Nina BaileyBSc (hons) MSc PhD ANutr

Managing Depression Through Diet

Mental health problems are extremely common!

1 in 4 British adults experience at least one diagnosable mental health problem in any one year, and 1 in 6 experience this at any given time

NHS expenditure on mental healthcare is high!

NHS and local authorities spent about £5 billion on adult mental health services in 2006/07 and the total cost of antidepressants was over £276 million in 200 7

Around 46.7 million prescriptions for antidepressants were dispensed in England in 2011 (a 9.1% increase on 2010 )

Costs for antidepressant prescribing rose by £49.8 million to £270 million (a rise of 22.6% on 2010)

http://www.nhs.uk/news/2012/08august/Pages/becoming-nation-of-happy-pill-poppers-fears.aspx)

And yet:

Food directly influences brain function and mood

Living with depression can have a significant impact on our appetite and eating habits

Some people lose interest in cooking and don't have the energy to prepare meals whilst others have physical or emotional symptoms that can be linked to either over-or-under eating

Standard antidepressant drugs, such as commonly prescribed SSRIs, (whilst providing relief for some suffers) can also present with side effects that affect appetite, leading to undesirable weight gain or weight loss

GP’s & mental health specialists do not generally give advice on nutrition!

Does the food we eat influence our risk of developing depression?

“Whereas the role of diet in the prevention of other noncommunicable diseases, such as cardiovascular disease (CVD), has been widely investigated for the last 50 years, the relationship between diet and depression is so far a novel and interesting field that has only emerged in the last five to ten years”

“Whereas the role of diet in the prevention of other noncommunicable diseases, such as cardiovascular disease (CVD), has been widely investigated for the last 50 years, the relationship between diet and depression is so far a novel and interesting field that has only emerged in the last five to ten years”

“Long term exposure to unhealthy dietary habits independently predisposes to depression over the

life course”

“Chronic inflammation may underlie the relationship between diet and depression”

Understanding diet quality - what is an inflammatory diet?

Pro-inflammatory foodsLower-quality foods include highly processed snack foods, sugar-sweetened beverages, refined (white) grains, refined sugar, fried foods, foods high in saturated and trans fats, and high-glycemic foods such as potatoes, white bread and pasta

Anti-inflammatory foodsHigh-quality foods include unrefined, minimally processed foods such as vegetables and fruit, wholegrains, healthy fats and healthy sources of protein

Packaged and processed foods have become the norm in most industrialised countries and increasingly throughout the world

Since the 1950s here has been a 70% decline in the purchase of flour – directly attributed to the availability of ready prepared foods

There are now approximately 320,000 different packaged food and drink products in the marketplace

In an average supermarket, there are approximately 25,000 + different products on the shelves - yet fresh food makes up a very small percentage

At the end of 2004, total sales of the top products in the main processed food categories (such as ‘bagged’ snacks and canned drinks) accounted for over £62 billion in the UK alone

Changing Diets, Changing Minds: how food affects mental well being and behaviour

Fish consumption and rates of depression

Prevalence of major depression decreases with apparent fish consumption in nine countries (HIBBELN JR. Fish consumption and major depression. Lancet 1998; 351: 1213)

The agricultural and industrial revolutions, followed by the globalisation of world food trade, mean that most people in rich countries (and growing proportions in poor countries) eat:

Small amounts of a few types of vegetables and fruit

Very few wholegrain products - our carbohydrates are mostly refined (such as sugar and products made from white flour) - and from a very narrow range of cereals (90% of the calories from cereals eaten in the UK are from wheat)

Very little oily fish, but large quantities of intensively produced meat, meat products and dairy products

Food

MicronutrientsFatProteinCarbohydrate

How does food affect mood?

Food

MicronutrientsFatProteinCarbohydrate

Vitamins & mineralsFatty acidsAmino acidsComplex &

simple sugars

Vitamins & mineralsFatty acidsAmino acidsComplex &

simple sugars

memoryconcentrationlearningbehaviour attentionappetitemoodsleepsexual function

Chemical messengers(neurotransmitters)

Brain (structure and function)

?

The combination of nutrients that is most commonly associated with good mental health and wellbeing:

Polyunsaturated fatty acids (particularly the omega-3 types found in oily fish)

Quality (organic-grass fed) animal protein

Minerals, such as zinc (in wholegrains, legumes, meat and milk), magnesium (in green leafy vegetables, nuts and wholegrain) and iron (in red meat, green leafy vegetables, eggs and some fruit)

Vitamins, such as folate (in green leafy vegetables and fortified cereals), a range of B vitamins (wholegrain products, yeast and dairy products), and antioxidant vitamins such as C and E (in a wide range of fruit and vegetables)

Eat protein-rich foods to boost alertness

Try to include a protein source in your diet several times a day, especially when you need to clear your mind, boost your energy, lift mood, promote relaxation and help deal with stress

Protein is broken down into amino acidsAmino acids provide the building blocks for the production of neurotransmitters

Combine protein with complex carbohydrates (protein slows down the absorption of sugars found in carbohydrates)

Vegetables (and fruit) provide vital ‘cofactors’ required to modify proteins and amino acids into neurotransmitters

L-Tryptophan

5-HTP

Serotonin

Melatonin

Tryptophan is an amino acid

High tryptophan foods include nuts, seeds,

tofu, cheese, red meat, chicken,

turkey, fish, oats, beans, lentils, and eggs

Magnesium, zinc & B6

L-Tryptophan

5-HTP

Serotonin

Melatonin

Tryptophan is an amino acid

High tryptophan foods include nuts, seeds,

tofu, cheese, red meat, chicken,

turkey, fish, oats, beans, lentils, and eggs

Magnesium, zinc & B6

Mood

Sleep

Choose your carbohydrates wisely!

The brain needs fuel, but at a constant rate

Glycaemic index

GI is a the measure of the effect that carbohydrates have on blood sugar levels

Carbohydrates that break down quickly during digestion releasing glucose rapidly into the blood stream will have a ‘high’ GI

Carbohydrates that break down more slowly, releasing glucose more gradually into the bloodstream will have a ‘low’ GI

Sugar is inflammatory!

The more processed and refined the carbohydrate, as a rule, the faster it breaks down in the digestive system, and the bigger the sugar rush it delivers

That’s why refined flours, sugars and sugar syrups pose such a problem for our systems

Sugar plays a direct role in inflammatory diseases

Poor regulation of glucose and insulin is a breeding ground for inflammation

L-Tryptophan

5-hydroxy tryptophan

Serotonin

Melatonin

Magnesium, zinc & B6

Mood

Sleep

High levels of Inflammatory products (cytokines) and cortisol (stress hormone) can

disrupt the normal production of serotonin affecting both mood and

sleep

Pro-inflammatory carbohydrates include sugar of all sorts, white rice and refined carbohydrates made from refined or “enriched” flour (such as pizza crust, bagels, most breads, crackers, most packaged cereals, biscuits, cakes, etc.)

Anti-inflammatory carbohydrates are the unrefined “whole” carbohydrates that come packaged just the way nature designed them including all fruits, vegetables, beans, legumes, and unrefined non-flour wholegrains

All anti-inflammatory carbohydrates are also brimming with nutrients, including vitamins & minerals, phytonutrients and antioxidants

Optimise your gut health!

Complex carbohydrate are also a good source of fibre

Fermented foods such as fermented vegetables are also important for optimal mental health as they are key to optimising your gut health (prebiotics and probiotics)

Your gut is literally your ’second brain’, and can significantly influence your mind, mood, and behavior

Your gut actually produces more mood-regulating serotonin than your brain does!

60% of our brain is comprised of fat

Deficiencies in specific kinds of fats can have a negative impact on intelligence, behaviour and mood

Omega-6 and omega-3 fats in particular are required for brain structure and function

Deficiencies in omega-3 are associated with a number of neurological conditions

- Developmental disorders (i.e., ADHD)- Depression- Bipolar- Schizophrenia - Dementia

Choose good fats!

FatsInclude AvoidCoconut oil MargarineOlive oil Sunflower oilRapeseed oil Canola oilButter (grass fed is optimal)Flaxseed oilFish oil

Vegetable oil

1:1 25:1

Omega-6 to omega-3 ratio

Omega-3Omega-6

Hunter-gatherer

Omega-6 Omega-3

Westernised diet

Omega-6 Omega-3

High inflammation!!!!

Marine products offer a unique nutritional package

Rich source of essential micronutrients acting as cofactors for neurological processes• Neurotransmitters• Methylation

Rich source of protein• Tryptophan - serotonin• Phenylalanine - dopamine

Major source of EPA and DHA

Fish vs Fish oils

What about supplements?

High strength pure EPA fish oils

1g EPA daily for a minimum 3 months

Effectively raise the ‘omega-3 index’ and reduce inflammation

As effective as SSRI’s (fluoxitine) for managing depressive symptoms !!

Neurotransmitter precursors - tryptophan and 5-HTP

Serotonin is made in the body and brain from the amino acid 5-HTP which is derived from tryptophan

Both can be found in the diet; tryptophan is found in many protein-rich foods such as meat, fish, beans and eggs

Tryptophan supplements are available as 500mg to 1000mg

The highest immediate form of 5-HTP is the African Griffonia bean (100mg-200mg dose)

Not advised to take alongside SSRIs

S-adenosylmethionine (SAMe) SAMe is an important co-factor involved in the biosynthesis of several

hormones and neurotransmitters which affect mood, such as dopamine and serotonin

Supplementing the diet with SAMe increases levels of serotonin and dopamine

Usual dose is 100-200mg daily

Cannot be taken alongside standard antidepressants

St John's Wort

St John's Wort is a herbal antidepressant containing the active ingredients hyperforin and hypericin

Scientific studies of the herb suggest that it acts to increase the activity and prolong the action of serotonin and noradrenalin, in a similar manner to standard antidepressants, but with far fewer reported side effects (dry mouth, dizziness, gastrointestinal problems, increased sensitivity to sunlight, and tiredness)

The ‘dosage’ is 300 mg of an extract (0.3% hypericin)

Cannot be taken alongside standard antidepressants

Vitamin D3

Vitamin D deficiency has long been associated with Seasonal Affective Disorder (SAD), as well as clinical depression

British National Diet and Nutrition surveys from 2008/2009 to 2011/2012 indicate that 25% of British adults have low vitamin D status (and more so in Winter months)

High dose vitamin D3 may be effective in treating symptoms (doses have ranged from 800 IU [20g] to 4000 IU [100g] day)

Vitamin B-complex

The B vitamins, especially vitamin B6, B12 and folic acid and can be helpful in mild depression

Eat well, spend less

Cutting down on unhealthy food items such as ready meals, sweets, cakes, crisps and fizzy drinks will free up more money for healthier items

Many unhealthy food items offer little or no nutritional benefit and can actually exacerbate feelings of depression

“Let food be thy medicine and medicine be thy food.”― Hippocrates c. 460 – c. 370 BC

Eat well, spend less

Get organised and try meal planning so that when you go shopping, you can write a list and buy only what you need

We can spend a lot of our precious budget on ‘impulse’ purchases because supermarkets are very clever at making us spend more than we want!

This also helps to avoid supermarket promotions, which are seldom related to good foods and often only encourage spending

Shopping with a friend can be a good idea (or buy on line), if you do want to take advantage of the healthier ‘buy one get one free’ offers!

Eat well, spend less

The nutrient content of fruit and vegetables begins to diminish as soon as they are picked, so ideally you should try to only pick/buy the quantities you really need for the next few days/meals

Frozen fruit and vegetables can be much better value than buying fresh

Frozen vegetables also tend to offer more nutrients, because they are frozen within a very short time of being harvested

‘Fresh’ vegetables, on the other hand, are sometimes transported thousands of miles, so aren’t always fresh when you finally eat them

Local markets or greengrocers often offer better value for money and are more likely to sell locally sourced produce

Grow your own veg or forage for ‘free’ food!

Eat well, spend less

Whilst organic, grass-fed animal products (meat & dairy) are the healthiest option when choosing a protein source, pulses and soy products can be much cheaper than meat, and offer additional nutrients not found in meat

Cuts of meat such as skirt, flank and shin (and offal) are cheap and nutritious

Tinned sardines, mackerel, pilchards etc offer very good value for money and are packed with omega-3!

Try cooking in bulk and freezing portions for when you don’t feel like cooking

Remember – it doesn’t have to be expensive to eat well in order to look after not only your brain, but your whole body

Eating the right foods can improve memory, mood and energy levels as well as improve sleep patterns

Top tips for managing mood

Adopt an anti-inflammatory diet

Eat at least 5 portions of fruit and vegetables a day (4 veg and 1 fruit)(raw fruit and vegetables provide the biggest nutrient hit)

Choose whole foods, not refined foods (and anti-nutrients i.e. sugar)

Choose good fats (limit omega-6 and increase omega-3)

Choose quality protein

Eat small portions regularly

Use supplements where appropriate

Pure EPA – 1g daily

Good quality B-complex

Prebiotics & probiotics

Magnesium (glycinate)

Vitamin D3

My top supplement recommendations

ninab@igennus.com