G is for Glucose

I have a sweet tooth….a mouth full of them in fact! I eat pretty healthy….protein, complex carbs, lots of vegetables…but it’s the dessert. I can’t say no. Especially when it is cake. I’m not kidding when I call myself a cake addict in my tagline. Cake is my reward for completing a goal and it is my comfort when I am not feeling well (physically or mentally). Everyone teases me. My Dad even threatens to stick a bumper sticker on my car, “I brake for cake!”.

I love cake

There have been a lot of articles recently about the food-mood connection, how blood sugar and brain chemistry are related. To my dismay, sugar is bad for you. I’m not talking about all sugar. Your body does, after all, need some sugar (glucose, specifically) to function properly. Think back to high school biology, cell respiration…remember that? It all starts with glucose. Like any good thing however, too much is bad. Dessert has a lot of sugar and your body breaks it down into glucose quickly. Sugar rush!! It’s not just dessert though. Everyday foods like rice, bread, soda or fruit juice can put you over the top too.

People with low levels of serotonin (like those with depression) crave sugar. Too much sugar exacerbates mental health problems. Yes, another another endless cycle that those with mental illness have to fight. It’s not fair is it? At least now I know why I’ve always been a sugar addict.

Carbohydrate cravings have been linked to lower serotonin levels. Ingesting sugar releases insulin from the pancreas. Insulin alters the ratios of amino acids in the body causing there to be more tryptophan available and less of other amino acids. This means there is less competition for tryptophan to cross the blood-brain-barrier. In the brain, tryptophan can be converted into serotonin, the feel-good neurotransmitter that is often low in those with depression. This explains why I reach for cake as soon as I start feeling down. The relief is only temporary though. Eventually things return to normal and less tryptophan is available to be converted to serotonin. This, of course, starts the whole sugar craving all over again. Keep in mind, this is just a fragment of a hugely complex picture.

Sugar has the potential to be addicting too. The more you eat it, the more you crave it. Sugar floods the brain with another feel-good neurotransmitter, dopamine. Studies have show that sugar activates the same areas of the brain as cocaine and we all know how addictive cocaine is known to be.

There are 3 potential mechanisms through which too much sugar can be a burden on mental health.

  • Insulin and leptin resistance. Insulin resistance can impair signaling between brain cells. You know that foggy feeling you get when you are feeling low. You can’t really concentrate and you’re having trouble remembering things….insulin resistance contributes to that. Leptin is released to tell the brain you are full, building up a resistance can lead to constant overeating which leads to weight gain. And that always makes us feel great about ourselves right?
  • Chronic inflammation. Sugar overload triggers a set of reactions that lead to a low level of chronic inflammation. This doesn’t cause problems right away, but in the long term, chronic inflammation contributes to things like heart disease, Alzheimer’s and Macular Degeneration. Inflammation in the brain is also thought to exacerbate depression.
  • Less Brain-Derived Neurotrophic Factor (BDNF). BDNF is necessary for healthy neurons. Sugar suppresses the production of BDNF. Studies comparing those with depression to those without have found that generally, people with depression have significantly lower levels of BDNF. Meaning, sugar just lowers it even more. Ugh!

So I guess sugar is my best friend and my worst enemy.

Sources:
Neurology
Diabetes Care
Food for the Brain

P is for Plasticity

I had a plethora of “P” words; Prozac, psychology, psychiatry, polarized thinking, phobias, panic attacks, perfectionism, pet therapy, powerlessness, Post Partum Depression and Psychotic Depression. I think this was the longest list of options I’ve had for any letter. The problem is, none of them inspired me. Well, that’s not true, I wrote about perfectionism and pet therapy recently. I was actually pretty happy with my perfectionism post. Read it if you get a chance.

Finally, I stumbled over plasticity, which I thought was a good word. Plasticity is the ability to be malleable and resilient. It was once thought that the mature brain was fixed, unable to repair damage. This is no longer the case, science has shown that the brain changes throughout life. It is plastic. Learning a new skill like a language for example, causes new connections between neurons to be made in the language area of the brain. This takes mere minutes. If you don’t use what you have learned and forget, the brain shrinks and and those connections are lost.

It has been shown that those who suffer from chronic stress, like those with anxiety and depression, have less brain plasticity. The hippocampus, the area of the brain for learning and memory, is highly influenced by stress hormones. Under chronic stress, the neurons in that part of the brain retract causing connects to be fewer and less efficient. This coincides with the difficulties in concentrating and remembering experienced by those with depression.

The damage caused by stress is not permanent though. Things like exercise and socializing can improve the connections in your brain. People with depression can have recovery of their lost connections through treatment with antidepressants that promote neurogenesis (the growth of neurons). Studies have shown that recovery from anxiety/depression with selective serotonin re-uptake inhibitors (SSRIs) coincides with the formation of new neurons in the hippocampus.

portrait 2

This has nothing to do with anything, but “Portrait” is a “P” word, so here it is.

Depressed or Dehydrated?

I’m continuing with the A to Z Blogging Challenge. Today is “D”. D is for depressed or dehydrated….or both!

Drink eight 8-ounce glasses of water a day. That’s about 2L. I’m sure you’ve heard this before, but do you actually do it? I know I don’t. This 2L is just for a regular day. If it’s hot out, or you are exercising, then you need even more! Chronic dehydration leads to all sorts of problems; fatigue, constipation, high blood pressure, digestive disorders….. I could go on forever. Your body is a bio-electric machine whose major component is water. In fact, the body is 70% water. Of course something is going to go wrong if you don’t get enough of it.

When the body doesn’t get enough water, it has to ration what it does have, which means cutting back on function. This means it takes water from your muscles, bones and brain. Yes, the brain! The brain is 85% water, 2% of the body’s water weight and it receives 15-20% of the body’s blood supply, most of which is water. Thirst is the survival mechanism that we’ve adapted to tell us our body needs more water. Thirst is the warning that occurs before function is too compromised and survival is at risk. The problem is, by the time thirst kicks in, we are already suffering the effects of mild dehydration. Mild dehydration occurs when 1.5% of normal body water volume is lost. That is not a big amount. Thirst is triggered somewhere between a 1-2% loss. By the time you feel like drinking, it has already had an effect on your mind.

Dehydration affects mood, energy and ability to think clearly. A study investigating mild dehydration in men reported that they complained of tension, anxiety and fatigue. On a cognitive test battery, they had trouble with working memory and concentration. It was even worse for women. They reported headaches in addition to fatigue. On the cognitive tests, like the men, women had difficulty concentrating, but they also reported the tasks to be more difficult compared to when they did them fully hydrated.

Why does this happen? There are a couple reasons. One is tryptophan, an amino acid and the precursor to serotonin, a neurotransmitter that contributes to our feelings of well-being and happiness. Tryptophan is an essential amino acid. This means it is essential for life and it cannot be synthesized by the body, so we must get it from our diet. Tryptophan is absorbed from the gut into the blood stream where it is transported to the brain. Here, it must cross the blood-brain-barrier before it can be converted into serotonin. Dehydration impedes the transport of tryptophan across this barrier leading to a drop in brain serotonin levels.

Another reason is histamine, another neurotransmitter. Histamine is responsible for triggering the thirst mechanism and rationing a limited water supply. When you are dehydrated, histamine levels increase. What does this have to do with anything? Histamine stimulates the release of….wait for it….serotonin, norepinephrine AND dopamine. All of which play a role in mood. Low levels of histamine cause high levels of dopamine which have been associated with hallucinations. Too much histamine distorts the release of serotonin, norepinephrine and dopamine causing the “racing mind” feeling.

So there you have it. Depression via dehydration. Are you depressed or just dehydrated? Only you know that answer, but I bet you’d feel better if you drank enough water. I mean pure water, no juice or tea and definitely no coffee or alcohol, those are dehydrating! There is some water in those drinks, but there are also a lot of other things in them that your body needs water to digest. In the end your body will need more water to digest that glass of juice than the juice actually provides. How do you know if you are drinking enough? You can tell by the colour of you urine. A pale yellow means the body has enough water while a deep yellow indicates concentrated urine, a sign of dehydration.

drink water

Sources:
PsychCentral
Armstrong et al., 2012

Cognitive Dysfunction in Depression

I have Major Depressive Disorder (MDD). It’s a battle I have to fight everyday. I’m proud to say I haven’t lost yet. It’s hard to make family and friends understand that this is a serious struggle. The symptoms commonly associated with MDD are changes in sleep, appetite and energy, combined with a lack of interest, low self-esteem and hopelessness. This gives MDD the image of an emotional attitude, something you can change or just snap out of. That’s not it at all.

I like to compare MDD to the weather. It’s always there, it changes, you can’t control it, but with skill, you can predict it and take precautions. It’s like a fog that rolls in and clouds your outlook on life. It’s dark and difficult to see through. It could last anywhere from hours to months. Then, a beam of light or a gust of wind dissipates it and the world looks brighter again. So asking why can’t they snap out of it is like asking why is the sky blue.

I’m hoping recent research on the symptoms of MDD will help lift the stigma. The old myth that depression is purely a mood disorder is slowly being overturned. Research has shown that patients with MDD can also suffer from cognitive dysfunction. What’s that you say? It’s that foggy feeling you get in your brain. You can’t concentrate, you forget what you’ve just read and processing information, let alone doing anything is hard. It’s not an excuse give up and be lazy. It’s a frustrating difficulty that we have to learn to work with.

What is cognition?

Cognition is not academic skills. Academic skills include knowledge about specific subjects like math or philosophy. Cognitive skills refer to thinking and how you interact with your environment, things everyone does everyday. Cognition allows you to perceive, acquire, understand and respond to information through abilities such as attention, memory, information processing, problem-solving and organization. These abilities are essential to function in our society. Cognitive dysfunction is when these abilities are impaired.

Recent Findings

Cognitive dysfunction can have a huge impact on the quality of life. Until recently, changes in cognitive function weren’t linked to the diagnosis of MDD. Using well-developed, objective cognitive function tests, Cogstate showed that the prevalence of cognitive dysfunction is almost 50% across a group of MDD participants. Those with cognitive dysfunction have lower productivity levels compared to normals and those who were depressed but cognitively normal. These cognitive symptoms are stubborn too. They don’t come and go with the fog of a depressive episode. They persist through the better times too. Researchers believe that cognitive symptoms may be more debilitating than the physical symptoms of MDD, possibly the underlying cause of disability.

Parts of the Brain Involved

Areas in the brain involved in cognition overlap and communicate with regions responsible for mood and emotion, namely the frontal-limbic circuitry and the hippocampus. The frontal part of the brain is responsible for cognition while the limbic system handles emotion and the hippocampus manages memory storage and processing. These areas communicate via neurotransmitters that I’m sure you are familiar with; serotonin, norepinephrine and dopamine. After all, these are what our medications aim to increase. A decreased level of serotonin explains the lack of motivation and will power that characterizes depression. Lower levels of norepinephrine decrease abilities to concentrate, while decreases in dopamine take away enjoyment. MDD is not just low levels of neurotransmitters, otherwise our anti-depressants would have put us all in complete remission.

Eureka!

Recent research has determined that our brains are structurally different from people who do not have MDD. Structural abnormalities are seen in the frontal-limbic and hippocampal areas of the brain. They are there at the beginning of MDD and may even precede it! This is shown by imaging studies on those experiencing their first major depressive episode, before starting treatment. After multiple episodes of depression, the volume of the hippocampus decreases. This decrease correlates with observed memory problems.

So far, research has determined the regions of the brain that are affected by MDD, but we don’t know why and there are few, if any effective treatments. Tune in tomorrow to learn about what is available to help combat the cognitive symptoms of MDD. Ultimately, more research needs to be done in this area to give sufferers relief from the frustrating cognitive symptoms.

MDD is not just a mood disorder or an attitude that you can change. Have you ever wished you had something to show for your pain…a broken leg, a tumor or something to explain why you are the way you are? There are physical abnormalities to explain my foggy thoughts and crumby short-term memory. Unfortunately we can’t all go get brain imaging done to prove it, but knowing that my issues are scientifically validated give me comfort. Even though I’ve known it for a while, a lot of the world doesn’t. I’m not lazy, I have MDD. It’s real. Take that stigma!

(P.S. I’m not a doctor or an expert, I’m just sharing what I’ve read that makes me say Wow!)

Sources:
cogstate.com 
Office of Mental Health 
Trivedi and Greer, 2014

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