Sunday, January 23, 2011

Seasonal Affective Disorder

     I do not remember experiencing a more joyful, active winter as I am feeling this season.  My mind is active, my mood lifted and I’m excited about my future.  Last winter was a different story.  I wrote the following column last year while in the depth of Seasonal Affective Depression.  I was sad!  Many readers empathized with me or gained understanding into their own depression after reading my story so I offer this experience again in hope more people seek help for their seasonal depression and vitamin D deficiency.        
     It’s winter in North Idaho and I’m depressed.  I don’t remember being depressed in winters past.  I love winter—snowy Christmas mornings, snowshoeing Fourth of July Pass, harvesting our Christmas tree from Fernan Saddle, cooking rich tomato soup from canned vegetables harvested from my summer garden, jeeping in the white powder at Lookout Pass, heavy sweaters, heavier boots; wonderful memories.  So why am I sad?
     Being the person I am I think, “Just buck-up and get to work.”  “You’re not sick.”  “Quit complaining and just live with it.”  I tell myself I should quit being sad and, if I put on a happy face, things will be okay.  After all, I’m a therapist, relatively intelligent and in touch with my mental wellness.  I should be able to fix me.  I was wrong. 
     The week before Christmas my life turned upside down.  I thought I had a brain tumor and was dysfunctionally and organically out of sorts.  My blood pressure was high and my heart palpitating.  I often felt anxious, sad, did not sleep and felt neck, jaw and shoulder pain—my whole body ached.  I was dizzy all the time and struggled to walk a straight line.   
     It took all effort I could muster to rise from my couch. I started calling in sick to work and I thought I was getting old and wondered if I was dying.  I remember sitting in my easy chair in the family room of our home and my wife, looking at my sad, desperate face asked, “What’s wrong?”  I could only answer, “I am just so sad!” This scared us both.     
     I scheduled a visit with my family doctor to discuss an acute onset of dizziness (vertigo).  My doctor asked many questions, examined my body and drew blood.  We discovered hypertension and high cholesterol with all else normal but had to wait for the results of a few tests.
     Two days later the news came; I am severely vitamin D deficient.  The doctor prescribed Zocor for my cholesterol and 50,000 IU of vitamin D weekly for 4-6 months.  The doctor explained the journey back to physical and mental wellness is a lengthy one taking months to build-up the vitamin D my body lacks.  I decided to learn more about the disorder that effectively stopped my enjoyment of life.  The following is what I discovered.  
     Symptoms of vitamin D deficiency might include hypertension, cardiovascular disease, cognitive impairment, achy and weak bones and muscles, lower immunity to illness, low mood and depression.  Vitamin D comes from two sources, the sun and the food we eat.  The further north one lives from the equator the less vitamin D they receive from the sun.  Living above 42 degrees north latitude affects ones ability to receive adequate vitamin D from the sun during the months of November through February.  North Idaho, my home, is 49 degrees north latitude and void of delicious, warm, solar vitamin D for four months. 
     If the sun offers vitamin D, how might one gain the vitamin when most specialist urge avoiding solar exposure at all costs?  Some believe any exposure to the sun is unsafe but vitamin D is necessary for healthy bone growth and mental wellness.  Bare your skin and let the sunshine in—if you dare. If one is susceptible to sunburn or has a history of skin cancer, use dietary supplements to gain vitamin D and avoid sun exposure.
     Ultraviolet radiation from tanning beds and direct sunlight are carcinogens responsible for most of the estimated 1.5 million skin cancers and the 8,000 deaths due to metastatic melanoma that occur annually in the United States.  Lifetime cumulative UV damage to skin is also largely responsible for some age-associated dryness and other cosmetic changes.
     It is not known whether a desirable level of regular sun exposure exists that imposes no (or minimal) risk of skin cancer over time. The American Academy of Dermatology advises that photoprotective measures be taken, including the use of sunscreen, whenever one is exposed to the sun.  Each person needs to weigh the risks and rewards of sun exposure and make a personal choice for their own mental and physical health.  
     Some studies suggest seasonal depression (Seasonal Affective Disorder—SAD) might be correlated to vitamin D deficiency due to lack of sun exposure and lack of availability to the healthy foods of summer.  For those who cannot find adequate sun, light therapy might be the answer.  Light therapy lengthens one’s day by adding artificial sunlight when no sunlight is available (usually early in the morning before sunrise). 
     Sitting in front of a light box (available on-line and at COSTCO) for 20-60 minutes daily might offer relief from seasonal depression symptoms.  The box must be capable of offering 10,000 lux of light at eye level to be effective. 
     The food we eat—foods rich in vitamin D include cod liver oil, salmon, mackerel, butter, mushrooms, fortified cereals, and milk—also support and build vitamin D in one’s body. Grilled salmon with sautéed mushrooms on top of basmati rice drizzled with extra virgin olive oil is a treat which will help one live longer while becoming happy in the dead of winter.
     I am now four months into the journey of recovery.  The changes I’ve made include eliminating almost all cholesterol in my diet, ingesting fish oil and vitamin E each day, taking a small dose aspirin a day and taking long-term prescribed medicine for the first time in my life, exercising (by walking briskly) 2 ½ hours a week and preparing most meals I eat at home.
     I am a private person but am disclosing this very personal issue in my life for this reason.  Many friends and family with whom I’ve shared my story share similar symptoms in their lives.  They then seek medical attention and discover they too have vitamin D deficiency.  See your doctor. It takes minutes and might answer questions one has about mood, energy level, achiness or dizziness.   
     My life is better.  The sadness has mostly disappeared, my cholesterol has dropped 70 points, my vertigo has decreased to once or twice a week and my energy level has increased substantially.  I enjoy life much more than before and am looking toward the future.  A simple blood test changed my life for the better.  See your doctor and get tested. 

Friday, January 14, 2011

Divorce and Children

      A child asked this week if I thought she was a bad kid.  I looked at her with surprise and asked, “What makes you ask such a question?  I think you’re a wonderful kid.”  The child, looking down at her feet cries quietly, “I think my mom and dad are getting a divorce because I’ve been a bad kid.  They always yell at me and are upset at me.  I try to be good but I just can’t.”   She slowly raises her head and looks into my eyes for her answer.  The girl and I have lots to talk about.   
     When a couple struggles in their relationship people know.  Friends, family, coworkers and children feel the stress of an unhealthy relationship.  They become the unwilling target of projected, unwarranted explosions and belittling by an angry, anxious, scared friend, daughter or mom whose about to end their marriage.  I hate divorce because I believe it is an easy escape to an uncomfortable but fixable situation.
     Couples get angry, intolerable, rude and verbally abusive.  When this happens in a marriage the marriage loses balance.  Balance must be regained for the marriage to be successful. 
     A non-negotiable action that must result in instant separation is physical abuse.  When a partner hits, someone has to leave.  Hitting is a powerful tool to gain control when all other attempts to control no longer work and cannot be condoned.  When someone hits, someone has to leave—period!
     Almost as devastating as physical abuse is infidelity.  When a partner wanders outside the marriage and becomes intimately physical with another person, a marriage is permanently damaged.  Trust is degraded; the victim becomes insecure in their ability to please their partner and the reason for the exploration always questioned.  Trust becomes improbable and frustration increases.  So, infidelity and physical abuse are relationship killers and intolerable.  Separation then rebuilding the relationship is the only answer.      
     How does one regain balance in a relationships to build a healthy marriage once that relationship has lost balance?  John Gottman in his book, “Why Marriages Succeed or Fail,” offer suggestions through years of research on the four behaviors that make marriages fail.  He calls them the, “Four Horseman of the Apocalypse.”
     The first horseman is CRITISISM.  Complaining is different that criticizing.  Complaining focuses on a person’s behavior, “When you wash my car you don’t clean the wheels, they always look dirty,” is complaining about the way one washes a car but does not criticize.  Criticizing is a personal attach such as, “You are lousy at washing cars and don’t care how my car looks.”  It is okay to complain but not criticize. 
    The next horseman is CONTEMPT.  Showing contempt for your spouse results in disrespect and being uncaring.  Being contemptuous includes insults and name-calling.  Calling ones’ spouse fat, stupid, ugly, a jerk, wimpy, and more creative or crude names result in degrading your spouse and forming a separation of intimacy.   
     Other forms of contempt include hostile humor and sarcasm, mockery and offering negative body language.  Rolling one’s eyes, making hurtful jokes or being sarcastic truly hurts, no matter the intent.  When a spouse says, “I was only joking, can’t you take a joke,” they are really saying, “I’m putting you down and degrading you and you need to accept it.”     
     The third horseman is DEFFENSIVENESS.  No matter what one’s partner charges, one insists they are not to blame and become defensive to everything one says.  Being defensive includes denying responsibility, making excuses, whining, offering a yes, but you did it first, excuse.  Mature, secure adults accept responsibility for their action and do not need to put blame on people who question their action.    
     The last horseman is STONEWALLING.  This is the strongest and most potent horseman due to its factor of control.  A person who stonewalls does not fight back; turns into a stone wall and does not argue, fight or show emotion. The stonewaller learns that it is safer to be quiet than to speak.  This really upsets the fighting spouse who wants feedback and is not getting it.  The stonewaller controls the debate by not participating in it.  Stonewalling stops communication and forces the spouse searching for feedback to search outside the home for a voice to listen to their discord. 
     How do we build an unhealthy relationship into a caring, nurturing relationship?  First, if you and your spouse are riding one or more horseman of the apocalypse, get off the horse.  Recognize your negative hurtful behavior and quit doing it.  If you can’t, search for help. 
     Second, if your relationship is dying and neither of you have committed the big non-negotiable acts (infidelity or physical abuse) it might be time to restart your relationship.  Look back to your wedding day.  Was it a happy day?  Do you have fond memories of your relationship when it was fresh and new?  If the answer is yes, it is time to rekindle that relationship.  If possible, move into different homes, maybe back with your parents and start dating again. 
     Ask each other out on the first date again (remember the four horseman and don’t fall into the hurtful, abusively controlling ways of the horseman again).  Wait for a few dates for that first kiss, become a gentleman and open the car door for your date, be kind, generous, bring flowers and talk about your future and what being in love might really look and feel like. 
     It is time to rewrite your past into a new future.  Your past as a couple didn’t work.  Reinvent your past and create a new future.  You will be surprised at the outcome. 
     Lastly, if none of this works and divorce is the only option, remember your kids.  The ONLY way kids remain healthy after divorce is if parents co-parent effectively.  Let your children know you are divorcing because mom and dad can’t get along and it has nothing to do with them. 
     When talking with your ex-spouse, pretend you still like each other.  Kids struggle with love and loyalty during divorce.  They are loyal to the custodial parent and will protect them 100%.  The opposite is true when they are with the other parent and protect that parent when visiting.  Don’t put kids in the middle of your divorce.  
     Never speak poorly about your ex-spouse in front of your kids.  Don’t make boys become the, “man of the house,” or girls become, “little moms.”  Let your kids be kids.  If you’re sad, be sad in private; don’t turn your children into caretakers.  Don’t pit kids against parents and keep them out of court proceedings.
     Divorce is evil and hurts all involved.  To lesson the hurt, be kind!                           

Wednesday, January 12, 2011

Winter Gardening

     Gurney’s, Burpee, Garden Fairy, Park Seed, Pepper Joe, Annie’s Annuals, Baker Creek Heirloom Seeds, The Cook’s Garden Plant and Seed and Willamette Valley Hop Farms catalogs will arrive in my mail box in the next few weeks and my soul feels warm as my body chills.  Seeing glossy pictures of summer fruit instantaneously transports my mind to summers past.  Memories of a Cherokee Purple heirloom tomato picked from the garden vine, cut lengthwise with my Swiss Army pocket knife and wrapped with three leaves of Thai basil begins to warm my body.  As I continue my daydream, I dreamily pop the taste of summer into my mouth and feel the red and purple juice moisten my beard making the winter snow and bitter cold bearable knowing; my seed catalogs and seed-sowing season are on the way. 
     Winter is not a death but seasonal rebirth.  The bitter and frozen emptiness of winter offers the gardener and chef an opportunity for reflection and personal growth.  As the trees and garden lay dormant I begin mental work.  Which crop will replace the tomato in their beds ensuring proper rotation and a healthy, pest-free yield?  Which plants belong on the northeastern side of the garden to ensure their height does not block the sun from the smaller plants?  “Forget the pole beans and sweet peas,” I decide because no one in my family eats them.  Extra carrots for ginger-carrot soup, which freeze well and taste great, are a must-grow.
    Winter is the season of mental and physical survival.   After spending seven years living in South Dakota I am reminded of our family’s fall tradition of adding a survival duffle bag to the trunk of our car.  The bag contained a wool blanket, waterproof matches, sterno, a flashlight, radio, bottles of water and canned chili—things one needs to survive a 30-degree below zero night in the middle of nowhere.    
     My North Idaho mental survival duffle bag this winter are garden books and seed catalogs, cook books and slow roasted beans, the blog picture of my family in last year’s garden and knowing I will plant seeds in starter beds next month supported by grow lights in the basement of my home.    
     To survive this winter, I open my mental survival bag and wait for the trees to bud, plants to appear in their beds, the first crocus flower to pop through the snow and bugs and birds to reappear.   
     This year new additions to the garden excite and energize my winter blues.  I plan to raise quail for meat and eggs (their poop is great organic fertilizer) and add edible flowers to the garden.  This spring I will grow hops over the arbor gate that opens into the garden to brew beer from this fall and pinot noir grapes on the side of the house for wine.  I plan to grow mushrooms in my kitchen and am searching the covenants in my neighborhood deciding if beekeeping is in my future.  Please read future columns to discover my success or failures in these endeavors.   
     Loyal readers of the column might remember an article written by this author about my struggle with vitamin D and depression.  Recent tests, after a daily dose of 6000 international units of the vitamin, show an increase of 30 points in my vitamin D level last month.
    My seasonal depression is gone.  I strongly urge all readers who find long winters in North Idaho to affect their mood in a negative way, visit their family practitioner to assess their vitamin D level.  This simple test changed my life for the better.
    Speaking of North Idaho in winter, it’s snowing again.  I lace up my boots and put a beanie on my head in preparation to remove the 11 inches of recently fallen snow from the driveway.  I start the snow blower, put it into gear and begin the task at hand. 
     Over the scent of burning gas and fresh snow, I smell garlic and onions cooking as my wife prepares a comforting pot of vegetarian minestrone soup using the last of the canned tomatoes and dried herbs from this past years garden. 
     Minestrone is an easy and fulfilling comfort meal to prepare on a cold January night when paired with homemade buttermilk biscuits and a tall glass of milk.  Here is the recipe:
Chele’s Vegetarian Minestrone Soup
(A note from my wife:  this recipe is a starting point depending on my mood, what I can find at the grocery store and what is in the pantry.  I add or delete ingredients at-will.  The outcome is always a surprise)  
¼ C olive oil
1 medium onion, sliced
2 garlic cloves, minced
2 carrots, sliced
2 celery stalks, sliced—including leaves
1 leek, halved length-wise then sliced
1 can (28 oz) whole tomatoes (or home-canned tomatoes)
1 qt vegetable stock
Seasoning to taste—fresh parsley, dried basil, dried oregano, salt and pepper
2 cans (15 oz) cannellini beans
2 C bok choy—shredded
2 medium zucchini, sliced
½ C small shell pasta
Fresh Parmesan cheese (omit for vegan diners)

Heat oil over medium-high heat in a large pot.  Add onions, garlic, carrots, celery and leek.  Sauté until vegetables are slightly caramelized.  Add tomatoes including juice to the pot and mash into bite-size pieces with a fork as they cook.  Stir in stock and add dry herbs.  Bring to boil then reduce heat.  Cover and simmer 20 minutes.  Stir in beans and cabbage and simmer 10 more minutes.  Add zucchini, parsley and pasta and simmer uncovered for 10 more minutes.  Ladle into bowls and shave cheese over the soup before serving.   

Thursday, January 6, 2011

Food Which Hurts and Heals

     A wise Spanish proverb states, “The belly rules the mind.”  Our tummy controls our behavior, cognition and mood.  We overeat to feed the growling beast within, refuse to eat to control parents who try to control and intake small portions while exercising to excess to become the perfect, pop-cultural misrepresentation of physical health. 
     One eats when sad, when happy, when angry or sometimes when feeling nothing at all.  A wide array of psychological and biological disorders result when one uses food to cure emotional ills instead of using food for its initial purpose, to nourish one’s body and mind.
     One forms a personal relationship with food which changes when one’s mood cycles.  When depressed or sad, one might dive into fatty, sugary, high carbohydrate foods which first comfort then deepens one’s depression and sadness as their waistband increases and body bloats. 
     At a holiday party one might indulge in culinary treats satisfying and lifting their mood which creates happy memories and reinforces one’s desire to celebrate life.  Let’s examine the dysfunction of food then celebrate its merits.
Anorexia nervosa          
     Anorexia usually begins as a weight-loss diet.  People feel overweight then begin to diet and, as their weight drops, continue to feel fat and remain obsessed with losing weight.  Most are women (9 out of 10) who continue to limit their food intake or exercise to excess even when their body is emaciated.

Bulimia nervosa

     Bulimia almost always happens when someone breaks a diet cycle and gorges on food.  Preoccupied with food (craving sweet and high-fat foods) but fearful of gaining weight, one with bulimia vomits, uses laxatives, fasts or exercises to excess to counteract the result of gorging. 
     People with bulimia often exhibit depression and anxiety following episodes of binging then purging.  About half of those with anorexia also display the binge-purge-depression symptoms of bulimia.  Unlike anorexia, bulimia is marks by weight gain and loss making the condition easy to hide.
     Common arithmetic equates people get fat by consuming more calories than they expend, but is this true?  Not always.  Once one becomes fat, they require less food to maintain their weight than they did to attain it.  Why?  Because compared with other tissue, fat has a lower metabolic rate—it takes less food energy to maintain it.  Once the weight is on, it stays on unless one decides to radically change their behavior. 
     Obesity has many causes which all start with food intake.  Putting large amounts of sugary, high-calorie foods in one’s sedentary body will increase one’s weight.  Eating low-calorie, low-fat food and moving one’s bodies more decreases one’s weight. 
     If a person wants to lose weight, following these seven tips will decrease the numbers on the scale.
  1. Begin a weightloss regiment only if you feel motivated and self-disciplined.  Weightloss is a life-long decision to change family food traditions, eating habits, becoming more active and maintaining these activities for life.  When struggling with motivation, a therapist might help define motivation and aid self-discipline.
  2. Minimize exposure to tempting food cues.  Remove unhealthy food from your house and go to the grocery store when full. 
  3. Take steps to boost your metabolism.  Move your body.  Walk, swim, run, play basketball or play with your children.  Moving your body creates a calorie burning body and is fun.
  4. Be realistic and moderate.  A realistic time line for a 10 percent reduction in body weight is six months.  It took time to put the weight on, allow time to take it off. 
  5. Eat healthy foods.  Add foods with color to your plate and remove golden food.  Replace bread and French fries with whole grains and fresh fruits and vegetables. 
  6. Don’t starve all day and eat one big meal at night.  Eating throughout the day maintains ones energy level and avoids the gorge of starvation at night. 
  7. Beware of the binge.  Most people occasionally lapse.  After lapsing remind yourself you’ve succeeded before and get back on the healthy eating horse.
     Mother’s of girls with eating disorders are often critical of their own weight and hypercritical of the weight and physical appearance of their daughter’s weight.  A family of children with bulimia has a higher-than-usual incidence of childhood obesity and negative self-evaluation.  Sufferers set perfectionist standards, fret about falling short of expectations and are intensely concerned with how others perceive them.
      There is a cultural explanation why anorexia and bulimia occur mostly in women and mostly in weight-conscious cultures.  Body ideals vary across culture and time.  In India, women students rate their body ideal as close to their actual shape.  In Africa—where thinness can signal poverty, AIDS, and hunger, and the prosperous are plump—bigger is better.  
      It seems clear that the sickness of today’s eating disorders lies not just within the victims but also within our weight-obsessed culture.  A culture that says fat is bad motivates millions of women to constantly diet.  This same culture encourages eating binges and purges by pressuring women to live in a constant state of semistarvation to achieve an unachievable perfect body image. 
Celebrate food       
     Food should not punish but reward.  Eating to punish or control creates dysfunction making food the enemy.  Food should be a friend not foe.  Eating a healthy, nourishing meal by one’s self or with family and friends creates memories that desire to be relived. 
     When happy, one remembers the food consumed as part of the happiness.  This creates a cognitive picture of the food experience reinforcing the eater’s desire to repeat the pleasant memory.  Continuing to create positive experiences around the dinner table forms a positive relationship with food which creates a happy human.      
     Eating healthy food in moderation ensures one retains a healthy relationship with food creating a healthy and often happy life.  Being happy is a choice.