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Spreads from Your Health magazine Capital Health May/June 2006 47 Your Health – Capital Health's magazine for living well YH_may-june06_46-53.indd 47 5/5/06 15:53:15 Your Health – Capital Health's magazine for living well January/February 2007 35 e humans are more in tune with our envi- ronment than we think. Despite our best efforts to work against natural cycles, the human body reacts to the seasons. Take Sarah* for instance. Sarah relocated to Edmonton in 1998 from the sunny Okanagan in central British Columbia to attend the University of Alberta. "I moved here in August and within a cou- ple of months I was so depressed I couldn't see straight," she says. "I thought I just missed my family and friends, but when I went home at Christmastime I didn't feel any better. It wasn't until April that my mood started to really pick up." Sarah thought her change in mood was due to school ending and summer approach- ing. When she returned in September, she says, life looked as rosy as it had all through the hot summer months. Then the dark days of autumn sank in. "By Halloween I could barely concen- trate on my classes and I almost flunked out that term. When I went home for Christmas my mom convinced me to go to our family doc- tor. He said that I was depressed and that it was likely due to a combination of stress and a sense of isolation from family." For the next two years Sarah struggled to be successful in her studies while doing all the things a person with a mild depressive disor- der – which her doctor had diagnosed in 1999 – is supposed to do: she tried to eat healthy foods, but found herself polishing off bags of potato chips in one sitting; she tried to get eight hours of sleep a night, but found it almost impossible to get to her first class on time. "All I wanted to do was sit in front of the television, eat potato chips and sleep," Sarah says ruefully. She gained 45 pounds on her previously petite frame and, when she returned home in the spring of 2000, her family and friends were shocked. "I realized then that I'd really neglected myself all winter; I'd focused all my energy on just get- ting through the day, getting my assignments in and coasting along. When finals were over, I realized I had to do something." Sarah and her mother sat down and had a long talk about how she was feeling. They charted out her feelings and experiences and realized that in mid-to-late October every year, Sarah started feeling blue. Her desire to sleep increased and her amount of energy went way down. And, by the end of April, her perspective seemed to magically change. "I thought it was because school was over and I could go back home to my friends and family, but I realize now it was a coincidence," she says. Sarah was in the grip an often-misunderstood depressive disorder that strikes thousands of Canadians a year: Seasonal Affective Disorder, or SAD. Fighting the winter blues may take more than just a positive attitude. Here's what you need to know about Seasonal Affective Disorder By Cait Wills | ILLUSTRATION BY STEVE ADAMS Don't be SAD w YH_jan-feb07_34-37.indd 35 12/15/06 16:32:10 Your Health – Capital Health's magazine for living well 46 May/June 2006 eather Dundass was out for a normal lunch with friends when her life was irrevocably changed. She was in her early 20s and was enjoying a quiet weekend, sipping on a Caesar and eating a nice pasta dish with tomato sauce and fresh vegetables. Suddenly she began to feel something was wrong. Dundass kept having to clear her throat, prompting one companion to make a joke about letting her know when she needed to get to a hospital. The innocent remark was an unfortunate foreshadowing of what was to come. The tingling sensations on her tongue and itchiness on the roof of her mouth quickly went from being a nuisance to constricting. Within minutes, she was having trouble breath- ing and indeed had to be rushed to emergency. "I tried not to panic but I was scared," says Dundass, a regional health assistant with the St. Living with food allergies can be frightening but a little forethought can save your life By David DiCenzo Albert Public Health Centre. "By the time we did get to the car, we drove like heck to get to the hospital. I walked into emerg, they took one look at me and said, 'What did she eat?'" Dundass was immediately given some Benadryl and shots of epinephrine but her allergic reaction was far from under control. "I remember the doctor saying, 'This next Epi better work," she says. "It was horrible. In the days afterwards, you feel like you've been hit by a truck. And once I recovered, I was scared to eat or drink." For Dundass, it was the first of approximately 20 allergic reactions she's suffered in the past dozen years. She now carries two EpiPens with her at all times – one to administer as soon as a reaction begins and another for the hospital ride if necessary. Testing eventually revealed that Dundass is allergic to a wealth of fruits with When Food Bites Back h YH_may-june06_46-53.indd 46 5/4/06 10:22:02 Your Health – Capital Health's magazine for living well 34 January/February 2007 w YH_jan-feb07_34-37.indd 34 12/15/06 16:31:56 May/June 2006 49 Your Health – Capital Health's magazine for living well And the Wiggers are empowered. Christian goes nowhere without his Medic Alert bracelet and at seven, he already knows that if he wants to try a new food, his EpiPen has to be nearby. However, taking personal steps is just a part of the equation. Wigger, who says that Christian's teachers and principal are fully aware of his allergies, had another scare when she had to pick up her son at school after a classmate inadvert- ently triggered another reaction by eating a pea- nut butter sandwich near him. His EpiPen was tucked away in his bag and he couldn't get to it quickly; he had to be rushed to the hospital. That experience convinced her to become an advocate. "Not a day goes by that I don't say 'what if?'" Wigger explains, painfully envision- ing the worst-case scenario. "If it could have happened, it will happen." The Wiggers have met with Gene Zwodesky, Alberta's Minister of Education, to come up with some legislation similar to an Ontario bill known as Sabrina's Law. As of January 1, 2006, that law requires schools to train staff to deal with life-threatening allergies, have plans for individual students who suffer from them and to have emergency responses in place for ana- phylactic students. The law follows the tragic death of 13-year-old Sabrina Shannon from Pembrooke, Ontario, who lost her life after eat- ing some fries in the school cafeteria. She had a dairy allergy and the fries are suspected to have come into contact with traces of cheese. Wigger is ecstatic about the progress, but realizes that an across-the-board effort is required for the legisla- tion to be effective. Knowing that a shot of adrenalin is cru- cial within the first 10 minutes of a reaction, Wigger has provided Christian's school with four EpiPens at her own expense. "He under- stands it," she Top Food Allergies Medical experts estimate that food aller- gies affect almost 4% of North Americans. Clearly, the science of allergies has evolved into a legitimate field, which wasn't always the case. "Twenty years ago, people would think it was just in your head," says Stephanie Madill-Bertani, a community dietitian with Capital Health for the St. Albert and Stony Plain areas. Madill-Bertani emphasizes the importance of getting a proper diagnosis. She says that for adults, the items most commonly involved with allergies that continue into later life are: peanuts, shellfish, soy, tree nuts and fish. Children have a longer list of potentially prob- lematic foods, beginning with egg whites. Cow's milk, peanuts, nuts, shellfish, fin fish, wheat, soy, beef, chicken and citrus fruits, including tomatoes, are the most hazardous foods for children, though any type of protein found in a food can be an allergen. At-risk kids can outgrow food allergies to items such as milk by the age of three but parents should take care about what they introduce into kids' diets and when. From six months to nine months, parents can introduce their infants to grains such as rice and millet; fruits and vegetables such as yams, carrots, green beans, pears, peaches, bananas and meats such as lamb and turkey. The list from nine months to two years continues to grow and by the age of 18 to 24 months, kids can sample eggs and dairy products such as ice cream. At three years, children can try fish, shellfish, sunflower seeds, peanuts, tree nuts, sesame seeds and flax seeds. Capital Health recommends that when intro- ducing solid foods to a moderate or high-risk child, try one new food every three to five days and watch for a reaction. And remember the role of family history. Children are at a low risk when both parents are free from food aller- gies, asthma or hay fever. If one parent or sibling suffers from these conditions, a child is considered at moderate risk for allergies, while two suffering parents (or one parent and a sibling) translates into a high risk that the child will suffer allergies. says of her son's grasp of the seriousness of his condition. "He doesn't forget how he felt (when he's had allergic reactions). He's fearful at times but he's developed strategies." The gripping panic involved with a life-threat- ening reaction is difficult to fully understand if you have never experienced it. Those who have know that they are always moments away from a disaster. That's why being prepared and proac- tive is so essential. Dr. Carr emphasizes that an allergy assessment and testing, if warranted, are initial steps for anyone with a suspected food allergy. "As Anaphylaxis Canada says, 'Be care- ful, not fearful,'" he says. Patients should be educated to avoid food aller- gens and treat suspected reac- tions, but they shouldn't live in fear. "We must respect the allergy, but if we all do our job properly, the risk is not terribly high and usually manageable." Heather Dundass has learned this point over the past 12 years. Like Christian Wigger, she wears her Medic-Alert bracelet everywhere she goes. She pays close attention to labels on packages and is ultra-careful about food prepa- ration, acknowledging that "going out for sup- per is never easy." Because Heather is unable to eat so many fruits and vegetables, she takes multivitamins to make up for the nutrients most people ingest without problems. The fam- ily history factor has also made her pay close attention to her five-year-old daughter Kelsey. An allergist recommended that Heather keep Kelsey away from the foods she is allergic to. But because the child has never had a reaction, she cannot be tested. Her mom has avoided giv- ing her nuts and didn't introduce her to fruits like apples until Kelsey was four. New foods are tried a teaspoon at a time. So far, so good for the youngster. Being so diligent is tough for Heather but it's much better than the alternative. "To me," she says, "this is the norm now." YH_may-june06_46-53.indd 49 5/4/06 10:22:52 Your Health – Capital Health's magazine for living well January/February 2007 37 in a dormant state." It is the primal reaction of a body experiencing SAD and causes people to sleep far more than normal. The other consid- eration in diagnosing SAD is the time frame of depressive occurrences: two full cycles occur- ring within a two-year period is considered the last piece in the puzzle of diagnosing someone with SAD. But SAD is known to appear irregu- larly, some years not affecting the patient at all. On average, women are more prone to develop- ing SAD than men. Studies have shown that women who have a family history of mood disorders, alcoholism, or postpartum depres- sion are susceptible. Children and teens are also vulnerable, but rarely experience the overac- tive appetites and desire to sleep, sleep, sleep. Symptoms include irritability, crying, worrying and fatigue. If you suspect your child or teen may be suffering from SAD, a professional diag- nosis and treatment is in order. Can you lighten up? When Dr. Rosenthal first published his research on SAD, he also suggested a solution: expose patients to more light; that way, the symptoms would decrease and, over time, disappear. Light therapy, or phototherapy, has proven effective in 60-70% of participants and is an effective treatment for SAD, according to experts. But, if you think you might be suffering from the winter blues, or Seasonal Affective Disorder, the first thing you need to do is get a profes- sional diagnosis. "It's so important to get a proper, professional dia- gnosis," says Dr. Chu. While he says psychother- apy is important, it's also crucial that the patient have all symptoms assess- ed. "You need to see someone familiar with this condition and have it treated accordingly," he says, adding that your doctor may also recommend antide- pressants for SAD or other depressive disorders. After Sarah realized that there was an obvious seasonal pattern to her depression, she followed up with her doctor in Kelowna. He put her on a trial prescription of antidepressants and, when she returned to Edmonton that fall, she says her experience was entirely different. "I know it helps that I knew there was some- thing wrong and was prepared, but my per- spective changed 100%," she says. "I lived in Edmonton for three years before realizing that, even though it can get really cold and windy, it's still a beautiful city in winter!" Now a mar- ried mother of three, Sarah was on low-levels of antidepressants for three yearly cycles. During that time she made an effort to spend sunny days outside and enjoy all the positive sides of winter in Alberta. "It was a bit of a wild ride, but I now know that if I start to feel blue in the fall, there are things I can do to combat it. And that feels great." * Name changed. Which tricks work? As SAD becomes more well-known, "cure- alls" seem to be popping up everywhere. Some of the newest and most popular include: Dawn simulator: Light therapy that works while you sleep, a dawn simulator does just that: it gradually illuminates your bedroom with the light intensity of a pre-dawn sky. Patients find it not only helps start the day on a positive note and the benefits, but also has been shown to be significant to those suffer- ing from SAD. The Sunshine Vitamin: Vitamin D has long been recognized as a major benefit from the sun's rays. It's fortified in milk and other food products and considered one of the building blocks of life. But does it help SAD sufferers? No, says Dr. Jack Chu. "Vitamin D affects the skin," he says. "There is no connection to SAD and Vitamin D," although experts suggest that in winter months you make sure your Vitamin D intake is sufficient. Health Canada recommends two to four servings of milk and milk products per day. Diet and exercise: Taking care of oneself at any time of year is key, but it's especially important during winter months, says Dr. Chu. "Having a routine lifestyle is crucial," he says. That includes going to bed and get- ting up at a regular time, eating healthfully, getting exercise and getting outside every day. Unless it's too cold to be outside safely, experts say that even 15 minutes outside on a cold, sunny winter day can improve your mood significantly. Remember your mitts and a toque and take a brisk walk around the block. Enjoy the sunshine sparkling on the ice-covered trees and bouncing off the crunchy snow. It's a beautiful day in your neighbourhood; get out and enjoy it. YH_jan-feb07_34-37.indd 37 12/15/06 16:32:57 48 May/June 2006 Your Health – Capital Health's magazine for living well a core or pits (apples, pears, peaches, plums, cherries and nectar- ines) and numerous veg- etables, like carrots, parsley, celery and parsnips. She also has nut allergies. She touches wood when she says that last year was a good one – just two reactions. A food allergy can develop early in life or much later, though little is known as to why an adult may suddenly succumb to something they've been eating for years without incident. Foods are the most common cause of anaphy- laxis, a serious, life-threatening reaction that Anaphylaxis Canada says affects between 1% and 2% of the population. A reaction is the immune system's response to a food that appears harmful to the body. The system determines the food is a danger, resulting in the creation of anti- bodies at first exposure. When that food is eaten again, the body releases a bevy of chemicals that trigger the reaction. Depending on its severity, a reaction can include anything from a simple tingling and swelling of the tongue to vomiting, a drop in blood pressure, loss of consciousness and death. An allergic reaction differs from a food intolerance, which is a different kind of physi- cal reaction triggered by a specific food or food additive. An allergy involves the immune system, releasing histamine into the body, a characteristic miss- ing in food intolerance. People with lactose intoler- ance, for example, don't produce enough of the enzyme lactase and therefore suffer diges- tive problems when they eat lactose-rich dairy products. Food intolerances also vary in degree, though the symptoms are generally limited to gas, cramping, diarrhea and chronic headaches. "No one really understands the cause of food allergy for any individual," says renowned Edmonton-based pediatric allergist Dr. Stuart Carr. "Basically, if someone is genetically predisposed to develop allergies, they have an increased risk for sensitizing (developing "allergic" IgE antibod- ies) to specific foods. That said, while as many as one-third of the population is allergic, only between 2% and 5% have food allergies. Obviously, there are other factors involved in the process that we do not fully understand," he says. The increased prevalence of allergic disorders over the past 50 to 60 years concerns Dr. Carr. While physicians have become more adept at recognizing and diagnosing aller- gic disorders, there has been a true increase in the sheer numbers of people with food allergies and other ailments such as asthma, allergic rhinitis (hay fever) and atopic dermatitis (eczema). Allergists continue to search for rea- sons behind the jump in numbers of allergy sufferers, but so far there are no clear answers. The hygiene hypothesis is one theory. It states that a lack of exposure to infections in child- hood, such as measles and tuberculosis, have affected the maturation of the human immune system. Dr. Carr says that diet is also pre- sumed to play a role. For example, populations with diets rich in antioxidants and Omega-3 fatty acids appear to suffer fewer allergies. Cigarette smoke, exhaust particles and other environmental pollutants are also believed to increase allergic sensitization. Peanuts are one of the most com- mon foods that trigger potentially deadly reactions. Experts estimate that 300,000 Canadians suffer peanut allergies. About five cases every year are fatal. Most of the fatal or near-fatal reactions occur in the 15- to 25-year age group. Dr. Carr explains that this statistical peak is due in part to extra- neous factors. Young people have less life experience and may exercise less caution, not keep their EpiPen handy and have poorly controlled asthma. Children are also at risk. Edmonton resident Ana Wigger has a vivid recollection of the day she found out her eldest son Christian, now seven, had life-threatening allergies. Influenced by her Portuguese background, Wigger is an avid cook, always sampling delicious interna- tional foods. When Christian was two years old, she created an exotic Thai dish containing peanut butter and shellfish among the myriad ingredients. Wigger says that her boy took one bite and simply said, "Mmmm." Then he froze. Within seconds, welts developed on Christian's face and he began to gasp. The welts and rash remained for a day or two but the Wiggers' new life was just beginning. "For the first two weeks, I cried," the mother says, admitting she was gripped by fear and depression. She cried at the unknown. "It takes over your life immedi- ately. There's no easing into it." Physicians determined that Christian was allergic to tree nuts, shellfish and sesame – all items that are a threat to his life on a daily basis. Wigger's middle son Sage is four but he outgrew his allergies to eggs and dairy products at the age of three, while Luke, the youngest of the brothers set to turn three soon, has no known allergies at this time. Wigger says that the revelation became consuming. Something as simple as allowing Christian to go to a buddy's to play has become an exercise in preparation and pre- vention. Parents of Christian's friends have reacted to his wide-ranging allergies in two ways, she says. The first group finds out what they can do ensure his safety. The second group simply avoid inviting Christian over. Wigger describes the learn- ing curve that her family has experienced over the past cou- ple years as "daunting." But eventually, optimism replaced trepidation when she saw what was achievable. "Education is power," she says emphatically. when food bites back YH_may-june06_46-53.indd 48 5/4/06 10:22:33 Your Health – Capital Health's magazine for living well 36 January/February 2007 What causes SAD? Mental health professionals attribute the unique elements of "winter depression" to lack of expo- sure to light. Lack of sufficient sunshine during the winter months, coupled with poor lighting at home or in the workplace, perhaps exac- erbated by a week or two of gloomy overcast days? That's a recipe for disaster for those prone to SAD. At the height of summer, Edmonton receives 17 hours and six minutes of daylight, with twilight extending well beyond that. The city regularly sees 2,289 hours of sunshine per year and is one of Canada's sunniest cities but, because it so far north, the sun rises later and sets earlier as winter trudges along. Edmontonians see only seven hours and 27 minutes of daylight on the shortest day of the year, December 21, so it's no wonder that the further north one travels, the more SAD cases one sees. But SAD appears everywhere. A study in Florida shows that 1.4% of the population suffers from SAD, although the length of the episodes is usually shorter in more southern climes. Seasonal Affective Disorder was listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) – the definitive medical resource used by the psychiatric community – in 1984, when Dr. Norman Rosenthal published the results of his Seasonal Pattern Assessment Questionnaire. He and his colleagues had found a startling similarity amongst patients at their Maryland practice during the winter months and, with the publication of his findings, Seasonal Affective Disorder was recognized as a real medical condition with very realsymp- toms. The DSM-IV defines Seasonal Affective Disorder as a "subtype of major depression." There are specific criteria which doctors look at when diagnosing someone with a depressive dis- order and, when diagnosing SAD, psychiatrists consider several more symptoms than those regularly considered with a major depressive disorder. While there are no firm numbers of people in Alberta who suffer from the illness, a recent study has shown that between 2% and 3% of Canadians exhibit symptoms of SAD every winter. More alarming, though, is the dis- covery that up to 15% of the population suffers from its milder form, the "winter blues." Are you SAD? While the winter blues can feel like just a bad day – or week – during a particularly long stretch of inclement weather, SAD can be far more debilitating. It can rob someone of their ability to be an active, contributing member of their family; it can alienate them from friends and loved ones and, for some, it can lead to a major depressive episode. Some of the most common symptoms amongst SAD sufferers include a cyclical depression, gearing up at one time of year, and disappearing, almost like clockwork, at another time of year. "SAD is a seasonal depression that usually happens to people in late September or October," says Dr. Jack Chu, staff psychiatrist at the Royal Alexandra Hospital in Edmonton. Dr. Chu regularly treats patients who suffer from SAD and knows how crippling it can be. "It's differ- ent from clinical depression, which is usually indicated by a loss of appetite and an inability to sleep." Contrary to other forms of depression, SAD causes a person to indulge in excessive car- bohydrate intake – "they seek comfort foods," says Dr. Chu – and start sleeping more. "In nature, animals that hibernate need high levels of starches and carbohydrates," he says. Hibernating is defined as "passing the winter C'mon, get happy If you suspect you have SAD, a professional diagnosis is the first step on the road to recovery. Here are some tips: Light Boxes: The original light box, designed in the 1980s, consisted of eight fluorescent or full-spectrum bulbs in a screened case. Now, light boxes are sophisticated and port- able. Some units look like desk lamps, some are vertical, and some look like visors. Light boxes bathe the user in about 2,500 lux – a unit of measurement of illumination – which equates to what you'd feel if you were exposed to a half-dozen 40-watt bulbs placed together. About light therapy: First, talk to a physi- cian before undertaking phototherapy. He or she will guide you in purchasing a unit (your health insurance may cover it); the length of time you need for exposure and the distance you should be from the unit. Medication: Depression is treatable with medication. Because there are, quite literally, thousands of prescriptions available, it's crucial that you speak to a health practitioner about the best course of treatment. If you suffer from clinical SAD, a combination of light therapy, psychotherapy and antidepres- sants may help kick the winter blues out the door and down the snowy walk. Common SAD Symptoms: • Weight gain, usually coupled with a craving for sweet or starchy foods • Decreased energy • Fatigue • Tendency to oversleep • Difficulty concentrating for extended periods • Increased irritability • Lack of desire to spend time in social situations • Generalized feelings of anxiety A recent study has shown that between 2% and 3% of Canadians exhibits symptoms of SAD every winter; more alarming though, is the discovery that up to 15% of the population suffers from its milder form, the "winter blues." Don't be SAD YH_jan-feb07_34-37.indd 36 12/15/06 16:32:36

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