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"[T]his is the first RCT to explicitly seek to answer the question: If I improve my diet, will my mental health improve?” Felice N. Jacka et al, BMC Medicine, January 30, 2017

Diet and Depression

Randomized Controlled Trial Confirms that Improving Diet Reduces Depression

Eat better and improve your mental state? That’s what the new field of nutritional psychiatry has been telling us for some time. Observational studies support the contention that diet quality is a possible risk or protective factor for depression. A randomized controlled trial from Australia earlier this year confirmed that observation. Called SMILES (Supporting the Modification of lifestyle In Lowered Emotional States) the 12 week study, published January 30, 2017, in BMC Medicine, enrolled 67 people who had moderate to severe depression and poor diets and randomized them into a diet group and a social support (control) group.

The intervention was that the diet group was encouraged to eat whole grains, vegetables, fruits, legumes, low-fat and unsweetened dairy foods, nuts, lean meats, and olive oil—and reduce refined grains, sweets, fried or fast foods, processed foods, processed meats, and sugary drinks. Moderate alcohol consumption was also permitted; no more than two standard drinks. In short, they were counseled to follow a whole foods Mediterranean diet approach.

The social support control group met with a clinician on the same schedule, but discussed neutral topics such as sports and music or engaged in board games and other activities. The idea was to make sure that one group didn’t do better than the other simply because they spent more time with the clinician.

After 12 weeks, the diet group demonstrated significantly greater reduction in depression and anxiety symptoms than the social support group. At the end of the trial, the diet group saw a 32 percent remission in depression, compared to 8 percent in the control group.

Importantly, the people who improved their diet the most were the ones who experienced the most improvement in mood. For about 1/3 of the diet group, depression symptoms dropped below the threshold for diagnosis. They were cured.

Jacka et al concluded: “[T]his is the first RCT to explicitly seek to answer the question: If I improve my diet, will my mental health improve? Whilst emphasizing the preliminary nature of this study and the imperative for replication in studies with larger sample sizes, the results of our study suggest that dietary improvement guided by a clinical dietician may provide an efficacious treatment strategy for the management of this highly prevalent mental disorder.”

A randomized controlled trial (RCT) is considered the ‘gold standard’ of research methods. So the results of this study carry considerable weight.

Why Is This Study Important?

Professor Jacka, who is director of the Food and Mood Centre and president of the International Society for Nutritional Psychiatry Research, said the findings offered an important new strategy for the treatment of depression.

“Mental disorders account for the leading cause of disability worldwide, with depression accounting for the large proportion of that burden,” she said. “While approximately half of sufferers are helped by currently available medical and psychological therapies, new treatment options for depression are urgently needed.”

She continued: “Importantly, depression also increases the risk of and, in turn, is also increased by common physical illnesses such as obesity, type 2 diabetes and heart disease. Successfully improving the quality of patients’ diets would also benefit these illnesses.” http://foodandmoodcentre.com.au/media/smiles-trial/

My Take

Like me, you are probably wondering about the definition of depression. The Mayo Clinic offers one that’s easy to understand: Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

It’s remarkable that something as basic as diet can cure a third of people with moderate to severe depression. It might shorten the appointment book of psychiatrists and add to that of dieticians. It certainly moves diet up the list of treatments for depression. Makes sense when you consider the effect low quality eating can have on blood sugar fluctuations—and mood.

In my first book Ripped, I wrote about the dramatic effect a very low carbohydrate diet had on my mood. I was “more than tired…My mental condition bordered on paranoia.” Eating two big nectarines brought me out of it. “I felt like a new person…I left the house an exhausted Mr. Hyde and returned a revived Dr. Jekyll.”

Dr. Jacka and her team listed more complex ways diet may influence depression. “There are many other biological pathways by which dietary improvement may influence depressive illness; previous discussions have centered on inflammatory and oxidative stress pathways, as well as brain plasticity and the new evidence base focused on the gut microbiota. Each of these pathways is suggested to play a role in depression and is also influenced by diet quality.” They also listed more mundane factors. “Moreover, behavioral changes associated with food (cooking/shopping/meal patterns) are an expected outcome of a nutrition intervention, and these changes in activity may also have had a therapeutic benefit.”

Like most people, I feel down at times. I usually come out of it by finding something meaningful to do.
Bill Reynolds, who took this photo of me in this breathtaking setting, was a brilliant and sensitive person
 with powerful emotional swings. He also ate unwisely. I saw him spoon sugar into his Coke.
 Joe Weider asked him why he did that to himself. He had no answer.

Most of us have had short bouts of depression or anxiety. I know that I have. My solution is usually to turn my mind to something challenging. Walking also helps. Coffee can also have a rebound effect, dampening spirits after a time. In the future I’ll check to see how long it has been since I had a quality meal. I have no doubt that food can have a powerful effect on mood.

Mayo Clinic adds this serious but hopeful caveat: More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

We can now add improved diet.

August 1, 2017

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