St Johns Wort

Tis not the season to be Jolly....
As the earth tilts on it's axis, the rays of the sun enter our atmosphere at a steeper angle.  The result is a commonly felt change in daylight (shorter days) but an uncommonly felt change in emotion (seasonal affective disorder).  Perhaps from primal instincts of nightfall being associated with predation, the brain seems to be more emotional, less tolerant, poor creativity, less enthusiastic, loss of interest, socially withdrawn.  These normally would be traits that would thin the heard, as animals that suffered this would separate from the group and be easy meals for man eaters.  In the modern era, darkness has been changed to be a time of community, family, story telling, camp fires and social gathering.  There still are a select few (4-10% of the population) who experience depression like symptoms during the winter.  It is usually more women than men, and more in the northern states than southern states.    The symptoms are subtle if just from the change in season,  You don't have to be labeled with preexisting major depression to suffer from SAD.  Sometimes all it takes is loss of a job, loved one, a move, major infection, new diagnosis, economic hardship.  (stressors that happen at the wrong time)


Diagnosis should be made by a professional, to make sure thyroid is working fine, adrenal gland is good, no vitamin deficiencies are occurring,   Behavioral therapy is a must when there is any form of behavioral imbalance.  My older patients are usually steadfast in saying "I'm not going to a shrink!".  My younger patients are more willing to experiment.  It does take strength to have someone examining and query your past and current emotional status, not to mention childhood years and related milestones along the way to adulthood.  It is thought that only through the delicate guidance of someone trained in behavioral health can one gain a good vantage point for introspection.   At that point when all the learned stress response and and poor coping skills are relinquished; problem solving can be started on how to heal-physical, emotional and spiritual.
To get through the rough spots while moving away from the trauma, sitting for couch time, trying to sleep......there are prescriptions given if symptoms are severe enough.   For mild to moderate depressive feelings, botanical supplementation has a track record of improvement in depression equal to that of standard antidepressant medications.
NIH study Zoloft vs St Johns Wort vs Placebo
To be included in the study symptoms had to be difficulty with concentrating, lack of energy, lack of interest, difficulty with completing tasks, oversleeping, craving carbohydrates, irritability, insomnia, and anxiety.  Bottom line with the results-SJW/Zoloft gave the same result for improving depression actually with placebo also ranking an effect to patients with mild to moderate disease.  My average patient believes once you get on "psych medicines" you will be on them forever (alot of hesitation).  The true use of any medicine is to make daily living sustainable until the body/mind corrects itself.  If nutritionally healthy, physically fit without any co morbid diseases, the body and mind should be able to heal itself.  If you wait until depression becomes severe, it will be much harder to reverse.   Seasonal affective disorder is a subcategory of Depression. 


Think of a rash from food; if you get a rash from something you ate, depending on how much you like the food and how bad the rash it determines how fast you resolve the issue.  If you keep on applying lotion yet indulging in the bad eating behavior, nothing will change.  One must change the connection to the toxic thing so you wont need the temporary fix.   In this case of SAD, if the temporary fix has little side effect, can be acquired without prescription and has been rigorously studied for safety-BINGO! 
-St Johns Wort (from a reliable company) is a great supplement/botanical.  It should not be used with certain HIV drugs, Chemotherapy, oral contraception, blood thinners.  It can be used along side current depression medicines but a wean up (SJW)/wean down (prescription depression med) schedule should be designed by an integrative doctor/integrative psychiatrist.   I often suggest (SJW) if a life trial occurs during the cold season.   If used as a maintenance during winter months, I suggest start at Thanksgiving and wean off by Easter.  In southern states the time period can be shorter.  As with any form of disorder in mood, therapy should be initiated with a pastor/social worker/licensed counselor/psychologist or psychiatrist.  It is very difficult to undo bad coping skills on you own.  (smoker stop smoking, teenager stop texting, eater stop binging, procrastinator start moving)  Having someone to be accountable to increases sustainability and success. 

Creatine use for muscle bulk

I remember in the 90's a competitive cyclist told me he was using creatine for his work outs and noted the when he was on it, bulk was thick, without it, training was same but doesn't think he got as "beefy".  At that time the information out there was it caused kidney failure if taken during times of dehydration.  It was theorized that benefits only came to endurance sports.   No great reproducible studies, only one or two case reports.   The amount of creatine used (during loading phase) is equal to about 5 steaks, I remember some friends from the 80's on Temple University's Power lifting Team that would get close to 3-4 steaks during competitive season.  I wonder if they went onto healthy futures with the Temple Hospital bypass team.  So if you could get the effects of creatine without any side effects of too much red meat, why not enhance your exercise?  According to Jay Hoffman (one of the profs from UCF where I was team physician) the idea is to use creatine to enhance training response.  Creatine helps to rephosphorylate ADP to ATP.  The more ATP in the muscle cell, the stronger the actin/myosin pulls, the stronger the muscle works to move, pull, push, contract.  With an effective training response, followed by good repair time and a healthy diet, the stronger the muscle is to endure the next exercise routine.  Note to beginners, if you are not fine tuned with an existing exercise routine, do that first to establish muscle fitness, cardio and proper body mechanics.  If you start out of the gate with expensive supplementation and a new exercise program (designed by someone trained in the exercise arena-personal trainer, certified instructor, exercise physiologist, physical therapist, sports medicine physician) no doubt my average patient usually gets muscle soreness and joint pain and really waste the dose of creatine.  For it to be effective, most studies suggest:
1-loading dose of 20-25grams daily for 5 days
2-maintenance of 2-5grams daily for 10 weeks (depending on size of athlete)
3-wash out period for 3 weeks (no creatine) it takes about 3-4 weeks of abstinence to have muscle levels return to baseline
Wash out suggested since there have been no reproducible studies on the long term effects of creatine on the bodies own production.  Yes, the body produces it, in fact those with high endogenous creatine will have poor to no results when ingesting the supplement.  Side effects are gastric bloating, and discomfort with the loading phase.  Muscle cramping also a smaller listed side-effect although when I used it at the above suggestions, during a post workout abdominal stretch, I suffered one of the most excruciating spasms to the rectus abdominis.  This causes 10/10 pain and locks the body into a forward fold until the muscle fatigues in a few minutes.....oh..it also cuts back inspiration so I couldn't breath.  Good thing I was in forward fold with my head down or I would have passed out. 

The wash out phase should be coordinated with the "max out" concept of muscle fatigue.  If your exercise routine is challenging, your "coach" will always design a progress/overload schedule over several weeks.  Care in designing this on your own as either we are too complacent and stick with no overload thus loose stimulation of muscle growth or too aggressive and push/crash (I took this term from my exercise physiologist Aimee Weber). 

Care in using creatine with exercise stimulants like "Amino Shooters", Redline or other pre workout energy drinks as they may have more ingredients than are written on the label.  (The FDA "asks" that companies watch-dog themselves and be honest in labeling ingredients....kinda like asking your teenagers to "be good" on a date).  These are great for enhancing reaction time, focus, training response but could also cause insomnia, high blood pressure, agitation (similar to caffeine overdose). 

Finally if there is pre existing kidney disease, you are on a blood pressure medicine (diuretic) or a diabetic, avoid this stuff and seek out another way to get you past your exercise plateau.

(A study in the UK was performed hoping creatine in pulmonary rehab patients would be able to gain muscle mass during therapy for lung disease.  No great results were found but more info necessary-I believe it was due to the participants did not hit their plateaus in fitness and were just tested during ordinary exercise endeavors) 

Creatine Use Video