Dr. Julie Zakutansky
According to the World Health Organization depression affects more than 120 million people worldwide, making it the leading cause of disability. In North America, the problem is even more pronounced multiple data sources show that at least 6 percent of U.S. adults are depressed and one in 10 are currently taking antidepressants. However, it is important to point out that many people are reluctant to reveal their secret sadness indicating that depression affects many more people than we realize.
Depression is characterized by feelings of worthlessness or guilt, poor concentration, loss of energy, fatigue, thoughts of suicide or preoccupation with death, loss or increase of appetite and weight, a disturbed sleep pattern, slowing down (both physically and mentally), agitation (restlessness or anxiety).
Studies show that many of the effects of depression go far beyond feelings of sadness but also manifest in physical symptoms including pain, inflammation, gut disturbance, poor memory and a host of other issues.
A study of High Schoolers suffering with depression showed:
- 23 percent couldn’t sleep.
- 36 percent couldn’t remember things.
- 30 percent felt overwhelmed.
Others felt lost, ate too much or too little, or felt like they were almost literally drowning — short of breath, gasping for air. It has been shown that compared to previous generations Millennials vastly outnumber them in depressive symptoms.
Often times despite the presence of so many symptoms depression and anxiety can be difficult to recognize…and admit. Even more difficult can be asking for help.
Not only is depression distressing, it’s one of the most common diseases, but unfortunately also notoriously — hard to treat.
About a third of people being treated for clinical depression are considered “non-responders.” Patients may try multiple medications, with no relief. Another third may feel a little better, but still not great or back to their “normal”.
If you’re depressed, you already feel bad and you may even feel like you’ll never get any better.
So what can you do? Of course there are additional treatments including psychotherapy which may help teach you mechanisms to cope and be a great help on the path to recovery. But what can we do every day?
What about what we eat??? Can nutrition actually make a difference?
Depressive disorders can be complex, as is the brain. The foods we eat, and the ways our bodies interact with these foods, these pathways are also complex. While we are continually improving our understanding of exactly how the brain works, and how nutrients may improve brain health there are some foods and lifestyle changes that show promising possibilities.
Your brain needs a lot of energy and building blocks to work properly and to create neurotransmitters. Without enough energy and the right nutrients, your brain won’t be able to function correctly. In fact, eating a lot of nutrient-sparse processed foods could up your chances of becoming depressed by as much as 60 percent.
Additional studies show that nutrient deficiencies can often look like mental health problems.
Did you know??
Most serotonin — the happy-making neurotransmitter — is made in the gut, not the brain. Poor GI health could prevent its production, meaning you’ve got less of those good, happy chemicals in your brain.
One of the first lines of treatment for depression in the medical field is using SSRI’s (Selective serotonin re-uptake inhibitors). SSRI’s are believed to increase the extracellular level of the neurotransmitter serotonin by limiting its re-absorption. Doesn’t it make sense then that if we improved our bodies own innate ability to produce serotonin that it might be beneficial in helping with brain chemistry and depression?
How about the GUT?
Your GI tract is responsible for absorbing the nutrients your organs, and tissues, including the brain, require in order to function normally. The gut is also responsible for keeping the unwanted substances, harmful bacteria and other undesirable substances out of the rest of the body. This requires healthy intestinal cells and trillions (yes trillions) of beneficial bacteria, which help digest your food, manufacture vitamins, and absorb minerals. If your gut microbiome (your gut bacteria population) is out of balance, or if a problem develops, via irritation or inflammation, you are at risk for developing a gut permeability (“leaky gut”) issue, if this happens it could definitely affect your brain in a negative fashion.
Sixty liters of blood are pumped into your brain every hour, providing oxygen, removing waste products, and delivering nutrients. If that blood is nutrient-deficient, or carrying junk that doesn’t belong, it’s going to interfere with your brain’s function, including its ability to create necessary neurotransmitters. Additionally, a permeable gut can encourage inflammation in the body, turning all of this into an ongoing destructive cycle.
How is inflammation related?
Chronic inflammation happens when our body turns on an immune response, then doesn’t turn it off again. The resulting damage is associated with a wide variety of health problems, including cancer, heart disease, diabetes, neurodegenerative disorders like Alzheimer’s, dementia… and depression.
Many scientists and doctors believe the inflammatory compounds interact with proteins in the brain, promoting changes that contribute to depressive illness, lowered neuroplasticity and aberrated brain function.
The brain uses various nutrients to produce brain-derived neurotrophic factor, or BDNF, a protein that’s essential to the central nervous system.
Some research suggests that BDNF could support neuroplasticity — the brain’s ability to adapt, rewire itself and grow. This would be especially beneficial in recovery from trauma and mental illness
Nutrition and your mitochondria
You may remember from high-school biology that mitochondria are the “generators” or “energy producers” of our cells. Mitochondria are small cellular structures (organelles) consisting of an outer and inner membrane, an intermembrane space and an intracellular matrix. The outer membrane covers the organelle, the inner membrane folds and forms cristae. This long surface area enables plenty of space for lots of chemical reactions.
Recent studies suggest that mitochondria play an important role in brain function and cognition — and that sub-optimal mitochondria, and mitochondrial dysfunction, may contribute to depression. Impaired function of mitochondria leads to impaired bioenergetics, decrease of ATP production (ATP=Energy), impaired calcium homeostasis, increased production of free radicals and oxidative stress.
So how do we feed our brain?
Anything that makes our bodies healthier is often beneficial for our brain. For example: fresh air, sunshine, clean water, exercise, de-stressing, vitamins and minerals, improved circulation, etc. all help make our brains healthier.
Some nutrients in particular seem to be linked to brain health.
- Omega 3 fatty acids (fish, nuts, seeds, algae): Omega-3 fatty acids provide building blocks for healthy brain development and function, and thus have been explored for their potential role in preventing everything from ADHD to Alzheimer’s, cardiac and blood sugar issues.
- B vitamins (meat, eggs, seafood, green leafy vegetables, legumes and whole grains): Studies have shown that a deficiency in B vitamins (particularly B12) can be linked to depression. Supplementing with B12, B6 and folic acid can improve a patients response to antidepressant medication.
- Vitamin D (sun exposure): Vitamin D is required for brain development and function. Deficiency in this “sunshine vitamin” is sometimes associated with depression and other mood disorders. Many patients who experience SAD or Seasonal Affect Disorder find significant benefit with Vitamin D supplementation. Research has also linked low vitamin D levels with obesity, diabetes, cardiovascular disease, autoimmune disease, osteoporosis and cancer.
- Selenium (cod, Brazil nuts, walnuts, poultry): Selenium is an essential mineral, meaning we have to get it from food. Among its various roles, selenium works with other nutrients to create antioxidant balance in our body’s cells. Selenium is also vitally important to thyroid function. Thyroid hormone metabolism is impaired without selenium because iodine-based enzymes, called iodothyronine deiodinases, cannot be synthesized. Many studies have shown a link between low selenium and depression, but the exact mechanism is unclear.
- Tryptophan (protein sources including turkey, beef, eggs, some dairy products, dark, leafy greens): An amino acid, tryptophan is a precursor to serotonin. Low tryptophan seems to trigger depressive symptoms.
- Probiotics: Bacteria have a reputation for causing disease, so the idea of tossing down a few billion a day for your health might seem literally and figuratively, hard to swallow. An estimated 100 trillion microorganisms consisting of more than 500 different species inhabit every normal, healthy bowel. These microorganisms (or microflora) don’t make us sick but in fact are very helpful. These “good” bacteria keep pathogens (harmful microorganisms) in check, aid digestion and nutrient absorption, and contribute to immune function.It is not as simple as just supplementing these nutrients. Many different nutrients can play a supportive role to brain health and help with both anxiety and depression. Nutrients work together in context.If you want to focus on particular nutrients and/or explore possible deficiencies, it’s best to do so with a trusted health professional like a registered dietician, nutritionist or doctor trained in functional medicine.
What Should you do?
Depression can be overwhelming. Please consider reaching out for help. Eat whole foods. Make this as easy as possible. Finding fresh foods that don’t require a great deal of prep like veggies and fruits or salads. Avoid foods that promote depression and mood dysregulation. Some common ones include:
- Alcohol is a nervous system depressant. So, not helpful.
- Caffeine: It brings you up then knocks you down. It may also worsen anxiety and insomnia.
- Sugar: It may numb the pain or distract you from it for a while, but then it makes you feel worse emotionally and physically, especially since it can worsen inflammation.
- Processed foods: Some folks notice that they’re sensitive to things like preservatives in processed foods.
- Avoid Gluten as much as possible. It can be a major source of mood dysregulation.
- Consider getting evaluated for other hidden food intolerances that may be affecting your brain and your overall health.
Nurture your gut health. Keep your gut bacteria and intestinal cells happy. Try eating yogurt and fermented foods such as sauerkraut, kimchi, and pickles, or drink kombucha. These must be in their raw, unpasteurized form to offer live bacteria. You’ll find them in the refrigerator section of a well-stocked grocery or health food store.
Take a probiotic good supplement. Cook with a good quality bone broth, a long-simmering stock made with chicken or beef bones. Simply put the bones in a pot, cover with water and a little vinegar of lemon juice, and simmer for a long time (12 hours at least 24 hours is better). The resulting stock contains glycine, which helps with internal wound healing, including the lining in your gut. It also contains minerals and other joint substances that promote various healing pathways. Choose meat and dairy products that are antibiotic and hormone free (if possible). Buy organic if you can. Consider Supplementation and a nutritional consultation to help you figure out what makes sense for your individual situation. We don’t know exactly how specific nutrients work in the context of individual foods, or how they work within the body so it’s best to work with a doctor and nutrition coach, who can help determine which ones might be right for you. Not all supplements are created equal. A low-quality vitamin might contain too low a dose or be hard to absorb.
Get out in the sunshine! If you have a pet spend extra time with them; the health benefits are well documented and significant. Move. Depression is immobilizing. Do your best to act against that force by moving whatever you can move, however you can move it. Express yourself. Draw, write, talk about what you’re feeling, howl at the moon play an instrument. Learn a martial art. Whatever gets the bad feelings out. Try not to hold it all inside.
Depression is a complex, pervasive, and complicated issue. While there are many modalities that can be used to treat depression it is often a combination of processes, medication, therapy, diet, exercise, lifestyle changes that are ultimately successful in helping someone with their depression. Building your personal toolbox of helpful actions can be incredibly empowering. Positive steps truly add up over time. Bit by bit, things can get a whole lot better. If you are struggling with your depression why not consider adding some additional treatment modalities or options? What can it hurt – all you risk is the possibility of feeling better. Eat well, move whenever possible, and live… better.