs the NHS about 26p to give a B12 injection (ideally once a month if you need it), compared to £26 for a month’s supply of antidepressants you don’t really need. The next best thing to an injection is a B12 lozenge that melts under the tongue, fast tracking it into your bloodstream.’

. You could just need to get out more...

When you miss out on exercise, you also miss out on the cascade of feel good endorphins that it triggers. Research shows that a brisk 20-30 minute walk works as well as a mild tranquillizer, and  the mental health charity Mind says research regular supervised exercise is proven to be just as effective as antidepressants for mild to moderate depression. Tip: walk outdoors – it’s twice as likely to boost your mood as indoor exercise according to a Mind study.

 . You’ve got a sweet tooth

Too much sugar leads to blood sugar highs and lows – and the lows are associated with big dips in mood, as well as cravings for more sugar, warns Patrick Holford, author of ‘Say No To Diabetes’ (£13.99 Piatkus). ‘The worse your blood sugar balance, the worse their mood will be – and diabetics, whose condition makes it difficult to control blood sugar, have a very high rate of depression. Sugar cravings can be brought on by a dip in levels of the brain chemical serotonin, which is made from the natural amino acid 5-HTP. Taking a 5-HTP supplement (eg Biocare 5-HTP, £17.50 for 60 capsules) can dramatically improve both your mood – and your craving for sugar.’

. Maybe you’re not eating enough fat

Or at least not enough of the right type of fat. ‘Modern diets are rich in omega-6 (from processed foods, biscuits etc) and often low in long-chain omega-3 fats and this imbalance can leave us deficient in mood-regulating ‘good fats’ such as EPA,’ says Nutrition Scientist Dr Nina Bailey, Nutrition Scientist. ‘You need sufficient levels of EPA to create feel-good chemicals tryptophan and serotonin. The prescription-strength supplement Vegepa E-EPA 70, £13.99 for 60 capsules - available from www.vegepa.com,www.vegepa.com, has been shown to be as effective as antidepressants. As with conventional medication, however, dosage is essential – 1 gram daily for a minimum of three months is required for therapeutic effects.’

. Or it’s because you’re already taking other medicines...

An A-Z of common medicines list depression as a possible but undesirable side effect – including many for heart disease, high blood pressure and cholesterol, and even some drugs used for anxiety, says pharmacist Shaina Shipton, who’s co-founder of OneClickPharmacy.co.uk. ‘If you suspect you’re depressed as a result of something you’re taking, ask your pharmacist for a Yellow Card form to report an adverse reaction to the Medicines and Healthcare Regulatory Authority (MHRA), visit your doctor as soon as possible for advice (eg reducing the drug or finding an alternative), and don’t stop taking the medication unless your doctor advises this.

.  And if you do just need more sunshine...

We get vitamin D from sunshine, and SAD (seasonal affective disorder) is notorious for affecting 1 in 50 people during the winter months, with as many as 1 in 8 getting a milder form of winter blues. But experts now realise that even in the summer months it’s hard for Brits to get enough vitamin D from sunshine, and research has shown that half of us have insufficient levels – and this is especially the case if you’re depressed, says women’s health guru Dr Marilyn Glenville. ‘You may also be more likely to develop PMS if you are lacking in vitamin D, so top up with a good multivitamin eg NHP's Healthy Woman Support (£22.97 for 60 capsules from health shops) which contains 400iu of vitamin D3.’

The bitter sweet truth about sugar

I’m fond of telling people I don’t have a sweet tooth – “Oh no, not me,” I say. “Give me something savoury like cheese any day...”

But when I told a nutritionist about my typical breakfast – yogurt, sweetened with honey, with a sliced banana or mixture of fresh berries on top, she raised an eyebrow. “That’s one big sugar fix!” she said.

I had to admit it – the yogurt on its own is too sour for me. And even the banana isn’t enough to stop me wincing.

I also need a sweet fix at the end of the working day – around 7.0 pm, I will start craving a glass of wine, or picking at any pastries lying around in the kitchen.

To stop these cravings I need to stabilise my blood sugar so it doesn’t dip and set me thinking about sweet things – but that’s easier said than done.

Although I can probably monitor my sugar consumption quite easily, as I tend to eat fresh home cooked foods, and rarely deliberately add sugar to anything (the big exception being the honey on my yogurt), temptations to eat processed high sugar foods are ever present.

Nutritionists say we should get no more than 10% of our daily calories from sugars of all types (from jam, honey, fruit, juices and other added sugars) – that’s around 50g (12 ½ teaspoons) of sugar a day. But the average UK citizen consumes 38 kg of sugar in a year – 26 teaspoons and 400 sugar calories a day according to the World Health Organisation. It’s in everything – start reading the labels.

Obesity researcher Zoe Harcombe says: ‘Try to buy a bread without sugar in it, or a soup, or a sauce/dressing or a ready meal. Check your vitamin tablets and even your sausages! Don’t be surprised to see some form of sugar (eg dextrose or fructose) on the list of ingredients. I can count on one hand the number of cereals without sugar. It has found its way into virtually every fake (processed) food on the market. Why? Because it's a cheap filler, it prolongs shelf life, and it appeals to the human sweet tooth. Forget that we're supposed to eat food for its nutritional content - sugar is added for any reason other than because it makes a product healthy.’

Kath Dalmeny of Sustain, the alliance for better food and farming, adds that ‘studies show that a processed, junk food diet is right up there with smoking and alcohol as a danger to our health.’

And Professor Robert Lustig, professor of clinical paediatrics at the University of California, and an expert in childhood obesity, says that sugar is behind the obesity epidemic and the huge rise in conditions such as cancer, diabetes, heart disease, and Alzheimer’s that are together killing more than 35 million people every year.

According to Professor Lustig sugar programmes us to eat more – by switching off the satiety hormone leptin that tells us we’re full. There’s even a biological reason why it does this – because when we were hunter-gatherers we needed to binge on sweet fruit at harvest time when there was an abundance of it, and that made up for the lack of fruit through winter.

But sugar in processed food is an anti-nutrient because it takes nutrients to digest it, and gives us nothing in return, says Zoe Harcombe. ‘Whereas we need fat and would eventually die without any fat in our diet, we need only 1tsp of sugar in our blood at any time and even a large apple will give us five times as much as that.’

The problem is that it’s hard to give sugar up – and that makes it very easy for marketing people to persuade us to eat more of it, never mind what it does to our health.

‘We all have an innate love of sugar and that’s what helped us seek out fruit when we lived as primitive hunter-gatherers,’ says Kath Dalmeny. ‘But now we’re surrounded by sugary foods – with sweet “treats” popping up to tempt us in the most unexpected aisles of the supermarket.

‘Never go shopping on an empty stomach – when you’re most likely to succumb to these sweet treats,’ Kath warns.

Sugar – in particular fructose -- gets stored as fat by the body when we cannot use it all up, and most of us are eating far more than we can use in energy.

I am going to start by swapping my honey for Xylitol – which is completely sugar free  - and my banana for berries, which aren’t so sweet... I’ve tried it before and it’s great. BUT, even then, I will still be pandering to my desire for something sweet, and nutritionists say I should be giving up on all sweet additives. Only then will I start to enjoy the natural flavours and sweetness of food.

Could you be lacking in B12?

I’ve been amazed by the exponential interest in vitamin D deficiency over the past couple of years – now everyone’s talking about it, writing about it, and worrying about it... But maybe that’s just a sign of general awakening to the importance of all vitamins and minerals. 

Most recently I’ve been writing about the desperate repercussions of a B12 deficiency. 

One expert, Dr Joseph Chandy, reckons this could be responsible for 20% of all chronic disease worldwide. And the fact that we live in the UK, where most of us should have access to adequate amounts of the many foods (including beef, cheese, and even marmite!) that provide B12, does not mean that we can take our B12 status for granted. If we lack the wherewithall to metabolise this vitamin, we will not reap its benefits – no matter how much we eat. 

This becomes more of a problem as we get older (past 65, B12 deficiency is a major cause of dementia – and experts say it should always be considered first when Alzheimer’s is being diagnosed) but some people are just born unlucky. Forgetfulness is just one symptom of B12 deficiency. Tiredness is another big one, and so is numbness of the limbs – with cases of assumed MS turning round dramatically when patients are treated with B12. 

You can read more about this fascinating – and very easily treated – condition in my article ‘the 60p injection that can boost your flagging energy’ in this week’s Daily Mail. But, before you do, I’d just like to mention the case of Fiona Porter-Smith, a GP from Penarth, Glamorgan.

Fiona was already passionate about B12 treatment, when she too was diagnosed with B12 deficiency and Pernicious Anaemia (the condition that causes a deficiency no matter what your diet is like) three years ago.

She told me: ‘I was tired and had a low mood – classic symptoms - but ironically, despite my knowledge, I didn’t think of vitamin B12 deficiency. Then I developed very bad pins and needles in my hands and feet, and, fearing Multiple Sclerosis, I went to my own GP. A blood test showed I was low in B12, but I thought that was just something else we’d stumbled on – not the cause of my ‘MS’.

‘B12 treatment – even at very high doses – did not seem to help. But then I discovered that the B12 we use in the UK, Hydroxocobalamin, is inactive and needs to be converted by the body before it can be used by it. Not everybody can do this.

‘Meanwhile in the USA a ready converted – active - form, Methylcobalamin, was being used.’

Fiona, 41, now takes very high doses of the US form of vitamin B12. She can only obtain it from a private consultant in the UK, and it costs her nearly £200 a month – but it keeps her mood and energy up. And, now cured of her pins and needles and fear of MS, she has gone on to have her first baby, Alfred, three months ago. Aah... We journalists do love a happy ending!

What are you whistling?

My husband and I have both been whistling ‘I can’t give you anything (but my love)’ by the Stylistics – from the 70s...

I started it, after watching Alan Yentob’s Imagine show on the power of the falsetto.

I think my husband started joining in after I told him about the show’s observation that women love a good male falsetto...

Steve’s whistling may not be up there with Russell Thompkins’ singing. But it’s a sure sign of happiness to be whistling or singing anything, regardless of talent.

And there’s also mounting evidence that singing is good for our health. It’s a known mood booster and now also proven to guard against memory loss. 

In one Japanese study participants who sang along as they worked out retained 70% more information than those who only exercised – even though exercise alone also sends blood to the brain to improve memory.

And, here’s a thing, when I asked Steve the name of that song we were whistling there was no hesitation - he came straight out with it!

Fat chance

Another email from a happy interviewee – and my heart danced with joy when this one arrived today.

Leanne Snowball suffers with a condition called lipoedema – it’s what used to be known as elephantitis. She was embarrassed talking about it, but had decided too few people understood the condition. She even bravely allowed us to publish pictures of her in this week’s That’s Life! magazine. Today she wrote to thank me for the way her story appeared.

Here it is...

‘I was ten years old when my periods started, and my body suddenly ballooned.

My mum, Angela Pink, 31, couldn’t understand it. All through my teens she thought I was overeating in secret. I swore I wasn’t – I was an unusually fussy eater who’d always hated crisps and sweets, along with most other foods.

But nobody could believe that I had really got so big from my tiny portions of plain chicken, pasta and salads.

At school I hid my body under my black blazer and trousers.

I hated dressing up and drawing attention to myself and, when, at 18, I met my first serious boyfriend, Robert Snowball, 19, I used text messaging as a way of helping him get to know me better between dates because I was so scared my size would be a turn off.

We fell in love and married on Robert’s 22^nd birthday, when I was 20.

At 21 I started working as a midwife and knew I should practice what I was preaching, and lose weight before starting my own family.

By 23 I’d lost nearly four stone – but it had all come off my torso. My arms and legs remained just as big as ever – and I needed size 28 trousers. 

I started to realise I could become anorexic and still have these huge embarrassing limbs.  It seemed so odd that I searched my symptoms on the internet and found Lipoedema or “Painful Fat Syndrome” - the modern name for what people used to call Elephantitis.

It caused the metabolism to slow down so anything a sufferer ate was likely to be stored as fat. But the main problem was the fatty build up on the limbs. It wasn’t just permanent, but also extremely tender and painful. My limbs were unbearably tender. I seemed to be a classic case.

Yet I was scared to approach my doctor... After all my dieting, and all the years Mum had thought I was stuffing myself, I would have been mortified if he dismissed my online diagnosis and said “No – You’re just fat!” 

It wasn’t until I’d had my sons Alexander, when I was 26, and Benjamin, when I was 28, that the pain got so bad that I finally went to a doctor I knew and trusted from work.

I could have cried when he agreed I had lipoedema. But the bad news was the excess fat had blocked my lymph nodes and now I also had a lot of painful excess fluid that couldn’t drain away – a condition called lymphoedema. 

My doctor referred me to a nurse specialist for treatments to reduce the fluid build up.

But nothing could or ever will shift the stubborn fat on my limbs. Even if I resorted to liposuction, which some women do, it could make the condition worse!

The pain is now so bad I need a morphine like painkiller – but it’s so zonking I daren’t take it when I’m looking after my boys, so can only get relief at weekends when Robert can take over.

Even worse, Lymphoedema makes cuts and bruises so slow to heal that some sufferers have had their infected limbs amputated.

That is a terrifying thought, but there are experts working on a cure!

In the meantime, I hope my story will warn other women not to ignore unusually stubborn fat. If your weight seems wrong for the amount you eat, then it probably is!’

The 30 seconds that could save your life!

This morning I had a lovely email from a woman I recently interviewed. Susan had had the horrible experience of being diagnosed with cervical cancer, and she told me all about it for a piece in Woman's Own magazine. Her story's now been published and she was basically writing to thank me for reporting it accurately (phew!) and for passing on the word about the importance of cervical screening.

Not everyone agrees that the test is important - but it saves 5000 lives a year.  

Here are three reasons for making sure you don't miss out. 

1. It takes just a few seconds

OK so you’ve also got to take time off work, sit in the waiting room, and then get half undressed. ‘But it’s worth it – because the smear test is the single best way of preventing cervical cancer by detecting precancerous changes,’ says Robert Music of Jo’s Cervical Cancer Trust. ‘It’s just a quick brush of the cervix to remove a few surface cells. The test itself takes a few seconds – usually with a nurse - and you’re in and out of the consulting room in minutes.’

2.  The test’s just got even better

Since April this year, all borderline or mild changes have also been tested for HPV (human papilloma virus), the virus that can lead to cervical cancer. Adeola Olaitan, a consultant gynaecologist at London’s University College Hospital, says: ‘Four out of five of us get HPV, caught from genital contact, and it usually clears up without causing any harm. But persistent HPV can trigger cervical cancer, so the combination of HPV and mild cell changes on a smear result is a sign of greater likelihood of precancerous cells, and you’ll be offered treatment to remove these (a procedure known as colposcopy, which takes about 20 minutes as an outpatient). The good news is that, if you have the same cell changes on your smear, but test negative for HPV, you can go back to the usual screening every three or five years. In the past you’d need a repeat smear six months after an abnormal result.’

3. It’s only once every three years

Some say that is not often enough. But it's all you'll be offered - so make the most of it. Once you hit 50 you’ll be invited for smears every five years instead of every three. To my mind that plants the idea that the smear is less important at this age, and a lot of women seem to be thinking the same thing as figures show a decline in attendance after this age.  I've been given no convincing reasons for the change from three-yearly to five-yearly screening post-50, but, with a rise in the divorce rate and hence the number of women in this age group starting new relationships, complacency is dangerous and,  with only two screenings in that decade, I consider this even more reason to make sure you don't miss out. Age does NOT confer immunity: there are around 550 cases a year among 50-64 year olds, and around 260 deaths, according to government statistics. ‘The only reason screening stops at 64 is that, with so few women using HRT (which helps keep vaginal tissue moist) the test can be extremely uncomfortable – so it is also important to take any symptoms seriously, whatever your age,’ says Dr Szarewski, a sexual health expert at the University of London.

Healthy Hints

We health writers receive a lot of gifts through the post – and not all of them useful. In the past few weeks I’ve had supplements for pregnancy, old age, men, and toddlers... I’ve had a huge rain poncho (extra large) under which my whole family could shelter, and a Japanese tummy warmer (which let’s face it could be more useful than you’d normally expect at this time of year). But one gift that really tickled me was Constance Moore’s pocket sized book of ‘Hints on Health from the Victorians’ (£3.99 Summersdale Publishers).

Here are my favourites:

. ‘A cigarette, despite it staining one’s teeth, is notably credited as a miracle cure for illness.’

. ‘Fight off general illness with a healthy dose of mercury, arsenic, iron or phosphorous. If one has a strong heart, mix all together.’

. ‘Treat earache by securing a freshly baked potato to the afflicted ear. Failing that, a baked onion works just as effectively.’

Warning: do not gift this book to anyone of a naïve disposition.