Feeling exhausted and not sure why? Ask your health-care provider to check your vitamin B12

Some doctors are adding a vitamin B check to their standard "baseline" workup, especially vitamin B12, the one most commonly deficient, Dr. Leigh Erin Connealy reports for Newport Natural Health.

"By some estimates, up to 40 percent of the population does not have sufficient levels of B12," Connealy writes.

The B vitamins work together as a family to  perform many important functions throughout the body, such as helping to convert our food to fuel, allowing us to stay energized through the day, helping maintain heart health, preventing birth defects, creating red blood cells or assisting with the production and repair of DNA, to name a few.

Vitamin B12, or cobalamin, keeps our blood, nervous system and heart healthy. It is found primarily in animal-sourced foods—all meats, dairy products, eggs, and shellfish. Liver, sardines, and salmon contain the greatest amount.

Image from webmd.com

While it is not uncommon for vegetarians and vegans to have low levels of B12, Connealy says that even meat eaters can lack it, usually because of poor absorption.

Absorption issues in younger people are often caused by acid-blocking medications, disorders such as Crohn's disease, leaky gut, diarrhea and other gastrointestinal problems.  Older people with a condition called hypocholorhydria, where the stomach does not produce enough acid to help with the absorption of nutrients, can have low levels as well, Connealy notes.

B12 deficiency can cause a wide variety of debilitating symptoms ranging from exhaustion and lethargy to depression, anxiety, memory loss, confusion, and other Alzheimer’s-like symptoms.

WebMD adds rapid heartbeat and breathing, pale skin, sore tongue, bleeding gums, stomach upset and weight loss and diarrhea or constipation to the list of symptoms.

Connealy notes that there are differing recommendations for the amount of B12 that should be in a supplement. The Dietary Reference Intake recommends between 2-3 micrograms daily, while the Center for Food Safety and Applied Nutrition recommends 6 mcg daily, based on a 2,000-calorie diet.

Connealy recommends the higher dosage, especially since "absorption problems are so common with age" and "it's nearly impossible to overdose." She also recommends B12 injections for severe deficiencies. In particular, she says that vegetarians, vegans and those age 50 and older should take an oral B12 supplement every day.

Obesity and depression may contribute to daytime sleepiness

Obesity and depression, not just lack of sleep, contribute to daytime drowsiness, according to Penn State College of Medicine researchers. Daytime drowsiness or sleepiness affects up to 30 percent of the U.S. population. It can reduce work productivity and cause car accidents. According to the States of Obesity report, 33.2 percent of Kentucky adults are obese.

The Penn State study used physiologic sleep data to show a connection between obesity and depression or sleepiness. Study participants filled out a comprehensive sleep history and physical examination and were evaluated in a sleep laboratory. "Obesity and weight gain predicted who was going to have daytime sleepiness," said Julio Fernandez-Mendoza, assistant professor of psychiatry at the Sleep Research and Treatment Center. "Weight loss predicted who was going to stop experiencing daytime sleepiness, reinforcing the causal relationship."

Body mass index and sleepiness association was independent of sleep duration, so obese people might be sleepy during the day regardless of how much sleep they get. Obesity is also associated with sleep apnea. The chief reason heavy people are more tired is that fat cells create immune compounds called cytokines that make one sleepy.

According to the study, depressed people have daytime drowsiness because they have trouble falling asleep and often wake up during the night. "The mechanism that we believe is playing a role here is hyperarousal, which is simply going to bed and being to alert; in other words, people with depression feel fatigued but do not necessarily fall asleep during the day, Fernandez-Mendoza said.

The study showed that a one-size-fits-all method for treating daytime drowsiness will not be effective. Daytime sleepiness doesn't always mean a person doesn't get enough sleep, Fernandez-Mendoza said. "The main causes of a sleepy society are an obese society, a depressed society and, to some extent, people who have a physiological disorder. By looking at our patients more closely, we can start personalizing sleep medicine."

Got the winter blues? Many treatments are available

(image from kidshealth.org)

For some, winter is more than just a season characterized by shorter, colder days; it is a time of year that brings on the "winter blues," Jill U. Adams reports for The Washington Post.

Officially, it's called seasonal affective disorder, or SAD, and is a type of depression. It begins during the late fall or winter of each year and disappears with the onset of spring. Common symptoms include: tiredness,even though the person is getting enough sleep; a loss of interest in usual activities; feeling sad, grumpy, moody or anxious; craving carbohydrates, eating more and gaining weight; and trouble concentrating, according to WebMD. Some even have suicidal thoughts.

SAD occurs in 1 to 2 percent of the population, with a milder version, "the winter blahs," occurring in 10 to 15 percent, Raymond Lam, a psychiatrist at the University of British Columbia in Vancouver, told the Post.

Therapy with light is the most common treatment for SAD and has proven effective, although many doctors and insurance companies still don't recognize it as effective. The disorder is also treated with medications and talk therapy, Adams notes.

Light therapy involves sitting near a very bright, broad-spectrum light for at least 30 minutes every morning, Adams reports. WebMd cautions that the fluorescent lights used in light therapy are not the same as ultraviolet lights, full-spectrum lights, tanning lamps and heat lamps, all of which should not be used for this purpose.

Experts are still trying to figure out exactly why light therapy works, but some evidence suggests that not getting enough light is the main trigger for SAD, which is more common in areas where the daylight hours are shorter, Teodor Postolache, a psychiatrist at the University of Maryland School of Medicine, told the Post.

Another study found that healthy people's eyes are more sensitive to light in the wintertime, while those with SAD have less sensitivity, University of Pittsburgh psychologist Kathryn Roecklein told Adams.

Experts told Adams that it is important that SAD not be self-diagnosed and that light therapy not be experimented with. They said a person may have health conditions that mimic these same symptoms or have untreated or under-treated depression that is not seasonally influenced, and some people take medications or have conditions that make them more sensitive to light.

“If your symptoms are severe enough to interfere with daily functioning, get an assessment at a mental health clinic or by a doctor,” Lam told Adams. “There are many causes and lots of treatments.”

Paul Hokemeyer, a licensed marriage and family therapist in Manhattan, offered nutritional suggestions to help those with SAD in an article for Fox News.

He suggests that people with SAD eat foods that will increase their serotonin levels: those high in Omega-3 fatty acids and tryptophan, which he says is "linked to mood regulation, and a deficit leads to depression." Some foods high in Omega-3 are trout, salmon, and walnuts; those high in tryptophan include lean turkey, chicken, milk, eggs, nuts and bananas.

Hokemeyer also suggests that those with SAD supplement their diet with foods rich in vitamin D because studies have found a correlation between depression and low levels of vitamin D. Foods high in vitamin D are egg yolks, fortified dairy products and cereal, beef liver and cod fish oil.

And finally, he suggests those with SAD eat whole, unprocessed foods to decrease mood swings caused by the "spikes and crashes" in blood sugar levels commonly associated with eating processed foods that are high in simple sugars and white flour.

Tips on getting around or through the 'holiday blahs'

The holidays are supposed to be the happiest time of the year, but for many it is a time of sadness and anxiety, Sarah Elizabeth Richards writes for the Daily Burn.

"There's so much emphasis on family and celebration, but it's hard if you're dealing with difficult memories or reminders that you're not close to your family,"  Sharon Melnick, author of Success Under Stress: Powerful Tools for Staying Calm, Confident and Productive When the Pressure's On, said, writes Richards. "It can feel like there's a big gap between what other people are experiencing and what you're experiencing."

Not only do holidays provide normal stresses like added financial burdens, gift giving and family and social expectations, add in cold weather and a lack of sunlight and you have created perfect conditions for a "world-class funk," she writes.

But there is a difference between seasonal affective disorder (SAD), which is estimated to affect up to 20 percent of Americans and the "holiday blahs," Richards notes.

"It's important not to classify all winter doldrums as SAD," Sarah Eckfeldt, a psychotherapist in New York City, told Richards. "Many people experience a drop in mood in anticipation of the holidays because they might be sad over a recent breakup or spending the first holiday after the death of a loved one and could benefit from talking to a therapist."

The good news is that the "holiday blahs" tend to go away after the season is over. Richards offers some tips to survive the season if you find yourself with a case of these "blahs."

• Seek social support. Make plans with a small group of friends, put a few events on your calendar to look forward to or explore a new activity that you have been interested in.
• Get to the gym. Make yourself go, even if you don't feel like it.
• Don't look at Facebook. Connect with your friends via phone or text message, talking only to the people who will lift you up.
• Reframe your thinking. Find opportunities to volunteer. Spend time doing what you enjoy.
• Remember that the holiday season will soon pass, You just have to make it to Jan. 2 and the season will be over.

"If you struggle with serious and continuous depressive symptoms, be sure to reach out to a healthcare provider to discuss your condition," Richards writes.

Depression should not be a taboo subject; rural Kentucky news editor details writes about her victory over it

By Tim Mandell
Institute for Rural Journalism and Community Issues

Depression is a subject people often shy away from discussing, but a large percentage of Americans suffer from, or have suffered from, serious depression. Around 50 million have become seriously depressed at some point during their lives, according to a report by the University of Kentucky Cooperative Extension Service. ­

The suicide last month of actor Robin Williams brought depression to the forefront of the national news for a few weeks, but as the national focus shifted to other stories, community journalists should continue to talk about depression, especially in rural areas where people might feel they will be ostracized if they express how they feel.

That’s why it’s important when journalists like Shelley Spillman, news editor of The Anderson News in Lawrenceburg, Ky., step forward and write columns detailing their own battles with depression. Spillman, who was inspired to write a column after Williams’ death and the suicide of a local man who suffered from depression, said in an interview, “This is not something we normally talk about and maybe we should. Maybe these people wouldn’t feel so alone."

"As journalists we’re part of the community too," she said. "I really enjoy people getting to know me, my real struggles in life and the things I’ve been through. It’s amazing how relating to people on a human to human level is one of the most difficult things to do. But it’s so important.”

In her column, Spillman wrote: “I, too, have suffered from the cold, metallic grip of depression. I know what it’s like to be in a room full of people and still feel alone. You’d give anything to feel the warmth of company without having to go through the mental gymnastics of plastering on a fake smile just so you don’t have to be berated with ‘are you OK?’ or ‘what’s wrong?’ It’s not their fault. Most people don’t know how to deal with people who suffer from depression. Even in our daily interactions people stop and ask ‘How are you doing?’ without sticking around long enough to hear anything other than a one-word utterance of ‘Fine.’”

“It does get better; give it time. I understand, though, that giving depression time, when a day with it can feel like carrying around the weight of a giant boulder, seems impossible, but you can. Sometimes when I think about my time with depression it seems so far away, like I’m at the fair soaring on one of those giant swings, examining bad memories of someone else’s life. I can feel black fog of depression permeating in my brain, trying to find a way back in, but I immediately recognize the intruder and sent it packing. Like I said, it’s a parasite, it’s always looking for a host to attach to.”

Spillman added, “You’ll find that you are a lot stronger than you may even realize now. You can make it out of this, and one day the clouds will part and you’ll be able to see the sun again. Let me tell you the sun feels glorious on your skin after a longtime in the dark.”

Spillman told The Rural Blog: “Readers who have called appreciate my honesty in my columns. It’s hard to put yourself out there and be that vulnerable, but I like for my columns to be honest and real. It’s a way for people to know who I am.” She said that writing a column like this is “a good way to get the ball rolling to get people talking about (depression).” She said she hopes columns like this can lead to there being more resources for people with depression, especially in small communities, and lead to depression being a subject that’s less taboo to discuss. (The Anderson News is behind a paywall but can be reached by clicking here.)

The Extension Service report details signs and types of depression, suggestions for those suffering from depression and suggestions for friends and family members of people who are depressed. Other valuable sources are available here, here, here, here and here.

Teens sensitive to light or noise after a concussion are more likely to suffer anxiety or depression, UK study finds

Teens who are sensitive to light or noise after a concussion may also have increased emotional symptoms, such as anxiety or depression, according to a study at the University of Kentucky.

“While most people recover from a concussion within a week, a number of factors affect their recovery, and studies have shown that teenage athletes may take up to seven to 10 days longer to recover than older athletes,” co-author Lisa M. Koehl said in a news release. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school.”

The study followed 37 athletes, ages 12 to 17, who had persisting symptoms for an average of 37 days following a concussion. They were checked for post-concussion changes in physical, emotional and cognitive symptoms. The study determined that there were no differences in the severity of concussions in the group, and that a family history of psychiatric problems did not affect post-concussion emotional symptoms.

But it did find that teens who are sensitive to light or noise after a concussion may also be more likely to have emotional symptoms, including irritability, aggression, anxiety, depression, apathy, frequent mood changes or excessive emotional reactions.

Of the 37 athletes studied, 22 had emotional symptoms, and of this group, five (23 percent) were sensitive to light while three (14 percent) were sensitive to noise. Of the 15 athletes with no emotional symptoms, only two (13 percent) were sensitive to light and no teens were sensitive to noise, according to the release.

"Teens who had anxiety were 55 percent more likely to self-report attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability," said co-author Dan Han. "While these findings are preliminary and require a larger sample size to predict outcomes with more confidence, we are intrigued by the potential these data offer in terms of providing teens with a better treatment plan based on their unique cognitive, physical and emotional response to concussion."

The researchers presented their findings at the American Academy of Neurology's Sports Concussion Conference in Chicago in July. Click here for more information about concussions.