Iron, like a Lion in Zion!

Must go to Jamaica soon and
connect with my heritage!

Thought I'd actually write a blog about nutrition which I haven't done for a while! I was feeling quite tired and sleeping excessively about a month ago after leaving my job so I went to my doctor to check my iron and vitamin B12 levels to rule out anaemia.

Turned out I was not anaemic, my red blood cell count was normal, my sleep patterns had just been disrupted by having no regular routine. My B12 levels were quite high (because I supplement it) and my iron (ferritin) levels were within the normal range but a little on the low side of average. Given that I'd been eating quite appallingly and neglecting my diet over the winter due to stress and comfort-eating, this was hardly surprising.  Since leaving my job I've had much more time and motivation to pay attention to my diet and I'm aware of ways to alleviate this, (just need to actually do them!) I'm going to try a bit harder with my diet and hopefully soon I will be iron, like a lion in zion (whatever that means!).

When considering removing meat from the diet, iron is commonly thought of as an area of concern.  Although I agree it's always good to be conscious of the necessity of replacing nutrients when cutting something out of the diet, iron is not, in my opinion the biggest concern with a plant based diet.

Red meat and liver (ugh) often spring to mind as some of the main sources of iron but it is also found in high amounts in a very wide range of plant foods.  

For a long time prior to doing my course I'd read a lot of books and evidence-based information about nutrition and so I was shocked to see how biased most of the lecturers we had were with regard to vegetarians and vegans and anaemia.  

Studies have shown that iron deficiency anaemia affects meat eaters and vegans equally and that it is just a generally common problem, particularly for pre-menopausal women.

Although red meat is a source of well-absorbed iron, its high levels of animal hormone residues can contribute to hormonal disturbances associated with heavy periods (the primary cause of anaemia in women). This is one of many potential reasons why there is more to maintaining healthy iron levels than simply eating red meat.

What do we need iron for?

Iron is a trace mineral, meaning it's needed in very small quantities but getting the right amount (not too little or too much) is crucial for health.  It's primarily stored in haemoglobin in our red blood cells and helps to transport oxygen around the body (yep, pretty important!). It is also needed for normal immune function, cognitive processes and cellular activities in the body requiring enzymes. Requirements vary depending on age and gender (women who are pregnant or of child-bearing age need more).

Signs of low iron status:

hope that's not too gross
the inside of your eyelid should be
red and not pale

• Tiredness/Exhaustion
• Getting breathless easily
• High heart rate (with insufficient red blood cells the heart has to work harder to transport oxygen around the body)
• Paleness (as opposed to redness under the eyelid)
• Poor immunity
• Brain fog, slowed mental processes
• Hair falling out
• Brittle, weak nails

Good plant sources of iron: Lentils, beans, chickpeas, nuts, seeds, particularly pumpkin seeds, dark green leafy vegetables, green superfoods (spirulina, chlorella) seaweeds (Wakame is nice with miso soup or in stir fries) dark chocolate (yey!) wholegrains, molasses (nice with porridge and baked goods like gingerbread), dried fruit (apricots, figs,prunes)

'But plant based iron is not well absorbed!'

Whilst is true that meat and offal contains haem iron which is more readily absorbed than that from plant sources, if we were to obtain the recommended daily allowance of iron solely from meat, this would entail eating several portions of red meat daily. I'm sure even most of the vegetarian-hating health professionals would agree this would be undesirable health and money-wise. So what's the solution then? To obtain all or the majority of one's iron from plant sources and adopt measures to ensure it's absorbed as well as possible.

Sprouted bread found in health food shops contains iron

in a better absorbed form

Currently 'paleo' diets based on the diet of our ancestors which exclude grains and legumes (lentils, chickpeas, beans) are popular. Whilst I don't disbelieve those who say this diet works for them I don't think it's necessary to eliminate grains order to have healthy iron levels.

It is said that grains and legumes are high in a substance called phytic acid which reduces mineral absorption (including that of iron). When I first heard about this in one of my nutrition lectures I was freaking out, thinking 'What am I going to do? literally everything I eat is high in phytic acid!'. Then I realised I didn't have any symptoms of all of these mineral deficiencies I should supposedly have according to my phytic acid-laden diet. Why is this? Because provided that we eat a nutritious diet overall and have a a well-functioning digestive system our bodies are able to neutralise its effects with our beneficial gut bacteria and digestive enzymes. (It's a different situation for those with digestive disorders such as coeliac disease or IBS). Sprouting and/or soaking grains and legumes helps to reduce intake of phytic acid and sourdough and sprouted bread contain more absorbable iron. What is often not said is that phytic acid is actually a beneficial antioxidant and its ability to bind to minerals is a blessing as well as a curse, as it facilitates the excretion of heavy metals from the body.

For more information on this see: https://selfhacked.com/2013/10/11/phytic-acid-the-ultimate-anti-aging-compound/#11_Phytic_Acid_Can_ProtectThe_GutFrom_Toxins

 But anyway..... Phytic acid schmitic acid!

Tips for having healthy iron levels

M&S do some nice
non-bitter dark
chocolates!

• Vitamin C is a well-known enhancer of iron absorption. Ensure a good intake by including a variety of fresh raw or lightly cooked fruit and vegetables daily and always try to have some with iron-containing meals.  If you are very stressed or exercise heavily you might need more than you are able to obtain from food (the adrenal glands that produce the stress hormones use a lot of vitamin C) and supplementation may help.
• Use a cast iron pan for cooking to increase the iron levels in your food. They are not cheap but you can buy them at large supermarkets and they are a good investment.
• Could you have low stomach acid levels?  If you find yourself feeling uncomfortably full a lot of the time and food takes a long time to digest, it's possible your stomach is lacking in acid which is crucial for efficient absorption of minerals.  This was the case with me and when I addressed it, the difference in my energy levels was amazing.  (See my old blog: http://samanthathesanevegan.blogspot.co.uk/2014/06/my-journey-with-nutritional-therapy.html), If you suspect this may be the case with you, a nutritional therapist can help you address this.
• Reduce tea, coffee and fizzy drink consumption as these all impair iron absorption.  Always drink these away from meal times.
• If you take calcium or zinc supplements, take them away from iron rich meals
• If you're someone cutting down on meat or going vegetarian, bear in mind that dairy products contain little to no iron and interfere with iron absorption so try to make meals centred around beans, lentils, nuts and vegetables rather than cheese. See my previous blog for more tips on how to incorporate these into your diet 
• http://samanthathesanevegan.blogspot.co.uk/2014/08/thyme-for-rice-peas-how-why-of.html
• Cooking using garlic and onions (yippee!! the basis of almost 100% of my meals!) may help to increase the absorption of plant-based iron.
• Before resorting to iron supplementation, do get your levels tested by your GP.  As I've mentioned, iron deficiency or anaemia is just one of endless possible reasons for being tired and it's not a good idea to supplement it if not necessary. Iron supplements might worsen any existing bacterial or yeast infections and an excess of iron is also associated with health issues such as diabetes and heart disease. (I've never taken iron supplements that I can remember). If you have a digestive disorder it's crucial to take steps to heal the gut first.

using a cast iron pan may help to increase the
 iron content of your meals

• If you have tried everything for years and still have low iron levels, it's worth investigating whether you have a condition such as coeliac disease, inflammatory bowel disease, in rare cases bowel cancer, a bacterial infection or any other underlying cause. 
• If you're a female who has anaemia caused by heavy periods, addressing the hormone imbalances (oestrogen dominance) may help to alleviate this although it's not an overnight process. See: http://mg.pim2.co.uk/womens-health-issues/heavy-periods/ for more info.

Now for the fun part! I've come up with a recipe for gingerbread cookies using iron-rich ingredients! Even healthier baked goods should not form the basis of one's diet but they'd make a great healthier treat for those PMS cravings!

Iron-rich gingerbread snaps! 

6oz oats (ground in a food processor)
2oz flour (whatever flour floats your boat)
2oz brown sugar (I used coconut sugar which is a low GI alternative)
2oz chopped dates
1 tablespoon molasses (also called black treacle)
1tsp ginger
1tsp cinnamon
4oz coconut oil

• Soften the coconut oil and mix in the brown sugar, dates and molasses
• Mix in the oats and 1 oz of the flour
• Press into a dough with your hands
• Sprinkle the remainder of the flour onto a clean surface
• Roll out the dough and use a cookie cutter or your hands to shape the cookies
• Bake in the oven at Gas mark 4 for 15-20 minutes

They are free from dairy, eggs, hydrogenated fat and nuts and can easily be made gluten free by using gluten free oats and flour.  The oats provide fibre, the molasses and dates provide some iron and other minerals, coconut oil is a healthy fat suitable for baking, ginger is an anti-inflammatory and cinnamon helps to stabilise blood sugar.

To be enjoyed without guilt!

War & Peace. Settling battles between humour and offence

I was inspired to write this blog after a brief, minor internet argument I had the other day. I'm a peaceful person and I feel strongly about being civil to those who have different beliefs and behaviour as I've mentioned in my blog.

http://samanthathesanevegan.blogspot.co.uk/

2014/07/cant-we-just-all-get-along-little-about.html .

Many angry heated arguments (both on the internet and in person) often spur from disagreements about issues and the way people interpret or misinterpret statements and supposed jokes. 

This is how it usually goes on facebook: 

• Joke is posted followed by x number of 'likes' and positive reactions. 
• Somebody is offended, feels the joke is targeted at them and becomes upset and retaliates
• The perpetrator of the joke accuses the offended of overreacting and having no sense of humour
• Heated argument and hostile comment thread that usually involves trying to find spelling mistakes in the other person's argument, accusing the other person of having too much spare time and other childish put-downs.

Perhaps the perpetrator genuinely didn't feel they said anything wrong or offensive (maybe they didn't) and feels no remorse for what they said. Or perhaps underneath they feel bad for upsetting someone or that their joke was deemed unfunny and wish to pass the all responsibility onto the victim, thus calling them a crybaby or accusing them of having no sense of humour.

How does the offended person feel?  They might be upset by what was said and more upset for being labelled a 'crybaby' and being told to just 'get over it'. Or maybe they don't actually really care that much. It can be hard to really tell on the internet even with emoticons!



Who's right and who's wrong? (& the number of 'likes' each comment gets does not determine this!) Does it really matter too much who has 'won' the argument?

I've been in both positions before and it can be hard to draw the lines sometimes. If we tried to speak and express ourselves without ever offending anyone no one would ever say anything.  I don't like political correctness taken to extremes and feeling like we're never allowed to use certain words or express ourselves.  At the same time there are some things that simply are not acceptable to say or joke about.  I don't think people should just think they can say whatever the hell they want without ever worrying about the impact it might have on someone. The 'sticks and stones' saying is not true, words can hurt.

As a vegan I still found the idea of
 a guy eating the pet dog of a girl he 
was trying to impress hilarious!
LOVE PEEP SHOW!

Although I'm a highly sensitive person or 'empath', I do love to laugh, I'm extremely sarcastic and I have quite a vulgar/weird sense of humour. I like to watch Peep show, the Inbetweeners and the Simpsons (which can be extremely politically incorrect sometimes!). I love to watch bad X factor auditions and laugh at other people making a complete fool of themselves, others might consider that cruel. I'm sure some people might find me offensive, I can become opinionated and sometimes come out with some strange things after a few drinks.

Nonetheless, I still personally find this 'if you're offended it's your problem' attitude extremely arrogant.  Both parties need to take some responsibility and have a think about what they've said and the other person's feelings.

If you're someone who tends to offend people frequently, rather than assuming the person you offended is just a 'crybaby' or accusing them of having no sense of humour, it's good to open your mind as to why that person feels the way they feel.  There might have been an experience in their life that made them particularly sensitive about certain things, they could have depression or another mental disorder. They could belong to a minority group that is constantly ridiculed (like vegans!) and/or oppressed and could be seriously tired of hearing it, even if it is deemed a joke.  

If you're a person who finds yourself frequently feeling offended and comments make a lasting impact on you remember that people are not usually trying to attack you personally. This doesn't mean you don't have to tolerate anyone saying something that's seriously offensive to you about your race, age, gender, religion, size, sexual orientation or anything else and you have the right to stick up for yourself. It doesn't make you a 'cry baby' or mean you have no sense of humour.

This is a slightly exaggerated version of me! 

On the other hand, if you do have issues with depression or low self-esteem that make you feel offended by the most minor things, it might be a good idea to get help. 

Sometimes when people have said to me I've lost weight when I haven't I find myself thinking 'Oh so you're saying I was really fat before?' I realise this is to do with how I feel about myself and is not really about what the person said. Let's face it, it's unlikely that 'you look like you've lost weight' was intended to be an insult! Like I said in my previous blog, it's great and liberating when you take steps to improve your self-confidence. You can learn to laugh at yourself and embrace your imperfections.



There's nothing wrong with a civil debate and differences of opinion but it's possible for this to occur without hostility, blame-shifting and resentment.

When we have a busy life we don't always take the time to stop and consider our own and other people's thoughts and feelings and how they impact on our relationships and interactions with people.  But I believe doing so might make for a more contented and peaceful existence. :)

More guilty nutritional therapy graduate confessions & how to let go of guilt

(within reason!)

Therapy has made me realise a lot of things about myself. I'm someone with a strong tendency to feel guilty about anything and everything from trivial things like making a cake that didn't turn out so well to feeling like I'm not doing enough to make a difference in the world. (Street charity fundraisers or 'chuggers' love people like me!). As I've mentioned a tendency to feel guilty is a feature of depression and can be a real barrier to achieving happiness and life satisfaction. 

My blog post:
http://samanthathesanevegan.blogspot.co.uk/2015/03/5-things-to-do-when-black-dog-strikes.html mentions letting go of guilt as a means of alleviating depression but this can be easier said than done. With time and a bit more self-awareness, steps can be taken towards allowing guilt to take over one's life.

So here are my steps to letting go of guilt and how I've managed to apply them to my life

Think about where the guilt is coming from.

Perhaps it's your parents, maybe it's seeing what other people are doing in your facebook newsfeed, or what you think society expects of you. When you've worked out where it's come from, question whether it's a valid reason for feeling guilty.

Often I end up feeling bad about myself due to supposed life obligations that (in my case) have no strong basis. Fortunately my parents have never really pressured me or tried to coerce me into choosing any particular career or life choice but I have a tendency to constantly compare myself with others and put myself down as a result, wrongly assuming everyone is ahead of or superior to me.  TV series and magazines can have much more of an influence than you'd expect.  Without being conscious of it I'll find myself looking at immaculate actresses with perfect hair, make-up and figures and thinking 'I don't look like that!' or looking at a fictional character in a TV series and thinking 'They are younger than me and they have their own flat and don't live with their parents!' Not really good reasons to feel bad about oneself.

If the source of your guilt is nonsensical, it's always good to be aware of this and change what and who you are exposed to in life (certain TV programmes, fashion or lifestyle magazines) if necessary.

If there was something you genuinely are doing or did do wrong in the past try not to dwell on it too much, just think about what you could do better next time and move on.

Sometimes when doing something we don't really enjoy such as work or studying we can get stuck in a procrastination/guilt cycle and sabotage our chances of doing the best we can.  It can be difficult to get out of bad habits (I'm sitting here writing this blog because I know I should really be job hunting, haha!) but try to establish what your real barriers are to doing what you should be doing and how you can overcome them. It always feels so much better when you've gotten something you dread out of the way and makes guilt-free enjoyment easier.

If it's something serious you feel guilty about and you've hurt someone or done something immoral, talking to someone you trust, a therapist or helpline about how you feel may help.  As long as you are taking steps to better yourself you deserve to forgive yourself and move on.

Think about what is right for you

 ....rather than following the crowd or being coerced into doing something because it's the societal norm. 

Obviously acting recklessly or being totally inconsiderate of those you care about is not a good idea but if you have a strong desire to do something (or not to do something!) it's important to choose what makes you happiest. 

I delayed becoming vegetarian and vegan for a very long time, partly for this very reason and it's a real shame. It can be difficult feeling different or like the odd one out but once you learn to stand by your own choices without guilt it can feel really good. If you are, for example, the sole single person in your social circle and your friends are all settled down and/or with children but this is not what you personally want, it's fine not to do this and any worthwhile friends will respect this.  Meeting more like-minded people through networking and meet-ups can really help to make it easier to be yourself.

Learn to laugh at yourself, embrace your mistakes and imperfections. 

This is something I've definitely become a lot better at as I've gotten older but it's taken time. Ageing does have its perks! Once you learn to do this it can be so liberating.

that's the spirit!

When I was a teenager I used to go ice skating sometimes with a friend who learned to skate by herself almost immediately whilst I felt sick with fear and clung to the side, terrified to let go. When I think about what I was afraid of, it was not falling over and injuring myself (which would have been quite a valid fear!). It was more fear that I would make a fool of myself and be laughed at. Given that I'm a sensitive person and sadly like a lot of people, I was teased and made fun of in both primary and secondary school, it's not surprising I would feel this way and it really prevented me from enjoying it. I did eventually learn to skate by myself and in my early twenties I decided to get lessons to improve my confidence.  The first thing we were taught was the correct way to fall over! The coaches stressed that falling over is part of learning to skate and what's important is to do it in the way that causes the least injury and that anyone afraid to fall over will never learn! I really enjoyed the lessons, I improved on a regular basis and it did wonders for my confidence. I didn't exactly reach Olympic standard but got to the stage where I could do the basic jumps and spins (albeit, badly!) which is an achievement for someone who used to cling to the side in fear.  It's quite rare that I fall over but now if I do I'm more worried about the pain than anything else! When you're no longer afraid to laugh at yourself you can make so much progression.

My experience of letting go of guilt!

If I were to write a list of the things I feel guilty about, this blog would never end but I'm going to apply these steps to the thing I felt most guilty about: not starting up a nutritional therapy practice after finishing my qualification.

Where has this guilt come from?

For such a long time I was so unclear about what I wanted to do with my life and some people would say to me that I should be doing something more challenging than being a library assistant and I agreed, I just wasn't sure what that something was.  When I chose to train as a nutritional therapist I was very excited about the fact that I finally knew what I wanted to do and I thought that was just 'it'. I really thought it was all or nothing and if I didn't pursue it there was nothing else I could do. Because I hit the big 3-0 at the end of the course I felt like I really should have decided. I would look at people in their twenties who were nurses or teachers and think 'what the hell is wrong with me!' But this idea that everyone knows what they are doing and that there is a deadline for it is completely false and causes a lot of unnecessary unhappiness.

Think about what is right for me

I went into the nutrition course being so sure I wanted to do it but it turned out to be a bit of a love/hate relationship. I'm sure no one feels permanently passionate about something and everyone has difficult days and stressful times when doing something worthwhile. Nonetheless, I felt that the extent to which the stress of the course made me feel depressed, anxious and overwhelmed sometimes was not good for me. One of the things the course taught me was that stress is usually one of the main factors in disease and it's so important to look after yourself. I do still believe that any worthwhile life change involves getting out of one's comfort zone but the if the feeling of stress is more dominant than the feeling of satisfaction it might not be the right route to go down. 

Learn to laugh at yourself, embrace your mistakes and imperfections:
My blog: http://samanthathesanevegan.blogspot.co.uk/2014/06/a-good-look-at-girl-in-mirror-little.html where I've listed all my unhealthy habits was great for this! A lot of the time the course made me feel guilty about the way I eat so I felt like being a bit rebellious!

what people think a nutrition
professional's fridge
looks like

Although on my course I realised that nutrition professionals are just normal everyday people who enjoy treats I still really felt like I don't fit the mould and maybe I don't and that's ok. 

I struggle to eat enough fresh vegetables (despite liking them and knowing how important they are for health) because I can't always be bothered to chop and wash them every day, especially when studying or busy doing something else.

Sometimes I might get really motivated and feel like cooking but I can never really make large quantities of food at a time because there's no space to store it in the fridge/freezer I share with 3 other adults who eat a different diet to me. Other times I can't get to the kitchen because someone else is using it and it's so small that wherever you stand you're getting in someone's way.  (With the way the housing situation is in London I'm sure many other people are living in similar circumstances!)

my section of my parents fridge!

I'm not full of endless healthy recipe ideas and I'm not an expert cook. I don't own and can't afford a vitamix juicer, I just have a smoothie maker worth about £25 that I got as a Christmas present.  When I look at some nutritionist's recipe blogs or cookbooks I feel completely intimidated.

I don't resent those who have a larger kitchen to themselves and are able to experiment more with recipes, I hope that will be me one day. I am still very interested in health and nutrition, I just felt like I couldn't quite live up to the expectations people may have of a nutrition professional.  And it's ok!

I believe having high standards and striving to be the best person you can be is a positive, but if it's to the extent that it's hindering your chance of being happy, it's something that needs to change.

We're all human and are going to make mistakes, make wrong choices and go through periods of uncertainty sometimes.

It's ok to be who you are and we all deserve a chance at happiness and to prevent guilt from holding us back from living the life we want to live.

'NO AMOUNT OF GUILT CAN CHANGE THE PAST AND NO AMOUNT OF WORRYING CAN CHANGE THE FUTURE'

.

I'm not sane but sanity is over-rated (and over-estimated!)

'normal people scare me' my vest says

I chose the name of this blog (Samantha, the sane vegan) with a bit of help from my brother in response to one of the vegan meet ups I went to where I encountered some vegans who were not so sane and perpetuated the stereotype of vegans as being puritanical, extreme and judgemental.  I've been very honest about the fact that I've had episodes of depression and have had hypomania (a lesser form of the full mania of bi polar 1 disorder) so it could be said that I'm not sane.  

Sometimes when going for a doctor's appointment or a therapy session I felt a bit upset and as if I was being labelled as having a problem or that there was something unusual about me.  What I've realised is that a) no one is labelling me, b) mental health issues are far more common than people think and c) it helps me to humble myself  and hopefully others will be able to relate to me.

I prefer to look at my hypomanic and depressive episodes as just another aspect of my individuality, what makes me unique.

I do not wish to undermine the seriousness of how horrific some mental illnesses can be. I'm fortunate to have never suffered to the extent that I was unable to work but it certainly has impacted on my work and studying. My aim is to be more open about my experience of mental illness and how to manage life in the midst of it so that stigma can be reduced and more people can open up. So here's my tale of my most recent episodes of depression and hypomania and what I've taken away from the experience.

Unexplained or hidden causes?

When doing Psychology 'A' level we were taught that depression could either be; a) reactive (depression that occurs as the result of life events) or b) endogenous (that with a physiological basis).  I don't really think it can always be categorised into one or the other and it's usually a mixture of both nature and nurture. I do have a family history of depression and bipolar disorder which makes me genetically susceptible. Lifestyle wise, my depressive or hypomanic episodes have not always occurred following anything particularly significant in my life and I thought it was just totally random and unpredictable like the weather (and therefore outside of my control).  I felt like my depressive episodes were a bit like British winters and every time they came they appeared to last longer and it felt like summer was never going to come.

'it was horrible, they called me 

chicken boy!' Therapy can help

you make peace with your past!

 I've found (though it took me a really long time) that the triggers can be found if you dig a bit deeper and once they are found you have a starting point for addressing the depression and no longer feel powerless to combat it. As we were taught on my course, the key to successfully tackling any illness is to find and treat the root cause, not just the symptoms.

Therapy is not necessarily helpful for everyone but it's helped me to recognise my triggers and helped me become a lot more self-aware.


2013- 2 of my triggers: Stress & Sloth!

When I started my nutrition diploma I was very excited and passionate about it and thought it was one of the best decisions I ever made to go back to studying. My second year, however, was incredibly stressful, with having clinic sessions in addition to all the essays, exams, assignments, seminar homework, personal development portfolio with no break between September and June. Fitting all this in alongside work paired with the pressure to eat well and live a healthy lifestyle that comes with studying for such courses left me truly mentally exhausted. (It's no wonder the drop out rate for my course at the time was 48%!  They have since reduced the workload!)

so true, better to just do something!

When I finally got a break and could do the things I enjoy again I was overwhelmed by feelings of excitement and really enjoyed myself. But the break was too long and by late August/September I'd done all the things I could afford to do, was just working 18 hours and really didn't know what to do with myself the rest of the time. I noticed the depressive symptoms coming back and knew I needed to get busier. I knew there were plenty of things I could do to make myself busier I waited too long to address it and my decision making ability was impaired. I would have a long list of things I could potentially do but I would over-think and end up doing nothing because I couldn't make up my mind and I was too worried about doing the wrong thing.  I know it sounds ridiculous but depression can make you behave and think in ways that are illogical and counter-productive to one's well-being.

Waking up in the morning and having nothing to do can make you feel over the moon after a long period of stress.  At the same time, getting up in the morning and knowing that if you stayed in bed all day it wouldn't matter to anyone whatsoever can also be the most depressing feeling ever.  I ended up losing my confidence and by the time I started back in October I was in an absolute state and crippled with doubts. I was thinking, I can't do this Nutritional therapy thing, what the hell am I doing? it's too hard. what on earth am I going to do with the rest of my life? I'm not good at anything and I can't be a library assistant for the rest of my life, why am I here? I really seriously considered dropping out of the course but something told me to just go along with it and see how it went.

'You're not rubbish, it's the depression talking!'

My first day back in clinic in my last year was in November. I was so crippled with anxiety I couldn't sleep the night before and on the way there I was fantasising about being involved in an accident (not one that would kill me) or something so I didn't have to do it. Many times before I've felt nervous prior to doing something but then once started I've been ok. This time I didn't feel ok at all. I was stuttering whilst talking and I just felt like it was such a disaster. I came out and was saying 'oh my goodness, that was the worst consultation ever. I'm so embarrassed, please apologise to the client for me'. To my complete surprise, the students observing me and tutor didn't think it was a disaster at all and had many positive things to say. I found it impossible to believe them though.

My first assignment was also a serious struggle. I felt like I didn't understand it at all and would wake up with a feeling of dread and just want it to disappear and really resented my course for making me so stressed and miserable around Christmas time! I was convinced what I was writing was nonsense but I just handed in what I'd done and hoped for the best thinking, 'I've most probably failed but maybe by some stroke of luck I can scrape 40% and pass'.  When the marks were out I couldn't bear to look but when I did I was very surprised to see 68%!  Which just goes to show although whilst in a depressive episode I might feel like I've completely lost my mind and that I'm totally useless at everything but this is not so!

when you first finish a course you
feel like this!

By late January I got my enthusiasm for the course back and felt more confident in my ability to get through the last year.  It wasn't easy at all but in June I finished, passed with merit and felt on top of the world, full of excitement about my career ahead of me, never thinking that the depression would come back again.

I'm on top of the world!

Sadly it did, and it came back worse than ever. 
Autumn 2014 - Post-University Depression 
(this should become a recognised medical condition!)

I started feeling a bit low around mid August, when I felt as if I should be getting on with my nutrition business, but I didn't really know how to address it, so all I did was procrastinate.  Every time I would think about the sheer number of things to do to start a Nutritional therapy business I would just feel completely overwhelmed and panic.  People would say to me to break it down and just take it step by step which I tried, but it didn't stop me from being overwhelmed by it and every time I tried to think of business ideas my mind just went blank.

I should have been feeling great at my graduation in September and I saw that the majority of graduates hadn't started their business and weren't sure exactly what they were doing. But I didn't feel proud, I would just look at all the people who had already started their business or got a distinction rather than a merit and just think 'there's nothing special about me I'm just a part time library assistant who lives with her parents at the age of 30, what a loser'.

It got into a bit of a downward spiral and by around November I reached the anhedonia (inability to experience pleasure in usually enjoyable things) phase. My favourite vegan foods didn't taste nice and I didn't have the motivation to cook, bake or eat properly at all so I began to binge eat on extremely unhealthy foods including non-vegan cakes, other baked goods and chocolates.  (Yes, for a long while I was neither sane nor vegan, which was why I didn't write on this blog for a while!)  My favourite music sounded horrible and I didn't want to listen to any music. I didn't want to watch TV series or films because I would just compare myself to the characters and dwell on how inferior I was in comparison to them, the same went for going on facebook. My brain fog (many do experience this during depressive episodes) was so bad, I couldn't read for pleasure.  Exercise didn't give me the same buzz either. It got to the stage where the only thing I found pleasure in was over-eating and sleeping. Most of the things mentioned in http://samanthathesanevegan.blogspot.co.uk/2015/03/5-things-to-do-when-black-dog-strikes.html wouldn't have worked. I felt like I didn't care about anything (animals, ethical living, the environment, my appearance or my health) and kept asking my siblings how they would describe me to someone else because I didn't know who I was any more.

I decided, however to count my blessings. Whilst I certainly wasn't where I wanted to be in life, I had a job, I was living in a safe and comfortable environment, I didn't have any financial burdens which meant I could at least afford my only source of comfort (food) when I needed it, I had (and still have) a good relationship with my parents and siblings.  And whilst many depression sufferers experience insomnia, I experienced hypersomnia, (excessive sleeping) so I was glad I at least had sleep as some escape from how I was feeling.

This didn't mean I wasn't entitling myself to feel negative or that I was punishing myself for how I felt, but I just realised I was very lucky in some ways and that I didn't have any problems that weren't fixable, and I had no reason to give up.

I was fortunate to have a very good GP who first referred me for the Guided Self Help therapy.  It was actually me who came back and suggested I probably should take medication because I felt I needed it. I was given a 2 week trial of fluoxetine (better known as Prozac) but it made me feel nauseous.  I had a further assessment and was prescribed escitalopram and instructed to take it for 6 months.

UNEXPECTED EARLY RECOVERY!

Around early to mid January I started feeling more like my usual self, all the depressive symptoms had lessened and my cravings for junk food were significantly reduced.  By the end of January I found myself waking up at 4 or 5 am (having gone to bed at midnight) full of energy and excitement. My state didn't feel like just an absence of depression, I felt sort of 'high' and how I would imagine illegal drugs make one feel despite only consuming caffeine in the form of green tea and dark chocolate and minimal sugar and alcohol.  I decided to stop taking my medication and go to my GP to see if he thought I had bipolar disorder or seasonal affective disorder, as I had seen similar patterns with my mood previously.

HYPOMANIA!!!!!!!!!!

Wheeeeeeee!!

When I went to my GP I described my behaviour and feelings. I was expecting to be diagnosed with bi polar disorder, given that I'd gone from one extreme to the other in such a short space of time. The best way I could describe it was like the feeling of an overexcited child at Christmas.  My favourite foods and drinks tasted amazing, music sounded better, I would be overwhelmed by the beauty of scenery, my nephews and niece looked cuter, colours would look more distinct. I would get fits of the giggles and struggle not to burst out laughing whilst walking down the street. My mind would be racing and instead of having no business ideas I had so many I couldn't switch off.

anyone remember the film American Beauty?

 Although I've had hypomania I have

yet to be overwhelmed by the beauty of a plastic bag

Hypomania does not mean that one feels happy all the time, it's more like an obsession with engaging in hedonistic activities and an intolerance of displeasure. It can result in serious irritability and impatience.    Although being overwhelmed by positive emotion is certainly more pleasant than being overwhelmed by negativity, it's still uncomfortable. In a hypomanic episode I feel overstimulated and overexcited about everything, I really resent my job for taking up my time up and stopping me from doing the things I enjoy (whereas in a depressive episode my job is one of the few things keeping me going).  At work I get over excited by all the interesting books I see and take out several but then I don't read them because I'm too restless and can't sit still. I can't watch films either because I have too much energy. I end up spending too much money because I get overexcited about everything I see and then end up getting frustrated for having to wait so long for the next pay day.  I have lots of pent up energy and get really frustrated if  I can't release it. I can even remember being jealous of people saying they were tired!

Although hypomania has its disadvantages, it can be quite a pleasant feeling. I think my hypomanic episodes are the reason I've never had any interest whatsoever in taking illegal drugs,  I see my ability to feel high naturally as a blessing. I become more creative and my brain is a lot more sharp and I'm sure my hypomanic phases helped give me the energy to fit my studying in with work and are responsible for some of my good marks.

Depressive episodes are certainly unpleasant but for me, the fact that I went for the therapy meant that I'm left with useful mind tools for when I see it recurring and I can empathise with and help others.

think I'm the 3rd one from the left
at the moment!

My doctor mentioned (but didn't diagnose me with) a milder form of bi polar disorder called cyclothymia. Some people find labels helpful, others don't. Personally, I feel that we are all prone to fluctuations in mood as we go through ups and downs and transitions in life, (who feels 'neutral' all the time?) I think that being a HSP or 'empath' as I've talked about in my blog: http://samanthathesanevegan.blogspot.
co.uk/2015/05/depression-part-2-food-mood-and.html just means they are more pronounced in me.  It can make life a bit more challenging to deal with but as you become more self-aware, you can learn to manage better and stop your condition from over-ruling your life.

If you have or think you might have a diagnosable mental health condition, don't be afraid to seek support from your GP, mental health organisations or read some mental health blogs. But remember there is nothing wrong with or 'freaky' about you and having a mental health condition does not make you not inferior.

You are not alone :)

Depression Part 2. Food, Mood and Personality

My most recent blog was also on depression but it's a subject that truly fascinates me and is close to my heart as it affects me from time to time as well as many people I know.  

My last post literally scratched the surface of some of the countless factors that can possibly contribute to depression. Genetic susceptibility, chronic stress, financial and housing problems, family and relationship issues, bullying or exclusion at school, college or in the workplace, bereavements and other difficult life events, physical illnesses in which there is inescapable pain or discomfort, unemployment and the daily pressures we face can all have an impact. 

HOW FOOD CAN AFFECT YOUR MOOD

Diet is also certainly something that can affect our mental well-being as it has a vast impact on our biochemistry and this is often not considered or addressed at all. It is a highly complex subject so I'll just give a brief, simplified summary of the main factors.  For anyone interested, Patrick Holford's books explain the subject of nutrition and mental well-being very well. 

user friendly guide to
 nutrition and mood

Biochemically speaking, depression is thought to be caused by a lack of or faulty signalling of 2 main neurotransmitters: serotonin (associated with feelings of calm and serenity) and dopamine (associated with motivation and drive).  The dietary choices we make over extended periods of time can dramatically alter our body chemistry, including that of the brain.  

Neurotransmitters (hormones of the nervous system if you like) are made from amino acids which come from protein, meaning consuming adequate protein (on average around 0.8g per kg body weight) is crucial.  B-vitamins, particularly vitamin B6 (sources include nuts and seeds, wholegrains and bananas) are needed to convert amino acids into neurotransmitters.  In order for these neurotransmitters to signal correctly, the correct quantity and type of fat is essential. Omega 3 (usually associated with oily fish but are also found in flax and chia seeds and their oils and algae supplements) and omega 6 fatty acids (nuts and seeds, vegetable oils) are both required by the brain but our current diet tends to be far too high in the omega 6 kind in comparison to omega 3. In addition to this, many of us also consume unhealthy fats found in deep-fried food, take-aways, poor quality baked goods and processed foods, which further impairs this signalling process. Think of your brain as a train network whose tracks need oiling with the correct kind of oil on a regular basis in order for the serotonin and dopamine trains to travel from one brain destination to another doing their job of making you happy, calm and motivated (if it helps!). 

antioxidants galore!

In addition to this, antioxidant rich foods (deeply coloured fresh fruits and vegetables, herbs and spices, nuts and seeds, dark chocolate) are essential to protect these fats from damage and keep our cells healthy.

What is becoming more widely researched in recently is an amino acid in the blood called homocysteine of which high levels are associated with depression (amongst many other illnesses including cancer, diabetes and Alzheimers). Folic acid and vitamin B12 are essential for keeping homocysteine at safe levels.  Vitamin D3 deficiency (very common due to the lack of sunlight in the UK!) is now also thought to play a part in the aetiology of depression and is being researched. No causal relationship has been established yet but it's definitely something worth investigating.

unhealthy foods give us a temporary 'high' but in
the long run they make us feel like this!

As you can imagine, long periods of eating the wrong kinds of food or failing to identify and correct nutritional deficiencies can seriously hinder your brain's ability to keep us mentally well. Nowadays many of us are so busy and stressed that we feel we don't have the energy to devote attention to our diets and can rely on unhealthy foods and alcohol to relieve stress.  

The likelihood is, most of us, whether we're omnivore, pescatarian, vegetarian or vegan are deficient or have less than ideal levels of one nutrient or other. My view is that vegans should not be singled out as at risk of suffering from depression due to dietary factors. Antioxidants, folic acid and vitamin B6 are plentiful in vegan foods, providing you eat a wide variety and in my post http://samanthathesanevegan.blogspot.co.uk/2014/07/you-can-have-your-cake-and-eat-it-under.html, I've mentioned about some of the vegan sources of protein and omega 3 fats. That being said, there are some nutrients that need attention. 

It's crucial for vegans (and everyone else!) to get enough vitamin B12 in order to keep homocysteine levels sufficiently low to avoid the risk of depression and other illnesses. Some foods and brands of dairy alternatives to milk are fortified with vitamin B12 and there are some kinds of algae that claim to be sources. I personally eat predominantly organic food (which cannot be fortified with B12) and it is not safe to rely on algae as a vitamin B12 source so I take a supplement. 

I've encountered many vegans who have the attitude of 'well I've not taken vitamin B12 in years and I feel fine!'   The trouble with this is, high homocysteine or inadequate vitamin B12 status might be symptomless and so it's not something you can assume is ok without a test. I've not had my homocysteine tested yet as it's not widely available on the NHS at the moment (I'm currently a nutritional therapist who can't afford nutritional therapy, haha!) but I take a B12 supplement daily and I've had my level tested recently by my GP. There are some vitamins and minerals that are harmful in excess but vitamin B12 is not one of them.  It's far safer to take it than to not take it. B12 supplements are also widely available and affordable.  

Vitamin D is also not widely found in plant foods and deficiency can affect anyone.  It's advisable to get one's levels tested in order to ascertain whether supplementation is necessary.

Specialist nutritional therapy and tests for potential nutritional causes of depression can be provided at the Brain Bio centre in Putney, London http://www.foodforthebrain.org/brain-bio-centre.aspx.

These nutritional factors are certainly something people should be conscious of, but as I've mentioned our nutritional status is one of many factors in depression and therefore nutritional therapy should never be used as a sole therapy without addressing the other issues.



ME, FOOD AND MOOD

If I'd had this ingrained in my brain all my life that
would have saved me from a great deal of  misery!

Some people might wonder why as a nutritional therapist I didn't cover this in my first blog on depression.  Everyone's experience is different and as I'd made it partly about mine I wrote a little about some of the factors that affect me most and how I've dealt with them.  

My personal most significant contributory factors are: genetic susceptibility (depression and other mental health issues run in my family) having had a difficult upbringing (poverty-wise), feeling excluded and different throughout my life (which contributed to low self-esteem) work and studying-related stress, comparing myself with others and putting unnecessary pressure on myself. 

don't compare yourself with
others Samantha!
certain recipe for depression!

Although the vegan diet might appear not to fare well in terms of mental health, looking at my history I don't consider this to be one of my main causes.   I've suffered from depression on and off from as long as I can remember, going back to when I was a meat eater and as an adult I've seen myself sink into depression or climb out of it without making any significant dietary or supplement changes (so far I've tested my B12 and vitamin D levels, both of which were fine). 

The other reason I've not used nutritional therapy to treat my depression is the lack of motivation that commonly accompanies depression. Making positive dietary changes can be challenging for anyone whether they have depression or not. Some sufferers might be willing to improve their diet and make positive changes whilst suffering from depression which is wonderful, but in my history I've always waited too long to address it and ended up at the stage where I have very little motivation to do anything. In my last episode I took an antidepressant of the SSRI class (escitalopram) for 6 weeks and had a kind of therapy called Guided Self Help which worked for me (in fact too well, I have hypomania now!). I was extremely lucky!

I've yet to research whether vegans are more susceptible to depression than others but even if this is the case, I doubt that diet is the sole cause.  I believe there may be another reason:

THE 'EMPATH' OR 'HIGHLY SENSITIVE PERSON'

I score 21 out of 23 on the 'Highly
Sensitive Person' scale!

Where there are psychopaths, on the opposite end of the scale, there is such a thing as an 'empath' or 'highly sensitive person' (HSP).  This personality type is characterised by a higher than average level of empathy, tendency to feel overwhelmed, low self-esteem and introversion (not in all cases, I don't consider myself an introvert). It doesn't appear to be very widely researched but reading Aron's book made me feel much more understood.  

I was considered shy as a child, I find it difficult to watch horror films, anything with cruelty or extreme violence, I'm a bit of an ignoramus when it comes to politics and current affairs because I can't cope with reading newspapers or watching the news, I support several charities and non-profit organisations, always try to do the right thing and wish I could solve all the problems in the world.  I always felt like I was strange because I didn't really know other people like me.  I'm very happy to know there's nothing wrong with me, it's just a personality type (that has its merits as well as disadvantages!).

It has been said that it's not necessarily the case that HSPs are more prone to depression but it would make sense.  As I said in my last blog what I feel most when I have an episode of depression is an overwhelming sense of being unable to cope whether it's with stress, measuring up to my self-imposed standards, sad or depressing life events or situations that happen in the world beyond my control.  In my opinion having this personality type has almost certainly contributed to my depression. 

anyone remember this episode of
Friends? me at the moment! 
hypomania is fun!

It's not all bad though.  It also means I sometimes have the ability to feel overwhelmed by positive emotions and excitement which I'm very grateful for!

I also believe that there might be some association between the HSP personality type and the decision to adopt a vegan diet. 

I'm sure it's not necessarily the case that all vegans are HSPs, you certainly don't have to be to be appalled by factory farming once you've read or seen videos about it. I'm also not suggesting that all non-vegans are psychopathic and insensitive. Given that an estimated 15-20% of the population have this personality and only about 1% of people are vegan, of course there are non-vegans who are extremely sensitive, caring people who feel more strongly about different causes.  But it would make sense that those who decide to adopt a dietary choice and lifestyle aimed at reducing suffering in the world would likely to have this personality. Where nutritional deficiencies have been ruled out in anyone, this personality type should be considered as one of the contributing factors to depression.

Being a HSP is not a mental disorder or something or something that needs 'treating'. It can, however make life slightly more challenging in some ways. Elaine Aron's book 'The Highly Sensitive Person' has useful advice on how to manage life as a HSP and view one's personality trait as a gift, not a flaw.

So, the moral of this very long story is: food can definitely be one of many factors contributing to depression and eating the correct foods and correcting nutritional deficiencies can certainly be of help.  But as it's such a complex illness, there is never one simple cause and as follows, there's no one simple treatment.  Anyone encountering a health practitioner who insinuates one's depression (or any health issue) is solely the result of not eating oily fish (I have encountered MANY with this attitude!) remember this blog!