Depression: A Nutritionist’s Perspective

The media has been full of articles, facts and myth-busting regarding depression.  A Google news search I ran this evening searching "depression" returned 210,000 results.  At the core of these awareness raising articles is that:  no one needs to suffer with depression or mental illness and that it is treatable, and they then go on to describe the front line therapies doctors will often utilize, including selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) and other prescription therapy.

I take issue with this for a couple of reasons, the first of which is discussed at length in Screening for Depression in Clinical Practice: An Evidence Based Guide: inadequate routine care and follow up for depression, coupled with the over-treatment of patients who are not depressed or who are unlikely to benefit from treatment. A meta-analysis by Berndt and colleagues estimate that 40% of depressed patients are administered treatment with little or no benefit, and a further 25% are made worse.

There is another way.

While I agree wholeheartedly that depression and other mental illnesses are treatable, as a nutritionist, my front line therapies are diet change, supplementation and lifestyle modification. The mind and the body are not separate entities, if we under-nourish one through a diet of processed, refined, pesticide laden food and an unbalanced life full of toxins, stress and little sleep, we also fail to nourish and throw out of balance the other.

So, what's food got to do with it?  A lot!

Your body doesn't just use nutrients for energy and growth, it uses them to build and repair, clean and communicate with, each and every cell in the body.  An optimal diet for mental health would include quality fats, protein and a large variety of fruits and vegetables and few, if any, grains.

Why fats?

Not only does the ingestion of good fat help stabilize blood sugar, each cell of the body has a cell wall that is made up of fat (aka lipids), and your brain is made up of a whopping 60% fat, with 25% of that being cholesterol.  If you wanted to building a strong wall in your home you would not use bricks that had been damaged and were crumbling, but that is the type of fat most people consume; overly processed oils, easily damaged by heat, light and oxygen.  Getting away from fried foods, vegetable, canola and soy oils and instead, choosing coconut, cold pressed grapeseed, olive, and flaxseed oil provides the body with stronger building blocks to form healthy cells, especially within the brain.  Fats can come from food as well, nuts and seeds, eggs and oily fish like salmon, herring and mackerel.

Don't Forget Protein.

Those nuts, seeds, eggs and fish also provide good quality protein, and that's important since almost all neurotransmitters are made from it.  The quality of a protein is determined by the number of amino acids it contains, coupled with the way in which it was raised or grown.  Eating a varied diet of lean meat or fish, organic when possible, and vegetable protein sources like beans and lentils (properly soaked and prepared), quinoa, nuts and seeds helps ensure a good balance of amino acids is available.  Some people have higher needs for certain amino acids and may find they must supplement, a trained health practitioner can help you decide if you are one of those people.

Stabilizing blood sugar levels reduces stress on the body.

Chronic blood sugar imbalance increases adrenalin and cortisol output by the adrenal glands.  High cortisol levels and insulin resistance hinder the formation of serotonin resulting in depression and insomnia.

Vitamins and minerals are important as well.

According to Patrick Holford, "Every one of the 50 known essential nutrients...plays a vital role in promoting mental health."    The list is seemingly endless as to how these nutrients interact in the body.

• Vitamin B3 or niacin may be the most well known and was used by Dr. Abram Hoffer and his collegue Dr. Osmond in the early 1950's in the treatment of schizophrenia.
• B5 is used to make hormones to cope with stress and boost memory.
• The trio of B6, B12 and folate control the methylation process in  the body; methylation problems are behind a number of mental health problems, many of them linked to the production of serotonin.
• Vitamin C, while famous for its immune boosting properties also plays a role in balancing neurotransmitters, reducing the symptoms of depression and schizophrenia.
• Calcium and Magnesium, not just for strong bones, magnesium is of critical importance to keep calcium in balance and in solution.  A magnesium deficiency can lead to muscle cramps, but can also make you anxious, irritable and aggressive, and with more severe deficiency can come anxiety, insomnia, substance abuse and suicidal thoughts.
• Zinc is considered the most commonly deficient mineral, and unfortunately is the most critical nutrient in maintaining good mental health.  Zinc deficiency is associated with a broad spectrum of mental health problems including autism, anxiety, anorexia, depression, schizophrenia and hyperactivity.  Your individual needs will vary depending upon how zinc depleting your lifestyle is.

Even with optimal nutrition, lifestyle can play a role in mental health.

How many use unhealthy coping methods; overeating, dependence on alcohol, tobacco and drugs both legal and illicit, too much television or computer use, overspending aka retail therapy, emotional outbursts and lashing out, or conversely, being a victim?  All of these things, while they may appear to help in the short term, simply complicate matters in the long term.  Choosing health means more than what you put on your plate; replacing these behaviours with healthy ones can go a long way to promoting true wellness.

A good night's sleep, is also essential.

Most of us need between 7 and 8 hours a night to function well, there may be a few who can do with much less than that but they are the minority, estimated to be between 2 - 10 % of the population.  Adequate protein intake and B vitamins can improve sleep greatly, allowing for the efficient conversion of serotonin to melatonin in the presence of darkness.  If you can see your hand in front of your face, the room is not dark enough.

It is important to note that many prescription medications list depression as a side effect.

Including, (but not limited to):

• acne medications (Accutane, Tetracycline),
• anti-anxiety medications (Valium, Xanax, Ativan),
• corticosteroids (Prednisone, Flovent, Nasocort),
• drugs used to manage high blood pressure (Lopressor),
• cholesterol lowering drugs (Lipitor, Zocor, Crestor),
• antacids (Tums, Rolaids),
• proton pump inhibitors (Gasec, Losec, Prevacid, Nexium, Pantozol, Tecta),
• those used to treat menopausal symptoms (Premarin) and,
• birth control pills.

There's a lot to consider when it comes to the treatment of depression and mental health.

Food sensitivity, pathogenic interference, impaired digestion and poor balance of gut bacteria can interfere with optimal digestion, assimilation and utilization of nutrients as well.   The environment we provide, through lifestyle, physical environment and mind frame is at least as powerful as genetics and can either flip on or off those switches we may have been born with that predispose us to diseases like depression.

Above all, if you're feeling depressed, talk to someone, seek treatment, know you have options - lots of options.  If the first thing doesn't help, try again, and keep trying, because you're worth it.

Yes you are.

Sources:

1. Berndt ER, Bir A, Busch SH, et al.  The medical treatment of depression, 1991-1996:productive inefficiency, expected outcome variations, and price indexed. J Health Economics. 2002;21:373-396.
2. Szalavitz, Maia, and Maia Szalavitz. "New Research on the Antidepressant-vs.-Placebo Debate | TIME.com." Time. Time, 18 Jan. 2012. Web. 13 Aug. 2014. .
3. Holford, Patrick, New Optimum Nutrition for the Mind, Basic Health Publications, Inc., 2009. p62.
4. Holford, Patrick, New Optimum Nutrition for the Mind, Basic Health Publications, Inc., 2009.
5. Hoffer, Abram, Who is Abram Hoffer. Riordan Clinic, 2004-2013, web: 13-08-2014, http://www.orthomolecular.org/history/hoffer/index.shtml
6. Mitchell, Alex J., MRCPsych, James C. Coyne, PhD, Screening for Depression in Clinical Practice: An Evidence-Based Guide. Oxford University Press Inc. 2010. p 350.
7. Murray, Michael T. N.D., Stress, Anxiety and Insomnia: what the drug companies won't tell you and your doctor doesn't know, Mind Publishing, 2012.
8. Rao, T. S. Sathyanarayana, et al., Understanding nutrition, depression and mental illnesses, Indian Journal of Psychiatry, Apr-Jun:50(2);77-82, 2008. web. 13-08-2014,  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738337/