While
some of us recognize that when we eat better and take nutritional supplements
our mood is better, for others this relationship may be difficult to evaluate.
It also may be surprising to learn that there are actually several significant
areas of research linking nutrition and mood. As described below, nutritional factors influencing
depression, for example, range from folate and vitamin D, to omega 3 fatty
acids and hypoglycemia. There are
also a number of nutritional supplements that can be important and they will be
described later as well. As is
always presented in this column, these approaches are most beneficial when they
are applied within the context of an overall integrative medicine program that
includes dietary guidelines, nutritional supplements, physical fitness,
relaxation techniques and other modalities, and then a uniquely developed
overall program is designed for each individual.
When
describing nutritional influences on mood and other symptoms or problems, it is
important to keep a couple of key points in mind. The first is that a healthy diet should always be the
foundation of a good nutritional plan.
Another way to say this is that you can’t make up for a poor diet by
taking a lot of supplements.
Targeted nutritional supplements can then be included to add to the
benefits of a good diet, producing an even better effect than each one would
have had by itself.
Dietary Influences
There
are several ways in which an imbalanced or poor diet can influence mood. This can be particularly
important when our diet is not as good as we would like it to be, but it can
often be compounded by other problems such as significant stress (which may
increase the requirement of specific nutrients), stomach or intestinal symptoms
(which may weaken digestion and absorption of important nutrients and
phytonutrients), aging effects, exposure to environmental insults, and/or other
influences.
One
primary characteristic of diet is that it provides essential vitamins and
minerals that serve as cofactors or facilitators for the production of specific
neurotransmitters or brain signal molecules. For example, the B complex vitamins (thiamine, riboflavin,
pyridoxine, cobalamin and folate) help to make the neurotransmitters dopamine,
serotonin, GABA and acetylcholine.
This understanding has led to the term “stress B-complex”, and a
B-complex nutritional supplement is often recommended for people who have high levels
of stress, or symptoms of depression and/or anxiety.
The
most well-documented influence for B complex vitamins has been found for folate
and depression, although low levels of vitamin B12 can also be very important
for mood and other nervous system
symptoms, and B12 deficiency or insufficiency is more common as we get
older. Some research suggests that
the relationship between folate and depression may be more significant in men
than women, and for recurrent depression more than a single depressive episode,
yet it would be important to look at for everyone that has depression. Since folate is found in healthy foods
such as vegetables, whole grains, beans, and fruit which are suggestive of
healthier dietary patterns, it may be difficult to separate out the influence
of folate specifically vs. the diet in general. However, there are other studies that have found that lower
folate levels were associated with poorer response to anti-depressant
medications (such as selective serotonin reuptake inhibitors -SSRIs) and that
folate supplementation may produce more benefit than SSRI therapy alone in
people with major depression.
Another important dietary factor to
discuss is that of healthy fats, specifically omega 3 fatty acids. A recent major study suggested that
omega 3 fatty acids had significant anti-depressive effects. Although much of this research has
looked at effects of supplemental fish oil, containing EPA and DHA, there is
other research that has shown that lower dietary fish and omega 3 fatty acid
intake and lower blood levels of omega 3 fatty acids are associated with
different types of depression.
The inclusion of healthy fat in the diet
is likely beneficial in several ways including: (a) nervous system function;
(b) anti-inflammatory effects – which occur with specific conditions and aging;
(c) following a healthy dietary pattern which would be similar to a
Mediterranean-type diet or vegetarian-based diet; and (d) helps to balance
macronutrients (protein, healthy fat and complex carbohydrates) and therefore
stabilize blood sugar. These
healthy omega 3 fatty acids or fats are primarily from specific types of fish
(salmon, sardines, tuna, etc), flax seeds, soy products, nuts/seeds and dark
green leafy vegetables). While
monounsaturated fats (primarily from olive oil, olives, nuts/seeds and avocado)
are likely helpful too, there is little research at this time to support a
relationship to mood.
The last dietary factor to discuss, yet
perhaps one of the most important, is hypoglycemia or abnormal glucose
tolerance/insulin resistance.
Although there has been little recent research, studies have suggested a
significant relationship between depression, and abnormal glucose metabolism
and/or insulin resistance. One
study found significantly higher blood sugar levels, greater glucose responses
during an oral glucose tolerance test (OGTT), larger insulin responses during
the OGTT, and insulin resistance in people with depression. Symptoms of hypoglycemia include
fatigue, headaches, depression, anxiety, heart palpitations, irritability
before meals and possibly other symptoms.
Causes of hypoglycemia include excessive sugar and refined carbohydrate
intake, missing meals, excessive coffee or caffeine intake, inadequate dietary
protein or fat (preferably healthy fat), significant stress and/or inadequate
magnesium or chromium intake.
Nutritional Supplement Effects
The use of nutritional supplements is an
essential part of a nutritional program that can boost mood. As already discussed, a B-complex supplement
with good amounts of vitamin B12 and folate is important to take, although some
good multivitamin and mineral supplements may work just as well since they
would have the range of vitamins and minerals that are important, as well as
about 25 to 50 mg of most B-complex vitamins. A fish oil supplement is another important product to take
to provide extra amounts of omega 3 fatty acids and insure therapeutic benefit.
A
third part of a foundation supplement program would be calcium, magnesium and
vitamin D. As we know calcium is
helpful for bone density and bone strength, but it can also be beneficial for
the nervous system. Magnesium,
which may be the nutrient that is most commonly deficient in the US, has a
calming effect on the nervous system, helps with blood sugar regulation, and
has other benefits for allergies, hormonal balance and heart functioning. Finally, vitamin D has been found to be
helpful for some people with seasonal mood fluctuations or season affective
disorder (SAD) and vitamin D is also
frequently found to be deficient when a blood test is done.
With
regard to other supplements that could be helpful, there are many. Probably the best researched products
are S-adenosyl-methionine or SAMe, and the herb, St. John’s Wort.
SAMe
is an amino acid that is a major factor needed in the production of several
neurotransmitters and for nerve cell membranes. There is actually extensive research spanning three
decades to support its use.
Although the exact mechanism of action is unknown, there is enough
clinical research and experience to suggest that SAMe is effective for many
people.
While
St. John’s Wort has been found very helpful for mild to moderate depression,
its use in major depression is less clear. It is also worth noting that there is significant potential
for an interaction between St. John’s Wort and other medications since they are
metabolized by the same liver enzymes.
It is therefore important to discuss these issues with your doctors and
other healthcare practitioners.
As
for other potentially useful supplements, it is not possible to describe them
in detail, but they would include products such as 5-HTP, DHEA, inositol,
supplements for sleep (for example, melatonin, valerian, etc.), and some others. To explore the use of these supplements
it would be best to work with an experienced and effective group of integrative
medicine practitioners.
Practical Approach
An
overall integrative medicine approach is essential. Since dietary changes and programs can be challenging, careful
consideration should be given to what is possible for each individual. Therefore, a reasonable diet or
therapeutic diet should be combined with targeted supplements, stretching and
exercise, relaxation techniques and other modalities.
It
is always helpful to get some blood testing done which can assess whether there
are some imbalances or clinical/subclinical deficiencies or
insufficiencies. Validated common
testing would include blood levels of vitamin B12, folate, and homocysteine, as
well as other nutrient measures such as, 25 hydroxy vitamin D, and red blood cell (RBC) magnesium and
zinc. Some tests commonly used by
integrative medicine practitioners, but not well validated, are urinary panels
for neurotransmitter metabolites, metabolic profiles, fatty acid profiles,
detoxification profiles and others.
With
regard to nutritional supplementation, one approach is to recommend a
foundational program. Such a
program might include a comprehensive multivitamin and mineral complex, omega 3
fatty acids/fish oil and a calcium/magnesium/vitamin D supplement. Additional targeted supplements could
be focused on anti-depressive effects, anxiety, sleep, and/or other aspects of
an individuals’ circumstances.
Through the combination of dietary guidelines and nutritional
supplementation as well as other integrative modalities, good mood and
emotional well-being will surely follow.
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