All blog posts from Dr. Allott are provided for educational and informational purposes only. As Dr. Allott is also a licensed medical practitioner, we must make it clear that nothing on the blog is intended to constitute medical advice, consultation, recommendation, diagnosis, or treatment. If you are concerned about your health, please seek appropriate care in your area.


New Study: Nutrition is a Cost Effective Tool for Major Depression

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.

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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

Positive Findings

  • 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

Downside costs

  • Higher cost of session delivery, travel and food costs

Social Support: 34 people received seven sessions of social support. No nutritional changes.

Positive Findings

  • Lover cost of session delivery, travel and food costs

Negative findings

  • 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.

Possible Experiments

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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?

The Science of Hope Applied to Holiday Eating

As we move into the holidays and start planning the 60-day sprint, I am reflecting on what has helped me through crunch times and sprints this year. HOPE made a difference.

In October, I was blessed to speak at the Kitsap County Resilience Summit. The keynote speaker was Chan Hellman Ph.D. from the University of Oklahoma. For the last decade he has been researching hope with individuals with high ACES (Adverse Childhood Events Scores). His new book, Hope Rising: How the Science of HOPE Can Change Your Life, will be available on Amazon in late November. I highly recommend it!

Here is a summary. He distinguishes hope from wishes. “Hope is the belief that a thriving future is possible and that you have the power to make it so. A wish is something that has no steps towards making it real and that you don’t have any influence over.” (p31 Hope Rising).

So let’s set our goals and raise our HOPE to get through the holidays with a little more self-compassion and self-care, and enter the new year with renewed resilience.

According to Dr. Hellman we need two things to raise our hopes and move toward them. Willpower and Waypower. Willpower is a combination of personal motivation for the goal and fuel supply for the brain to have the energy and mental clarity to stay focused on the goal and hold onto the hope. Waypower is the pathway to get it done. It’s the small little steps of success that lead you down the path toward your goal. We often need support from others for both the willpower and the waypower. I love the definition of hope used at Camp HOPE, a camp for children surviving domestic violence, that is shared in this book. Hope is “believing in yourself, believing in others, and believing in your dreams.”

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So what are your holiday hopes? Do you have steps identified along a path to achieve them? Are they really goals that you, personally, want for you or your family? Which ones are you sure of? Which ones do you need to strengthen your Hope Plan around?

Here are some Hopes that I often hear people talking about for the Holidays:

  • Seeing family or having solitude

  • Going hiking, seeing a holiday show

  • Cooking traditional or non-traditional food

  • Seeing the holiday lights

  • Not over eating

  • Managing holiday winter depression

For those who want to learn more, here is a link to a presentation given by Chan Hellman on this topic, titled Pathways of Hope. He also has a number of videos on YouTube.