Treating Mood with Food: A Functional Nutrition Approach

May 15th, 2022

Treating Mood with Food: A Functional Nutrition Approach

You can’t watch television today without being bombarded with pharmaceutical ads promising to help you feel like your old self again.  It’s no wonder, since prescription medications are the mainstay of traditional treatment for the most commonly diagnosed mental health conditions like anxiety and depression (1). According to the Centers for Disease Control and Prevention (CDC), between 2015 and 2018, 13.2 percent of U.S. adults used antidepressant medications, with use among women being much higher than men (2).

The COVID-19 pandemic has only worsened mental health statistics. For U.S. adults, symptoms of anxiety and depression increased after August 2020 and continue to remain higher than pre-pandemic estimates (3). One study published in JAMA Network Open, found the prevalence of depressive symptoms to be three-fold higher (4).

While medication may be necessary for some, more natural approaches like wholesome food, dietary supplements, mindful movement, restful sleep, and stress management should also be considered front-line treatments. After all, the underlying cause(s) of many mental health symptoms are linked to nutrition and lifestyle-related factors. Before diving into how food and everyday life impact mental health symptoms, let’s talk about mood disorders.

What Are Mood Disorders?

Mood disorders are psychiatric conditions characterized by disruptions in emotions that increase morbidity and mortality, and also decrease quality of life.  Examples of mood disorders include major depressive disorder (MDD), bipolar disorder, and premenstrual dysphoric disorder, but there are a variety of others (6).

Along with disruptions to mood, patients can suffer the following symptoms, which can last weeks to years (7):

  • Depression
  • Anxiety
  • Agitation
  • Irritability
  • Insomnia
  • Appetite changes
  • Fatigue
  • Headaches
  • Abdominal pain
  • Poor concentration
  • Gastrointestinal disturbances
  • Musculoskeletal pain
  • Suicidal ideation

Depression, more common in women than men, is the most frequently diagnosed mood disorder with a lifetime prevalence of up to 13 percent for men and 21 percent for women (8).  But you don’t have to have a formal diagnosis to experience mood disorder symptoms that disrupt your daily life. In fact, one 2017 review found two-thirds of all cases of depression to be undiagnosed (9).

While the development of a mood disorder is multi-factorial and unique to an individual, several nutrition-related factors can contribute to or exacerbate symptoms.

How Does Nutrition Affect Mood?

  1. Micronutrient deficiency and insufficiency. The standard Western diet is notoriously nutrient-poor. As reported in the World Journal of Psychiatry, the inadequate intake of several specific nutrients has been linked to the development of depressive symptoms (10):
  • Folate
  • Iron
  • Magnesium
  • Potassium
  • Selenium
  • Thiamine
  • Vitamin A
  • Vitamin B6
  • Vitamin B12
  • Vitamin C
  • Zinc
  • Omega-3 fatty acids

Many of these nutrients help to promote the production of brain-derived neurotrophic factor (BDNF), which influences neuroplasticity (10).

  1. Poor blood glucose control. Studies have shown an increase in depressive symptoms in healthy patients that are fed high glycemic diets (1). These types of diets can lead to quick shifts in blood glucose levels potentially increasing the secretion of cortisol, adrenaline, growth hormone, and glucagon to offset the change. Alterations in these hormone levels can lead to anxiety, irritability, and other mood-related changes (1).
  1. Altered immune system response and chronic inflammation. When the body is under attack, the immune system releases both pro- and anti-inflammatory mediators to help restore balance. However, in those with MDD this process is altered and immune system activation is sustained (8). Research has shown pro-inflammatory cytokines and acute phase proteins to be elevated and the function of anti-inflammatory cytokines to be altered in MDD. In addition, there’s an increase in the gene expression of inflammatory pathways (8). Diets high in processed foods and inflammatory fats can induce and/or exacerbate this type of chronic inflammation, affect the immune response in the central nervous system (CNS), and lead to mood changes (8).
  1. Gut microbiome alteration. The gut microbiome is now known to have a substantial influence on overall health, including mental health. Research has shown the gut microbiome to be altered in depressed patients when compared to healthy controls (11). An imbalanced gut microbiome may contribute to depressive symptoms via the following pathways (11):
  • Hyper-activation of the hypothalamic-pituitary-adrenal axis (HPA axis)
  • Altered levels of neurotransmitters
  • Disrupted neural circuits
  • Excessive production of pro-inflammatory cytokines
  • Intestinal barrier dysfunction (leaky gut)

In MDD, diet and stress are the two most important factors that affect the gut microbiome and diet quality has been shown to influence the severity of the disease (11).  In addition, probiotics have been shown to reduce depressive symptoms in those with MDD and also reduce depression risk in healthy people (12).

Using Food to Improve Mood

The Integrative and Functional Nutrition Academy (IFNA) STAIN model provides the optimal framework to help determine what may be contributing to a patient’s mental health symptoms. By creating a personalized plan to address stress, toxins, adverse food reactions, infections, and nutrition-related factors, you can begin to reverse negative symptoms and significantly improve quality of life.

While specific nutrients may be important for those with mood disorder symptoms, the diet on the whole is the more important consideration. Mediterranean diets are probably the most researched, but any personalized, whole foods, anti-inflammatory meal plan that corrects nutrient insufficiency, optimizes blood sugar control, and nourishes the gut microbiome will likely lead to symptom improvement.

You’ll likely want to implement the 5-R protocol to improve gut health (remove, replace, repair, reinoculate, and rebalance) and then focus on a well-balanced, anti-inflammatory diet for maintenance.

Let’s look at some diet-related research:

  • One large study of college students adhering to a Mediterranean dietary pattern found a greater than 30 percent reduced risk of depression when compared to those not following that type of diet (10).
  • A randomized controlled trial found the Mediterranean diet, along with fish oil supplementation, to improve depressive symptoms and quality of life (13).
  • Those following a traditional diet (based on whole foods) in Japan, Norway, and China have been found to have lower depression risk (10).

Using Lifestyle to Improve Mood

Addressing nutrition-related factors is very important, but is just one piece of the puzzle. By working through both the STAIN model and the 5-R Protocol, functional nutritionists can partner with patients to create a personalized plan that includes:

  1. Stress management techniques. One randomized controlled trial found a yoga and meditation-based lifestyle intervention significantly increased BDNF and neuroplasticity, and reduced MDD severity (14).
  2. Exercise. One meta-analysis found exercise to have a significant anti-depressant effect and stated “exercise is an evidence-based treatment for depression” (15).
  3. Daily sun exposure. Low vitamin D is associated with an increase in depressive symptoms. One randomized controlled trial found people who participated in daily sun exposure along with behavioral activation (where patients are active and social regardless of how they feel) experienced not only improved vitamin D levels, but improvements in depressive symptoms (16).
  4. Sleep. Patients with depressive symptoms often have disrupted sleep related to neuroinflammation, alterations in melatonin production and circadian rhythm, and medication use (17). Working through the STAIN model and 5-R protocol will likely lead to significant improvements in sleep. For example, one randomized controlled trial found probiotic therapy (think reinoculation in the 5-Rs) led to significant reductions in anxiety and depression along with improvement in sleep quality (18).

Functional Nutritionists Provide Medication-Free Hope

Functional nutritionists have the opportunity to provide medication-free symptom relief in a world where antidepressants and other prescription medications are considered standard of care. While treating a clinically diagnosed mood disorder will likely require a team of professionals, functional nutritionists are poised to be leaders in this area, especially for people who experience mood changes related to diet and lifestyle. To learn more about using the STAIN Model and the 5-R Protocol to improve mood, register for IFNA training today.

by Kellie Blake RDN, LD, IFNCP

References

  1. Firth J, Gangwisch JE, Borisini A, Wootton RE, Mayer EA. Food and mood: how do diet and nutrition affect mental wellbeing? [published correction appears in BMJ. 2020 Nov 9;371:m4269]. BMJ. 2020; 369:m2382. Published 2020 Jun 29. doi:10.1136/bmj.m2382
  2. Centers for Disease Control and Prevention National Center for Health Statistics. Antidepressant Use Among Adults: United States, 2015 to 2018. Accessed on March 28, 2022. Products – Data Briefs – Number 377 – September 2020 (cdc.gov).
  3. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report. National and State Trends in Anxiety and Depression Severity Scores Among Adults During the COVID-19 Pandemic — United States, 2020–2021. Accessed on March 28, 2022. National and State Trends in Anxiety and Depression Severity Scores Among Adults During the COVID-19 Pandemic — United States, 2020–2021 | MMWR (cdc.gov)
  4. Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open.2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686
  5. Rabeea SA, Merchant HA, Khan MU, Kow CS, Hasan SS. Surging trends in prescriptions and costs of antidepressants in England amid COVID-19. Daru. 2021;29(1):217-221. doi:10.1007/s40199-021-00390-z
  6. Sekhon S, Gupta V. Mood Disorder. [Updated 2021 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558911/?msclkid=3b18bcc2aea611ecb077b073f6aaf1dc
  7. Leyse-Wallace, R. (2013). Nutrition and Mental Health. CRC Press
  8. Beurel E, Toups M, Nemeroff CB. The Bidirectional Relationship of Depression and Inflammation: Double Trouble. Neuron. 2020;107(2):234-256. doi:10.1016/j.neuron.2020.06.002
  9. Williams SZ, Chung GS, Muennig PA. Undiagnosed depression: A community diagnosis. SSM Popul Health. 2017;3:633-638. Published 2017 Jul 28. doi:10.1016/j.ssmph.2017.07.012
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  11. Bastiaanssen TFS, Cussotto S, Claesson MJ, Clarke G, Dinan TG, Cryan JF. Gutted! Unraveling the Role of the Microbiome in Major Depressive Disorder. Harv Rev Psychiatry. 2020;28(1):26-39. doi:10.1097/HRP.0000000000000243
  12. Huang R, Wang K, Hu J. Effect of Probiotics on Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2016;8(8):483. Published 2016 Aug 6. doi:10.3390/nu8080483
  13. Parletta N, Zarnowiecki D, Cho J, et al. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutr Neurosci. 2019;22(7):474-487. doi:10.1080/1028415X.2017.1411320
  14. Tolahunase MR, Sagar R, Faiq M, Dada R. Yoga- and meditation-based lifestyle intervention increases neuroplasticity and reduces severity of major depressive disorder: A randomized controlled trial. Restor Neurol Neurosci. 2018;36(3):423-442. doi:10.3233/RNN-170810
  15. Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: A meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42-51. doi:10.1016/j.jpsychires.2016.02.023
  16. Thomas J, Al-Anouti F. Sun Exposure and Behavioral Activation for Hypovitaminosis D and Depression: A Controlled Pilot Study. Community Ment Health J. 2018;54(6):860-865. doi:10.1007/s10597-017-0209-5
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  18. Lee HJ, Hong JK, Kim JK, et al. Effects of Probiotic NVP-1704 on Mental Health and Sleep in Healthy Adults: An 8-Week Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021;13(8):2660. Published 2021 Jul 30. doi:10.3390/nu13082660