Since Felice Jacka’s landmark study in 2010, accumulating evidence shows that poor nutrition contributes to depression and anxiety. For years studies have shown the importance of B vitamins, omega 3 fats in the form of EPA and DHA, and individual amino acids for correcting depression. Dr. Felice Jacka pioneered research demonstrating that whole food nutrition counts for adults and adolescents in treating depression and anxiety.
A new study (SMILES) provides evidence that that nutrition is a cost-effective treatment for major depression. The prospective research comes from Australia and New Zealand where they enlisted 67 adults meeting the criteria for a poor-quality diet and major depression. These individuals were randomized in one of two arms of the study: nutrition support (33 people) or social support (34 people). The nutrition arm provided up to seven sessions with a nutritionist, and the social support provided the same amount of time and emotional intensity. The study took into consideration both healthcare costs and time lost at work from major depression. Below is a summary of the significant findings of the study.
Nutritional intervention: 33 people received 7 sessions with a nutritionist for support enacting the Mediterranean diet
Higher remission rates of major depression
Lower missed paid and unpaid work days
Lower use of health care services
Overall health care costs on average was $940 lower
Lost productivity costs were $1589 lower
Higher cost of session delivery, travel and food costs
Social Support: 34 people received seven sessions of social support. No nutritional changes.
Lover cost of session delivery, travel and food costs
Lower recovery rates and lower remission rates of depression
More use of allied professionals occupational therapists, such as: physiotherapists, osteopaths dentists, podiatrists, orthodontists
More lost productivity due to missed paid and unpaid work days.
Higher health care costs and lost productivity costs
Although this is a small study, the accumulating scientific evidence suggests that nutrition provides support for depression as a therapeutic tool. Additionally, major depression increases the risk of diabetes, cardiovascular disease, and obesity. All of these conditions are costly to the person, negatively impact productivity at work, drive health care costs up, and have studies associated with them that show nutrition can slow or reverse the disease. When we are connected to a person suffering from depression helping them take action to address the depression can be life-changing.
The typical therapeutic tools for major depression are psychotherapy, medications, and maybe mindfulness. If nutrition is going to be referred to, we have to create a path that lowers the shame. Most people believe that they should be able to improve their diet on their own and recognize that they don't--causing shame.
I want to review some options for getting traction when examining a person’s diet, used in the context of a therapeutic ally or psychotherapist.
1. First, I am going to refer to our previous blog about Hope Rising by Chan Hellman, Ph.D. When someone is stuck in depression it is possible that they are missing some important tools. Dr. Hellman discusses that for Hope to exist we have to have both Waypower and Willpower to achieve our goals. In other words, we need to have a path with small achievable steps laid out, and we need willpower which is a personal investment in our goal and good nutrition to keep us in our pre-frontal cortex (the "smart brain") and out of our the limbic system (the "lizard brain"). So when I am discussing the causes of depression with someone, I try to identify whether they know what the next couple of steps are toward a goal -- any goal, or if they do not have the will power to move forward. If they don't have the willpower and their diet is low in nutrients, I will start doing 3-day experiments with food or movement/exercise. (See my handout on 3 Days of Protein to increase energy and mental clarity).
2. From a motivational interviewing perspective, giving them a choice on what they are willing to try to address their depression and then set a time to see if the therapy helped. For example, I will go see a nutritionist 7 times over 12 weeks. I will walk every day for 10 minutes for 30 days.. The activities can include medication, nutrition, mindfulness, movement/exercise, or a gratefulness diary, to name a few. Put a timeline on how long you will try that path before trying another path.
3. At the start of a relationship, or when a client reports a particularly bad day, simply ask, “What did you eat yesterday?” The brain needs fuel just like the body and sometimes what and when we eat or don’t eat has an influence on how we feel. One child therapist I know asks the parents when they meet, "What is happening in the home?" She always follows up with questions about what the child has been eating. She barely has to comment on the cereal, pizza and mac and cheese pattern for them to notice the relationship between the food quality and their child's behavior. Our intention of healthy meals easily becomes lost in the busyness of life.
4. If a person is stuck in their depression, ask if they are willing to do an experiment for 3 days to change their nutrition. We have a video and a handout on increasing protein to improve energy and mental clarity. Note that some people may not be able to notice a difference until they go back to their original diet.
5. Find a good referral for nutrition in your area. There are many professionals that can discuss nutrition. Here are some professionals to approach possible referrals: nutritionists, acupuncturists, naturopathic physicians, and health coaches, to name a few. One of the important questions to ask is if the person is comfortable helping someone improve their diet without the goal of losing weight. If the depressed person is overweight, I find that it’s important to focus first on having more energy and mental clarity and feeling better day-to-day before embarking on losing weight. Often the loss of fat can make an individual feel bad because fat contains hormones, heavy metals, and other toxins. The release can overwhelm the liver and cause fatigue and distress. Without the right context, this can be confused with depression even though it is a physiological response to losing fat from their body.
We all know that when we feel better, and have more energy and mental clarity, work and life don’t seem as overwhelming and those small steps towards a goal are more accessible. Better management of anxiety and depression through nutritional interventions is a cost-effective way to improve both quality of life and productivity. What are the first steps that businesses can take support their employees on this path?