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?

Dealing with Fatigue or Depression

In the United States, 33.7 million people live with some type of mental health issue. Studies show that prolonged fatigue is linked with anxiety and depression and all too often we assume that these symptoms emotionally driven without taking the time to rule out potential physical triggers, such as hypoglycemia, anemia or even possible drug interactions.

In part, this is because differentiating fatigue from anxiety and depression is hard to do and those suffering often don’t know what questions to ask.

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I always recommend that people begin by describing their symptoms to their primary healthcare providers as fatigue rather than anxiety or depression.  The medical questions around fatigue can be answered with a number of blood tests. Be sure to ask for the following labs:

  • CBC rules out overt anemia.
  • Comprehensive metabolic panel rules out liver and kidney problems and identifies issues with glucose regulation (prediabetes and diabetes directly affect brain function).
  • CRP is a metabolic marker implicated in cardiovascular disease, diabetes, obesity, and depression.
  • Ferritin levels below 50 correlate with increased fatigue, especially in women.
  • Hemoglobin A-1 C is a marker for diabetes. Studies have shown that diabetes predicts depression and depression predicts diabetes. A1C should be below 5.7 to be considered normal.
  • Homocysteine levels (a Vitamin B marker) greater than 12 indicate a 70% increase in risk of depression.
  • Lipid panel is important in diagnosing cardiovascular disease. Additionally, when total cholesterol is below 120, suicidal ideation increases.
  • TSH rules out hypothyroidism or hyperthyroidism.

While there is a cost for running these labs, the cost of treating fatigue strictly as an emotional symptom is even higher. A recent article in Money magazine states that the treatment costs for mental disorders is more expensive than treatment of diabetes or hypertension– and that the cost falls mostly to the patients. Insurance companies put up road blocks for receiving mental health treatment, finding in-network care can be challenging and, if you do, the cost of prescribed medications is high. Very often, mental healthcare is a budget buster. Particularly if the primary care provider, prescriber, or therapist have not addressed the true problem – Fatigue. Nutritional studies are showing that poor nutrition and dysfunctional physiology cause 50% of the symptoms of fatigue.

I've created a sample letter requesting the above blood work from your primary care physician that you can use to help start this discussion.

In addition to asking your healthcare provider for the lab work, I have seen the following self-care steps help in relieving fatigue:

  1. Walk outside everyday – move your body for at least 10 minutes.
  2. Be in bed for 8 hours a night – even if you’re not sleeping, the rest is helpful.
  3. Eat protein with every meal.

If these steps feel hard, ask yourself what you can do to make it happen. Don’t think of it as a lifestyle change, but consider it an experiment. Start with one of the above steps and commit to doing it for at least 3 days to see if it helps.

If there was one solution for fatigue, everyone would be doing it. Ask your provider to rule out the most common causes of fatigue/depression. It may not be all in your head ─ it may be that your body needs help.

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