Part Two: Nutritional Therapy in the Treatment of Depression

Today is Part Two of my thoughts on utilizing nutrition to aid in the treatment of depression. Part One can be read here.  

As a disclaimer, I DO NOT think simply modifying the diet can “cure” depression. Depression is an incredibly complex disease, not to be taken lightly. I do believe there is efficacy in nutritional therapy for the treatment and prevention of depression

The Standard American Diet and Depression

The prevalence of Depression has been on the rise in the last 50 years. Another disease that is on the rise is obesity. The trend of poor nutrition  in our country that contributes to obesity could also be associated with higher rates of  depression. The diets of Americans are full of artificial ingredients, trans fats, sugars and an excess of calories. While nothing is wrong with a little bit of theses things, the problem is many do not practice moderation with these types of foods.

Many Americans don’t meet the daily recommendation for fruits and vegetables and their diets are devoid of critical vitamins, minerals and essential fatty acids. There are several vitamins and nutrients that research suggests may have an effect on depression. Perhaps it is a lack of these nutrients that is causing more and more people to develop depression. I believe that in many cases depression is caused by an interaction between genes and environment. Perhaps when someone is biologically predisposed to depression, then they eat a poor diet and have other life stressors, it triggers something in the brain that leads to depression. People can not control many stressors in life, but they can control what they eat.

Those struggling with depression often have diets lacking in essential nutrients. When someone is in the depths of the disease, they often make poor food choices that could even be contributing to the maintenance of their depression. Sometimes they don’t eat at all or eat very little, which also leads to nutritional deficiencies. Dietary intervention is often overlooked and doctors turn to medication. However, medication cannot work properly if the diet is poor.

The Role of Fatty Acids

The first nutrient I would like to discuss is omega-3 polyunsaturated fatty acids, or PUFAs. Fats are critical for the brain to function correctly.  Studies show that sufficient long chain PUFAs may decrease the development of depression. When the brain does not get enough omega-3 PUFAs there is significant disturbance in neural functioning (Rao et al, 2008). There is evidence to support the idea that chronic inflammation influences the development of depression.  The standard American diet is full of inflammatory foods such as caffeine, sugar, refined carbohydrates and alcohol. The brain releases inflammatory cytokines under stress. Many Americans live with chronic stress just in their everyday lives, so when you combine an inflammatory diet, the results are quite detrimental. Chronic stress wreaks havoc on the brain, and a diet rich in omega-3s may help to reduce the inflammation as omega-3 fatty acids have anti-inflammatory properties as they decrease the number of cytokines produced (Bergmans & Malecki, 2017).

Folate and Antidepressents

The second nutrient that I believe to be important in the treatment and prevention of depression is folate. Folate has a critical role in brain metabolic pathways. The diets of depressed patients are generally lacking in folate. This could be because a patient’s diet is usually poor in general when they are depressed, or a diet lacking in folate could have some influence in the development of depression. Low levels of folate are also associated with poor response to antidepressants (Coppen & Bailey, 2000). Supplementing folic acid (the synthetic form of folate) may improve the effects of certain antidepressants. In a study, 500 μg folic acid was prescribed to a group of depressed individuals along with 20 mg of fluoxetine daily.  There was a significant improvement in symptoms in the group that took the folic acid along with the fluoxetine (Coppen & Bailey, 2000).

A Traditional Way of Eating

The final dietary intervention that could be important in the treatment of depression is the   Mediterranean diet. A Mediterranean diet is a traditional way of eating that focuses on consuming mostly plant-based foods such as fruits, vegetables, whole grains, legumes and nuts. Fish is moderately consumed, while red meat and dairy are limited. Olive oil is the predominate source of fat which is rich in monounsaturated fatty acids (MUFAs). MUFAs may improve the binding of serotonin to its receptors. Studies have shown that in countries such as Greece and Spain where olive oil intake is high there are much lower rates of suicide (Sanchez et al, 2009).  I believe that this whole food diet, full of antioxidants and lacking in inflammatory foods could be very beneficial when coupled with psychotherapy in the treatment of depression. Mediterranean diets are also inherently rich in folate and omega-3 fatty acids, both believed to be beneficial in the treatment and prevention of depression.

Food as Medicine

We know food is medicine and that a healthy diet leads to a healthy body. When the body becomes deprived of healthy nutritious foods it begins to suffer. Mental health and physical health are not completely separate. A healthy body correlates to a healthy mind and vice versa. Think about it, you feel good on the inside so you are able to go out and enjoy life! You have sustained energy to engage in work and leisure. Depression is an incredibly complex, multifaceted disorder. Relapse rates are high.

While I do not think nutritional therapy is the end all be all cure, I am convinced that it is a critical tool in preventing and treating depression. Prescribing antidepressants to patients can be helpful to alleviate symptoms, but that is the problem- they are only scratching the surface of the disease.

Instead of reaching for pills, I would like to see the medical community gravitate towards instilling health eating behaviors in their patients. A brain that is not adequately nourished cannot fully engage in, and reap the full benefits of psychotherapy. If medication is prescribed, the body has difficulty metabolizing the medication and using it to its full potential if it lacks the nutrients that guide the metabolic process.

When the patient begins to eat in a way that supports proper bodily functioning, then therapy and medication have the potential to work for the patient. Until then, money and time is being wasted on interventions that will not hold up in the long term and the patient is likely to relapse. This becomes a vicious cycle of managing symptoms for a little while, but then relapse follows the brief period of remission. As the cycle continues, the patient becomes more and more frustrated with the process, and they risk losing the support of friends and family who feel exasperated.

It shocks me that there is still no dietary recommendation for the treatment of depression. It is time to change that. The scientific community pours millions of dollars into other interventions for depression, but somehow, the age old “Let food be thy medicine,” falls under the radar. Food can be medicine, if we give it the chance. It is time to invest in the whole body, and start  fueling the body, mind and soul in a way that will allow it to heal.

 

Sources

Bergmans, R. S., & Malecki, K. M. (2017). The association of dietary inflammatory potential with depression and mental well-being among U.S. adults. Preventive Medicine, 99313-319. doi:10.1016/j.ypmed.2017.03.016

Coppen, A., & Bailey, J. (2000). Research report: Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial. Journal Of Affective Disorders, 60121-130. doi:10.1016/S0165-0327(00)00153-1

Rao, T. S. S., Asha, M. R., Ramesh, B. N., & Rao, K. S. J. (2008). Understanding nutrition, depression and mental illnesses. Indian Journal of Psychiatry, 50(2), 77–82. http://doi.org/10.4103/0019-5545.42391

Sánchez-Villegas, A., Delgado-Rodríguez, M., Alonso, A., Schlatter, J., Lahortiga, F., Majem, L. S., & Martínez-Gonzalez, M. A. (2009). Association of the Mediterranean Dietary Pattern With the Incidence of Depression. Archives Of General Psychiatry, 66(10), 1090.

Part One: Nutritional Therapy in the Treatment of Depression

This past semester, I took a course called Mood Disorders where we explored all facets of Depression. Honestly, I have never learned more in a college class than I learned in this one. I can only imagine what it’s like living with a disease that is so crushing and that doctors don’t have answers for.

 I believe in holistic health and wellness. In my term paper I wanted to explore how nutrition can play a role in the treatment of depression.  

As a disclaimer, I DO NOT think simply modifying the diet can “cure” depression. Depression is an incredibly complex disease, not to be taken lightly. I do believe there is efficacy in nutritional therapy for the treatment and prevention of depression. This will be a two part series.

Part One

“Let food be thy medicine and medicine be thy food.” – Hippocrates

The father of modern medicine was on to something by making this statement.  Hippocrates believed that mental illness was cause by imbalanced bodily fluid. He believed melancholia, or what we now call depression, was cause by too much black bile. To treat it, he utilized blood-letting, bathing, exercise and diet. We all know that good nutrition correlates to a healthy body. I firmly believe that nutrition also plays a critical role in mental health and that there could be efficacy in using nutritional therapy in the treatment of depression.

Referencing a Greek philosopher in the context of treating modern day depression may seem rudimentary. However, the fact that 2500 years later, depression is the leading cause of disability, with more than 300 million people living with the disease worldwide (WHO, 2017) suggests that we have not made all that much progress in terms of finding a treatment for depression.

What is Depression?

After taking the Mood Disorders course, I have learned that depression is an incredibly insidious disease, and it is a disease that as a medical and psychological community, we still know very little about. We have hypotheses  but, there are no concrete answers as to how to go about preventing and treating the disease. There are so many variables that could be involved in the etiology of depression.

Some biological theories of the disease include abnormalities in genes, hormones and neurochemicals such as serotonin, norepinephrine and dopamine. There are theories that too much, too little or even variations of any given neurochemical cause depression. There is also a theory that prolonged hypercortisolism due to stress impairs the HPA system leading to decreased hippocampal volume which is seen in depressed patients. Then again, it is also unclear if some people are born with a smaller hippocampus and leads to depression.

As you can see, there are multiple conflicting theories in the realm of biology (and I only mentioned a few theories and causal factors) on causal factors of depression. Depression becomes even more complex when looking at psychological causal factors.  There are multiple cognitive vulnerabilities associated with depression such as the helplessness and hopelessness theories, which are associated with a negative attribution styles. Behaviorally, excessive negative affect and neuroticism link to depression. There are theories on stressful life events causing depression. Interpersonal factors such as low social support may also help to promote and maintain depression.

Treatment Options

Effectiveness of treatments for depression is another area full of unknowns. Medication and therapy are the two most popular treatment options. There are no guarantees that any one medication will work for an individual, and deciding which medication to prescribe is essentially an educated guess by the physician. In most cases, a patient will go through multiple medications to find one that works for them. I also firmly believe that medication should not be used as a stand-alone treatment. They must always be coupled with talk therapy of some type.

Studies show that cognitive behavioral therapy is effective in preventing relapses after the patient discontinues drug therapy (Fava et al, 1998). Medication may treat the symptoms of depression, but therapy addresses the root of the disease and therefor can be effective in sustaining recovery. Taking antidepressants is like taking pain medication when you have a broken bone. It will not fix the break, but it will relieve the pain until you can go to the doctor the get the bone set- like going to therapy. If  the bone is not set, it will definitely cause problems down the road. If someone forgoes therapy and chooses to only take antidepressants, the likelihood that they will relapse is very high.

Food as Medicine

I believe that nutrition can play a key role in preventing depression and aid in the treatment of those currently diagnosed with the disease. As I have stated, the prevalence of depression is extremely high. As of 2014, in the United States, 15.7 million adults had experienced one or more major depressive episodes within the past year (ADAA,2016). These statistics imply that the current treatment options are not effective for all cases of the disease.

For this reason, I believe we need to be looking beyond antidepressants and therapy for treatment and prevention of depression. We need to look deeper into the neurobiology of the disease and come up with alternative treatment options. It is well established that poor nutrition leads to a multitude of physical ailments. It only makes sense that diet also plays a critical role in mental health.  I would like to address the role of nutrition in the treatment and prevention of depression.

Sources

ADAA. (n.d.). Depression. Retrieved April 12, 2017, from https://www.adaa.org/understanding-anxiety/depression

Fava, G.A., Rafanelli, C., Grandi, S., Conti, S., & Belluardo, P. (1998). Prevention of recurrent depression with cognitive behavioral therapy. Archives of General Psychiatry, 55, 816-820.

 

Part two coming soon. Please feel free to share your thoughts in the comments. 

Linking up with Amanda at Running With Spoons for Thinking Out Loud

The Skinny Rules… Are you Freaking Kidding Me?

I hesitated in writing this post. I came across Bob Harper’s Skinny Rules on Pinterest, and thought, surley no one could actually believe that these are rules they should be following?

 

But then I thought, when I was 13 years old I would have took these rules for law. These rules would have been my bible, and I would have followed every one to a T. That being said, when I was deep in my eating disorder I did follow these insane rules and MORE. And you know what happened? I lost weight I did not even have to lose. My hair started falling out, I had no energy, my butt and back bones were so exposed that I got bruises from sitting… The list goes on.

Today I wanted to destroy some of these “rules.” I want someone to read this post and know that these rules are NOT okay. They are incredibly unhealthy and should be banned from the internet.

Some of the Most F***ed Up “Rules” On the Internet

Drink a large glass of water before every meal- no exceptions.

Okay water is good, water is essential, I drink at least a galloon a day myself. But before every meal? No exceptions? Umm no, drink when you are thirsty and your body will tell you how much you need to stay hydrated.

Don’t drink your calories

Ever heard of a glass of milk full of calcium and vitamin D? Or a protein shake post workout to give your body the energy it needs to recover? Or a fun latte at Starbucks with a friend? Ya, all those things are incredibly healthy in their own way.

Eat Protein at EVERY Meal -or stay hungry & grouchy!

protein

While protein does help keep you satiated, and I do agree you should have protein at every meal, there shouldn’t be this much pressure.

Slash Your Intake of Refined Flours & Grains

I eat white rice almost every single day. It is a fast digesting carb to refuel your body. And everything in moderation folks!

Eat 30-50 grams of FIBER per day!

The recommendation is  28-30 grams a day. And 50 grams? Prepare to be very bloated and constipated.

Eat Apples & Berries Every single day- Yes, EVERY-SINGLE-DAY!

There are plenty of other delicious fruits out there. How about a banana or some melon? Maybe I don’t want berries every freaking day.

NO Carbs after Lunch

needs carbs

Just NO. Carbs are the body’s primary source of energy. Unless you want to be a tired, hangry biatch… don’t do this.

Stop Guessing about Portion Size & Get it Right-for good!

This-screw you serving size

No more added sweeteners-including artificial ones!

I agree we should avoid too much artificial sugar, but eliminating anything completely can lead to an unhealthy attitude toward food.

Get rid of White potatoes!

potato

Why? They are just as good for you as any other potato.

Get rid of Fast foods & fried foods

Eating these things once in a while won’t kill you.

Banish High Salt Foods

You need sodium to live. Too little electrolytes will send your body into shock. Don’t poor the whole salt shaker on your food, but don’t be afraid of poor old salt.

Go to bed hungry

LMAO, I average about 500 calories right before bed every night, and I am doing just fine. Personally I would be up all night with hunger pains if I didn’t eat right before bed. Your body is not a clock, so freaking eat when you’re hungry!

Plan one splurge MEAL per week

I do not believe in “cheat” meals or “splurges.” Food is food, using these words to describe it make food seem like it is either good or bad. Food just is, that cookie won’t kill you, and the carrot stick won’t make you a Saint.

nutrition

I would love to hear your thoughts on these “rules” and other insane nutrition and health myths!

Note: I am not a registered dietitian. This is what I do know about proper nutrition and this post reflects my opinions on health and wellness.