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Anxious About Anxiety?

mid-adult-male-portraitYou’re not anxious about going on vacation or performing a pleasant task. You’re enthusiastic (but not enthused). You could be anxious about going to the dentist or to defend your last income tax return. Here, you’re entertaining a feeling of dread or apprehension, probably lacking clear justification.  Anxiety results from a subjective way of looking at a situation in the absence of a clear and actual danger. Of course, the sweating, increased pulse, and tension coupled with self-doubt about being able to handle the matter tell a different story. Sometimes respirations increase, the mouth gets dry and the intestines gurgle. All this is part of a defense mechanism. Anxiety can be particular, such as a panic attack in a crowd of people, in which case the stimulus can be identified. Or it may be generalized, being a long-term experience with no explanation of its cause. Obsessive-compulsory disorder (OCD) is an anxious state characterized by quandaries of uncertainty and compulsions to act. If the act is frustrated, the uncertainty remains and anxiety is intensified. Anxiety is considered a normal, but transient, response to stress, encouraging a person to take action in order to deal with what is perceived to be a difficult situation.

What’s The Risk?

Women are twice as likely as men to become anxious, mostly because of hormones and the archaic expectations that women are supposed to take care of everybody else before themselves. Age plays a minor role, in that OCD, separation anxiety and social phobias that include panic disorder show up in childhood and the teenage years. Early identification and treatment can forestall later problems. Certain environmental factors, such as poverty, separation from family, overly strict parents, family conflicts, anxious family members and lack of support can induce anxiety disorders. That anxiety runs in families is accepted, but it’s not known if the onset is genetic or learned, or both.

Physiologically, anxiety may be prompted by faulty brain chemistry, where an imbalance of serotonin, for instance, may result in irregular moods and emotions. There may be a structural fault, too.  The amygdala is the part of the brain in charge of processing emotional reactions and memory consolidation, including the recollection of fear.  If it’s overactive, this structure will heighten the fear response and increase anxiety in social situations.   Non-structural physical concerns, such as health problems, can cause anxiety.  Diabetes, alcoholism, heart disease, odd sensations that have no apparent cause, and thyroid disease are a few.

How Do I Handle Anxiety?

Besides the traditional psychotherapy practices and anti-anxiety medications, there are a few things you can do to take charge. First, you need to know that withdrawal from a psychoactive drug can cause anxiety. So, weaning from benzodiazepines causes the thing for which you took the drug in the first place. But beta-blockers, typically used for blood pressure control, have no such effect. They’re used off label to control rapid heartbeat, nervousness, trembling voice and shaky hands that accompany anxiety attacks. Alcohol withdrawal causes anxiety in many people.

Alternative approaches to anxiety treatment include things you can do and things you can swallow. Some modalities that require active participation include music therapy, art therapy, aromatherapy and meditation. With these you have to turn the music on, wield a paintbrush, light a candle, or think about pleasant things. But many people are unwilling or unable to be so engaged because of time constraints, family and job obligations, or simple faineance. Deglutition is the answer.

Options to psychological interventions for anxiety were sought in order to overcome limitations on time and resources. Because of adverse side-effects, alternatives to anxiolytic drugs also were explored. There is a shrub from the South Pacific islands that’s been used for centuries to calm the nerves, Piper methysticum, commonly known as kava kava. In a meta-analysis performed by the Cochrane Database at England’s Exeter University, researchers found that anxious subjects who took kava extract as a sole constituent in their treatment experienced a substantial reduction in symptoms compared to those taking a placebo (Pittler, 2000, 2003). One of the differences between a natural substance and a synthetic one is the time it takes to demonstrate effectiveness.  With a natural substance—in this example, herbal—you get the active ingredient and all the supportive components of the plant. Many enjoy an unexplainable synergy.  With a synthetic one—a drug—you get an isolated chemical that is not toned down by collaborative elements. Although earlier study found kava to be effective at taming anxious moments, it took eight weeks for kava’s superiority to placebo to be displayed (Volz, 1997).

Benzodiazepines are the drugs commonly used to treat anxiety. Their side effects, besides excessive drowsiness and decreased alertness, include paradoxical consequences, such as aggression, impulsivity, and irritability. Cognitive impairment and tolerance can result, as well. Tapering off these medications requires deliberation and a watchful eye. Using kava kava during such an ordeal, patients who were weaned from the drugs while being introduced to the herbal showed good tolerance and improved symptoms over a period of two weeks in a five-week trial in Germany (Malsch, 2001).

Generalized anxiety disorder has responded well to another folk remedy, passion flower. In a study comprising three dozen individuals, half received passion flower plus placebo and half received a benzodiazepine plus placebo in a one-month trial. The outcome showed both the herb and the drug to be effective in controlling anxiety symptoms. The drug, with rapid onset of action, impaired job performance (Akhondzadeh, 2001). The herb did not. Pharmacologically, extracts of the upper parts of the passion flower plant are most dynamic (Dhawan, 2001).

If you’ve taken fish oil for heart and brain health, that’s good. It’s been discovered that low levels of omega-3 fatty acids play a significant role in a number of mental irregularities (Buydens-Branchley, 2008) and that mood disorders respond especially well to omega-3 supplementation, with EPA getting better press than its companion, DHA (Ross, 2007). With a ratio of 3 to I, EPA to DHA, a fish oil product called Kirunal appears more than adequate to satisfy the mono- or adjunctive therapy approach in treating mood anomalies. For decades it’s been given that omega-3 fats are effective in the treatment of major depressive disorders, so it is reasonable to submit that they be likewise in anxiety disorders (Ross, 2009). If the presence of a substance yields a specific result, then the absence of that substance should yield the opposite. A deficit of n-3 fats has been identified in the red cell membranes of anxious persons (Greena, 2006), specifically those with social anxieties. Overall, it’s been proposed that human foods be supplemented with omega-3 fats as a strategy to improve behaviors and cognitive functions (Vinot, 2011). This makes one wonder if the education community needs to sit up and take notice. If that’s an inflammatory statement, n-3 supplementation can ameliorate that while reducing self-induced anxiety (Kiecolt-Glaser, 2011).

A relative newcomer on the anti-anxiety supplement stage is curcumin, the active ingredient of the turmeric spice common to Southern Asian and Middle Eastern cuisine.  Known predominantly as an anti-inflammatory agent, curcumin was found to have antidepressant like activity similar to tricyclic antidepressants, such as fluoxetine and imipramine (Sanmukhani, 2011). Because it is a natural substance, doses of curcumin used in an Indian trial were extraordinarily high, at 100 mg per kilogram of body weight, which equates to about 6,800 mg (6.8 grams) for a 150-pound person. Lesser dosages, from 10 to 80 mg/kg, demonstrated a positive effect on serotonin and dopamine activity, acting similarly to commonly prescribed drugs (Kulkami, 2008).

If you maintain a healthy diet, making sure to get the full array of macro and micro minerals, especially magnesium and zinc, as well as sufficient B vitamins, focusing on B 12, you’ll be able to avoid at least one cause of anxiety. Cutting back on alcohol and caffeine, and getting ample sleep are others. A caveat: before embarking on a supplement regimen to address anxiety, check with a healthcare professional to look for interactions with medicines and foods.

References

Andreatini R, Sartori VA, Seabra ML, Leite JR.
Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study.
Phytother Res. 2002 Nov;16(7):650-4.

Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M.
Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam.
J Clin Pharm Ther. 2001 Oct;26(5):363-7.

Buydens-Branchey L, Branchey M.
n-3 polyunsaturated fatty acids decrease anxiety feelings in a population of substance abusers.
J Clin Psychopharmacol. 2006 Dec;26(6):661-5.

Buydens-Branchey L, Branchey M, Hibbeln JR.
Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers.
Prog Neuropsychopharmacol Biol Psychiatry. 2008 Feb 15;32(2):568-75. Epub 2007 Nov 1.

Dhawan K, Kumar S, Sharma A.
Anti-anxiety studies on extracts of Passiflora incarnata Linneaus.
J Ethnopharmacol. 2001 Dec;78(2-3):165-70.

Dhawan K, Kumar S, Sharma A.
Anxiolytic activity of aerial and underground parts of Passiflora incarnata.
Fitoterapia. 2001 Dec;72(8):922-6.

Ernst E.
The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John’s Wort, Ginseng, Echinacea, Saw Palmetto, and Kava.
Ann Intern Med. 2002 Jan 1;136(1):42-53.

Ernst E.
Herbal remedies for anxiety – a systematic review of controlled clinical trials.
Phytomedicine. 2006 Feb;13(3):205-8. Epub 2005 Aug 15.

G. Fontani, F. Corradeschi, A. Felici, F. Alfatti, S. Migliorini, L. Lodi
Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects
European Journal of Clinical Investigation. Vol 35, Iss 11, pages 691–699, Nov 2005

Pnina Greena, Haggai Hermeshb, Assaf Monselisec, Sofi Marom, Gadi Presburger, Abraham Weizman
Red cell membrane omega-3 fatty acids are decreased in nondepressed patients with social anxiety disorder
European Neuropsychopharmacology. Feb 2006; 16(2): 107-113

Harauma A, Moriguchi T.
Dietary n-3 fatty acid deficiency in mice enhances anxiety induced by chronic mild stress.
Lipids. 2011 May;46(5):409-16. Epub 2011 Feb 7.

Jadoon A, Chiu CC, McDermott L, Cunningham P, Frangou S, Chang CJ, Sun IW, Liu SI, Lu ML, Su KP, Huang SY, Stewart R.
Associations of polyunsaturated fatty acids with residual depression or anxiety in older people with major depression.
J Affect Disord. 2012 Feb;136(3):918-25. Epub 2011 Nov 21.

Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R.
Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial.
Brain Behav Immun. 2011 Nov;25(8):1725-34. Epub 2011 Jul 19.

Kinrys G, Coleman E, Rothstein E
Natural remedies for anxiety disorders: potential use and clinical applications.
Depress Anxiety. 2009;26(3):259-65.

Kulkarni SK, Bhutani MK, Bishnoi M.
Antidepressant activity of curcumin: involvement of serotonin and dopamine system.
Psychopharmacology (Berl). 2008 Dec;201(3):435-42. Epub 2008 Sep 3.

Lakhan SE, Vieira KF.
Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review.
Nutr J. 2010 Oct 7;9:42.

Malsch U, Kieser M.
Efficacy of kava-kava in the treatment of non-psychotic anxiety, following pretreatment with benzodiazepines.
Psychopharmacology (Berl). 2001 Sep;157(3):277-83.

McBride S, Graydon J, Sidani S, Hall L.
The therapeutic use of music for dyspnea and anxiety in patients with COPD who live at home.
J Holist Nurs. 1999 Sep;17(3):229-50.

Pittler MH, Ernst E.
Efficacy of kava extract for treating anxiety: systematic review and meta-analysis.
J Clin Psychopharmacol. 2000 Feb;20(1):84-9.

Pittler MH, Ernst E.
Kava extract for treating anxiety.
Cochrane Database Syst Rev. 2003;(1):CD003383.

Ross BM, Seguin J, Sieswerda LE.
Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid?
Lipids Health Dis. 2007 Sep 18;6:21.

Brian M. Ross
Omega-3 polyunsaturated fatty acids and anxiety disorders
Prostaglandins, Leukotrienes and Essential Fatty Acids. Nov 2009; 81(5): 309-312

Saeed SA, Bloch RM, Antonacci DJ.
Herbal and dietary supplements for treatment of anxiety disorders.
Am Fam Physician. 2007 Aug 15;76(4):549-56.
Sanmukhani J, Anovadiya A, Tripathi CB.
Evaluation of antidepressant like activity of curcumin and its combination with fluoxetine and imipramine: an acute and chronic study.
Acta Pol Pharm. 2011 Sep-Oct;68(5):769-75.

Song C, Li X, Leonard BE, Horrobin DF
Effects of dietary n-3 or n-6 fatty acids on interleukin-1beta-induced anxiety, stress, and inflammatory responses in rats.
J Lipid Res. 2003 Oct;44(10):1984-91. Epub 2003 Jul 1.

Vinot N, Jouin M, Lhomme-Duchadeuil A, Guesnet P, Alessandri JM, Aujard F, Pifferi F.
Omega-3 fatty acids from fish oil lower anxiety, improve cognitive functions and reduce spontaneous locomotor activity in a non-human primate.
PLoS One. 2011;6(6):e20491. Epub 2011 Jun 7.

Volz HP, Kieser M.
Kava-kava extract WS 1490 versus placebo in anxiety disorders–a randomized placebo-controlled 25-week outpatient trial.
Pharmacopsychiatry. 1997 Jan;30(1):1-5.

tYehuda S, Rabinovitz S, Mostofsky DI.
Mixture of essential fatty acids lowers test anxiety.
Nutr Neurosci. 2005 Aug;8(4):265-7.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Tuning In Your ADD/ADHD Child

tv-head-childAll of us know children who have a hard time staying still, who find it difficult to listen, who can’t follow directions no matter how many times you present them, and who occasionally blurt out comments at the most inopportune times. Often the criticism is poorly aimed. Are they just being kids, or could they be suffering from attention deficit disorder or attention deficit hyperactivity disorder?  ADD/ADHD can make it difficult for a person to inhibit his spontaneity. The diagnosis is not a simple one, and too often relies on nothing but subjective reports from school personnel and parents, leading to a prescription pad resolution. A complete examination is required for diagnosis. Have there been any sudden life changes, such as divorce, moving, death in the family, or entering a new school? Have thyroid and sleep problems been considered? How about anxiety or depression? Could there be heavy metal toxicity or other toxic exposure?

Some kids with ADD are hyperactive, but not all. Some have a physiological reason, some don’t. Many are able to pay close attention to things they like, while others get bored quickly. Some are impulsive or quick-tempered. Those who seem disobedient may not be so intentionally. Whether they outgrow this or not is anyone’s guess; there are plenty of adults with ADD/ADHD.  As often as drugs are prescribed, they might not be the best option for you or your child. At one end of the spectrum, there are the hyperactive kids; at the other end are the quiet dreamers who stare off into space. Bad parenting is not an issue, but effective parenting strategies can go a long way to correct problems.

One theory of ADD/ADHD has to do with a person’s executive function, which involves the cognitive processes needed to organize thoughts and actions, to prioritize tasks, to manage time efficiently, and to make decisions. Looking at this list, we might know more people with executive dysfunction than we thought, especially when it comes to situations that require the control of habitual responses or of resisting temptations. Occasionally a parent hears that his child is a joy in the classroom, making the parent wonder why that doesn’t hold true at home. More often, however, the parent hears the opposite. In school, the teacher’s strategies to manage executive function problems might include inhibition, organization of materials, peer tutoring and other student-friendly approaches. Parent strategies often stop at inhibition, others being clouded by frustration. Weakness in executive function may not be characteristic of all cases of ADD/ADHD, but appear to be one important component of the disorder (Willcutt, 2005).  Adults with frontal lobe damage exhibit similar behaviors as children suspected of having the ADD/ADHD spectrum, leading some researchers to associate the physiological dysfunction while implicating the catecholamine neurotransmitters that respond to the stressors that arouse fight or flight (Faraonea, 1998).

Have you ever heard static on your radio or seen a snowy picture on the TV? That kind of interference in a child’s brain can jostle the connections. You might be able to tune out extraneous input and focus on what has your interest, like Sunday’s football game, but kids can’t always do that because, first of all, their brains are far from being completely wired and, second of all, they might have a few aberrant neurons. Multiple, simultaneous stimuli compete for neural attention, whether visual or auditory in the case of formal education. It requires purposive attention to separate stimuli and to focus on an assigned task. Therefore, goals need to be announced prior to a task and motivation needs to be stirred. The first part is easy; the second, not. Even in the presence of imminent reward, children may be hard to motivate. Negative feedback or punishment is futile (Stevens, 2012) (Crone, 2003). In some instances there is a need for family counseling, especially where cognitive disorders appear to have a heritable nature.  Attendant conduct disorders (Toupin, 2000) can amplify and become legitimate societal concerns. Socioeconomic status may or may not be involved, although attention disorders may interfere with economic wherewithal, present and future. This may co-occur with food insecurity, in which case nutritional deficit plays a role in ADD/ADHD, where even subtle nutritional irregularities can affect attention and motor behavior (Conners, 1982).

It has been suggested that children of lower socioeconomic status who are academically and behaviorally challenged be supplemented with micronutrients and essential fatty acids to learn if positive changes in cognition, learning and behavior occur, for such effect has been seen in developed and developing societies (Frensham, 2012). No reason was given for targeting this population. Since many educators have had remarkable social and academic interactions with this group, this is curious. Although the cause of ADD/ADHD has not been absolutely identified, its link to vitamin/mineral/fatty acid deficiencies has been proposed. Zinc, iron, magnesium and iodine, and the long-chain polyunsaturated fats may have a profound impact on the development and aggravation of ADD/ADHD symptoms (Konikowska, 2012). The fact is that all of us should keep an eye on levels of these nutrients (Milne, 2000) (Fuchs, 2002).

It has been established that zinc is a co-factor in more than a hundred enzymes, including those that metabolize carbohydrates, prostaglandins and nucleic acids. It has a striking effect on neurotransmission, as well, and may be factored in hyperkinetic disorders, especially noting that children diagnosed with ADD/ADHD suffer from low levels. Low zinc values may point to other nutrient deficits, such as outright malnutrition.  Feasting on bags of snacks and sweets may fill an empty belly, but doesn’t answer physiological needs despite the low cost. Maternal habits that increase exposure to additives, alcohol and smoking during pregnancy are other factors to consider (Dodig-Curkovic, 2009). Magnesium is part of more than three enzymes, and its shortfall is conspicuous in ADD/ADHD individuals. That many youngsters avoid a wide range of vegetables, limiting themselves to corn and French fries, helps to explain this.  Supplementation with these minerals has brought positive outcomes (Starobrat-Hermelin, 1997, 1998) (Kozielec, 1997).

Whether ADD/ADHD will pervade a child’s life or not is undetermined. Many have outgrown the disorder, or at least have matured to the point of controlling the outward signs. Because mature gustatory sense admits a variety of plants into the diet, this alone might make a difference. Being proactive matters and introducing a child to one concept, task or image at a time can make a considerable difference in forming concepts from percepts.

References

Arnold LE, Bozzolo H, Hollway J, Cook A, DiSilvestro RA, Bozzolo DR, Crowl L, Ramadan Y, Williams C.
Serum zinc correlates with parent- and teacher- rated inattention in children with attention-deficit/hyperactivity disorder.
J Child Adolesc Psychopharmacol. 2005 Aug;15(4):628-36.

Carol Ballew, PhD; Sarah Kuester, MS, RD; Cathleen Gillespie
Beverage Choices Affect Adequacy of Children’s Nutrient Intakes
Arch Pediatr Adolesc Med. 2000;154:1148-1152

C.Keith Conners, Arthur G. Blouin
Nutritional effects on behavior of children
Journal of Psychiatric Research. Vol 17, Iss 2, 1982–1983, Pp 193–201

Eveline A. Crone, J. Richard Jennings, Maurits W. Van Der Molen
Sensitivity to interference and response contingencies in Attention-Deficit/Hyperactivity Disorder
Journal of Child Psychology and Psychiatry.  Vol 44, Iss 2, pp 214–226, Feb 2003

Dodig-Curković K, Dovhanj J, Curković M, Dodig-Radić J, Degmecić D.
The role of zinc in the treatment of hyperactivity disorder in children.
Acta Med Croatica. 2009 Oct;63(4):307-13.

Stephen V Faraonea,  Joseph Biederman
Neurobiology of attention-deficit hyperactivity disorder
Biological Psychiatry. Volume 44, Issue 10, 15 November 1998, Pages 951–958

Mariellen Fischer, Russell A. Barkley, Lori Smallish, Kenneth Fletcher
Executive Functioning in Hyperactive Children as Young Adults: Attention,
Inhibition, Response Perseveration, and the Impact of Comorbidity

DEVELOPMENTAL NEUROPSYCHOLOGY, 2005; 27(1): 107–133

Frensham LJ, Bryan J, Parletta N.
Influences of micronutrient and omega-3 fatty acid supplementation on cognition, learning, and behavior: methodological considerations and implications for children and adolescents in developed societies.
Nutr Rev. 2012 Oct;70(10):594-610. doi: 10.1111/j.1753-4887.2012.00516.x.

Nan Kathryn Fuchs, Ph.D.
Magnesium: A Key to Calcium Absorption
http://www.mgwater.com/calmagab.shtml

Koller, Harold P.
Visual processing and learning disorders
Current Opinion in Ophthalmology. September 2012 – Volume 23 – Issue 5 – p 377–383

Konikowska K, Regulska-Ilow B, Rózańska D.
The influence of components of diet on the symptoms of ADHD in children.
Rocz Panstw Zakl Hig. 2012;63(2):127-34.

Kozielec T, Starobrat-Hermelin B
Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD).
Magnes Res. 1997 Jun;10(2):143-8.

Mares D, McLuckie A, Schwartz M, Saini M.
Executive function impairments in children with attention-deficit hyperactivity disorder: do they differ between school and home environments?
Can J Psychiatry. 2007 Aug;52(8):527-34.

McMains S, Kastner S.
Interactions of top-down and bottom-up mechanisms in human visual cortex.
J Neurosci. 2011 Jan 12;31(2):587-97.

Millichap JG, Yee MM.
The diet factor in attention-deficit/hyperactivity disorder.
Pediatrics. 2012 Feb;129(2):330-7.

David B. Milne, PhD and Forrest H. Nielsen, PhD
The Interaction Between Dietary Fructose and Magnesium Adversely Affects Macromineral Homeostasis in Men
J Am Coll Nutr February 2000 vol. 19 no. 1 31-37

Sonuga-Barke EJ, Sergeant JA, Nigg J, Willcutt E.
Executive dysfunction and delay aversion in attention deficit hyperactivity disorder: nosologic and diagnostic implications.
Child Adolesc Psychiatr Clin N Am. 2008 Apr;17(2):367-84, ix.

Starobrat-Hermelin B, Kozielec T.
The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test.
Magnes Res. 1997 Jun;10(2):149-56.

Starobrat-Hermelin B.
The effect of deficiency of selected bioelements on hyperactivity in children with certain specified mental disorders.
Ann Acad Med Stetin. 1998;44:297-314.

Alexander A. Stevens, Leeza Maron, Joel T. Nigg, Desmond Cheung, Edward F. Ester,
Edward Awh
Increased Sensitivity to Perceptual Interference in Adults with Attention Deficit Hyperactivity Disorder
Journal of the International Neuropsychological Society (2012), 18, 1–10.

Jean Toupin, Michèle Déry, Robert Pauzé, Henri Mercier, Laurier Fortin
Cognitive and Familial Contributions to Conduct Disorder in Children
Journal of Child Psychology and Psychiatry. Vol 41, Iss 3, pp 333–344, March 2000

Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF.
Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review.
Biol Psychiatry. 2005 Jun 1;57(11):1336-46

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Childhood Success At School

boy-eating-breakfastThe electronic babysitter holds a place of great esteem in modern society, although there are plenty of families who relegate it to the limbo of indifference. That being said, we’ll mention a caution issued by the University of Montreal that admonishes against more than two hours of TV a day for toddlers because of its cumulative negative effects, notably on school readiness. Motor skills and psycho-social skills fall at the hands of PBS and the cable. Physical activity and reading skills falter, and social difficulties, include being bullied, float to the surface. The ability to follow instructions doesn’t improve, either. All this influences performance in kindergarten, which predicts success in later grades (Pagani, 2013). But TV viewing is only one of the variables in a child’s lifestyle that can be controlled. Here is a factor that can’t be blamed on genes and heredity, but can be placed at the feet of nonadaptive parents or guardians.

Two other life experience variables that matter in eventual, and even immediate, school performance are eating and sleeping. In fact, they influence adult life too because wellness behaviors don’t stop at either end of the longevity spectrum. For starters, the brain can’t function the right way with too little fuel…or with the wrong blend. Your everyday sedan might be able to get away with 89-octane. But don’t even think about using that puny formula in a high-performance car that demands 100-octane. The brain is a high-performance, original-equipment-only body part, interchangeable with nothing.

Even though breakfast has been touted as the most important meal of the day, there’s not a whole lot of data to back that up. But what’s lacking in quantity is more than accommodated in quality. Regardless of a chintzy toaster-pastry high-carb breakfast, kids who eat breakfast at all fare better academically than those who skip it. Yeah, the octane is really low, but sputtering and pinging trump sitting in the driveway. Breakfast eaters generally consume more daily calories, yet are less likely to be overweight. Not every breakfast skipper packs on the pounds, though (Rampersaud, 2005). Add a little fiber and some protein to that meal and sit back and watch the action.

In children whose nutritional status is compromised, the effects of breakfast consumption are more dramatic than in those who are nutritionally secure (Hoyland, 2009). This is part of the reason why school breakfast programs were initiated decades ago. It’s not a matter of bleeding heart liberalism, either, because breakfast reduces the amount of vagrant behavior a teacher has to put up with, and increases the volume of measureable education for which the teacher is responsible. In a practical sense, breakfast also improves school attendance, and that can have fiduciary ramifications in many areas.

There’s not much room to address all the vitamins and minerals the body needs to be its best, but consider iron as an ingredient in the recipe for scholastic luster. It’s been accepted that iron deficits high enough to cause anemia put kids at an academic disadvantage, and that iron therapy improves cognitive performance (Taras, 2005). An additional benefit of dietary iron, one that has psycho-social merit, is the improvement in hyperactive, inattentive behavior (Konofal, 2004) (Cortese, 2012). Enriched breakfast cereals, spinach omelets, nuts and seeds, and potatoes are sources of iron. A study at Tufts University found that kids who ate cooked oatmeal (which supplies almost 20% of the iron we need), in contrast to ready-to-eat cereal, displayed enhanced cognitive functioning, especially where visual processing was required. Spatial memory and short-term memory showed remarkable improvements. The compositional variations in cereal proteins, the fiber content and the glycemic scores indicate that what kids eat before school is important (Mahoney, 2005). What’s more, oatmeal provides a slower and more sustained source of energy. Non-heme iron needs vitamin C for assimilation, so that glass of OJ can make a difference. Supplemental vitamin C counts.

Studies on diet and success at school are trans-oceanic. You can find undernourished, stunted, hungry poor performers in other countries, sharing characteristics that can be modified by eating breakfast (Grantham-McGregor, 2005) (Ni, 2010). The only drawback to some school programs is that a handful of people see themselves excused from their obligations. See this story: http://www.washingtonpost.com/wp-dyn/content/article/2009/01/06/AR2009010601195.html?hpid=moreheadlines. Among the obligations is getting the kids to bed at a reasonable hour.

Kids grow when they are horizontal. The major secretion episodes of growth hormones occur soon after the onset of sleep. Disruption in the sleep-wake cycle upsets hypothalamus timing and causes observable neuro-cognitive consequences that affect learning, memory capacity and academic performance (Curcio, 2006). Sleep quality and quantity are closely tied to what happens in school because the prefrontal cortex, the “CEO” of the brain that orchestrates thoughts and actions toward specific goals, is vulnerable to sleep loss.

It’s not uncommon for high-school kids to fall asleep early in the school day. For many teens, school starts too early. Seven hours sleep won’t satisfy the need, and by the third or fourth class of the day, about twenty-five percent of kids are ready to go back to bed. If your teenager snores or grinds his teeth regularly, you might consider a visit to the doctor (Ng, 2009). Sleep deprivation will make kids moody. If they’re old enough to drive, it will increase the risk for an accident, as well. It’s one thing to fall asleep at school; another at the wheel (Carskadon, 2004).

No matter the part of the globe, children sleep more during the off season than during the school year. Still, there are things that affect sleep quantity—parent influence on bedtime, homework and extra-curricular activities, recreation and TV time. The problem is that sleep-wake patterns shift during the second decade of life and most kids get stuck at a certain point (Crowley, 2007) (Wyatt, 2004). Good habits have to start early and remain consistent. That’s where dad and mom enter the scene…maintaining consistency. Of course, a common-sense-but-not-likely-ever-to-happen solution is to start school at a different time. Even exposure to bright light early in the A.M. does little to improve academic performance (Hansen, 2005), but starting school as little as thirty minutes later has been associated with improved motivation, reduction of depressed mood, and measurable increases in academic success (Owens, 2010). Arising early in autumn means the kids have to go to bed early, too (Carskadon, 1998). Kindergarten foreshadows high school (Pagani, 2013). Start ‘em young.

References

Carskadon MA, Wolfson AR, Acebo C, Tzischinsky O, Seifer R.
Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days.
Sleep. 1998 Dec 15;21(8):871-81.

Carskadon MA, Acebo C, Jenni OG.
Regulation of adolescent sleep: implications for behavior.
Ann N Y Acad Sci. 2004 Jun;1021:276-91.

Cortese S, Angriman M, Lecendreux M, Konofal E
Iron and attention deficit/hyperactivity disorder: What is the empirical evidence so far? A systematic review of the literature.
Expert Rev Neurother. 2012 Oct;12(10):1227-40.

Crepinsek MK, Singh A, Bernstein LS, McLaughlin JE.
Dietary effects of universal-free school breakfast: findings from the evaluation of the school breakfast program pilot project.
J Am Diet Assoc. 2006 Nov;106(11):1796-803.

Crowley SJ, Acebo C, Carskadon MA.
Sleep, circadian rhythms, and delayed phase in adolescence.
Sleep Med. 2007 Sep;8(6):602-12.

Curcio G, Ferrara M, De Gennaro L.
Sleep loss, learning capacity and academic performance.
Sleep Med Rev. 2006 Oct;10(5):323-37.

Dubois L, Girard M, Potvin Kent M, Farmer A, Tatone-Tokuda F.
Breakfast skipping is associated with differences in meal patterns, macronutrient intakes and overweight among pre-school children.
Public Health Nutr. 2009 Jan;12(1):19-28

Eliasson A, Eliasson A, King J, Gould B, Eliasson A.
Association of sleep and academic performance.
P Sleep Breath. 2002 Mar;6(1):45-8.

Gleason PM, Dodd AH.
School breakfast program but not school lunch program participation is associated with lower body mass index.
J Am Diet Assoc. 2009 Feb;109(2 Suppl):S118-28.

Grantham-McGregor S.
Can the provision of breakfast benefit school performance?
Food Nutr Bull. 2005 Jun;26(2 Suppl 2):S144-58.

Hansen M, Janssen I, Schiff A, Zee PC, Dubocovich ML.
The impact of school daily schedule on adolescent sleep.
Pediatrics. 2005 Jun;115(6):1555-61.

Hoyland A, Dye L, Lawton CL
A systematic review of the effect of breakfast on the cognitive performance of children and adolescents.
Nutr Res Rev. 2009 Dec;22(2):220-43.

Konofal E, Lecendreux M, Arnulf I, Mouren MC
Iron deficiency in children with attention-deficit/hyperactivity disorder.
Arch Pediatr Adolesc Med. 2004 Dec;158(12):1113-5.

Caroline R. Mahoney, Holly A. Taylor, Robin B. Kanarek, Priscilla Samuel
Effect of breakfast composition on cognitive processes in elementary school children
Physiology and behavior. 2005; 85: 635-645

Ng EP, Ng DK, Chan CH.
Sleep duration, wake/sleep symptoms, and academic performance in Hong Kong Secondary School Children.
Sleep Breath. 2009 Nov;13(4):357-67.

Ni Mhurchu C, Turley M, Gorton D, Jiang Y, Michie J, Maddison R, Hattie J.
Effects of a free school breakfast programme on school attendance, achievement, psychosocial function, and nutrition: a stepped wedge cluster randomised trial.
BMC Public Health. 2010 Nov 29;10:738.

Owens JA, Belon K, Moss P.
Impact of delaying school start time on adolescent sleep, mood, and behavior.
Arch Pediatr Adolesc Med. 2010 Jul;164(7):608-14.

Pagani LS, Fitzpatrick C.
Children’s School Readiness: Implications for Eliminating Future Disparities in Health and Education.
Health Educ Behav. 2013 Feb 27.

Pagani LS, Fitzpatrick C, Barnett TA.
Early childhood television viewing and kindergarten entry readiness.
Pediatr Res. 2013 Jun 20.

Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD.
Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents.
J Am Diet Assoc. 2005 May;105(5):743-60; quiz 761-2.

Shenghui Li, Lester Arguelles, Fan Jiang, Wenjuan Chen, Xingming Jin, Chonghuai Yan, Ying Tian, Xiumei Hong, Ceng Qian, Jun Zhang, Xiaobin Wang, and Xiaoming Shen
Sleep, School Performance, and a School-Based Intervention among School-Aged Children: A Sleep Series Study in China
PLoS One. 2013; 8(7): e67928.

Taras H.
Nutrition and student performance at school.
J Sch Health. 2005 Aug;75(6):199-213.

Van Cauter E, Plat L, Copinschi G.
Interrelations between sleep and the somatotropic axis.
Sleep. 1998 Sep 15;21(6):553-66.

Vanelli M, Iovane B, Bernardini A, Chiari G, Errico MK, Gelmetti C, Corchia M, Ruggerini A, Volta E, Rossetti S; Students of the Post-Graduate School of Paediatrics, University of Parma.
Breakfast habits of 1,202 northern Italian children admitted to a summer sport school. Breakfast skipping is associated with overweight and obesity.
Acta Biomed. 2005 Sep;76(2):79-85.

Wyatt JK.
Delayed sleep phase syndrome: pathophysiology and treatment options.
Sleep. 2004 Sep 15;27(6):1195-203.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.

Wintertime Depression

concerned-young-manWhen the winter solstice occurs and the sun is above the Tropic of Capricorn, do you turn from Prince or Princess Charming into an ogre? It’s the time of year when people report feeling more depressed—overwhelmed by the impending holidays, bothered by dried out bank accounts, disconcerted by situations at work. Folks get irritated by things that don’t raise a hackle the rest of the year. They get testy, feel low or inferior, and lose energy, concentration and drive. This relationship among body, mind, and environment is called seasonal affective disorder (SAD). Blame it on the sun, or rather its scarcity, and the shortage of what the sun provides…vitamin D, the sunshine vitamin.

Are You Vitamin D Deficient?

Even in the sunniest places on the planet, people are deficient in vitamin D. You’d think that in Oman, at twenty-one degrees north of the equator, just within the tropical zone, the people’s vitamin D stores would be sufficient to prevent signs of deficit. In that part of the world it’s significant that women are covered, and for various reasons avoid sun exposure. This interrupts the complex relationship of sunlight, cholesterol and other factors that cause the body to manufacture vitamin D. (Alshishtawy. 2011) Likewise, in Bangkok, Thailand, whose latitude is even closer to the equator, vitamin D levels are surprisingly low. People living in Thailand’s municipal areas have lower circulating vitamin D than those in the rural areas. (Chailurkit. 2011) Might there be a connection between vitamin D levels and the seasonal blues?

It’s accepted that vitamin D deficiency is rampant, and that for a variety of reasons. People fear skin cancer, so they slather themselves with sun blocker or stay indoors or under cover. Some lack the physiological ability to manufacture vitamin D, perhaps with a cholesterol level insufficient to do the job. If brain development depends on ample vitamin D stores, then brain function seems to follow, especially in the realm of cognition and behavior as they relate to the presence or absence of pro-inflammatory molecules that are modulated by the vitamin. (McCann. 2008) Because seasonal affective disorder is often recurrent and predictable with the change of seasons, internal mechanisms related to circadian rhythms that are directed by vitamin D activity have been evaluated in aspects of SAD related to the major monoamine neurotransmitters, serotonin, norepinephrine, and dopamine. More than one vulnerability factor is suspected, including the environment and genetic susceptibility. (Levitan. 2007)

Vitamin D Deficiency Research

Studies at the University of Texas uncovered an association of high vitamin D levels to low scores on standardized measures of depression. Persons with a history of depressive symptoms were found to have lower levels of vitamin D. (Hoang. 2011) Also in 2011, Dutch scientists found similar relationships between vitamin D deficiency and depression, observing that a poor diet and lack of sun exposure were common elements. (Koater. 2011) The geriatric population is even harder hit with SAD. Their failure or inability to maintain healthy eating habits, and their often self-imposed seclusion prevent them from attaining optimal vitamin D levels through what may be considered normal daily activity by other groups. (Stalpers-Konijnenburg. 2011)

Reports abound that recommend the testing of vitamin D levels for individuals affected by depressive symptoms of any kind, including SAD. The research finds this to be a cost-effective and simple way to effect a therapy that would improve long-term health outcomes and quality of life. (Penckofer. 2010) (Humble. 2010) Additional study has tentatively linked vitamin D deficiency to autism and schizophrenia, the incidence of both hypothetically linked to developmental (prenatal) vitamin D deficiency. (Humble, Gustafsson, et al. 2010)

How To Increase Your Vitamin D Intake

Vitamin D is usually obtained from the skin through the action of ultraviolet-B radiation on a kind of cholesterol, called 7-dehydrocholesterol, after which time it gets metabolized to 25-hydroxyvitamin D (the stuff measured in a blood test). It gets further metabolized to the hormonal form, 1,25-hydroxyvitamin D. Although genetics may play a part in vitamin D blood levels, adequate calcium intake, exercise, and less obesity can help to support them. (Mason. 2011)

Almost everyone decries going to bed in the dark and then waking in the dark. Exposure to bright light in the morning can get you revved up for the day. The problem is that, when you awake in the dark, the eye sends a message to the pineal gland that it’s time to go to sleep, and melatonin is made. That resets the sleep-wake cycle. But this is supposed to happen at night. Light therapy is accepted as an effective treatment for the winter time blues. (Virk. 2009) (Pail. 2011) You can buy lamps that radiate the full spectrum of sunlight. Even your incandescent reading lamp can help. (Szadoczky. 1991) After a couple of weeks of daily use, linked with vitamin D supplementation, you’ll feel better than new.

References

Alshishtawy MM.
To be or not to be exposed to direct sunlight: vitamin d deficiency in oman.
Sultan Qaboos Univ Med J. 2011 May;11(2):196-200.Chailurkit LO, Aekplakorn W, Ongphiphadhanakul B.
Regional variation and determinants of vitamin D status in sunshine-abundant Thailand.
BMC Public Health. 2011 Nov 10;11(1):853.Hoang MT, Defina LF, Willis BL, Leonard DS, Weiner MF, Brown ES.
Association between low serum 25-hydroxyvitamin d and depression in a large sample of healthy adults: the cooper center longitudinal study.Mayo Clin Proc. 2011 Nov;86(11):1050-5.
Hoogendijk WJ, Lips P, Dik MG, Deeg DJ, Beekman AT, Penninx BW.
Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults.
Arch Gen Psychiatry. 2008 May;65(5):508-12.Humble MB, Gustafsson S, Bejerot S.
Low serum levels of 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients in Sweden: relations with season, age, ethnic origin and psychiatric diagnosis.
J Steroid Biochem Mol Biol. 2010 Jul;121(1-2):467-70.
Humble MB.
Vitamin D, light and mental health.
J Photochem Photobiol B. 2010 Nov 3;101(2):142-9.Koster JB, Kühbauch BA.
Vitamin D deficiency and psychiatric patients.
Tijdschr Psychiatr. 2011;53(8):561-5.

Kuningas M, Mooijaart SP, Jolles J, Slagboom PE, Westendorp RG, van Heemst D.
VDR gene variants associate with cognitive function and depressive symptoms in old age.
Neurobiol Aging. 2009 Mar;30(3):466-73.

Lewy AJ, Lefler BJ, Emens JS, Bauer VK.
The circadian basis of winter depression.
Proc Natl Acad Sci U S A. 2006 May 9;103(19):7414-9.

Lewy AJ, Emens JS, Songer JB, Sims N, Laurie AL, Fiala SC, Buti AL.
Winter Depression: Integrating mood, circadian rhythms, and the sleep/wake and light/dark cycles into a bio-psycho-social-environmental model.
Sleep Med Clin. 2009 Jun 1;4(2):285-299.

Levitan RD.
The chronobiology and neurobiology of winter seasonal affective disorder.
Dialogues Clin Neurosci. 2007;9(3):315-24.

Mason RS, Sequeira VB, Gordon-Thomson C.
Vitamin D: the light side of sunshine.
Eur J Clin Nutr. 2011 Sep;65(9):986-93.

McCann JC, Ames BN.
Is there convincing biological or behavioral evidence linking vitamin D deficiency to brain dysfunction?
FASEB J. 2008 Apr;22(4):982-1001. Epub 2007 Dec 4.

Pail G, Huf W, Pjrek E, Winkler D, Willeit M, Praschak-Rieder N, Kasper S.
Bright-light therapy in the treatment of mood disorders.
Neuropsychobiology. 2011;64(3):152-62.

Penckofer S, Kouba J, Byrn M, Estwing Ferrans C.
Vitamin D and depression: where is all the sunshine?
Issues Ment Health Nurs. 2010 Jun;31(6):385-93.

Privitera MR, Moynihan J, Tang W, Khan A.
Light therapy for seasonal affective disorder in a clinical office setting.
J Psychiatr Pract. 2010 Nov;16(6):387-93.

Shipowick CD, Moore CB, Corbett C, Bindler R.
Vitamin D and depressive symptoms in women during the winter: a pilot study.
Appl Nurs Res. 2009 Aug;22(3):221-5.

Stalpers-Konijnenburg SC, Marijnissen RM, Gaasbeek AB, Oude Voshaar RC.
Can I have some sunshine to cheer me up? vitamin D deficiency and depression in the elderly.
Tijdschr Psychiatr. 2011;53(6):365-70.

Szádóczky E, Falus A, Németh A, Teszéri G, Moussong-Kovács E.
Effect of phototherapy on 3H-imipramine binding sites in patients with SAD, non-SAD and in healthy controls.
J Affect Disord. 1991 Aug;22(4):179-84.

Virk G, Reeves G, Rosenthal NE, Sher L, Postolache TT.
Short exposure to light treatment improves depression scores in patients with seasonal affective disorder: A brief report.
Int J Disabil Hum Dev. 2009 Jul;8(3):283-286.

*These statements have not been evaluated by the FDA.
These products are not intended to treat, diagnose, cure, or prevent any disease.