ASK SARAH Dr Sarah Jarvis answers readers’ questions
Dr Sarah Jarvis answers your health questions and rounds up the latest medical news
Lighten your mood
Q I dread the onset of winter, because just before the clocks go back my mood drops and all I want to do is hibernate. What can I do?
A It sounds as though you may have seasonal affective disorder (SAD), which affects between one in 20 and one in 30 people in the UK. Symptoms typically start in late September or October and include feeling sluggish, having problems waking up and an increased appetite. These are often followed a couple of months later by poor concentration and sleeping more, then anxiety or depression – feeling down or hopeless, finding no pleasure in activities you usually enjoy and having feelings of worthlessness or guilt.
It’s not known exactly what causes SAD, but there are several possible factors, which may be interlinked. The reduced daylight in late autumn and winter can disrupt your circadian rhythm (internal body clock). A change in levels of melatonin, a hormone that plays an important role in sleep patterns and, to some extent, mood, may also be triggered by a change in the seasons. Reduced sunlight may also lead to a drop in serotonin, an important nerve signal transmitter in the brain.
If you’ve experienced symptoms for at least two years, starting at the same time each autumn, which lift by spring, you’re likely to have SAD. Unlike with other forms of depression, where talking therapy (often cognitive behavioural therapy, or CBT) is usually the initial choice of treatment, I always look to light therapy first. That doesn’t mean that CBT, or CBT combined with antidepressants, won’t be needed, but for many, light treatment is enough.
In mild cases, this could be as simple as adapting your lifestyle to maximise exposure to natural daylight, especially in the middle of the day. For many, though, a light box is very effective. You sit two to three feet away from it for 30 minutes to three hours a day, depending on the light strength. You can carry out your everyday activities while doing it.
Crucially, however, if at any time your mood is low enough that you don’t think life is worth living, you should seek immediate medical help.
QMy sister gave up gluten recently and thinks that I should, too. I feel fine and don’t believe I need to, but she says gluten is unhealthy. Who’s right?
AWhen I first became a GP, the only people I saw who avoided gluten were those diagnosed with coeliac disease, an auto-immune condition that causes severe gut problems, tiredness and nutritional deficiencies if even a trace of gluten (found in wheat, rye and barley) is consumed.
Recent years have seen a surge in people avoiding gluten, including those with non-coeliac gluten sensitivity (this causes less extreme symptoms than coeliac disease).
These days, nearly half of people who avoid gluten do so for reasons other than gut problems, with almost two in three believing that going gluten-free is ‘healthier’.
Marketing has played a major role: the value of the gluten-free industry worldwide has more than doubled from around £1.3bn to £2.7bn in five years and continues to rise.
A recent study by Sheffield University examined the impact of a gluten-free diet on healthy people with no gut symptoms. To avoid bias, researchers and participants had no idea who was in each group. At the end of the study, there was no difference in gut or wellbeing symptoms between the two groups.
This study was small but well designed, and gives clear evidence that people without gut problems have nothing to gain by avoiding gluten. And given that gluten is an important source of protein, fibre and micronutrients, it’s important to remember that it’s not just a question of ‘it can’t do any harm’; there can be downsides to cutting out whole food groups as well.