January 31, 2012
American Psychiatric Association Task Force on supplements for major depression
The American Psychiatric Association recently commissioned a task force to study the state of “alternative and complementary” therapies for major depression. This follows widespread interest from the scientific community and a considerable accumulation of research to date. The Task Force reported in a 2010 article that focused special attention on these supplements: omega-3 fatty acids (commonly taken as fish oil supplements), St John’s Wort (the botanical Hypericum), Folic acid (a synthetic form of folate, a B vitamin found in leafy green vegetables, citrus fruits, beans, and fortified breads and cereals), and S-adenosyl-L-methionine (SAMe).
We welcome this acknowledgment by the mainstream US medical establishment that supplements have a role to play in treating a disabling condition that affects millions of people per year, and is not always easily treatable. (Only one-third of adult patients newly diagnosed with major depression achieve complete symptom relief when taking one antidepressant, so there is often an extended search for the right combination of drug and other treatment needed for remission.)
Below is a brief recap of some of the latest thinking on these key supplements for depression. Of course NYBC recommends that you use these supplements in consultation with your healthcare provider. More information on these supplements can be found by following the links to the NYBC website.
Omega-3 Fatty Acids (fish oil) recommended as a stand-alone treatment for people concerned about side effects, such as those with multiple medical conditions. It has also been combined with other antidepressants as an adjunct therapy. Fish oil’s blood-thinning property makes it problematic for doses above 3g/day. Added benefit: fish oil supports cardiovascular health.
St. John’s Wort is an herb widely studied and used, especially in Europe, for mild to moderate depression, though it hasn’t proved effective for major depression. Those taking protease inhibitors or certain other drugs should avoid St. John’s Wort because it interferes with their action.
SAMe (S-adenosyl-l-methionine). Supplementing with SAMe increases concentrations of neurotransmitters that influence mood, and multiple studies have confirmed its antidepressant effect. A dose of 400-800mg/day has been studied for mild-to-moderate depression, and 800-1600mg/day for moderate-to-severe. Studied as a stand-alone treatment, or as an adjunct treatment. Added benefit: SAMe supports joint health and liver function.
When combined with an antidepressant, folic acid supplements can improve symptoms, particularly in women. However, folic acid supplements are not a stand-alone treatment for depression. The safe upper limit is 1,000 mcg per day.
September 23, 2011
Follow-up on folate and cancer risk
We’ve had a recent comment on our own post regarding the importance of B12 and folate supplementation for people with HIV. The comment expressed concern about some reports that folate may be associated with increased cancer risk. Here’s a reply to that comment:
We recommend this web page for a recent study of folate and REDUCED colorectal cancer risk:
http://www.michaelmooney.net/FolateReducesCancerWillet.html
The 2011 article cited, by a well-known nutrition scientist, finds folate from diet and folate from supplements both associated with reduced colorectal cancer incidence–when taken over a long period (we’re talking about 15-20-30 years). This fits with what is generally understood about the value of vegetables in reducing cancer risk. Not surprising to us is the other finding of the study: that short-term folate intake, around the time of the development of pre-cancers, is not going to help reduce cancer incidence! Indeed, many supplements do not necessarily produce pronounced short-term effects, but rather show health benefits over the long term.
October 14, 2010
Mayo Clinic’s Guide to Alternative Medicine 2011
This is an easy-to-read, magazine-style guide created by the Mayo Clinic, the world-famous healthcare facility which also happens to have a long-standing receptiveness to alternative and complementary therapies for wellness and prevention. (That’s one of the reasons why it has recently been cited as an example of best practices in American healthcare–the kind of practices that need to be more widely imitated.)
The section on dietary supplements provides capsule reviews of the scientific evidence for the safety and effectiveness of several dozen popular products, from botanicals like ginseng, echinacea and St. John’s Wort, to vitamins C, D, E, B-3 (niacin), and B-9 (folate or folic acid), as well as minerals like selenium, calcium and zinc. Also discussed are fairly well-known categories of supplements, including probiotics and omega-3 fatty acids (these often obtained with fish oil supplements).
The guide rates these supplements with a green, yellow or red light symbol, depending on the strength of the evidence for their use and their safety profile. We weren’t too surprised by most of the ratings. For example, green for niacin, folic acid, Vitamin C and Vitamin D, but a yellow caution light for Vitamin E, which has shown no effectiveness in several good studies dealing with cardiovascular health and cancer, leading some researchers to wonder if the standard “alpha-tocopherol” form of the vitamin is a good format for supplementation. Also, a yellow light for St. John’s Wort, not because it isn’t effective for mild/moderate depression, but because it can interact with a lot of other medications.
Other supplements getting the green light from the Mayo Clinic editors: SAMe (for depression); saw palmetto (for enlarged prostate); green tea (for cardiovascular health, possibly for cancer prevention, and apparently–according to a large epidemiological study–for longevity); gamma linolenic acid (for peripheral neuropathy); CoQ10 (for cardiovascular health, for which it’s used by millions in Japan); glucosamine chondroitin (for osteoarthritis).
Also getting the green light, a supplement most have probably never heard of, but which is featured in the Health Concerns formula Cold Away, available from NYBC: the botanical Andrographis (a cold remedy, showing promise where many other products have disappointed).
See the NYBC entries for more details on how best to take supplements:
http://www.newyorkbuyersclub.org/
July 1, 2009
B vitamins for eye health
A heart disease study sponsored by the NIH has also yielded some interesting information about the relationship between B vitamins and eye health. The research study, from Brigham and Women’s Hospital in Boston, found that taking a mixture of B vitamins, including B-6, folic acid and B-12, lowered the chance of middle-aged women developing macular degeneration (a common form of vision loss in older adults) by one-third. The study, which tracked more than 5000 women age 40 and older, was published in the Archives of Internal Medicine, Feb. 23, 2009.
Note that NYBC stocks this B vitamin supplement:
B-right includes folic acid, B-6 and B-12; one of the rationales for its formulation is to prevent buildup of the chemical homocysteine, which in studies has been associated with heart attacks.
October 31, 2008
Folate (Folic acid) supplementation: a recommendation for acute, continuation and maintenance treatment of depression
Here is a dosage recommendation for supplementation with Folate/Folic acid during the treatment of depression. It’s the conclusion offered by Simon N. Young, Dept. of Psychiatry, McGill University in a 2004 review article:
What about the recommendation that 2 mg of folate be given during the acute, continuation and maintenance treatment of depression? The actual dosage may be debatable; 1 mg may suffice, particularly in countries where there is voluntary or compulsory fortification of food with folate, and the addition of a vitamin B12 supplement may be prudent, but the general principle is reasonable. With our current knowledge, the potential benefits seem to far outweigh any disadvantages.
Reference: Simon N. Young, “Folate and depression—a neglected problem” in J Psychiatry Neurosci. 2007 March; 32(2): 80–82.
For further discussion, see the NYBC entries:
October 8, 2008
Nutritional supplements for depression: recommendations from an expert on integrative/holistic health
NYBC has been following recent developments in the use of dietary supplements for depression for quite some time now, and we’d like to recommend a recent guide to this topic by Hyla Cass, which appears in her book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition.
Dr. Cass, a practicing physician and an expert on integrative (“holistic”) health, devotes a chapter of her 2007 book to depression. The core elements of her recommendations are the B vitamins, Folate, Omega-3 fatty acids, Calcium, and Vitamin D (especially in winter). She also discusses SAMe, a natural mood enhancer essential for the manufacture of neurotransmitters (like serotonin), and two botanicals that have a history of use as anti-depressants, St. Johns Wort and Rhodiola.
Dr. Cass’ account is particularly good at reviewing the role of neurotransmitters in depression, and explaining how supplements and nutrition have an impact on them. For example, tryptophan, eaten together with carbohydrates, will raise levels of serotonin, the neurotransmitter that makes you feel happy and calm and helps you sleep well. The amino acid 5-HTP, meanwhile, can also help the brain produce more serotonin, though unlike tryptophan it does not need the carbs for it to enter the brain.
Anti-depressant prescriptions, as Dr. Cass notes, are among the top sellers among US pharmaceuticals, with 60 million prescriptions written per year at a cost of $10 billion. And while “antidepressants may be enormously helpful, even life-saving for some people,” she continues, “they are often overprescribed, at too high a dose, over too long a time, and often before a good medical evaluation has been done.” (p. 117) Hence her timely guide to using supplements to help maintain the “nutritional balance necessary for good mental health,” or to create “neurotransmitter balance in depression.”
Reference: Hyla Cass, M.D. “Prescriptions for Psychological Health,” in Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition. (Basic Health Publications, 2007)
See also the NYBC entries on supplements mentioned above:
April 30, 2008
Recommendations for Cardiovascular Health: from “Supplement Your Prescription,” by Hyla Cass, M.D.
We return to this excellent guide published in 2007 by Hyla Cass, a practicing physician and expert on integrative medicine.
In Chapter 4 of the book, Dr. Cass reviews recent findings that call into question the idea that dietary cholesterol causes cardiovascular disease. In line with the current scientific thinking on this subject, she suggests looking at underlying inflammation as essential to any understanding of risks to heart and circulatory system health. As a consequence, she says, people who want to reduce risk of cardiovascular disease should consider dietary changes that are anti-inflammatory (that is, a diet high in antioxidants, anti-inflammatory herbs, and antioxidant-rich foods–that’s colorful fruits and vegetables, curry, turmeric, rosemary, ginger, green tea, dark chocolate, low-toxin fish like salmon or sardines).
Statin drugs, though they come with some side effects, have proven of benefit to certain groups of people with cardiovascular complications, including diabetics, those who have had a heart attack, and those diagnosed with cardiovascular disease. Like many others, Dr. Cass recommends supplementing with CoQ 10 if you’re taking statins. She also supports use of omega-3 fatty acids (from fish oil), niacin (though not recommended for diabetics), plant sterols, tocotrienols (a form of the antioxidant vitamin E), and D-ribose for controlling cholesterol and otherwise countering cardiovascular disease. In addition, the B vitamins are recommended to help lower homocysteine, high levels of which are associated with artery damage and increased risk of heart disease.
Citation: Hyla Cass, M.D., Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition (Basic Health Publications, 2007).
March 7, 2008
Depression and B vitamins – University of Maryland Medical Center’s Complementary Medicine Website
Here’s more on the role of the B Vitamins in depression, together with some common supplementation strategies.
Source: University of Maryland Medical Center’s Complementary Medicine web resource
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DepressionStudies suggest that vitamin B9 (folate) may be associated with depression more than any other nutrient. Between 15% and 38% of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed. Many healthcare providers start by recommending a multivitamin (MVI) that contains folate, and then monitoring the homocysteine levels in the blood to ensure the adequacy of therapy. Elevated homocysteine levels indicate a deficiency of folate even if the levels of folate in the blood are normal. If the MVI alone is not enough to lower homocysteine and improve folate function, the provider may suggest additional folate along with vitamins B6 and B12 to try to bring the homocysteine levels down, thereby eliminating the functional folate deficiency and, hopefully, helping to improve feelings of depression.
Note: NYBC stocks Douglas Lab’s Added Protection Without Iron, a highly bioavailable multivitamin that includes a comprehensive B complex. The no-iron formula is recommended especially if you have elevated liver enzymes or hepatitis.
You can also consider Added Protection With Iron if you want to include iron in your supplements.
Another choice for focusing on the B Vitamins is Jarrow’s B-right, which is especially formulated to provide optimal amounts of folate/folic acid (B-9), B-6 and B-12 for lowering homocysteine levels.
March 3, 2008
Why Vitamin B12 and Folic Acid (Folate) are important to people with HIV
We’ve adapted this piece from the NYBC Info Sheet on Vitamin B12.
NYBC members often supplement with B-right B complex or with Methylcobalamin, a form of B12 that is better absorbed by the body than other forms of B12.
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B-12 may play a very critical role in preventing HIV disease progression: a large Johns Hopkins University study found that people with HIV who are deficient in B-12 have a two-fold increased risk of progression to AIDS. In this study, those who were B-12 deficient progressed to AIDS four years faster than those who were not. The exact mechanism by which adequate B-12 in the body may slow progression is not known, but the finding is not surprising, given all the roles B-12 is known to play in healthy human function.
B12 and another B vitamin, folic acid, are critical to prevent or eliminate the often-overwhelming fatigue that so often accompanies HIV disease, as well as to help prevent some forms of neuropathy and brain and spinal cord changes. Maintaining adequate B12 levels also supports the bone marrow’s production of blood cells (crucial to prevent white and red blood cell decreases), and helps protect the heart.
There are countless anecdotal reports from people with HIV that using B-12 supplementation has dramatically improved their lives by its ability to reverse fatigue, often restoring normal energy to people who had previously been so exhausted that their daily functioning had been greatly affected. Many people have also reported significant improvements in memory and mental functioning, improvements that have made a huge difference in daily life. The possibility that B-12 supplementation might also help prevent or reverse the spinal cord changes that can have such devastating effects on some people is also very encouraging.
B-12 and folic acid should always be given together. Doses of B-12 (1000 mcg given daily via pills, or one to several times weekly via prescribable nasal gel or injections) and folic acid (800 mcg daily via pills) may be useful for restoring energy, treating neuropathy, protecting the heart, increasing overall feelings of well being, and boosting mental function (especially when combined with thiamin, niacin, and folic acid, since all four of these B vitamins are needed for normal neurological function) even when tests don’t indicate obvious deficiencies.
Deficiencies of B-12 can result in deterioration of mental function and neurologic damage that will yield such symptoms as memory loss, decreased reflexes, weakness, fatigue, disorientation, impaired pain perception, tinnitus (chronic ringing in the ears), neuropathy, burning tongue, and various psychiatric disorders. B-12 deficiency can also cause canker sores in the mouth, impaired bone marrow function, loss of appetite, and loss of weight, as well as impaired antibody responses to vaccines.
Folic acid deficiency can also cause fatigue and weakness, along with irritability, cramps, anemia, nausea, loss of appetite, diarrhea, hair loss, mouth and tongue pain, and neurological problems. In addition, folic acid deficiency is believed to play a role in the development of numerous and varied types of human cancers.
A combination of B-12 and folic acid deficiency can allow increases in blood levels of homocysteine, a chemical that can damage artery walls and contribute to heart disease.
One of the known causes of B12 deficiency is chronic viral illness with resulting poor gastrointestinal absorption. AZT use may contribute to deficiencies of both B-12 and folic acid. Many other drugs may worsen folate status in the body including TMP/SMX (Bactrim, Septra), pyrimethamine, and methotrexate (all three of which are folate antagonists), as well as phenytoin (Dilantin), various barbiturates, and alcohol (all of which block folate absorption). B-12 deficiency can also worsen folate levels in the body because B-12 is required to change folate into its active form.
February 29, 2008
Folic acid/folate (Vitamin B9) to protect against development of cancer
The University of Maryland Medical Center’s website on Complementary Medicine (a clearly written, up-to-date resource, by the way) provides this review of folic acid (also known as folate or Vitamin B9) as a supplement protecting against the development of cancers. The strongest evidence appears to be for folic acid’s ability to protect against colorectal and breast cancers. In our excerpt below, we have highlighted two significant passages.
For recommendations on how to take this supplement (you may be getting it in a multivitamin or a B-complex supplement), see the NYBC entry on Folic Acid.
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Cancer
Folic acid appears to protect against the development of some forms of cancer, particularly cancer of the colon, as well as breast, esophagus, and stomach, although the information regarding stomach cancer is more mixed. It is not clear exactly how folate might help prevent cancer. Some researchers speculate that folic acid keeps DNA (the genetic material in cells) healthy and prevents mutations that can lead to cancer.
Population-based studies have found that colorectal cancer is less common among individuals with very high dietary intakes of folic acid. The reverse appears to be true as well: low folic acid intake increases risk of colorectal tumors. To have a significant effect on reducing the risk of colorectal cancer, it appears that at least 400 mcg of folic acid per day over the course of at least 15 years is required. Similarly, many clinicians recommend folic acid supplementation to people who are at high risk for colon cancer (for example, people with a strong family history of colon cancer).
Similarly, one population-based study also found that cancers of the stomach and esophagus are less common among individuals with high intakes of folic acid. Researchers interviewed 1095 patients with cancer of the esophagus or stomach as well as 687 individuals who were free of cancer in three health centers across the United States. They found that patients who consumed high amounts of fiber, beta-carotene, folic acid, and vitamin C (all found primarily in plant-based foods) were significantly less likely to develop cancer of the esophagus or stomach than those who consumed low amounts of these nutrients. Another important, good-sized study, however, did not find any connection between folic acid intake and stomach cancer. The possibility of some protection from folate against stomach cancer in particular needs clarification and, therefore, more research is warranted.
Low dietary intake of folate may increase the risk of developing breast cancer, particularly for women who drink alcohol. Regular use of alcohol (more than 1 ½ to 2 glasses per day) is associated with increased risk of breast cancer. One extremely large study, involving over 50,000 women who were followed over time, suggests that adequate intake of folate may lessen the risk of breast cancer associated with alcohol.
December 18, 2007
Folate, the feds, and you
Folate, a B vitamin, frequently appears in news about dietary supplement research. (Note: folic acid is the form found in supplements or fortified foods.)
For example, an article earlier this year offered this announcement: “Higher Folate Levels Linked To Reduced Risk For Alzheimer’s Disease. ” (JAMA and Archives Journals: 2007, January 9)
And you wouldn’t have to look too far to discover current research on folate deficiency associated with the potential for cardiovascular problems, or folate deficiency linked to higher rates of breast, pancreatic, or colon cancer.
Of course, when folate was first identified and studied 70 years ago, the chief draw for researchers was its role in combating anemia and supporting the health of women during pregnancy. But since then, as understanding of the vitamin has grown, it’s come under scrutiny for many other reasons.
Indeed in 1996, the US federal government decided that the health benefits of folic acid were very clear–and yet too many Americans were not getting enough from their diets. The response? The Food and Drug Administration (FDA) published regulations requiring the addition of folic acid to enriched breads, cereals, flours, corn meals, pastas, rice, and other grain products–where you’ll find it today (check nutritional labels).
For more information on whether you’re getting enough folate in your diet, and who should consider supplementing, see the Office of Dietary Supplement fact sheet on FOLATE:
