Depression among the Elderly

This question from S.R. in Tuckahoe:  Thank you for the information about SAD, but my grandma seems to have SAD all of the time. Any thoughts?

Seasonal affective disorder, or SAD, is a mood disorder that predictably happens at about the same time every year.

Typically it begins in the late fall and continues through the winter and is related to the decreasing amount of sunlight and its effect on the production of various brain hormones, particularly serotonin. If someone is sad all of the time, then they don’t have SAD but could be sad for a myriad of other reasons.

Symptoms like:

• difficulty concentrating, remembering details and making decisions
• fatigue and decreased energy
• feelings of guilt, worthlessness and/or helplessness
• feelings of hopelessness and/or pessimism
• insomnia, early-morning wakefulness or excessive sleeping
• irritability, restlessness
• loss of interest in activities or hobbies once pleasurable, including sex
• overeating or appetite loss
• persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
• persistent sad, anxious or "empty" feelings

are all classical signs of depression. If this sounds like your grandma, then it is important that she see a mental health professional because left untreated not only is her quality of life negatively impacted but she could become suicidal. Therefore, treating depression isn’t a do-it-yourself-at–home kind of thing but should be taken seriously.

As we age our production of hydrochloric acid in our stomach decreases, which makes it harder to digest and absorb some important nutrients. Furthermore, the accumulated effects of the “wear and tear” of life begin to take their toll, again increasing our need for many different nutrients.

In the recently published article  "The effect of low-dose omega 3 fatty acids on the treatment of mild to moderate depression in the elderly: a double-blind, randomized, placebo-controlled study," it was again demonstrated how important good nutrition is. They reported that just a small daily intake of fish oil containing only 300 mg each of EPA and DHA can have useful effects against depression in the elderly population.

Now that winter seems to be finally abating, go with your grandma for long and regular walks, the exercise and sun exposure will do you both good, make sure she is eating a broad and varied diet with a good daily multivitamin and include some fish oil in her supplements. In our office we use the Metagenics brand of fish oil because of its purity and mild taste.

Maintain Your Brain: Tips to Retain Concentration and Memory

This question from E.T. in Bridgehampton: Last week you wrote about depression and you mentioned trouble with concentration, my dad has trouble with his memory and concentration but I don’t think that he’s depressed. Any ideas?

Many of us in the “49 and holding” crowd joke about “senior moments.”

But when they start happening to you more often, they’re not funny at all. Instead, they’re frustrating, embarrassing and perhaps even worrisome especially to your kids who immediately have visions of nursing homes and diapers. Have you ever walked into a room — and forget what you went in to get? Run into someone you haven’t seen lately — and can’t recall their name? (I can never remember names.) Misplaced your glasses, your house keys or your car? It’s ironic. Just when you’ve got life almost figured out with all of this wisdom and experience under your belt, your brain is no longer “old reliable.” You never know when it’s going to trip you up, frustrate you, embarrass you, or make you wonder if you’re starting to lose your marbles.

So what’s a dad to do? Researchers at Harvard have been doing extensive studies in this area, lest they suffer the same fate as us mortals, and have dutifully been reporting their findings. Aside from stress and the myriad distractions of daily life, they have concluded that there are both structural and functional reasons for our brain faux pas.

Once we become an (AARP) card carrying member of the “49 and holding” crowd, structural changes become evident in our brain. Oxidative damage and the accumulation of toxins cause damage to the protective myelin sheath which makes our nerves short circuit a bit thus causing “data loss.”

Furthermore, as we age our levels of neurotransmitters and brain hormones, decrease causing a functional slowing of the transmission of information. The pharmaceutical industry has responded with drugs like Provigil, Aricept and Namenda to name but a few. These drugs try to close the gate after the chickens already flew the coop by manipulating neurotransmitter levels.

From a more pro-active perspective there are some natural supplements that have proven themselves to be helpful. Phosphatidylserine restores the brain's supply and output of acetylcholine, the neurotransmitter so important to memory, and so may turn back the clock in an aging brain. Alpha-glycerylphosphorylcholine, or Alpha-GPC is a cholinergic brain supplement that increases the synthesis and secretion of the neurotransmitter acetylcholine, which is the brain's messenger responsible for sending signals across the brain and to the muscles of the body. And Acetyl L-Carnitine (ALC) is basically a fat soluble amino acid that has the ability to cross the blood-brain barrier and get to the brain blood circulation, where it acts as a powerful antioxidant, which helps in prevention of the brain cells' deterioration. Its supplementation has been shown to be neuroprotective in instances of cerebral ischemia and may be useful in treating peripheral nerve injury. There are numerous supportive supplements ranging from blueberries to ginko and vinpocetine, to name but a couple.

Back to our friends at Harvard who put together 10 research-proven tips for a better memory:

1. Believe in yourself. Middle-aged and older learners do worse on memory tasks when exposed to negative stereotypes about aging and memory, and better if exposed to messages about memory preservation into old age.

2. Economize your brain use. Take advantage of calendars and planners, maps, shopping lists, file folders and address books to keep routine information accessible. Designate a place at home for your glasses, keys, and other items you use frequently.

3. Organize your thoughts. New information that’s broken into smaller chunks, such as the hyphenated sections of a phone or social security number, is easier to remember than a single long list.

4. Use all your senses. The more senses you use when you learn something, the more of your brain will be involved in retaining the memory.

5. Expand your brain. Widen the brain regions involved in learning by reading aloud, drawing a picture or writing down the information you want to learn (even if you never look back at your notes).

6. Repeat after me. When you want to remember something you have just heard or thought about, repeat it out loud. For example, if you’ve just been told someone’s name, use it when you speak with him or her: “So John, where did you meet Camille?”

7. Space it out. Instead of repeating something many times in a short period, as if you were cramming for an exam, re-study the essentials after increasingly longer periods of time — once an hour, then every few hours, then every day.

8. Make a mnemonic. Mnemonic devices are creative ways to remember lists. They can take the form of acronyms — such as the classic “Every good boy does fine,” to remember the musical notes E, G, B, D and F on the lines of the treble clef.

9. Challenge yourself. Engaging in activities that require you to concentrate and tax your memory will help you maintain skills as you age. Discuss books, do crossword puzzles, try new recipes, travel and undertake projects or hobbies that require skills you aren’t familiar or comfortable with.

10. Take a course. Memory-improvement courses are becoming more common. Choose one run by health professionals or experts in psychology or cognitive rehabilitation. Stay away from courses that center on computer or concentration games, which generally won’t help you with real-life memory problems. Select a course that focuses on practical ways to manage everyday challenges.

Embarrassing Digestive Problems

This question from F.K. in Sagaponack: My husband seems to be healthy but his digestive problems can be ... embarrassing, any ideas?

Digestive problems can occur for numerous reasons and many a book has been penned about them.

As usual, any problem that is new, severe, of rapid onset or accompanied by pain or blood in the stool should be checked out by your physician. Fortunately, most problems are of a functional nature.

As we age, three things commonly happen to our digestive tract. Things tend to slow down, so we need more roughage/fiber and water. Our stomach’s production of hydrochloric acid decreases as does our production of digestive enzymes. As a result we can develop symptoms of gas, bloating and indigestion as the good bacteria in our digestive tract are thrown out of balance by their changing environment.

To add fuel to the fire, as our production of hydrochloric acid and enzymes decreases, it makes us more susceptible to infections. Over time the accumulated assaults of innumerable tiny and sometimes not so tiny infections in the digestive tract can cause damage to what are referred to as the “tight junctions,” so that incompletely digested molecules are absorbed into our blood stream. This will then lead to the development of food allergies which will only make these symptoms worse.

Now, what is hubby to do? First, to address the slowing down issue — which allows food to putrefy and produce gas — eat more fiber, drink more fluids and exercise.

As we exercise — fast walking, bicycling or swimming being among the best — it not only helps our muscle tone, bone density and svelte appearance, but it also stimulates our gut to move more regularly, hopefully at least twice per day. To compensate for our decreased production of hydrochloric acid, the natural supplement Betaine HCL right before meals can be very helpful. Taking a supplement like Similase BV after meals can support our decreased production of digestive enzymes. To minimize the effects of inflammation and infection, making sure that we have plenty of good microbes in our digestive tract is of vital importance. Probiotics like Jarro-Dophilus or Pro-Flora can easily fit the bill here.

If the digestive problems remain then coming in for food allergy testing and addressing the undigested molecules that are leaking into the blood stream can often solve the problem, if not then more extensive testing is indicated. Until then, Glade air freshener can work wonders.

Why Am I Always Getting Sick and Never Healing Well?

This article by Dr. Jesse Stoff appeared on Southampton Patch on April 23, 2011

A. J. in Sagaponack asks: I seem to be always sick with something and not healing well. Any thoughts?

When my daughter, Summer, gets a small cut on her finger and asks for a Band-Aid, she does so with the full expectation that when the Band-Aid is removed a couple of days later, the cut will have been “magically” healed.  She is usually rewarded by her faith in her body’s healing capacity.

On a macroscopic level, healing appears to us as a miracle or as magic because of all the little elements that go into the repair of the damaged tissue. The removal of foreign material and destruction of harmful bacteria all happens in a microscopic world that is not directly accessible to our unaided eye.

My daughter’s unquestioning child’s faith in the healing powers and magic of her body are also an important ingredient when it comes to healing more severe or recurrent diseases. Left to its own devices, the body tends towards health. When someone doesn’t heal well or keeps getting sick there is reason that lies in one or more of the five areas that affect the integrity of our immune system. The first of these is nutrition. Nutrition supplies the basic biochemical building blocks that provide the infrastructure for our immune system to function properly. Just eating a broad diet doesn’t guarantee that you’ll get what your immune system needs because there are issues of the quality of the food and the efficiency of the digestive system to be reckoned with.

Infection is the second area that affects the functioning of our immune system. Viruses that directly attack immune function like EBV, CMV and HIV will have long term consequences on our ability to protect ourselves from future infections. EBV and CMV are common. More than 96 percent of the population have been exposed to them at some point. Imbalances in the micro-organisms in our digestive tract will also have a profound affect on immune system.

As a consequence of our industrialization, toxins now abound throughout our environment. A casual perusal of http://toxnet.nlm.nih.gov will give you some small idea of how big and prevalent the problem is. That’s why it is important to limit your exposure to toxins wherever you can such as choosing to eat as much organic food as you can and drinking plenty of pure water, fluoride not included.

Trauma is the next agent of immunological suppression. The only form of trauma that can directly hurt our immune system is that which comes from the exposure to radiation. This not only brings to mind Chernobyl, Three Mile Island and Fukushima but also commercial flight. When you are cruising at 35,000 feet, you are above much of the atmosphere that protects us from ionizing radiation. Studies have shown that air flight personnel have a higher incidence of severe and chronic diseases because of this.

The fifth horseman of immunological apocalypse is stress. The term stress was coined by Dr. Hans Selye just more than 70 years ago. According to Selye, “dis-ease is an attack on any particular aspect of your body or mind that creates a distressed physiology.”  Stress is an individual’s non-specific response to any stimulus, conscious or unconscious, physical or physiological. It is such an integral component of our existence that Selye has stated that, “Complete freedom from stress is death.” There are two categories of stress: eustress (characterized by happiness and enjoyment) and distress (characterized by anguish, tension and worry).  During distress the adrenal glands secrete the steroid hormone cortisol to excess and without the normal cycling that usually occurs, which will then suppress immune function.

Based on your history and physical findings, lab tests can determine the best way to proceed both by answering the question of why your immune system isn’t protecting you as it should and what medical disorders you have now that should be directly addressed.

What To Do About Stubborn Acne

This article by Dr. Jesse Stoff appeared on Southampton Patch.

This question comes from P.L. in Hampton Bays: I have recently been getting more acne and it is very stubborn and resistant to the treatments that I’ve tried. Any ideas?

Most people know that those familiar yet annoying red and white pimples of acne are largely influenced by hormones.

Hormone levels and their balance influence the production of sebum, the oily skin lubricant. Fluctuating hormone levels cause the sebum to get thicker and clog skin pores, trapping otherwise harmless bacteria and allowing a small local infection to occur known as acne. Treatment can be a bit tricky. The use of long term antibiotics can throw the delicate balance of intestinal micro-organisms out of whack leading to chronic digestive problems and bigger health problems. Topical lotions and creams can dry out the skin causing cracking and allowing the bacteria to track in deeper and can just be uncomfortable to deal with.

Your action plan should include addressing the known nutritional deficiencies that can predispose to acne infections by lowering your immunological resistance. Amino chelated zinc — that is zinc that is attached to an amino acid like zinc gluconate or methionine —  vitamin C, vitamin A, probiotics, like acidophilus, and essential fatty acids are helpful in supporting immune function. Eating a diet that is higher in predominantly organic vegetables than animal proteins is helpful in reducing some hormonal stress. Lower fat diets seem to make it easier to get acne under control. Getting more and higher quality sleep — which means going to sleep by 10, not to watch TV — is also important as it will reduce stress levels that can further throw your hormones out of balance. Increasing your water intake, regular exercise and addressing possible underlying food allergies, like we do in the office, are all very helpful in stopping and reversing acne.

Skin inflammation is a common symptom of allergies and if you have recurrent acne it may be worth looking into. Topically a non-petroleum based cream, like lanolin, with tea tree oil and Calendula can be very helpful. Warm Epsom salt water compresses, or yellow clay are better for drawing out the infected material than jabbing a needle into it and possibly spreading the bacteria deeper.

Why Am I Tired All The Time Since My Pregnancy?

This article by Dr. Jesse Stoff appeared on Southampton Patch.

This week's question comes from M.M. in Tuckahoe: Since I recently gave birth to my son, I have been so very fatigued, but all of my blood tests look “good.” Any thoughts?

As with any health problem, in order to feel better you first have to know what’s wrong.

Looking for a quick fix rarely gives lasting results. In fact, taking stimulants will, in the long run, usually make the problem worse, so put the coffee down and let’s sort this out.

As with any problem, we start at the beginning with a differential diagnosis. Unfortunately, in the various textbooks of differential diagnosis, the list of illnesses that have fatigue as a major component of their presentation goes on for pages and pages of very small print. If the fatigue is really debilitating then that list has to be seriously looked at.

This is where experience and common sense come in handy as a way to eliminate most of the causes. For instance, since you recently gave birth to your son (congratulations, by the way) then it’s a safe bet that you don’t have prostate cancer. But, there is a variety of problems with your endocrine system (balance of hormones) that can cause severe fatigue and are related to pregnancy. Some of these include thyroid or adrenal imbalances and diabetes, just to get us started. The “usual” blood tests won’t pick up an early thyroiditis, for example, as special blood tests are needed and must be specifically ordered.

During pregnancy there are many changes that occur to your biochemistry. With the increased demands placed upon it, nutritional deficiencies are a real possibility. Since biochemistry underlies everything, if it gets out of balance your hormones can quickly follow suit and a so called post-partum depression may ensue, which often has fatigue as a prominent symptom.

Furthermore, many changes occur to your immune system during those blessed 40 weeks which can result in the onset of new allergies, re-activation of a dormant viral infection or the development of an autoimmune problem where, again, severe fatigue is a leading problem.

It’s not good medical practice to just do an Epstein-Barr VCA IgG antibody test, have it come back positive and say that you have “chronic fatigue syndrome” (CFS). To diagnose a chronic or reactivated EBV infection requires a six-antibody blood test panel; anything less is guess work. Also, according to the CDC, before you can diagnose CFS you must eliminate that looooong list of differential diagnoses, that I mentioned, and then methodically address the problems that show up. Taking short cuts won’t work.

In the mean time, attend to what you can: a good, balanced, predominantly organic food diet; going to sleep — not to bed to read or watch TV — by 10 p.m. is very important; mild, regular exercise, plenty of water and enlisting help from hubby are all very helpful steps that you can take today and are not to be underestimated. Beyond that, a thorough medical evaluation followed by well coordinated integrative care is your best bet for regaining your health.

Lyme Disease Symptoms May Continue After Treatment

This article by Dr. Jesse Stoff appeared on Southampton Patch.

Today’s question is from E.K. in Water Mill: Last summer I was bitten by a tick. Afterwards I had a red ringed rash around the bite site and felt sick. My doctor said that it was probably early Lyme disease and that I should take antibiotics, which I did. The rash went away but I still feel tired and achy and my blood tests are negative for Lyme disease. Any thoughts?

Lyme disease is caused by a spirochete called Borrelia burgdorferi, and is the most common tick-borne disease in the United States. The number of reported cases has more than doubled between 1992 and 2006, and almost 29,000 new confirmed cases were reported in 2008. Additional studies have shown that the actual number of cases of Lyme disease may exceed reported cases by a factor of 6 to 12 in endemic areas, such as where we live. There are several other infectious organisms that can be transmitted with the Borrelia spirochete and these co-infections can be as bad or worse as Lyme disease itself. The principle means of transmission of the disease is a tiny tick and at this point all of the different types of ticks are known to carry these infections. If you remove a tick from your skin you should save it and have it tested, through your local clinical laboratory, for Lyme disease.

Although common, in certain areas, some aspects of Lyme disease continue to be poorly understood and are a source of intense controversy among patients, physicians and researchers. When correctly diagnosed, the majority of patients, with acute Lyme disease, can be usually treated with a standard course of antibiotics such as Doxycycline. However, 10 percent to 20 percent of patients with acute Lyme disease, after completing the standard course of antibiotic therapy, still have symptoms. Some of these patients have an untreated co-infection, others still have an active Borrelia infection and a third group go on to develop chronic symptoms now identified as post-Lyme disease syndrome.

Post-Lyme syndrome seems to be a secondary auto-immune response to a cross reactive antigen to the Borrelia organism. These patients usually have abnormalities in their blood tests that range from an increase in inflammatory markers to evidence of anti-neuronal antibodies. These antibodies can attack the central nervous system and can account for a wide range of variable and changing symptoms. Treatment options also vary and may include; the use of anti-inflammatory supplements and/or drugs, antigen desensitization to raise the number and activity of TR1 suppressor cells all the way to the use of immuno-suppressive drugs in severe cases. Individual treatment varies depending upon the specific blood test results.