What is the best diet for depression ?
Let me start by saying that I don’t believe there is one best diet for everyone. I don’t buy into one diet being the best or the healthiest. The best diet for you is whatever diet you can maintain for the long-term that makes you the happiest, strongest and healthiest. Only you, often by trial and error, can decide which diet that is. That said, this blog will focus on what the published research suggests is the best diet to follow when you have depression.
The evidence for what is the best diet for depression strongly supports the Mediterranean Diet, as well as the Modified Mediterranean Diet. The essentials of the Mediterranean diet are: eating mostly fruit and vegetables, whole grains and nuts; red wine; replacing butter with extra virgin olive oil, limiting the consumption of red meat to three times per month, and eating fish or chicken twice a week. While extra virgin olive oil and nuts are recommended for the Mediterranean diet, and while they both contain the “good kind of fat,” I recommend limiting yourself to portioned-out serving sizes. Oils and nuts are calorie dense, and too many calories results in extra pounds. One should also be mindful of alcohol consumption. Under the Mediterranean diet, red wine is only consumed with meals, and no more than 2 glasses ( each glass = 100 mil of wine) per day.
A study published in the European Journal of Clinical Nutrition showed that a higher consumption of the Mediterranean diet in 6000 women was associated with a lower prevalence of depression. A study on 11,000 people conducted in Navarra, Spain and published in the Archives of General Psychiatry showed that people who followed the Mediterranean diet had a significantly lower risk of depression. A randomized controlled trial involving over 100 adults with self-reported depression showed that eating a Mediterranean diet and substituting with fish oil capsules significantly reduced symptoms of depression. This study also showed a positive correlation between amount of omega three fatty acids consumed and reduced depression symptoms. The SMILES trial showed that following a modified Mediterranean diet ( the ModiMed) diet improved symptoms of depression in individuals diagnosed with major depressive disorder. The ModiMed diet is very similar to the Mediterranean diet with a few noteworthy adjustments. The ModiMed diet recommends 3-4 servings of lean red meat per week, which is based on a study that showed women who ate less (or more) than the recommended amount of red meat were more prone to major depression and anxiety disorders. ( Red meat is rich in iron and B12, and deficiencies in both of those have been linked to mental disorders. Female athletes who struggles with depression should especially pay attention to this.) The ModiMed also recommends only raw and unsalted nuts; between two-three servings of low-fat dairy ( or calcium-fortified soy products); and specifies oily fish, such as salmon, tuna and sardines.
While research supports the Med and ModiMed diets as the best diet for depression, evidence also shows that the worst diet for depression is the Western diet. The Western diet is made up of processed carbohydrates, processed meats, chips, white bread, pizza, a ton of sugar, and lots of flavored drinks. It’s fast, easy and cheap and anything that is fast, easy and cheap usually isn’t good for you.
The Western diet isn’t just linked to depression. It’s linked to a variety of chronic diseases, including obesity, diabetes, autoimmune disorders, attention deficit disorder and cancer. Most people know that the Western diet isn’t the healthiest, yet they still eat it, perhaps because of its convenience and rich, addictive taste. I know how it feels to work all day, have no energy to cook, despite being super hungry, and be tempted by the fast, unhealthy options. Unfortunately, when we give into those temptations, we do ourselves no favors when it comes to depression.
Sweetened desserts, fried foods, processed meat, refined grains, and high-fat dairy products have all been linked to depression. A cross sectional study of women showed that eating processed foods, drinking beer, and having sugary treats was associated with a higher risk of both depression and anxiety. Another study showed a positive correlation between consumption of fast foods ( hamburgers, sausages and pizza) and commercial baked goods ( muffins, doughnuts and croissants) and increased risk of depression. One study showed that university students who ate highly processed foods ( lots of additives) and did not exercise were at a much higher risk of depression. There’s more studies, but you get the point.
How does the Western diet increase one’s risk of depression? Is it as simple as eating crap makes you feel like crap? Maybe, in some cases. In a previous blog, I wrote about several theories for depression, including: The Vascular Hypothesis; The Maladaptive Cytokine Response Theory; The Brain Derived Neurotropic Factor Deficiency Theory, and the Oxidative Stress Theory. The “low serotonin” hypothesis for depression is not the only show in town anymore, which should also make us reconsider the first line of treatment, Selective Serotonin-Reuptake Inhibitors) In regard to the Vascular Hypothesis, the Western diet is known to increase the risk of vascular disease, which means the brain may not have optimal blood flow to function properly. The Western diet is associated with higher amounts of C-reactive Protein, an indicator for inflammation in the body, which could be related to a maladaptive cytokine response. On the opposite spectrum, the Mediterranean Diet is preventive against vascular disease, is rich in antioxidants, omega 3 fatty acids, and associated with less inflammation. (Again, these are theories and much research is needed to narrow down exact mechanisms.)
In conclusion, I want to mention my own struggle with depression and diet. When I was in the throes of my bulimic struggle, my depression was significantly worse. In fact, I don’t even know if I had depression, or if it was the heavy, dark spawn of disordered eating, poor sleep, poor social support, uneasiness about where I was in life and a complete lack of a genuine sense of self. And by the way, all of those factors fuel each other. I did seek conventional help, both from an eating disorder specialist and my med school’s psychiatrist. Both recommended that I take an SSRI within the first session of meeting me. I took it, because I was taught that it was THE solution for depression, I was struggling and two experts recommended it. I didn’t read the fine print or research side effects. The pills blunted me. I often tell folks that they made my emotions feel like shoes stuck in gum. I also developed dry mouth, and the entire time, I was still binging, purging and not sleeping well. After a few weeks, I upped and quit medical school, bought a one-way ticket to Los Angeles and started a romance with a strange man on the beach. Yes, you read that right. Did the pills make me manic? Maybe. I’m careful not to fall victim to recall bias, and there was a lot wrong in my life at the time. You can read about my adventure in my novel Manic Kingdom, and while I don’t know what specifically caused my manic breakdown, I can say this with one hundred percent certainty: Before anything else, I had to fix my diet and sleep pattern to stabilize my mood. Sleep and diet are intimately linked and if you sleep badly, you’ll often eat badly, and vice versa. I should have never, ever, ever swallowed a pill until those two aspects of my life were optimized. Through a lot of hard work, setbacks and misfires, I developed a personal sleep strategy, an optimal diet and, maybe more importantly, cultivated a healthy philosophy about eating. To this day, my diet is a combination of the ModiMed diet and Mindful eating. I plan on writing more about mindful eating and how I personally got “there”, so stay tuned.
Erin Stair, MD, MPH
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