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Vitamin D May Elevate Mood During the Winter

Vitamin D SunshineWhen the days get shorter, we spend more time indoors, as most of the day’s sunlit hours are occurring during the workday. For our bodies, this is a significant change to adjust to, especially for those of us who live in cooler climates. It’s common to experience some decline in mood during the winter – feelings of anxiety and depression are known to be more prevalent throughout the colder months. For some individuals, these seasonal mood changes occur as do fatigue, irritability, and appetite changes that can be especially pronounced, and this is often called Seasonal Affective Disorder (SAD).1 Incidence of SAD increases with distance from the equator, and light therapy is an effective treatment for many individuals with SAD. Reduced sunlight exposure, resulting in shifts in circadian rhythms and alterations in serotonin metabolism, is thought to underlie this condition.2

Timing of exposure of the retina to light affects the sleep-wake cycle, and inadequate light exposure during the winter disrupts this cycle. Light therapy is effective because of its effect on neurotransmitters, not because of its effects on vitamin D production. Therapeutic lights used for this purpose in northern climates do not provoke vitamin D synthesis. Light therapy is most effective if used in the morning hours, is known to be effective for treating SAD and major depression. SAD has been successfully treated with light therapy since the early 1980s. For non-seasonal depression, a meta-analysis in 2005 revealed that the effectiveness of light therapy was comparable to that reported in many trials of anti-depressant drugs.3 When used in the morning, the light entry into the retina inhibits production of melatonin, a hormone that promotes sleep. Light therapy helps to restore melatonin, the neurotransmitter serotonin, and other mood-regulating molecules to their normal time cycles and levels of production; consequently depressive symptoms are reduced.4

Reduced exposure to sunlight during the winter also means less natural vitamin D production by the skin, and vitamin D itself may also regulate mood. There is still much unknown about how vitamin D works in the brain, but there are plenty of vitamin D receptors in the brain, and it is thought to affect daily biorhythms and production of neurotransmitters, including serotonin.1 Also, low circulating vitamin D is associated with SAD and major depression.5 So far, only a handful trials of vitamin D supplementation for seasonal depressive symptoms have been performed, and some of these used doses that were likely too low to have any measurable effect (400 IU; currently many experts believe that 2000 IU/day or more may be necessary for most people to maintain adequate blood 25(OH)D levels 6). A dose of 800 IU improved mood of healthy subjects during winter in one trial,7 but had no effect in another trial.8 A third trial used a dose of 4000 IU/day for six months starting in the summer, and then evaluated feelings of wellbeing during the December-February time period. The 4000 IU dose of vitamin D produced an average 25(OH)D level of 45 ng/ml and improved wellbeing scores compared to a 600 IU dose (average 25(OH)D level of 32 ng/ml). 9

Current research is investigating the connection between depression and diabetes with a focus on vitamin D. Because depression is associated with insulin resistance, and vitamin D is thought to affect insulin secretion by the pancreas, ongoing studies are evaluating whether vitamin D supplementation can help to prevent diabetes. 10 In fact, healthy adults with low vitamin D levels were more likely to develop diabetes within 10 years compared to those with adequate levels, according to a recent study. 11

Vitamin D is active in essentially every cell and tissue in the human body. It is crucial (for everyone, not just sufferers of SAD) to maintain adequate vitamin D. Usually supplementation with Vitamin D3 is recommended. Especially if you note mood or sleep issues during the winter, be sure to accompany vitamin D supplementation with plenty of morning light. For most people, 2000 IU/day (the dose I include in my multivitamins) is sufficient to reach the favorable range of 25(OH)D in the blood; favorable 25(OH)D levels (30-45 ng/ml) should be confirmed with a blood test. Some people may require more than 2000 IU, but it is also important to avoid excess. Very high doses (for example, an annual dose of 500,000 IU) have been associated with increased risk of fractures,12 and observational studies of blood 25(OH)D have not shown any further decrease in mortality risk above the 30-45 ng/ml range.13, 14

Other nutritional factors in depression:
The omega-3 fatty acids EPA and DHA affect brain function, and supplementation with EPA has been shown to improve symptoms of depression.15 EPA and DHA levels may be low in those who do not eat fish, so supplementation is worthwhile.16-18 Exercise has also been shown to be an effective treatment for depression. 19 A Nutritarian diet itself acts as a mood elevator, as the brain requires antioxidant nutrients for proper function and oxidative stress markers are associated with depression symptoms.20 In contrast, sugar and junk food can alter brain chemistry, and high processed and fast food intake is associated with a greater likelihood of depression.21 Vitamin D inadequacy may play a role in tipping some individuals over into depression, especially if their dietary habits, exercise and omega-3 status are also not favorable.

Learn more about the role of high-nutrient foods, omega-3 fatty acids and exercise in these articles, “Natural Treatment for Depression” and “Counteract the Winter Blues Naturally.”


References:

1. Bertone-Johnson ER: Vitamin D and the occurrence of depression: causal association or circumstantial evidence? Nutr Rev 2009, 67:481-492.
2. Lurie SJ, Gawinski B, Pierce D, et al: Seasonal affective disorder. Am Fam Physician 2006, 74:1521-1524.
3. Golden RN, Gaynes BN, Ekstrom RD, et al: The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry 2005, 162:656-662.
4. Miller AL: Epidemiology, etiology, and natural treatment of seasonal affective disorder. Altern Med Rev 2005, 10:5-13.
5. Murphy PK, Wagner CL: Vitamin D and mood disorders among women: an integrative review. J Midwifery Womens Health 2008, 53:440-446.
6. University of California - Riverside (2010, July 19). More than half the world's population gets insufficient vitamin D, says biochemist. ScienceDaily [http://www.sciencedaily.com/releases/2010/07/100715172042.htm ]
7. Lansdowne AT, Provost SC: Vitamin D3 enhances mood in healthy subjects during winter. Psychopharmacology (Berl) 1998, 135:319-323.
8. Dumville JC, Miles JN, Porthouse J, et al: Can vitamin D supplementation prevent winter-time blues? A randomised trial among older women. J Nutr Health Aging 2006, 10:151-153.
9. Vieth R, Kimball S, Hu A, et al: Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients. Nutr J 2004, 3:8.
10. Loyola University Health System (2010, March 8). Vitamin D lifts mood during cold weather months, researchers say. ScienceDaily. [http://www.sciencedaily.com/releases/2010/03/100303162854.htm ]
11. Valencia W: Abstract 125: Prospective risk of hyperglycemia in a South Florida population with low levels of vitamin D. In World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease 2010.
12. Sanders KM, Stuart AL, Williamson EJ, et al: Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010, 303:1815-1822.
13. Melamed ML, Michos ED, Post W, et al: 25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population. Arch Intern Med 2008, 168:1629-1637.
14. Zittermann A, Iodice S, Pilz S, et al: Vitamin D deficiency and mortality risk in the general population: a meta-analysis of prospective cohort studies. Am J Clin Nutr 2012, 95:91-100.
15. Martins JG: EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr 2009, 28:525-542.
16. Davis BC, Kris-Etherton PM: Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Am J Clin Nutr 2003, 78:640S-646S.
17. Sanders TA: DHA status of vegetarians. Prostaglandins Leukot Essent Fatty Acids 2009, 81:137-141.
18. Kornsteiner M, Singer I, Elmadfa I: Very low n-3 long-chain polyunsaturated fatty acid status in Austrian vegetarians and vegans. Ann Nutr Metab 2008, 52:37-47.
19. Saeed SA, Antonacci DJ, Bloch RM: Exercise, yoga, and meditation for depressive and anxiety disorders. Am Fam Physician 2010, 81:981-986.
20. Tsuboi H, Shimoi K, Kinae N, et al: Depressive symptoms are independently correlated with lipid peroxidation in a female population: comparison with vitamins and carotenoids. J Psychosom Res 2004, 56:53-58.
21. Sanchez-Villegas A, Martinez-Gonzalez MA: Diet, a new target to prevent depression? BMC Med 2013, 11:3.

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