Supplements have a role in treating depression/sleep disorders

As 2013 drew to a close, there was much buzz about new studies showing that curing insomnia in people with depression might double the chance of a complete recovery from depression. The studies, financed by the National Institute of Mental Health, were welcomed as the most significant advance in treating depression since the introduction of Prozac 25 years ago. In effect, the new research findings turn conventional wisdom on its head, since they suggest that insomnia may be a main cause of depression, rather than just a symptom or a side effect, as has usually been assumed. So, if you can successfully treat a depressed person’s insomnia, you may be eliminating one of the main factors causing the depressed state.

As we followed news stories about this breakthrough research on insomnia and depression, we were especially encouraged to read comments from Washington DC psychiatrist James Gordon, who has advocated for an integrative approach to treating depression. Here’s his letter to the New York Times:

I welcome a new report’s finding that cognitive behavioral therapy is improving the outcome for depressed people with significant insomnia (“Sleep Therapy Seen as an Aid for Depression,” front page, Nov. 19).

It reminds us that changes in attitude and perspective, and a therapeutic relationship, can right biological imbalances — like disordered sleep — and significantly enhance the lives of troubled people. The study also puts the therapeutic role of antidepressant medication in perspective: the depressed participants who received behavioral therapy did equally well whether or not they were taking the drugs.

I hope that these results will encourage the National Institute of Mental Health, researchers, clinicians and all of us to expand our horizons.

There are a number of other nonpharmacological therapies — including meditation, physical exercise, dietary change and nutritional supplementation, acupuncture and group support — that show promise for improving clinical depression and enhancing brain function.

It is time to undertake authoritative studies of integrative approaches that combine these therapies, perhaps as well as behavioral therapy, in the treatment of both depression and insomnia.

JAMES S. GORDON
Washington, Nov. 19, 2013
The writer, a psychiatrist, is the author of “Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.”

We at NYBC have long been interested in exploring research on supplements and mood disorders, and supplements and sleep disorders. In fact, you’ll find these categories of supplements in a single section of our catalog, at

Supplements for Mood and Sleep Disorders

Please feel free to browse this section, and learn more about supplements such as melatonin, theanine, SAMe, DHEA, and others. There is considerable research on many of these already published, and we believe they will have a role to play in a new, more integrative treatment strategy for depression.

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Probiotics: effectiveness of supplements

An interesting discussion about probiotics is underway on our hometown newspaper’s website. See The New York Times blog “Well”:

http://well.blogs.nytimes.com/2009/09/28/probiotics-health-or-hype/

We were interested to read the first comment in the queue, from an M.D. who discusses the problem of the viability of probiotic species (many don’t survive the stomach’s acidity to reach the intestines), and identifies some of the successful supplement designs, such as Florastor, that overcome this problem and have a demonstrated effectiveness. (In the case of Florastor aka Saccharomyces boulardii, the supplement has shown the capacity to decrease the incidence of a relapse in clostridium difficile colitis. It also has some other documented therapeutic successes.)

For more on Florastor, see the NYBC entry:

FLORASTOR

See also additional entries under Saccharomyces boulardii on this blog for applications and dosage recommendations.

Time to throw out the supplements? Comments on The New York Times article: “Vitamin Pills: A False Hope?”

Several people have asked us to comment on recent news stories about research showing that taking vitamin pills has little if any health benefit, and in fact may be harmful in certain instances (such as for people with a cancer diagnosis). A representative article in this vein is the New York Times piece “Vitamin Pills: A False Hope?” by Tara Parker-Pope, published Feb. 16, 2009, and accessed by us online at http://www.nytimes.com/2009/02/17/health/17well.html.

Here’s our commentary, which takes its start from a key passage in the article:

NYT: In any event, most major vitamin studies in recent years have focused not on deficiencies but on whether high doses of vitamins can prevent or treat a host of chronic illnesses. While people who eat lots of nutrient-rich fruits and vegetables have long been known to have lower rates of heart disease and cancer, it hasn’t been clear whether ingesting high doses of those same nutrients in pill form results in a similar benefit.

NYBC BLOG: 1. In fact, most of the studies making news are surveys of people with no known vitamin deficiency and no evident health problem. The studies cited generally found that there was no improvement in rates of disease development over time (heart disease and cancers, primarily) for people taking the vitamins, as opposed to those who didn’t. On the other hand, NYBC’s interest has focused on the detection of vitamin deficiencies in people with chronic illnesses such as HIV, and then targeted supplementation and its results. For example, supplementation with Vitamin D (plus calcium) in people that are deficient has been found to have benefit, both for bone health and for reduction of cardiovascular disease risk (and, according to more recent research, for cancer risk as well). The same goes for supplementation with people deficient in minerals; in a well-known study, University of Miami researchers identified selenium deficiency in people with HIV, and also found that supplementing with this mineral improved health in this group. More generally, many vitamin and other nutrient deficiencies have been detected in people with HIV, and there have been many studies showing health benefits from supplementing to counteract these deficiencies. So, in conclusion, we are not terribly surprised if people with no known vitamin deficiencies and no known health problems are found not to gain much, if any, health benefit from taking vitamins–but that’s really a different question from those (many) studies showing that specific deficiencies and their related disease states can often be successfully addressed by supplementation.

2. Regarding vitamins and cancer: we certainly recommend caution here, and have frequently referred people to the Memorial-Sloan Kettering Cancer Center website on complementary medicine for guidance. Studies have indicated that vitamin supplementation (with C, for example) can accelerate certain cancers. However, as the MSKCC website shows, there is wide interest in, and much evidence for, use of certain dietary supplements as adjuncts in cancer therapy. The world of dietary supplements is much bigger than just the short list of vitamins; and research on supplements and cancer is a major topic among projects funded by such sources as the federal government’s National Center for Complementary and Alternative Medicine. Indeed cancer research has focused quite often on the therapeutic potential of botanical sources. The cancer drug paclitaxel, to give just one example, derives from the yew tree; and many traditional botanicals continue to be studied for their anti-cancer properties: turmeric/curcumin, green tea (with its polyphenols), silymarin, astragalus, to name just a few.

3. While the vitamin studies reported in the NYT article are negative, no one disputes the fact that nutrition has an enormous impact on health. In fact, the New York Times also recently ran articles reiterating the substantial health benefits of the “Mediterranean diet” (good fats like olive oil rather than bad fats; fish rather than meat; carbs from beans, peas, lentils; more veggies than meats), which has been associated with lower risk of heart disease and–in a newer area for research–a lower risk of depression and other mental health disorders. So, can the clear health benefits of a particular diet be translated in any useful way to the field of supplements? One obvious “yes” comes in the increased study and use of fish oil/omega-3 fatty acid supplements over the last few decades. Here’s a case in which an individual nutrient within a healthful diet has been isolated and can be usefully delivered as a supplement that bestows health benefits. (Fish oil supplements have a particular advantage over food sources, too: they can be refined to eliminate mercury contamination, a growing concern these days, whether you are eating fresh or canned fish.) We certainly know that it is possible to extract a component from food and use its particular properties to confer a health benefit, while leaving behind some other parts of the food that we don’t want or need. (This is the case with whey protein powders, which leave behind milk fat, but keep the whey protein with its interesting nutritional benefits.)There may also be increasing recognition that effective supplementation can require a wide-spectrum approach. Instead of emphasis on single vitamins, we’ve known for a while that the B vitamins work together and are usually best taken as a complex; or that a complex of carotenoids from vegetable sources is probably better than just a few select samples of these compounds. Of course, we would like to have more research about the particular value conferred by “food-based” supplements such as the popular “green foods.” In short: do choose a good diet to stay healthy, but don’t throw out the supplements, which can also make their contribution to your health and well-being!

Statin side effects: reason to consider the alternatives?

There’s been a lot of buzz about a new study published in the New England Journal of Medicine that found that statin use by people with low cholesterol but high levels of an inflammation marker (C-reactive protein, or CRP) very substantially decreased heart attack and stroke rates over a two-year period. The study participants were men 50 and older and women 60 and older with no history of cardiovascular disease or high cholesterol, but with high levels of CRP. Many also had other cardiovascular risk factors such as obesity, high blood pressure, or smoking.

Does this study suggest that millions of people with normal cholesterol levels but high levels of CRP should start taking statins on a regular basis? There is a caution here, which was raised by an editorial in the NEJM accompanying the study, and has been echoed in many other places, from the New York Times to the British Journal of Medicine: what about the long-term effects of taking statins? It was worrisome to note that in this study, participants taking the statin (Crestor) over the two-year period had an increase in diabetes. This finding brings to mind an unfortunate pattern marring the US drug approval process in recent decades: drugs win approval and are widely marketed, but several years later it turns out that there are side effects to long-term use, sometimes so prevalent and so severe that recommendations for use of the drug must be curtailed. So it’s best to give very careful thought to “who should take a statin?” (This was the title of the New York Times editorial regarding the study.)

Furthermore, when discussing how to manage chronic conditions over the long term, we shouldn’t neglect good options in nutrition and dietary supplements. Here’s how George Carter at our sister organization FIAR puts it, in his direct response to the NEJM study:

Are there cheaper and safer alternatives to lowering CRP? Yes! A low-fat diet, for example, can cut CRP in half in 4 weeks.

How about just adding some fiber? See http://www.medscape.com/viewarticle/553590.
They found an 18.1% reduction in CRP using supplemental fiber. While rosuvastatin appears to have done better with a 37% reduction, just using fiber can get one half way there. Also, it is unclear what degree of reduction might be clinically important, although a generally agreed upon level of greater than 1.0 mg/liter CRP is considered problematic.

Vitamin C has also shown some benefit. One study reported that participants who took about 500 milligrams of vitamin C supplements per day saw a 24 percent drop in plasma C-reactive protein (CRP) levels after two months. Another study among healthy non-smokers saw a 25.3% reduction in CRP levels among those with a level greater than 1.0 mg/L at the beginning of the study.

We’ll conclude by adding that of course dietary supplements like fish oil (with their omega-3 fatty acids), niacin, pantethine, CoQ10 and the B vitamins also have a role to play in controlling cardiovascular risk. Their effectiveness has been widely studied and documented, they have been in use for a long time, and they have very well-known safety profiles. It only makes sense that these supplements should be part of the arsenal of protective and preventive means available to those concerned about managing risk to the heart and circulatory system.

References:

Ridker, PM, et al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. NEJM, 9 Nov 2008

Who Should Take A Statin? Editorial in the New York Times, Nov. 17, 2008. Accessed at http://www.nytimes.com/2008/11/17/opinion/17mon2.html?hp

FIAR press release on NEJM statin study accessed at
http://www.fiar.us/StatinResultsMediaLetter.pdf