Sunday, January 29, 2012

Nutritional Guidelines to Enhance Mood and Emotional Well-being by Joel Edman


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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