Vitamin D

By: Georgia Tetlow, M.D. Integrative Physician


Vitamin D, a fat-soluble vitamin, is essential for homeostasis. Vitamin D is considered a hormone since it meets the basic definition: it can be synthesized in the body, it has specific target tissues, and it doesn't have to be supplied by the diet. Vitamin D is also responsible for maintaining normal blood levels of calcium and phosphorus which are vital for normal neurological function and bone growth. Vitamin D works in concert with other vitamins, minerals and hormones to promote optimal bone mineralization, and to meet many physiological needs, as outlined below.

There are two ingested forms of vitamin D -- D3 and D2. Vitamin D3 (cholecalciferol) can be produced in the skin after exposure to ultraviolet-B (UVB) radiation from sunlight, or it can be supplied by the diet. Plants also produce a form of vitamin D called vitamin D2 (or ergocalciferol), which also has activity in people. Both vitamin D3 and D2 are used to fortify foods and dietary supplements in the US. Cholecalciferol (D3) is the preferred form of vitamin D as it can be easily used by the body and doesn’t require additional hydroxylation. Ergocalciferol (D2) is the form added to most functional foods, such as cereals and milk, but requires the additional hydroxylation step by the kidneys and is not as bioavailable. Evidence shows that cholecalciferol (D3) seems to boost blood levels of usable vitamin D for a longer period of time than ergocalciferol (D2), and that D2 is 33% less potent than D3 (Armas LA et al. 2004). D2 (ergocalciferol) is made from yeast, while D3 is made from lanolin or fish oil.

Immune system

There is considerable scientific evidence that 1,25(OH)2D has a variety of effects on immune system function that may enhance innate immunity as well as inhibit the development of autoimmunity (Holick, 2005). Vitamin D in the form of 1,25(OH)2D is a powerful immune system modulator.

Insulin secretion

Pancreatic cells that secrete insulin also express the VDR, or vitamin D receptor. Although the data are limited, clinical studies suggests that suboptimal vitamin D levels may have an adverse effect on insulin secretion and glucose tolerance in individuals with type 2 diabetes (Holick, 2005).

Blood pressure

Vitamin D is also thought to play a major role in blood pressure regulation. Krause et al. (Krause et al., 1998) reported that hypertensive subjects exposed to UVB and UVA rays from tanning beds experienced a significant increase in circulating vitamin D and a decrease in both systolic and diastolic blood pressure compared to individual exposed to only UVA rays.

Heart failure

In cardiovascular patients, deficiency in vitamin D has been linked with an increased risk for heart failure (Zittermann et al., 2003 ). Also, a high incidence of vitamin D deficiency has also been reported in patients with peripheral vascular disease. While it is not fully understood how vitamin D may protect against cardiovascular disease, it is possible that it may be secondary to the role that vitamin D plays in maintaining blood pressure. It is known that 1,25(OH)2D is potently down-regulates the blood pressure hormone renin in the kidneys (Holick, 2005). Additionally, atherosclerosis is considered an inflammatory disease, and vitamin D has been shown to relax smooth muscles in the vascular system (Weishaar & Simpson, 1987).

Deficiency

Insufficient vitamin D impairs absorption of calcium. Subsequently, the parathyroid glands increase their production of parathyroid hormone (PTH) to mobilize calcium from the skeleton in order to maintain normal serum ionized calcium levels. In cases of severe vitamin D deficiency, rapidly growing bones fail to mineralize, resulting in rickets. Although the growth-plates continue to enlarge, in the absence of bone mineralization, weight-bearing limbs can bow, resulting in skeletal abnormalities. Although the bones of adults are no longer growing, another medical condition, known as osteomalacia, can occur as a result of severe vitamin D deficiency.
Though the fortification of foods with vitamin D (primarily milk) has practically eradicated rickets, there are a large number of children and adults worldwide who are vitamin D insufficient but not to the degree that skeletal or calcium metabolism abnormalities are apparent.

Assessing Vitamin D Status

Serum 25(OH)D level is the best indicator of vitamin D deficiency and sufficiency, but the cutoff values are debated. Severe deficiency, associated with rickets and osteomalacia, is generally associated with serum 25(OH)D values less than 20-25 nmol/L (Heaney, 2003; Glerup et al., 2000). Although 50 nmol/L has been suggested as the low end of the normal range (Malabanan et al., 1998), more recent research suggests that PTH levels (Chapuy et al., 1997; Thomas et al., 1998) and calcium absorption are not optimized until serum 25(OH)D levels reach approximately 80 nmol/L (Heaney et al., 2003).

Food Sources

Very few foods are naturally rich in vitamin D, therefore fortified foods are the most common sources of vitamin D. Although milk is fortified with vitamin D, other dairy products produced from milk, such as cheese and ice cream, are typically not fortified with vitamin D and therefore contain small amounts. Commercially-prepared fortified breakfast cereals generally provide 10-15% of the Daily Value defined for vitamin D. There is also some vitamin D in eggs, organ meats, and certain fish including salmon, sardines, and herring. The following table provides a listing of foods that provide vitamin D in varying amounts.

Food	Serving Size	Vitamin D (I.U.)
Pink salmon, canned	3 ounces	530
Sardines, canned	3 ounces	231
Tuna, canned	3 ounces	200
Cow's milk	8 ounces	100
Orange juice fortified with vitamin D	8 ounces	100
Fortified breakfast cereals	1 serving (~1 cup)	40-50
Cod liver oil	1 ounce	1,360

Disease Prevention and Intervention

Osteoporosis

It is estimated that over 28 million adults in the United States have, or are at risk of developing low bone density and osteoporosis. Prevention and early intervention is paramount.
Osteoporosis is most often associated with inadequate calcium intake, however, a deficiency of vitamin D contributes to the development of osteoporosis due to inadequate calcium and phosphorus absorption. While rickets and osteomalacia are extreme examples of vitamin D deficiency, osteopororsis is an example of a long-term effect of vitamin D deficiency. Adequate storage levels of vitamin D help keep bones strong and may help prevent osteoporosis in older individuals, non-ambulatory individuals (those who have difficulty walking and exercising), post-menopausal women, and individuals on chronic steroid and antiepileptic therapies.
Sufficient vitamin D intake is also associated with a reduction in falls (Graafsman et al., 1996). Vitamin D supplementation for the prevention and management of osteoporosis is considered an effective public health benefits due to its low costs, excellent tolerance, and overall health benefits.

Cancer

Laboratory, animal, and epidemiologic evidence suggests that vitamin D may be protective against some cancers. Epidemiologic studies suggest that a higher dietary intake of calcium and vitamin D, and/or sunlight-induced vitamin D synthesis, can correlate with lower incidence of cancer. In fact, for over 60 years researchers have observed an inverse association between sun exposure and cancer mortality, however, it wasn’t until the late 1980s that Garland and colleagues found that the mortality rate associated with colon cancer was higher in the Northeastern US compared to southern states (Garland et al., 1985). A wealth of accumulated data reveals that the risk of developing and dying of breast, colon, esophageal, non-Hodgkin’s Lymphoma, ovarian, and prostate cancers is associated with living at higher latitudes, associated with a greater risk for vitamin D deficiency (Holick, 2005; Hanchette & Schwartz, 1992; Grant, 2002). A meta-analysis showed reduction of cancer risk by up to 50% (for colon, breast, prostate and ovarian cancer) with adequate vitamin D intake and levels (Garland CF et al. 2006).

Alzheimer's disease

Alzheimer's disease has been associated with an increased risk of hip fractures. This is likely linked to the fact that many Alzheimer's patients are older, homebound, and exposed less to sunlight. With aging, less vitamin D is converted to its active form. One study, which included elderly women with Alzheimer's disease, found that decreased bone mineral density was associated with a low intake of vitamin D and inadequate exposure to sunlight (Sato et al., 2005). However, with regular sunlight exposure and calcium supplements, bone mineral density increased by 2.7% and serum 25(OH)D levels increased from 24 nmol/L to 52 (Sato et al., 2005). The need for vitamin D supplementation should be part of an overall treatment plan for those with Alzheimer's disease.

Autoimmune Conditions

Components of the immune system, including macrophages, monocytes, and T and B lymphocytes, also have a VDR, thereby allowing vitamin D to have an impact on regulating cytokine synthesis, monocyte maturation, macrophage activity, and more (Holick, 2005). The risk of developing Type 1 diabetes and multiple sclerosis (MS) was significantly reduced or prevented in animals receiving vitamin D. Reportedly, living at a latitude greater than 37° increases the risk of developing MS >100% during one's lifetime (Holick, 2005). The risk for both MS and rheumatoid arthritis was decreased by ~40% in women taking a multi-vitamin supplement with as little as 400 I.U. of vitamin D (Holick, 2005). Other studies have shown a role for vitamin D in modulating the immune system via regulation of T helper cell and dendritic cell function, with reduced risk of multiple sclerosis and rheumatoid arthritis with adequate vitamin D intake (Munger KL et al. 2004; Cantorna MT, Mahon BD 2004).

A Clearing by Dean Solon

clear the mind.
clear your mind.
the way(s) you have been trained to think;  the way(s) you have been taught to organize---to compartmentalize---your thoughts;  the way(s) you have learned to view the environment inside and outside yourself, the ecology, the earth-plane where you are living and breathing, are moving and being moved;  how does it relate with what is?  how is it connecting you with what is?
is your perceiving of what is have anything, have much of anything, to do with what, really and truly, is?

you brainwashed. 
and you, with clear waters pouring over you and through you, washing your brain, purifying you, renewing you, reawakening you...

closing the eyes, softly, and gently...opening your mind.
feeling, being, the sensitive one you are, being moved and moving...opening your heart.
breathing, breathing in and breathing out...opening your lungs.
listening, attending lightly, your breath rising, your breath falling...opening your big buddha ears.
being quiet, being peaceful, being present, here and now,
being with what is...
being with whatever is...

you as light, in a great spaciousness of light
you as seer and shaman[ess], in a universe/multiverse of innumerable seers and shamans
you as an activity of presence, in a vast expansiveness of activity and presence
you as a jewel, in a sea of jewels, gleaming, glistening, shimmering and shining ever so brightly

you nearly nothing, you almost everything.
white light caressing you, white light cradling you,
white light cascading over you, white light behind you and before you, above you and below you,
white light circling you and surrounding you, protecting you...and cleansing you...and purifying you...and loving you. 

Integrative Recommendations for Rheumatoid Arthritis

An integrative approach to autoimmune illness, including rheumatoid arthritis, includes general measures to reduce inflammation in the body.  Simultaneously reducing stress and improving stress management maximizes your healing response and can help reduce flares, because stress is expressed as inflammation in the body.

Mind- Body Techniques

Meditation is highly recommended for all patients with severe generalized inflammation. Consider enrolling in a Mindfulness Based Stress Reduction program, or learning vipassana meditation. Mindfulness has been shown to measurably reduce salivary cortisol and plasma DHEAS (“Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS)….Carlson et al, Psychoneuroimmunology 2004.

Relaxation exercises and the development of improved methods to cope with stress are also believed to be helpful, through the use of Tai Chi, Yoga, or a similar body based meditative practice. 

Reflective or disclosure journaling is helpful, particularly writing regarding emotionally charged events in your life. 

Removing toxins

Eliminate coffee and tobacco.  Make alcohol are rare treat, if at all. Consider elimination of commonly offending foods, with or without IgG food sensitivity testing.  Dairy, wheat, citrus, and nuts are common culprits.  Total elimination of suspected foods from your diet for three weeks followed by reintroduction of each food separately may be revealing.

Shift to an organic based diet, including dairy, eggs, and meat products.  At least avoid the more pesticide laden foods – see foodnews.org to learn which foods are more important to get organic. Limited research suggests a substantial improvement for some people with rheumatoid arthritis with a change to a vegan diet.  Improvement is seen only after several months.

Nutrition

Increase omega-3 fatty acid intake by eating more cold water fish, adding ground flaxseeds, or fish oil.  See www.ewg.org/node/15436 for information to help you avoid excessive mercury exposure. Consider the recommendations of the anti-inflammatory diet and gradually incorporate as many of these as make sense to you. 

Acupuncture

Helpful for many people with Rheumatoid Arthritis; less likely to be beneficial for those taking corticosteroids such as prednisone.

Supplements

Fish oil supplements are recommended.  Look for high quality brands like Nordic Naturals or Carlsons.  Determine your dose not by the total amount shown on the front of the bottle, but with the sum content of DHA plus EPA.  Start with a daily dose of 1000 mg  of DHA + EPA, and increase every five days or so until you take a total of 25 mg DHA and 15 mg EPA / lb of body weight, or 3-5 g/day, ideally split between morning and evening doses, with food.

GLA (Gamma Linolenic Acid), as GLA 1.4-2.8 gm/day) or Evening Primrose Oil (12-22 gm/day). Start two weeks after beginning fish oil, and use ONLY IF TAKING MODERATE DOSE OF FISH OIL AS WELL!

Vitamin D, 2000 IU/day or as indicated by testing.

Calcium 1000 mg daily, ideally as Ca Citrate

Magnesium 400 – 750 mg daily, as tolerated.

Selenium 100 mg  (not to exceed 400 microgram/day) and less if you eat many nuts (one brazil nut provides an average of 100 micrograms of selenium.)

AND PERHAPS: Vitamin C, 250 mg twice daily.

Botanicals:  (each are included in the supplement Zyflamend)

Ginger, starting with 1 gm twice daily, increasing weekly up to total of 2 gm twice daily. Turmeric, ½ gm twice daily, increasing to 1 gm twice daily.  To absorb it, cook it must be cooked in oil.

Exercise

A personalized well balanced exercise program has numerous and significant benefits.

Avoid herbal supplements that stimulate the immune system, such as Echinacea, Astragalus, Alfalfa Sprouts, Iron, St. Johns Wort. Alfalfa sprouts contain the amino acid L-canavanine, which can stimulate the immune system in people with lupus and increase inflammation. Other legumes are safe to eat as they have a much lower concentration of L-canavanine.  It’s probably best to also avoid iron unless you are anemic and iron deficient.  (Keep in mind some menstruating women will need appropriate doses of iron to prevent anemia.)  St. John’s Wort can cause many other medicines to be less effective.

Pharmaceuticals

As recommended by your rheumatologist.

Post Authored by : 
Georgia Tetlow, MD
Clinical Assistant Professor of Rehabilitation Medicine, Thomas Jefferson Medical College
Phone: (888) 702-7974
Email: info@beingmybestself.com
Website: www.beingmybestself.com

What to do if you suspect your teen is using drugs or alcohol - by Wendy Sunderlin

Despite all of your efforts to keep your kids drug-free, one day you might suspect that your son or daughter is using drugs or alcohol. By the end of eighth grade, approximately 50% of adolescents have had at least one drink and more than 20% report having been “drunk” (American Academy of Pediatrics). Drug and alcohol use increases chances of addiction and it can change the developing brain.

One thing remains true, parents are the most influential people on a teen’s decision about drug use. So what are the facts? Substance use (including alcohol) can change the direction of a young person’s life physically, emotionally, and behaviorally. It can weaken the ability to concentrate and retain information, impair judgment, lead to risky behaviors, and cause poor decision making.

Parents are sometimes afraid that they will push their teen away when talking to them about substance use. You may be worried that your child will get in trouble with the law and it will ruin his ability to qualify for scholarships or hold a job. The ultimate goals is to protect your child from harm and irreparable damages.

When you have your first suspicion that your teen may be using, what should you do?

• Sit down in a place without distractions (yes, your teen should put down his/her cell phone) and  
talk with your child. Be sure to choose a time when you are calm and when there is plenty of time.
• Tell your child what you see and/ or feel. Be specific about the things you have observed that have caused concern. Make it known if you have found any alcohol cans/bottles, drug paraphernalia, etc.
• Explain exactly how their appearance or behavior has changed and why it concerns you.
• Directly state your family rules on substance use. “In this family, we don’t smoke marijuana.” Then be clear on your house rules. Most importantly, FOLLOW THROUGH WITH OUTLINED CONSEQUENCES.
• Be prepared for your teen to deny using any substances. Your child may get angry and try to change the subject. If you child asks you about your substance
use history, be honest and share the consequences you experienced.
• Ask your child why he/she is using drugs or alcohol. Once you get a better idea of the situation, pressures, or motivation then you have a clearer direction of what to do next.
• Do not deny any substance use is taking place with your teen.
• Provide a safe, nonjudgmental person for your child to talk to. This could be a counselor, coach, grandparent, church leader, or another mentor.

For more information on talking to your teen about substances visit:

www.drugfree.org
www.theantidrug.com
www.mayoclinic.com/health/teen- drinking
http://www.parentactionondrugs.org/ parentquestions.php

Your pediatrician or family doctor can be a great resource as well.

For more information and to read additional articles on teen trends and talking with teens, visit Wendy Sunderlin's TeenLifeTalks website at http://www.teenlifetalks.com/Resources_Newsletters.php

The Importance of Vitamin D - by Georgia Tetlow, MD

Vitamin D is inversely associated with risk of colorectal cancer. The higher your vitamin D level, the less likely you are to get cancer of the colon or rectum. Big news!!

A few years back, Dr. Freedman and colleagues studied 16,818 participants in the Third National Health and Nutrition Examination Survey (Freedman et al. 2007). Colorectal cancer mortality was found to be inversely related to vitamin D blood levels, with levels of 80 nmol/L or higher associated with a 72% risk reduction (95% confidence interval = 32% to 89%). Levels lower than 50 nmol/L supported the inverse relationship between 25(OH)D levels and colorectal cancer mortality—again—the higher the levels, the lower the cancer risk. Overall, a meta-analysis showed that in all five studies, a significant protective effect against developing colorectal cancer was conferred by vitamin D sufficiency. (Gorham et al. 2007)
Additional research is forthcoming regarding vitamin D’s important role in the prevention of breast, prostate and pancreatic cancer.

It’s important to get your vitamin D level tested, and essential to get repleted to the right level! Unlike integrative physicians, so many conventional physicians still underdose. Make sure your levels are appropriate for the upcoming winter months, when a higher dose of vitamin D is often needed.

Vitamin D Prevents Colorectal Cancer: Dose-Response Relationship. Gorham et.al. American Journal of Preventive Medicine Volume 32, Issue 3, March 2007, Pages 210-216.

Dr. Georgia Tetlow practices integrative medicine at The Resiliency Center. Visit www.beingmybestself.com, call 888-702-7974 or email info@beingmybestself.com.

Read other articles by Dr. Tetlow here:  [Insert link to: http://drgt-integrativemedicine.com/]

Nutritional Guidelines to Enhance Mood and Emotional Well-being by Joel Edman

While some of us recognize that when we eat better and take nutritional supplements our mood is better, for others this relationship may be difficult to evaluate. It also may be surprising to learn that there are actually several significant areas of research linking nutrition and mood.  As described below, nutritional factors influencing depression, for example, range from folate and vitamin D, to omega 3 fatty acids and hypoglycemia.  There are also a number of nutritional supplements that can be important and they will be described later as well.  As is always presented in this column, these approaches are most beneficial when they are applied within the context of an overall integrative medicine program that includes dietary guidelines, nutritional supplements, physical fitness, relaxation techniques and other modalities, and then a uniquely developed overall program is designed for each individual.

When describing nutritional influences on mood and other symptoms or problems, it is important to keep a couple of key points in mind.  The first is that a healthy diet should always be the foundation of a good nutritional plan.  Another way to say this is that you can’t make up for a poor diet by taking a lot of supplements.  Targeted nutritional supplements can then be included to add to the benefits of a good diet, producing an even better effect than each one would have had by itself.

Dietary Influences

There are several ways in which an imbalanced or poor diet can influence mood.    This can be particularly important when our diet is not as good as we would like it to be, but it can often be compounded by other problems such as significant stress (which may increase the requirement of specific nutrients), stomach or intestinal symptoms (which may weaken digestion and absorption of important nutrients and phytonutrients), aging effects, exposure to environmental insults, and/or other influences.

            One primary characteristic of diet is that it provides essential vitamins and minerals that serve as cofactors or facilitators for the production of specific neurotransmitters or brain signal molecules.  For example, the B complex vitamins (thiamine, riboflavin, pyridoxine, cobalamin and folate) help to make the neurotransmitters dopamine, serotonin, GABA and acetylcholine.  This understanding has led to the term “stress B-complex”, and a B-complex nutritional supplement is often recommended for people who have high levels of stress, or symptoms of depression and/or anxiety.

            The most well-documented influence for B complex vitamins has been found for folate and depression, although low levels of vitamin B12 can also be very important for  mood and other nervous system symptoms, and B12 deficiency or insufficiency is more common as we get older.  Some research suggests that the relationship between folate and depression may be more significant in men than women, and for recurrent depression more than a single depressive episode, yet it would be important to look at for everyone that has depression.  Since folate is found in healthy foods such as vegetables, whole grains, beans, and fruit which are suggestive of healthier dietary patterns, it may be difficult to separate out the influence of folate specifically vs. the diet in general.  However, there are other studies that have found that lower folate levels were associated with poorer response to anti-depressant medications (such as selective serotonin reuptake inhibitors -SSRIs) and that folate supplementation may produce more benefit than SSRI therapy alone in people with major depression. 

Another important dietary factor to discuss is that of healthy fats, specifically omega 3 fatty acids.  A recent major study suggested that omega 3 fatty acids had significant anti-depressive effects.  Although much of this research has looked at effects of supplemental fish oil, containing EPA and DHA, there is other research that has shown that lower dietary fish and omega 3 fatty acid intake and lower blood levels of omega 3 fatty acids are associated with different types of depression. 

The inclusion of healthy fat in the diet is likely beneficial in several ways including: (a) nervous system function; (b) anti-inflammatory effects – which occur with specific conditions and aging; (c) following a healthy dietary pattern which would be similar to a Mediterranean-type diet or vegetarian-based diet; and (d) helps to balance macronutrients (protein, healthy fat and complex carbohydrates) and therefore stabilize blood sugar.  These healthy omega 3 fatty acids or fats are primarily from specific types of fish (salmon, sardines, tuna, etc), flax seeds, soy products, nuts/seeds and dark green leafy vegetables).  While monounsaturated fats (primarily from olive oil, olives, nuts/seeds and avocado) are likely helpful too, there is little research at this time to support a relationship to mood.

The last dietary factor to discuss, yet perhaps one of the most important, is hypoglycemia or abnormal glucose tolerance/insulin resistance.  Although there has been little recent research, studies have suggested a significant relationship between depression, and abnormal glucose metabolism and/or insulin resistance.  One study found significantly higher blood sugar levels, greater glucose responses during an oral glucose tolerance test (OGTT), larger insulin responses during the OGTT, and insulin resistance in people with depression.  Symptoms of hypoglycemia include fatigue, headaches, depression, anxiety, heart palpitations, irritability before meals and possibly other symptoms.  Causes of hypoglycemia include excessive sugar and refined carbohydrate intake, missing meals, excessive coffee or caffeine intake, inadequate dietary protein or fat (preferably healthy fat), significant stress and/or inadequate magnesium or chromium intake.

Nutritional Supplement Effects

            The use of nutritional supplements is an essential part of a nutritional program that can boost mood.  As already discussed, a B-complex supplement with good amounts of vitamin B12 and folate is important to take, although some good multivitamin and mineral supplements may work just as well since they would have the range of vitamins and minerals that are important, as well as about 25 to 50 mg of most B-complex vitamins.  A fish oil supplement is another important product to take to provide extra amounts of omega 3 fatty acids and insure therapeutic benefit.

            A third part of a foundation supplement program would be calcium, magnesium and vitamin D.  As we know calcium is helpful for bone density and bone strength, but it can also be beneficial for the nervous system.  Magnesium, which may be the nutrient that is most commonly deficient in the US, has a calming effect on the nervous system, helps with blood sugar regulation, and has other benefits for allergies, hormonal balance and heart functioning.  Finally, vitamin D has been found to be helpful for some people with seasonal mood fluctuations or season affective disorder (SAD) and vitamin D is also  frequently found to be deficient when a blood test is done.

            With regard to other supplements that could be helpful, there are many.  Probably the best researched products are S-adenosyl-methionine or SAMe, and the herb, St. John’s Wort.

SAMe is an amino acid that is a major factor needed in the production of several neurotransmitters and for nerve cell membranes.   There is actually extensive research spanning three decades to support its use.  Although the exact mechanism of action is unknown, there is enough clinical research and experience to suggest that SAMe is effective for many people.

While St. John’s Wort has been found very helpful for mild to moderate depression, its use in major depression is less clear.  It is also worth noting that there is significant potential for an interaction between St. John’s Wort and other medications since they are metabolized by the same liver enzymes.  It is therefore important to discuss these issues with your doctors and other healthcare practitioners.

As for other potentially useful supplements, it is not possible to describe them in detail, but they would include products such as 5-HTP, DHEA, inositol, supplements for sleep (for example, melatonin, valerian, etc.),  and some others.  To explore the use of these supplements it would be best to work with an experienced and effective group of integrative medicine practitioners.

Practical Approach

An overall integrative medicine approach is essential.  Since dietary changes and programs can be challenging, careful consideration should be given to what is possible for each individual.  Therefore, a reasonable diet or therapeutic diet should be combined with targeted supplements, stretching and exercise, relaxation techniques and other modalities. 

It is always helpful to get some blood testing done which can assess whether there are some imbalances or clinical/subclinical deficiencies or insufficiencies.  Validated common testing would include blood levels of vitamin B12, folate, and homocysteine, as well as other nutrient measures such as, 25 hydroxy vitamin D, and  red blood cell (RBC) magnesium and zinc.  Some tests commonly used by integrative medicine practitioners, but not well validated, are urinary panels for neurotransmitter metabolites, metabolic profiles, fatty acid profiles, detoxification profiles and others. 

             With regard to nutritional supplementation, one approach is to recommend a foundational program.  Such a program might include a comprehensive multivitamin and mineral complex, omega 3 fatty acids/fish oil and a calcium/magnesium/vitamin D supplement.  Additional targeted supplements could be focused on anti-depressive effects, anxiety, sleep, and/or other aspects of an individuals’ circumstances.  Through the combination of dietary guidelines and nutritional supplementation as well as other integrative modalities, good mood and emotional well-being will surely follow.

A Wave by Dean Solon

you sitting by the ocean, the waves rolling in, washing ashore, a few feet from your outstretching toes...
you swimming in the ocean, the waves rolling over you, washing you down...
you sitting, here, now, waves circulating and coursing through your body...
and you a wave, you the wave, splashing into the sand, and you the water receding back into the sea...

allowing an unfolding of intention, lightly...
allowing an unfolding of practice, lightly...
because this is not really about attaining anything,
because this is not really about achieving anything.

sitting...with the unexplainable, with the inexplicable, with the surprise, of breathing in and breathing out, of being with a body, with a mind, in a life, here and now.

sitting...with a pulsing, with a pervading, of awareness, of alertness, of your heart beating, of being here now.

here is the place
here is the place
now is the time

sit with this.  sit with this.
sitting with awareness of THIS, without attachment to THIS.
sitting with this...with this body, with this mind, with this life, with this breath.

here is the place
now is the time