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indexThe journal Nutritional Neuroscience, published a paper in April 2017, exploring the relationship between diet and depression.[1]

The authors note that converging evidence from laboratory, population research, and clinical trials suggests that healthy dietary patterns, such as the traditional Mediterranean-style whole-food diet, and specific dietary factors, including omega-3 polyunsaturated fatty acids (PUFAs), vitamin B6 and folate, antioxidants, and zinc, may influence the risk for depression. Despite the consistency of published evidence on the relationship between dietary patterns and depressive disorders, arising from numerous observational studies carried out in recent years on large and heterogeneous populations (including diverse cultures and age groups), and the emerging evidence suggesting that dietary improvement may prevent depression, there are no dietary recommendations currently available regarding depression.

Background:

Major depressive disorder is a common, chronic condition that imposes a substantial burden of disability globally. As current treatments are estimated to address only one-third of the disease burden of depressive disorders, there is a need for new approaches to prevent depression or to delay its progression. While in its early stages, converging evidence from laboratory, population research, and clinical trials now suggests that dietary patterns and specific dietary factors may influence the risk for depression. However, largely as a result of the recency of the nutritional psychiatry field, there are currently no dietary recommendations for depression.

Aim:

The aim of this paper is to provide a set of practical dietary recommendations for the prevention of depression, based on the best available current evidence, in order to inform public health and clinical recommendations.

Results:

Five key dietary recommendations for the prevention of depression emerged from current published evidence. These comprise: (1) follow ‘traditional’ dietary patterns, such as the Mediterranean, Norwegian, or Japanese diet; (2) increase consumption of fruits, vegetables, legumes, wholegrain cereals, nuts, and seeds; (3) include a high consumption of foods rich in omega-3 polyunsaturated fatty acids; (4) replace unhealthy foods with wholesome nutritious foods; (5) limit your intake of processed-foods, ‘fast’ foods, commercial bakery goods, and sweets.

Conclusion:

Although there are a number of gaps in the scientific literature to date, existing evidence suggests that a combination of healthful dietary practices may reduce the risk of developing depression. It is imperative to remain mindful of any protective effects that are likely to come from the cumulative and synergic effect of nutrients that comprise the whole-diet, rather than from the effects of individual nutrients or single foods. As the body of evidence grows from controlled intervention studies on dietary patterns and depression, these recommendations should be modified accordingly.

The paper makes five key recommendations:

  1. Follow ‘traditional’ dietary patterns, such as the Mediterranean, Norwegian, or Japanese diet. The available evidence suggests that traditional dietary habits may be beneficial for positive mental health.
  2. Increase your consumption of fruits, vegetables, legumes, wholegrain cereals, nuts, and seeds. These foods should form the bulk of the diet as they are nutrient dense, high in fibre, and low in saturated and trans-fatty acids.
  3. Include a high consumption of foods rich in omega-3 PUFAs. Fish is one of the main sources of omega-3 PUFAs, and higher fish consumption is associated with reduced depression risk.
  4. Limit your intake of processed-foods, ‘fast’ foods, commercial bakery goods, and sweets. These foods are high in trans-fatty acids, saturated fat, refined carbohydrates, and added sugars, and are low in nutrients and fibre. Consumption of these foods has been associated with an increased risk or probability of depression in observational studies.
  5. Replace unhealthy foods with wholesome nutritious foods. Healthy dietary patterns (e.g. fruits, vegetables, wholegrain cereals, and fish) and unhealthy dietary patterns (e.g. sweets, soft-drinks, fried food, refined cereals, and processed meats) are independent predictors of lower and higher depressive symptoms, respectively.

Comment

As all NTs and functional medicine trained practitioners will recognise, these core recommendations make good clinical sense, but in themselves will not transform someone’s mental health alone. Further manipulation of the microbiome, may be another intervention, as well as suitable personal skill developments.

Reference

[1] Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Ruusunen A, Jacka FN. Dietary recommendations for the prevention of depression. Nutr Neurosci. 2017 Apr;20(3):161-171. View Abstract

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imagesDr Carrie Decker ND, reviews these common conditions and explores strategies and treatments.

Supporting patients who experience anxiety, depression, insomnia often is a long arduous task for both the patient and provider. Although these conditions have standard labels, there often are many changing factors as contributors, never mind that supplements which have been introduced also can change the playing field. With the information that is now available with genetic assessment, specific nutrient supplementation or nutrient forms such as methylated folate or methylcobalamin are more thoughtfully directed at supporting the biological pathways which impact neurotransmitter balance and symptoms such as these. Even though these nutrients may help facilitate enzymatic function and neurotransmitter metabolism, it still is worthwhile to consider other aspects of physiology which may be dysfunctional in these clinical settings, and how supplemental therapies may be directed at addressing them.

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indexPsychiatric disorders in general, and major depression and anxiety disorders in particular, account for a large burden of disability, morbidity and premature mortality worldwide. Omega-3 polyunsaturated fatty acids (PUFAs) have a range of neurobiological activities in modulation of neurotransmitters, anti-inflammation, anti-oxidation and neuroplasticity, which could contribute to psychotropic effects. [1]

NEUThe relationships between magnesium deficiency and human health are extensive. Whilst this is an animal model the possibility that some of the benefits seen from magnesium supplementation may be mediated through its effects on the gut microbiota is an interesting twist.

The paper published in Acta Neuropsychiatry in Feb 2015 sheds some light on the possible mechanisms involved.[1]

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s_cover_y1114For some time now, the idea that at least in part, depression is the manifestation of loss of control over defensive inflammation and that inappropriate induction of these historical  mechanisms, for a prolonged period will induce changes in behaviour and mood has been gaining ground

Whilst single intervention treatments aimed at reducing the binding of inflammation proteins and fats to key receptors or the induction and conversion of mediators are reductionist in thinking, they may also represent a primary point of care helping people recover some of their function and allowing them time to work on solving the cause.

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A paper out in the Journal of Nutrition raises an interesting notion that augmentation of Fluoextine in paediatric patients may well enhance the clinical outcomes. Putting aside for one moment the increasing challenges faced by anti-depressants to be validated as a worthwhile therapy in mild to moderate depression, plus their numerous side effect it raises an interesting possibility.[1] A safe oral supplement of ascorbates may either biochemically or circumstantially enhance recovery in young patients and that is something worth considering.[2]

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Depression is the leading cause of disability worldwide.  According the World Health Organisation (WHO), depression affects about 350 million people.  Untreated depression can lead to suicide, and the WHO estimates that 1 million people worldwide commit suicide every year.    Their estimates project that depression will rise to second place in the global burden of disease listing by the year 2020.[i]

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At present no chronic disease has a greater drag on global function than mental illness.[1] A remarkable 40% of the European population is affected in any given year with depressive symptoms, and these numbers are rising.

Core symptoms include depressed mood, anhedonia (reduced ability to experience pleasure from natural rewards), irritability, difficulties in concentrating, and abnormalities in appetite and sleep (‘neurovegetative symptoms’). In addition to mortality associated with suicide, depressed patients are more likely to develop coronary artery disease and type 2 diabetes. Depression also complicates the prognosis of a host of other chronic medical conditions. The chronic, festering nature of depression contributes substantially to the global burden of disease and disability.

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A study published August 2010 in the Journal Pediatrics looked at a large cross-sectional study of Japanese teenagers and describes that a higher intake of fish, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) is independently associated with a lower prevalence of depressive symptoms in boys but not in girls.[1]

Now whilst it is generally felt that the role of fatty acids is vital in terms of brain health and function there is a scarcity of substantive epidemiological evidence to support direct benefits in terms of inhibiting depression.

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B Vitamins Beat Depression

Wednesday, 18 August 2010 by

This month’s (August) American Journal of Clinical Nutrition presents a longitudinal study supporting the use of B vitamins in the management of mental health.

In Nutritional Therapy practice when we are faced with patients who seem to be struggling with depression and are finding recovery hard as well as trying to prevent recurrence after resolving their current symptoms we often think – B Vitamins

But what is the evidence for this apparently normal recommendation – is there anything of substance that supports the therapeutic use of these water soluble vitamins.

To date most studies have been conducted using a cross sectional approach[1],[2] (a class of research methods that involve observation of some subset of a population of items all at the same time, in which, groups can be compared at different ages with respect of independent variables) rather than the preferred prospective style investigations (an analytic study designed to determine the relationship between a condition and a characteristic shared by some members of a group). A prospective study may involve many variables or only two; it may seek to demonstrate a relationship that is an association or one that is causal. Prospective studies produce a direct measure of risk called the relative risk.

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