Treating Depression with Diet and Lifestyle
Depression is no fun. It can blacken the physical, emotional and spiritual wellbeing of an individual interfering with the ability to play, work, love, grow and prosper. It can permeate the lives of friends and loved ones and create a vacuum of loneliness in which life has lost all meaning. It can tear a person apart from the inside and forever impede the journey towards health. Layer an insatiable desire for drink or drug on top and you’ve created one of the most dynamic and unrelenting illnesses that may baffle even the most knowledgeable and experienced practitioners. Unfortunately, the “gold standard” in treatment may not help. The mechanistic application of medicines that manipulate neurological function often fail to produce lasting improvements and may ultimately prove detrimental to one’s wellbeing. However, diet and lifestyle modifications that improve microbial balance in the gut, reduce intestinal permeability, and enhance neurochemical synthesis, storage and release in the brain can prevent and treat depressive disorders before they become too great.
According to The Journal of American Medical Association, a person who feels sad all the time or loses interest in usual activities may have major depression, which can develop at any time and in response to circumstances unique to each individual. Having at least five of the following symptoms, including at least one of those marked with *, occurring nearly every day for at least two weeks can be diagnosed as having a depressive disorder.
- Feeling sad or empty*
- Decreased interest or pleasure in activities*
- Appetite change with weight loss or weight gain
- Decreased or increased sleeping
- Fatigue or loss of energy
- Feeling worthless or guilty
- Being either agitated or slowed down
- Difficulty thinking or concentrating
- Recurrent thoughts of death or suicide
Western medicine has identified several possible causes of depression, each of which act independently to influence an individual’s predisposition for psychological illness, specifically depression. Factors identified to influence the development of depression, include: stress, genetics, neural monoamine irregularities, faulty synaptic transmission, endocrine (hormone) imbalance, and neuroimmune dysfunction.
The American Medical Association proposes four treatment protocols for depressive disorders that can be used independently or together in a multifactorial approach to therapy. Pharmaceuticals, dubbed the “gold standard” in depressive disorder treatment, have been shown effective in treating depression with the magnitude of benefit increasing with severity. Psychotherapy, or talk therapy, that involves evaluating and changing the thoughts, attitudes, and relationship problems associated with depression is also a viable treatment option. Less widely accepted conventional treatment protocols for depressive disorders include bright light therapy and electroconvulsive therapy that increase exposure to natural light and apply acute electric currents to the brain, respectively, may also be considered in the treatment of depressive disorders.
Pharmaceutical treatment for depression began with tricyclic antidepressants (TCAs) and MAO, monoamine oxidase, inhibitors (MAOIs), which work by increasing concentrations of 5-HT and/or norepinephrine in the brain. Unfortunately, side effects with these drugs can be pretty severe and can translate into reductions in compliance. TCAs can act on many other transmitter systems in the central nervous system and periphery and can contribute to sedation, hypotension, blurred vision, dry mouth, and may be fatal in overdose due to their effects upon the cardiovascular system. MAOIs can also interfere with cardiovascular health by promoting lethal hypertension.
Side-effect and compliance concerns with first generation antidepressants sparked demand for a safer and more tolerable class of antidepressants, which includes selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors, dual reuptake inhibitors, and multiple receptor acting substances. These drugs inhibit reuptake of neurotransmitters from the synapse leading to an increase in concentration and, therefore, an increase in neurotransmission. These drugs are highly used today and constitute the standard pharmaceutical treatment in depressive disorders. Unfortunately, according to the journal Dialogues in Clinical Neuroscience, there are severe treatment-resistant forms of depression, which may not be adequately treated by these drugs and may require augmentation therapies that utilize the addition of a second agent to an existing antidepressant regiment.
In addition to the physical side effects that may occur with antidepressant use, chemical dependence may become an issue when the production of neurotransmitters is artificially stimulated or their reuptake is inhibited. The brain may stop producing neurotransmitters naturally and antidepressant use is discontinued it may cause a great deal of physical and psychological distress.
Alternative “Holistic” Treatment
Contrary to the conventional approach to treating depressive disorders, holistic practitioners such as myself believe that diet and lifestyle have a large influence on increasing rates of depression and other mental health disorders. According to the journal Gut Pathogens, a Western diet and lifestyle promotes depression by altering microbial balance and contributing to a highly permeable gastrointestinal tract lining that increases neurological exposure to endogenous and exogenous toxins. High energy, low plant carbohydrate diets typical of industrialized economies diminishes levels of beneficial bifidobacteria in the gut and elevates blood levels of LPS. A reduction in beneficial bifidobacteria allows opportunistic, “bad”, bacteria to flourish, which can weaken the lining of the gut and contribute to leaky gut. Once gut integrity has been compromised, LPS, which resides in the cell lining of harmful bacteria, can escape the stomach and compromise the integrity of the blood-brain barrier allowing more toxins into and preventing their removal from brain tissue.
Lifestyle factors that can influence an immune response, promote inflammation, and damage the gut to increase neurological susceptibility to toxins include excessive or chronic stress; alcohol consumption, over-the-counter, pharmaceutical and illicit drug use; and high intensity exercise.
Correcting microbial balance and healing a leaky gut through diet and lifestyle modification is the easiest, safest, and most sustainable way to prevent or correct the damage caused by an industrialized diet and lifestyle. Eating and living to promote beneficial bifidobacteria populations in the gut will help neutralize neurotoxins produced by harmful bacteria that permeate the blood-brain barrier to promote depressive disorders. Also, establishing a healthy bacterial balance prevents the spread of bad bacteria that can also damage the gut lining and allow the passage of endogenous and exogenous toxins into the blood and brain.
The Healthy Gut Diet
According to Dr. Natasha Campbell-McBride, author of Gut and Psychology Syndrome a diet that promotes bacterial balance, includes:
- High-quality meat, game, poultry, organ meats, fish and shellfish that are ethically sourced and raised without the use of hormones or antibiotics.
- Organic, cage-free eggs
- Non-starch vegetables such as broccoli, Brussels sprouts, carrots, cauliflower, cucumber, mushrooms, onions, peppers, sprouts, tomato, and green leafy vegetables like spinach, kale, chard and mustard greens6
- Fresh, ripe fruit with an emphasis on berries such as blueberries, raspberries, blackberries and strawberries
- Nuts such as almonds, walnuts and cashews
- Seeds such as pumpkin, sesame, and sunflower
- Beans and legumes, if they are well tolerated.
Cooking should be done with saturated animal fats like those found in butter, ghee, and coconut oil, because those found in unsaturated fats like vegetable oils contain large amounts of pro-inflammatory fats that become increasingly harmful when they are heated. Modest amounts of cold-pressed extra virgin olive oil are okay as long as it is eaten raw.
Beverages should be limited to water, freshly pressed vegetable juice, and meat or fish stock.
Honey and dried fruit may be used sparingly to sweeten foods naturally.
According to an study published in the Journal of Physiological Anthropology, fermented foods such as sauerkraut, kimchi and pickle can also have a profound effect on the microbiota by magnifying the antioxidant and anti-inflammatory effect of foods; reducing intestinal permeability and the harm caused by LPS; improving glycemic control and nutritional status; directing production of GABA and other brain boosting bioactive compounds; and positively shifting gut-to-brain communication.
Referring again to Dr. Campbell-McBride’s work, a diet that helps reestablish microbial balance is casein and gluten free and helps manage the presence of gut toxins such as Candida Albicans. A healthy gut diet should not include:
- Highly allergenic substances like gluten, wheat, and dairy or foods that may contain them
- Nutrient deficient processed foods that are generally high in refined carbohydrates like white flour, added sugars like sucrose and industrial fats like hydrogenated and vegetable oils
- Soy foods such as tofu, edamame or soy based dairy alternatives
- Added and artificial sugars such as sucrose, cane sugar, high fructose corn syrup, corn syrup, and aspartame
- Highly refined white flours such as those found in cakes, cookies, breads and ready to eat frozen foods.
- Starchy vegetables like potatoes, corn, acorn and butternut squash.
Lifestyle Modification for the Gut and Brain
In addition to improving diet to correct microbial balance, lifestyle modification can also greatly improve ones psychological wellbeing and reduce susceptibility to depressive disorders. For example, Dr. Richard Louv, author of Last Child in the Woods, found that exposure to nature is essential for physical and emotional health and can improve an individuals cognitive abilities and resistance to negative stresses and depression. However, nature therapy may be ineffective in the most severe depressions.
Exercise can also help modulate the production of beneficial neurochemicals and is an important consideration in the holistic treatment of depressive disorders.
Finally, and touching on our specific purpose here at TwelveWellness, Psychiatric Times went to great lengths in exploring depression and alcohol dependence comorbidity, which carry significant risks and whose severity are greatly associated with each other. The more we drink, the more depressed we become, and the more we subsequently drink – a vicious cycle in every sense. Obviously, complete abstinence in individuals who exhibit alcoholic behaviors can greatly reduce the risk of developing depressive disorders.
Psychological illnesses such as depression have become a pillar in industrialized, Western economies highly influenced by the diets and lifestyles to which we have become accustom. Unfortunately, the standard pharmaceutical treatment can sometimes create more damage than the original condition and place an overwhelming physical and psychological burden on those afflicted. However, developing a holistic treatment program that utilizes dietary and lifestyle modification to help improve microbial balance in the gut; reduce intestinal permeability; and enhance neurochemical synthesis, storage, and release can greatly reduce or completely prevent the development depressive disorders.
Image courtesy of Maverick Shaw